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44 Cards in this Set
- Front
- Back
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What are the 3 most likely reason for a hospitalized pt to have a dysrhythmia? |
-Myocardial ischemia, Infarction -Degeneration of conduction system -Electrolyte imbalance |
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Other common reasons for dysrhythmias? |
-drug effects or toxicity (dig toxicity: heart goes really slow) -caffeine (speeds HR) -emotional crisis -pericardial edema -anemia, hypovolemia -vagal stimulation -Metabolic problems (thyroid dysfunction, fever) |
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What population is degeneration most common in? |
-in the elderly (just goes bad, will se pt w/ pacemakers) |
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What about extreme tachy/brady? |
Even if normal rhythm, but extremely tachy/brady then it is considered a dysrhythmia |
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What stimulates the vagal nerve? |
-extreme pain -having a BM -Bearing down -vomiting -gagging |
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Evaluating dysrhythmias. What do you do? |
-how is it being tolerated* -Identify cause (o2 low? electrolyte imbalance) -Treat cause |
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What are s/S of decreased CO? |
-hypotension -dizzy/light-headedness/syncope -nausea -decreased LOC, O2 sats -Diaphoresis -chest pain -Cool, clammy mottled skin -Pallor/cyanosis -diminished/irregular pulses, palpitations -Weakness, fatigue |
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What is one of the first steps when pt is dysrhythmic? |
Check BP (objective measure to see how pt is tolerating) |
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How to evaluate dysrhythmias? |
-assessment: s/s, timing w/ activity, food, beverages (complaints of racing heart, skipped beats, palpitations) -ECG: 12 lead -Continuous monitoring: O2, telemetry, HOlter -Electrophysiology studies -Lab work: electrolytes, drug levels |
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What are electrophysiology studies? |
Can stimulate the heart to go into dysrhythmias to check to see what is going on in the heart -diagnostic or therapeutic interventions -observe electrical activity -ablation treatment |
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Complications of electrophysiology study |
-VF -perforation (poke through, causing bleeding into pericardium) -Pericardial effusion -Tamponade |
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Class I dysrhythmia drugs |
fast channel blockers: slow impulse conduction and affect repolarization -Lidocaine (IV only med)
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Class II dysrhythmia drugs |
Beta blockers: decrease SA automaticity, AV conduction and contractility (also take for BP) -Atenolol, metoprolol |
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Class III dysrhythmia drugs |
Sodium channel blockers prolong repolarization -Amiodarone |
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CLass IV dysrhythmia drugs |
Calcium channel blockers -Diltizem, verapamil |
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Other dysrhythmia drugs |
Slow SA automaticity, AV conduction -Digoxin, Adenosine |
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Amiodarone |
popular drug for dysrhythmias, used to have potential for causing other organ problems |
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Verapamil |
Losing popularity, because decreases contractility a lot |
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Adenosine |
Used for fast HR, must be given IV push, must be given rapidly because of very short 1/2 life |
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Vagal maneuvers |
-valsalva maneuver "bear down" -Carotid sinus massage (MD ONLY), can cause worsening dysrhythmias, but can also work |
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Cardioversion |
-often elective -Pre/post op care (lab work, consent, IV, Tele, conscious sedation, manage airway) -Short acting Versad usually given -Crash cart must be nearby |
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What do you have to look for prior to cardioversion? |
Always do a TEE prior to look at blood clot potential |
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Cardioversion is synchronized. Why? |
so that it isn't given during the refractory period (the brick wall) |
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What is a stubborn rhythm to do cardioversion on? |
A. Fib |
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Defibrillation |
-no organized rhythm (V. tach/V.fib) -don't defib someone in asystole (needs electricity) |
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What is a pacemaker? |
-electrical circuit created to cause heart to depolarize and contract -Senses electrical activity, provides impulse when non is detected -Temporary, permanent, dual chambered |
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When is a pacemaker stimulated? |
When HR drops below 60 bpm |
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Where is a pacemaker fed into? What type of contraction is necessary for a pacemaker to work? |
Subclavian vein -need ventricular contraction (don't NEED atrial contraction)
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Post procedure care for a pacemaker |
-minimal overhead movement -monitor pacer function -pain control -CXR
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Complications of a pacemaker |
-infection -bleeding at site -pacer malfunction -myocardial perforation (causing bleeding into cardiac sac = tamponade) -cardiac tamponade -Pneumothorax |
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What type of test can a pacemaker pt not have done? |
MRI |
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Home care: pacemaker (activity restrictions) |
-shower after 5 days, -avoid arm raising, no golf, tennis, bowling for about 6 months -weight lifting restrictions 10 lbs (1mth) -no driving 2-4 weeks
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Home care: pacemaker (pacer malfunction signs) |
-dizzy -fatigue -palpitations -weak -chest pain -pulse checks |
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Home care: pacemaker (safety) |
-Always carry ID card -cell phone on opposite side -no strong magnetic fields -pacer checks (check from home Q3mths, every anniversary check at clinic) |
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Implantable cardioveter/defibrilator (ICD) |
-prevents sudden cardiac death ->100,000 implanted/yr -98% success rate (same post op care as pacer) -Feels like a kick in the chest -Senses changes in rate and morphology (shape of the rhythm) |
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ICD fires when? |
fires after monitoring change in rhythm ~15-30 seconds; delivers electrical charge of 25-30 joules -200-360 joules on the outside |
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Catheter ablation |
-EP study, can cure dysrhythmia -Mapping, pt doesn't stay in normal rhythm (trying to find the area of heart causing dysrhythmia) -can take 2-3x before working -Ablation: use radio frequency to burn/ablate ectopic area |
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Funny little beats often come from? |
-outside the conduction system (hypoxic tissue ex) -conduction system |
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Funny little beats. Why do they develop? Why bad? |
-develop because low O2 or electrolyte imbalance -Bad because low CO to no CO |
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Conductivity |
Like a wave (usually down and to the right) SA to AV to Purkingje -L side takes longer due to its bigger size |
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Automaticity |
Like snapping of fingers less would be from lack of oxygen increase from sympathetic NS |
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Excitability |
Like a lightning bold: how responsive the cell to depolarization -Lack of O2, electrolyte imbalance, drugs -beta blockers effect excitability -If increase excitability, extra beats (dysrhythmias( |
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Contractility |
want to synchronize contraction. Want all or none. |
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Action potentials |
Ventricular cell needs a stimulus pacemaker cells (constantly drifting towards threshold, so doesn't need stimulus) |
