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109 Cards in this Set
- Front
- Back
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What does stimulation of the vagus nerve do to the heart?
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It is parasympathetic, so it slows the heart rate.
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What does stimulation of sympathetic nerve fibers do to the heart?
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Increase the heart rate.
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What charge does K have?
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Negative
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What charge does Na have?
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Positive
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What happens when the heart cell depolarizes?
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Na from outside the cardiac cell quickly moves inside to make the inside positively charged.
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What happens when the heart cell repolarizes?
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Slow movement of ions across the cell membrane restore the cell to being negatively charged (More K inside cell)
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What do the small squares on ECG paper represent?
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0.04 seconds horizontally
0.1 mV vertically |
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How many small squares in one large square on ECG paper?
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5 horizontal and 5 vertical
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How many large squares in one minute?
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300
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How do you calculate BPM on ECG paper?
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Every 3 seconds, a mark appears. Count the number of upstrokes (R waves) in 6 seconds, then multiply by 10.
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How do you put an electrode on a client?
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Clip excessive chest hair with scissors. Rub skin with dry gauze until it is slightly pink. If skin is oily, wipe with alcohol first. If pt is diaphoretic, apply skin protectant before placing the electrode.
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What is an artifact?
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Due to loose ECG electrodes or dry conductive gel.
Big distortion of baseline and waveforms. |
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What are the nursing responsibilities for Holter monitoring?
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Apply electrodes and leads. Teach pt to keep accurate diary of activities and symptoms. No shower during monitoring.
Pt wears ECG for 24-48hrs and keeps a diary while doing regular activities. |
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What is electophysiologic study?
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Invasive. Cathetar electrodes inserted through femoral or jugular vein induces and terminates dysrhythmias. Records electrical activity of the heart.
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What are the nursing responsibilities for an electrophysiologic study?
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D/C antidysrhythmic meds several days before study.
Pt NPO 6-8 hrs before test. Premedicate to relax pt. Freq VS and continuous ECG after the procedure. |
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What are the nursing responsibilities for cardiac cath?
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Pt NPO 6-18hrs prior to test.
Check for iodine sensitivity. After procedure, assess circulation for extremity used q 15 min for 1 hr, puncture site for bleeding. VS and ECG. Assess for hypo/hyper tension, dysrhythmias, signs of pulmonary emboli. |
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How fast is sinus tachycardia?
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101-200BPM
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Signs and symptoms of sinus bradycardia
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Pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion or disorientation; SOB
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Tx for sinus bradycardia (Rx)
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Atropine or pacemaker
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Symptoms of sinus tachycardia
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Dizziness, dyspnea, hypotension, angina, increase in infarction size
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Tx of sinus tachycrdia
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beta blockers
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What does the ECG look like for a premature atrial contraction?
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Abnormal P wave
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Tx of premature ventricular contractions
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Beta blockers, withdrawal of the cause (caffeine/sympathomimetic drugs)
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ECG of paroxysmal supraventricular tachycardia
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Rate 150-220 BPM with abnormal P wave and a normal or shortened PR interval
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S/S of paroxysmal supraventricular tachycardia
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hypotension, dyspnea, angina
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Tx for paroxysmal supraventricular tachycardia
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Vagal stimulation like valsalva and coughing
IV adenosine 1st line betal blocers, ca channel blockers, amidodarone Cardioversion last choice |
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Adenosine
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used for paroxysmal supraventricular tachycardia
administer IV rapidly over 1 or 2 seconds followed by rapid NS flush Monitor pt ECG continuously. Brief asystole is common Observe pt for flushing, dizziness, chest pain, or palpitations |
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Wolff-Parkinson-White syndrome
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preexcitation
paroxysmal supraventricular tachycardia |
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Atrial flutter ECG looks like...
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sawtooth pattern P waves and
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Why would a person have atrial flutter?
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It is associated with CAD, HTN, mitral valve disorders, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism, and the use of drugs such as digoxin, quinidine, and epinephrine.
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Rate of atria and ventricles in atrial flutter
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Atria - 250-300BPM
Ventricles - 150 |
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Medication given to pts with atrial flutter
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coumadin to prevent thrombus
amiodarone propafenone (Rythmol) ibutilide (Corvert) flecainide (Tambocor) Dronedarone (Multaq) is tx of choice for a flutter whose hearts have returned to normal rhythm or for those who will undergo drug or electric shock tx to restore a normal heartbeat. |
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Tx of choice for atrial flutter
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Cardio ablation
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Atrial fibrillation on an ECG looks like...
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Total disorganization of atrial electrical activity from multiple ectopic foci.
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What diseases are associated with atrial fibrillation?
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CAD, rheumatic heart disease, cardiomyopathy, HTN, HF, pericarditis. Acutely with thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, cardiac surgery.
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The ECG with atrial fibrillation looks...
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P waves replaced by chaotic, fibrillatory waves.
Atrial rate 350-600 Ventricular rate: irregular |
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How many large squares in a second? In a minute?
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5 a sec
300 a min |
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Types of ventricular responses with atrial fibrillation?
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<60 = slow ventricular response
60-100 = controlled ventricular response >100 = rapid ventricular response |
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Drugs for atrial fibrillation
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Ca channel blockers, beta blockers, digoxin, dronedarone (Multaq)
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Most common drugs given for conversion of dysrhythmias to normal sinus rhythm are......
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amiodarone and ibutilide
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What if a person is in a fib for more than 48 hours?
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Give coumadin for one week before cardioversion.
MAKE SURE THERE ARE NO CLOTS BEFORE CARDIOVERSION!!!!!!!!!! |
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Moderate risk factors for a fib
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Age >75
Heart failure HTN LV ejection fraction <35% Diabetes |
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High risk factors for a fib
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Previous stroke, TIA, or embolism
Mitral stenosis Prosthetic heart valve |
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What is the Maze procedure?
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Incisions in both atria and cryoablation to stop a fib
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What is a junctional dysrhythmia?
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When the electrical impulse starts in the SA node and travels backward to AV node
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What causes junctional dysrhthmias?
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CAD, HF, cardiomyopathy, electrolyte imbalances, inferior MI, rheumatic heart disease, digoxin, amphetamines, caffeine, nicotine
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ECG characteristics of junctional dysrhythmias
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Abnormal or inverted P wave that may be hidden in the QRS complex
HR 60 bpm Accelerated junctional is 60-100bpm Junctional tachycardia is 100-180 bpm |
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What is contraindicated with junctional dysrhymias?
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CARDIOVERSION b/c junctional dysrhythmia is a safety mechanism when SA node is not working
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Rx for junctional dysrhythmias
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If a pt is symptomatic, atropine
In accelerated, stop the drug (like digoxin) In absence of digitalis toxicity, beta blockers, Ca channel blockers, amiodarone |
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What does the ECG look like in first-degree AV block?
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Prolonged PR interval (greater than two small boxes) (0.4sec)
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Significance of first-degree AV block
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It may be a precursor to more serious AV block
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What is second degree AV block, type one?
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2 P waves...1 QRS complex missing
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Drug of choice for 2nd degree AV block, Type I
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Atropine to increase HR
Or, stop the digoxin or beta blockers that are causing the rhythm |
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Other name for AV blocks
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Mobitz or Wenckebach
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What does the ECG look like for 2nd degree AV block, Type II?
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Multiple P waves for each QRS complex b/c some impulses from the SA nodes are not conducted to the ventricles at all PR interval is REGULAR
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How do you treat 2nd degree AV block, Type II?
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Pacemakers
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3rd degree heart block ECG
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Variable PR interval and missing QRS complexes
POOR PROGNOSIS |
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What is 3rd degree heart block associated with?
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severe heart disease, amyloidosis, scleroderma, digoxin, beta blockers, Ca channel blockers
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What makes 3rd degree heart block so dangerous?
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The ventricles are not contracting, so there may be ischemia, HF, and shock
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Tx for 3rd degree heart blockf
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Atropine, epinephrine, isoproternol, and dopamine until a pacemaker is inserted
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What is a contraction of the ventricles resulting from an ectopic focus called?
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PVC
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What is it called when every other beat is a PVC?
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ventricular bigeminy
ventricular trigeminy if it's every 3rd |
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What are 2 consecutive PVC's called?
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Couplet
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Tx of PVC's
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Depends on the cause...
O2 for hypoxia Electrolyte replacement for imbalances Beta blockers, procainamide, amiodarone, lidocaine |
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What is a run of 3 or more PVC's in a row called?
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Ventricular tachycardia
Monomorphic if QRS complexes are all the same, polymorphic if they are different |
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What is Torsades de pointes?
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Polymorphic VT with prolonged QT interval (long line at the top of the ECG)
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Does ventricular tachycardia have a good prognosis?
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NO. IT'S OMENOUS. Pt may be pulseless.
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How is ventricular tachycardia treated?
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If there is no pulse, cardioversion, CPR and then epinephrine and amiodarone
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What dysrhythmia does hyperkalemia cause?
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Ventricular fibrillation
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How do you treat asystole?
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Defibrillation, CPR, intubation, epinephrine, atropine
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What causes asystole?
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End stage heart failure or prolonged cardiac arrest
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What does sudden cardiac death usually result from?
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Ventricular dysrhythmias
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What is a prodysrhthmia?
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When a dysrhythmia drug causes what you are trying to fix.
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Why do we monitor pts in the hospital when they start dysrhythmia drugs?
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Possibility of prodysrhythmias
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Which drugs slow the heart down?
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Propafone, beta blockers, Cardizem
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Which drugs speed the heart up?
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lidocaine, phenytoin epinephrine
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What are biphasic difibrillators?
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Defibrillators that deliver energy in 2 directions so that they can use less electricity 120-200 joules as opposed to 360 with monophasic, and they have less post shock consequences
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Where do the defibrillator pads go?
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One to the rt of the sternum, under the clavicle...one to the left of the apex
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Nursing responsibility for synchronized cardioversion
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Medicate pt with Versed first
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What do you make sure of if you are going to defibrillate?
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Synchronizer switch is OFF
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What do you make sure of if you are going to do cardioversion?
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Synchronizer switch is ON
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Teaching for an implantable cardioverter-defibrillator
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Do not raise arm above shoulder level or drive until cleared by the doctor.
Avoid magnetic fields including MRI's. If you travel, tell the security officer about the device and don't use wand over the area If ICD fires, once call doc, more than once or you don't feel well call EMS Carry card with make/model of ICD and a list of all meds with you at all times. |
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Where are pacemakers implanted?
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Pectoral muscle on pt's nondominant side
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What are the 3 types of temporary pacemakers?
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Transvenous (placed in ER or ICU)
Epicardial (prophylactic during heart surgery) Transcutaneous (one pad on pt back, one on chest) |
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Nursing interventions for transcutaneous pacemaker
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Tell pt that muscles will contract and it will be uncomfortable until pt gets transvenous pacemaker
Provide analgesia or sedation |
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What are the two problems with pacemakers?
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Failure to sense - it fires when it's not supposed to
Failure to capture - not sending enough jolt to affect the heart |
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Nursing interventions for all pacemakers post op
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Prophylactic antibiotics to prevent infection
Chest x-ray to ensure it's in the correct place - no pneumothorax Limit activity on side of pacemaker to avoid dislodging. |
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Activity after pacemaker insertion
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Pt out of bed once stable
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Are microwave ovens safe for people with pacemakers?
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YES
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Nursing interventions post cardioablation
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Fast for 6-18 hrs beforehand
Explain feeling of warmth when contrast is given. Check CWMS in extremity used post-op |
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Troponin I
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Negative is <0.5
Positive >2.3 Suspicious is in between |
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What is the head up, tilt test?
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Strap pt to table and tilt table 60-80 degrees. If abnormal HR or BP in 30 min, test is positive
Do for syncope pt's |
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What is most suggestive of ACS with ischemia?
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Depressed ST segment
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ECG changes with infarction
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ST segment elevation
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How do you calculate HR on ECG strip?
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1500/# of small boxes in R-R interval
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What do you do for stable ventricular tachycardia?
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Amiodorone - don't shake the bottle (bubbles that won't go away)
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What is R on T phenomenon?
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PVC on T wave - can throw pt in to ventricular tachycardia
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What is torsades de pointes?
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polymorphic ventricular tachycardia...PVC on R wave...THINK HYPOMAGNESIUM WITH THIS.
Certain antiarrhythmics can cause it too. |
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How do you treat v. fib?
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Make sure it's not artifact, and then defibrillate.
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What is the 1st symptom of CAD?
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V fib, many times
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How do you treat asystole?
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Drugs and CPR...hopefully return pt to v fib where we can shock.
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What causes pulseless electrical activity?
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Think of the 6 H's and the 5 T's. Hypovolemia, hypoxia, hypo/hyperkalemia, H+ ions (acidotic), hypoglycemia, hypothermia. Toxins (drug overdose), temponade, tension pneumothorax, thrombosis, trauma.
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How do you treat pulseless electrical activity?
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CPR, ACLS, drugs
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What is an EKG artifact?
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it's the pt moving/breathing, electrical interference (seizure, chills from a fever, pt moving in bed),
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When do we use defibrillators ?
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V fib, pulseless Vtach.
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When is a pacemaker indicated?
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b/c they have damaged hearts, electrical system is shot
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What are the types of pacemakers?
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Transcutaneous (patches on outside of body), Transvenous (go in to jugular or femoral vein in emergent situation), permanent pacemaker (placed in cath lab)
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What is the nursing care for a pacemaker?
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be careful about the arm on the side of the pacemaker. Post-op, put arm in sling, keep immobile for 3-6 weeks. No heavy lifting or high reaching. No MRI's!!
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What does a pacemaker look like on the telemetry monitor?
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Wide QRS complex.
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