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56 Cards in this Set
- Front
- Back
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ECG tracing
Isoelectric line P-Wave--- |
• Atrial Depolarization (Electrical activation of muscle cells-usually indication of contraction)
• Alike in size and shape- usually smooth and rounded • Upright lead II • On fast rhythms-look for a hump on the T Wave |
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ECG tracing
Isoelectric line P-R interval |
• Beginning of p wave to beginning of QRS complex
• Normally 0.12-0.20 seconds • Over age 65 up to 0.24 is normal |
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ECG tracing
Isoelectric line QRS complex |
• The Q wave is the first negative deflection in the QRS complex
• Not every QRS complex has a Q wave • R wave is the first positive deflection after the P wave • S is a negative wave that follows the R • Normal duration is 0.06-0.10 • Wider width indicates slower conduction of impulse through ventricles J Point-Point at which the QRS complex and the ST segment meet-called junction or j point |
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ECG tracing
Isoelectric line ST segment-the line that follows the QRS complex and connects it to the T wave. |
ST segment-the line that follows the QRS complex and connects it to the T wave.
• Under normal circumstances, should be isoelectric (same height as the P-R interval) • May be depressed or elevated when myocardium is hypoxic • Digitalis causes a depression (scoop) of the ST segment |
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ECG tracing
Isoelectric line T-Wave-Follows the QRS complex |
• Represents ventricular repolarization (resting returns to ready
• Refractory period- a stage of resistance to stimulation • Last half of T-wave is relative refractory period • Stimulus can send heart into chaos. |
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ECG rhythm analysis
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• Step 1. Determine Rate
• P-waves = atrial and R waves = ventricular • 6 second method= #R’s X 10 • Memorize sequence 300, 150, 100, 75, 60, 50, 43, and sequence with large boxes between two consecutive complexes for rate Step 2. Determine regularity Step 3 Assess P wave morphology (smooth and rounded=sinus not origination) Step 4. Assess P to QRS relationship (?1 P wave/QRS) Step 5. Determine interval durations (PRI & PRS)- Measure with calipers or count small squares Step 6. Identify abnormalities= ectopic (premature) beats, deviation of the ST segment above or below baseline and abnormalities in waveform shape and duration |
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Normal Sinus Rhythm
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• Rate 60-100
• Regular • Consistent P waves – smooth and rounded • 1 P wave/QRS • PRI 0.12-0.20 & QRS 0.12 or below (0.6-0.10) • Normal-no treatment • Identification NSR – Every part is normal • All waves are positive in lead 2 |
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Sinus dysrhythmia
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Sinus dysrhythmia-Normal phenomenon that occurs with respiration change in intrathoracic pressure
• Rate 60-100 beats per minute • Rhythm: irregular (R-R intervals shorten during inspiration and lengthen during expiration • P Waves Normal appearance, one before each QRS • PR interval 0.12-0.20 seconds • QRS: usually 0.10 seconds or less • Etiologies: Normal |
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Sinus Bradycardia
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Sinus Bradycardia
• Slower, treat whenever person gets symptomatic • Rate: less than 60 bpm • P waves: uniform in appearance, upright in Lead II, one before each QRS • PR interval: 0.12-0.20 • QRS: usually 0.10 seconds or less |
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Sinus Bradycardia
Etiologies |
Etiologies
• Often seen normally in athletes • Parasympathetic stimulation—Increased vagal tone, (vagal maneuvers—Carotid massage, vomiting, straining at stool, increased intracranial pressure • Myocardial disease • Hypothermia • Pharmacologic agents precipitating (causing) sinus bradycardia: o Digitalis o Beta Blockers o Calcium Channel Blockers |
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Sinus Bradycardia
Associated Symptoms: |
• Decreased Cardiac output—chest pains, SOB, change in level of consciousness, dizziness, hypotension—Drop in persons normal BP of 20 mmHg or more
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Sinus Bradycardia
Nursing Implications: |
Nursing Implications: No treatment required unless patient is symptomatic
• Place patient in head flat position if respiratory status permits—Brings BP up • Assess need for oxygen supplement • Assure patent has patent IV access • Document rhythm strip, vita signs, and patient activity prior or during the brady event |
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Sinus Bradycardia
Pharmacological and medical management: |
Pharmacological and medical management:
• Administer Atropine per protocol |
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Sinus Tachycardia:
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• Rate: greater than 100 beats per minute (usually 100-160 but may be higher in children)
• Rhythm: Regular • P waves: uniform in appearance, upright in Lead II, one before each QRS • PR interval-0.12-0.20 • QRS: usually 0.10 seconds or less |
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Sinus Tachycardia:
Etiologies: |
Etiologies: Sinus Tachycardia
• Normal in children 10 years and younger • Occurs as normal response to body’s demand for increased oxygen • Fever, pain, and anxiety, hypoxia, CHF, MI, infection, sympathetic stimulation, hypovolemia, dehydration, exercise. • Pharmacologic agents precipitating (causing) tachycardia • Epinephrine • Atropine • Bronchodilators • Caffeine, nicotine, and Cocaine |
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Sinus Tachycardia:
Associated symptoms: |
• Signs of decreased cardiac output related to decreased ventricular filling time.
• May cause angina due to increased oxygen demand of the heart muscle itself |
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Sinus Tachycardia:
Nursing Implications: |
• Treatment aimed at identifying and treating underlying cause
• Institute measures to reduce the body’s metabolic demands. How?? |
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Supraventricular Tachycardia (SVT)
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• Called paroxysmal supraventricular Tachy (PSVT) when I suddenly starts and stops
• Rate: Greater than 100 beats per minute (Usually 150-200BPM) • Rhythm: Regular • P waves: often not identifiable • PR interval: May be < 0.12 seconds • QRS: Usually 0.10 seconds or less |
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Supraventricular Tachycardia (SVT)
Etiologies: |
Etiologies:
• Sympathetic nervous stimulation—fever, sepsis, hyperthyroidism • Heart Diseases-CHD, MI, rheumatic Heart disease, myocarditis • Abnormal conduction pathways: Wolff Parkinson-White syndrome |
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Supraventricular Tachycardia (SVT)
Associated Symptoms |
• Complaints of palpitations and racing heart
• Signs of Decreased Cardiac output related to decreased ventricular filling time • May cause Angina due to increased oxygen demand of heart muscle itself • Anxiety, dyspnea, diaphoresis, Extreme fatigue, polyuria (UO may reach 3 liters in first few hours- Fluid collecting in Atria secreted out through the kidney |
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Supraventricular Tachycardia (SVT)
Nursing implications: |
No treatment required unless patient symptomatic.
• Assess need for oxygen supplement. • Assure patient has patent IV access • Document rhythm strip, vital signs and patient activity prior or during SVT |
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Supraventricular Tachycardia (SVT)
Pharmacological and medical management: |
• Vagal maneuvers: bear down like straining at stool, gag or vomit
• MD”s only-carotid sinus massage-periorbital pressure • Oxygen therapy • Meds: o Adenosine, med given fast as you can shoot it in, and flush fast o Verapamil o Procainamide o Propranolol o Esmolol • Synchronized Cardioversion • Ablation if frequently recurrent |
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Atrial Flutter
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• Rate: Depends on degree of AV block per minute (Usually <150)
• Rhythm: Regular or Irregular • P waves: F (flutter) waves-sawtooth or picket fence appearance of P waves • PR interval usually not measured • QRS: usually 0.10 seconds or less |
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Atrial Flutter
Etiologies: |
Etiologies: Sympathetic stimulation—anxiety, caffeine or alcohol
• Tyrotoxicosis • Heart disease-MI, rheumatic heart, valvular disorders • Abnormal conduction syndromes—Wolf Parkinson-White |
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Atrial Flutter
Associated Symptoms: |
Associated Symptoms:
• Signs of decreased Cardiac Output related to decreased “atrial kick” filling and Contraction • May cause angina due to increased oxygen demand of heart muscle itself • Nursing Implications: Assess need for oxygen supplement • Assure patient has patent IV access • Document rhythm strip, vital signs |
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Atrial Flutter
Pharmacological and medical management |
Pharmacological and medical management
• Synchronized cardioversion • Meds to slow heart rate-beta blockers and calcium channel blockers |
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Atrial Fibrillation
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• Rate: Varies-Chart ventricular response as “moderate” (<100) or rapid (>100)
• Rhythm: Irregularly irregular • P waves: F (fibrillation waves) • PR interval: not measurable • QRS: Usually 0.10 seconds or less |
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Atrial Fibrillation
Etiologies: |
Etiologies:
• Thyrotoxicosis, hyperthyroidism • Heart diseases-CHF, Rheumatic heart, valvular disorders |
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Atrial Fibrillation
Associated symptoms: |
Associated symptoms:
• Signs of Decreased cardiac output related to decreased “atrial kick” filling and contraction • Peripheral pulses irregular |
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Atrial Fibrillation
Nursing Implications: |
Nursing Implications:
• Assess need for Oxygen supplement • Assure patient has patent IV access • Document Rhythm Strip, vital signs • Monitor anticoagulant administration and related symptoms |
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Atrial Fibrillation
Pharmacological and medical management |
Pharmacological and medical management
• Synchronized cardioversion • Meds to slow ventricular rate- digitalis and beta blockers • Anticoagulant therapy (Coumadin)- Decreases incidence of emboli and stroke |
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Junctional Rhythm AKA Nodal Rhythm
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• Rate 40-60 beats per minute (possible 60-140)
• Rhythm: regular • P waves: absent, inverted, or behind QRS • PR interval: frequently <0.10 if visible • QRS: usually 0.10 seconds or less |
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Junctional Rhythm AKA Nodal Rhythm
Etiologies: |
Etiologies:
• Failure of higher pacemakers (sinus) • Overdose of digitalis, beta blockers, and calcium channel blockers • Heart disease-CHF, MI • Increased vagal tone • Hypoxemia • Hyperkalemia |
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Junctional Rhythm AKA Nodal Rhythm
Associated Symptoms: |
Associated Symptoms:
• Signs of decreased Cardiac output related to decreased “atrial kick” filling, and contraction • Ndx decreased Cardiac output |
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Junctional Rhythm AKA Nodal Rhythm
Nursing Implications |
Nursing Implications
• Assess need for oxygen supplement (only treat if symptomatic (Atropine) • Assure patient has patent IV access • Document rhythm strip, vital signs • Report signs and symptoms of med toxicity • Monitor anticoagulant administration and related symptoms |
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Junctional Rhythm AKA Nodal Rhythm
Pharmacological and Medical management |
Pharmacological and Medical management
• Evaluate for med toxicity • Treat cause if client is symptomatic |
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Premature ectopic beats-Premature atrial contraction (PAC)
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Premature ectopic beats-Occurs early, originating from a different focus
Premature beat occurs and has a P wave of a different form than other beats. QRS same as all other beats. Interpret underlying rhythm first and then analyze premature beat |
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Premature ectopic beats-Premature atrial contraction (PAC)
Etiologies: |
Etiologies:
• Often seen normally in children • Alcohol and caffeine intake • Stress • Smoking |
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Premature ectopic beats-Premature atrial contraction (PAC)
Associated symptoms |
Associated symptoms
• Frequently Asymptomatic • Heart disorders-MI, PE, valve disorders, hypoxemia, digitalis toxicity. • Electrolyte imbalance. Decreased Potassium and Decreased Magnesium |
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Premature ectopic beats-Premature atrial contraction (PAC)
Nursing Implications |
Nursing Implications: No treatment required unless patient symptomatic.
• Document rhythm strip with estimate of frequency (Frequent may progress to A-Fib) • Advise PT to reduce intake of stimulants-smoking, alcohol, and caffeine |
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Premature Junctional Contraction (PJC) Ectopic focus in junction
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Premature beat occurs and has absent, inverted or retrograde P wave. QRS usually < 0.12. Interpret underlying rhythm first and then analyze premature beat.
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Premature Junctional Contraction (PJC) Ectopic focus in junction
Etiologies Associated Symptoms Nursing implications |
Etiologies
• Cardiac ischemia or injury Associated Symptoms • Frequently asymptomatic Nursing implications: no treatment required unless patient symptomatic. • Document rhythm strip with estimate of frequency |
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Premature ventricular contractions (PVCs) Ectopic focus in ventricles
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Premature beat occurs and no P wave
QRS usually >0.12 with wide and bizarre complex. T wave frequently in opposite direction of QRS. Interpret underlying rhythm first and then analyze premature beat Types of PVC’s for charting • Uniform-All look the same (initiated from same focus in ventricle) • Multiform-Look different • Pattern of occurrence o Bigeminal PVC’s Occur every other beat o Trigeminal PVC’s – occur every third beat o Quadrageminal PVC’s occur every fourth beat. • Couplet’s-PVC’s that occur in pairs-no normal beat between • Run, salvo or burst of V-Tachy- indicates extreme irritability • Triplets or more are considered a burst of V-Tachy • PVC’s that fall on the T wave of the preceding beat (R on T phenomenon) |
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Premature ventricular contractions (PVCs) Ectopic focus in ventricles
Etiologies: |
Etiologies:
• Can occur in healthy people with no apparent reason • The most common ventricular dysrhythmia • Arises from an irritable site within either ventricle • Increase in catecholamines (drugs ex epinephrine) and stimulants (alcohol, caffeine, and tobacco) • Electrolyte disorders- lowered potassium, lowered calcium, lowered magnesium • Hypoxemia-Cardiac ischemia or injury • Digitalis toxicity • Drug induced (epinephrine, dopamine, phenothiazines, isoproterenol) • Stress, emotions, fear • Acidosis • Congestive heart failure |
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Premature ventricular contractions (PVCs) Ectopic focus in ventricles
Associated symptoms |
Associated symptoms
• May be asymptomatic • Patient indicates “heart skipping” • Decreased cardiac output if frequent |
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Premature ventricular contractions (PVCs) Ectopic focus in ventricles
Nursing implications: |
Nursing implications:
• Assess perfusion of PVC-Pulse deficit—pulse may not be felt with PVC • Do PVC’s occur with activity or increase with exertion? • Are PVC’s associated with client c/o angina • Document rhythm strip with estimate of frequency and type • No treatment required if infrequent and asymptomatic. • Advise patient against stimulant use (caffeine, nicotine) consider aminophylline, dopamine, epinephrine • Monitor ECG continuously during lidocaine or amiodarone administration; may monitor lidocaine blood levels and observe for neurological side effects. |
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Premature ventricular contractions (PVCs) Ectopic focus in ventricles
Pharmacological and medical management |
Pharmacological and medical management
• Treat underlying cause. Ex. Give potassium, magnesium, or calcium, Or 02 • Meds: Lidocaine bolus then maintenance drip to infuse: 1-3 mg/min • Amiodarone |
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Ventricular Tachycardia (VT)
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Ventricular Tachycardia (VT) – 3 or more consecutive PVCs
• Rate: 100-250 beats per minute • Rhythm: regular • P waves: usually not identifiable • PR interval: none visible • QRS: usually >0.12 bizarre shape |
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Ventricular Tachycardia (VT)
Etiologies: |
Etiologies:
• Myocardial ischemia and injury—hypoxemia • Drug toxicity • Heart disease-valvular, rheumatic, cardiomyopathy |
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Ventricular Tachycardia (VT)
Associated Symptoms: |
Associated Symptoms:
• Signs of decreased cardiac output |
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Ventricular Tachycardia (VT)
Nursing implications: |
Nursing implications:
• Check Pulse—If no pulse (call code) or unstable, then defibrillate • Assure patient has patent IV access • Administer lidocaine, or amiodarone or procainamide per protocol • Assess need for oxygen supplement-pulse oximetry • Document rhythm strip, vital signs |
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Ventricular Tachycardia (VT)
Pharmacological and medical management |
Pharmacological and medical management
• Evaluate for med toxicity • Lidocaine • Amiodarone • Procainamide • AICD Placement |
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Stable
Unstable Steps in a code |
Stable
Evaluate O2, IV, Bolus Amiodarone and IV gtt Lidocaine Unstable Premedicate-Versed Cardiovert Bolus-Amiodarone, Lidocaine, or Pronestyl, maybe Mag sulfate O2 monitored Steps in a code Check A, B, C Defib x 3 up to 360 joules Epinephrine/Vasopressin Intubate Bolus IV and gtt Amiodarone Lidocaine Maybe mag Sulfate |
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Ventricular Fibrillation
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Rapid ventricular quivering without contraction-Heart does not pump
• Rate: uncountable-Chaotic • Rhythm-Grossly irregular • P waves: not identifiable • PR interval: none visible • QRS: usually > 0.12 bizarre varying shapes |
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Ventricular Fibrillation
Etiologies: Associated Symptoms: |
Etiologies:
• Myocardial ischemia and injury-hypoxemia • Drug toxicity • Heart disease-Valvular, rheumatic, cardiomyopathy Associated Symptoms: • Unresponsive • Pulseless • Nursing Implications: • Check Pulse-if no pulse (call code) then defibrillate • Assure patient has patent IV access • Administer epinephrine, lidocaine, or amiodarone or procainamide per protocol • Follow code protocols • Document rhythm strip, vital signs |
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Ventricular Fibrillation
Pharmacological and medical management |
Pharmacological and medical management
• Medications o Epinephrine o Lidocaine o Amiodarone o Procainamide • Intubate and oxygenate |
