EKG and Arrhythmia

Helpfulness: 0
Set Details Share
created 3 years ago by johnchristianson19
241 views
updated 3 years ago by johnchristianson19
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

Cardiac Conduction System

Most start in SA node (pacemaker)

SA node--intranodal pathway--AV node--bundle of His--bundle branch--purkinje

2

SA node beat

60-100

3

AV node beat

40-60

4

Ventricle beat

20-40

5

ECG and electrical activity of myocardium

card image
6

CO

HR x SV

4-8 L/minute is normal

7

Determinanty of Cardiac Output

preload

afterload

contractility

8

Alpha receptor: location and action

Lungs, veins, arteries

vasoconstriction

9

Beta 1 receptore: location and action

Heart

increased heart rate, contractility, automaticity

10

Beta 2 receptors: location and action

lungs, veins, arteries

vasodilation and bronchodilation

11

Beta blocker action

Both 1 and 2 receptors

12

Parasympathetic nervous system

slows down heart

innervates SA, AV, and Atrial muscle via vagus nerve

13

S/S of Decreased CO

card image

Big signs and symptoms are bolded

14

ECG Paper small boxes

.04 seconds

.1mV

15

ECG paper large boxes

.2 seconds

16

Electrocardiographic Segment:

Line (usually isoelectric) that connects two waves without including either one of them.

17

Electrocardiographic interval

Portion of the EKG (ECG) that includes a segment and one or more waves

18

P wave

80ms

P wave Refects firing of AV node and depolarization of atria

19

P-Q interval

120-200ms

20

PR segment

50-120mg

is measure from end of P wave to beginning of QRS

SA node to AV node

21

QRS complex

80-120ms

Magnitidue of venticular depolarization is greater than atrial repolarization, so it overshadows it

22

ST segment

80-120ms

ST segment is the early phase of vent. Repolarization (MI or ischemia); inactivity period between depolarisation and the beginning of ventricular repolarisation.

23

T wave

160ms

T wave rep. vent. Repolarization

24

ST interval

320ms

25

QT interval

300-430 ms

The QT interval represents the electrical ventricular systole, that is, the set of ventricular depolarisation and repolarisation. Its value varies with the Heart Rate, so it is advisable to adjust its value to the Hear Rate.

26

Electrodes

attached to patient to detect cardiac electrical activity

apply to clean, dry skin and change every 24 hours for accurate signal

27

Wires

cables connected to electrodes that transmit the electrical signal to the monitor

28

Leads

particular arrangement of electrodes and wires

Where you place them on our patient determines the picture you see

29

Steps for Rhythm interpretation r

card image
30

Sinus Arrhythmias

Originate in the SA node

hallmark is normal P waves

Conduction sequence: SA-AV-Ventricles

NSR, Sinus Tach, Sinus brady

31

Normal Sinus Rhythm

card image
32

Sinus Tachycardia

card image
33

Causes of sinus tach

card image
34

Nursing responsibilities and treatments of sinus tach

assess for signs and symptom of decreased CO

Treat underlying cause-ONLY IF SYMPTOMATIC

Treatment: vagal maneuvers, Beta blockers, cardioversion

35

Sinus Bradycardia

card image
36

Causes of Sinus Brady

sleep

increased cranial pressure

MI

vagal stimulation (vomit or suctioning)

Parasymp. Drugs (cholinergic drugs like tear gas)

hypoxemia

phys. cond. with aerobic exercise

cardiac drugs

37

Nursing responsibilities of sinus brady

assess for S/S of low CO

notify provider of change and associated symptoms

38

Treatment of Sinus Brady

Treat the cause:

-counteract drugs

-change doses

If symptomatic:

-oxygen

-atropine (if ineffective transQ pacing or a dopamine/epinephrine infusion)

-pacemaker

39

Atropine

.5-1mg IV push

decreases vagal tone and increases induction through AV node

40

Atrial Arryhtmias

originate in atria, away from the SA node (skip the SA node)

hallmark is abnormal atria activity

41

Atrial Arryhtmias sequence

abnormal atrial depolarization--AV Node--ventricles

42

Types of atrial arrhythmia

Afib, Aflutter, SVT

43

AFib

Quiver

Atria and ventricle beat rapidly (not as fast as atria though)

Fast and irregular

MOST COMMON type of arrhythmia

Normal QRS

cannot measure PR interval

P waves not present

44

Controlled AFib

less than 100

45

Uncontrolled Afib

more than 100

start to see symptoms of decreased CO mostly here

46

Atrial Flutter

card image

very common too

more regular rhythm

sawtooth patter is hallmark

isoelectric line is flutterig

count number of flutter waves per QRS complex (4:1 in example)

47

Causes of Afib and Flutter

Are the SAME!

CHF

Acute MI: loss of blood flow

Vascular disease (atrial chamber enlargement)

increased sympathetic tone

hyperthyroidism

Stress: pneumonia and surgery (post-op)

48

Treatment of AFib and Flutter

IF Symptomatic:

Rate control: drugs (slow ventricular response by increasing AV block)

-keep it less than 100 HR (better change of it flipping back to SR)

-IV metoprolol (5mg three times), diltiazem infusion (Ca blocker), amiodarone infusion (IN THAT ORDER FIRST)

-anticoagulants because of increased risk of blood clots

Cardioversion

49

Amiodarone

can be toxic to veins

50

Cardioversion

same equipment as defibrillation

lower voltage

patient sedated

51

Supraventricular Tachycardia (SVT)

card image

umbrella term for Atach, Afib, Junctional tachycardia, and A flutter

-Need to slow it down to figure out which rhythm it is

Paroxysmal SVT: comes and goes or stops suddenly

52

Causes of SVT

card image
53

Responsibilites of SVT

assess for S/S of decreased CO

notify provider of change

restrict activity

54

Treatment of SVT

support the patient in vagal maneuvers: have pt bear down like having a bowel movement; stimulates Vagal nerve to decrease HR

-doesn't work all the time

medications: adenosine, iltiazem, digoxin, beta blockers

cardioversion

eliminate stimulants

55

Adenosine

6-12 mg IV push (ask if pt has gotten it before and which dose worked)

common that patient will feel terrible (chest pain, doom, feeling flushed)

Large IV

Flush, Slam it in quickly (1-2 seconds), then another Flush (20mL rapid)

give 12mg if 6mg doesn't work

have code cart and alert others in the area

56

Junctional Arrythmias

originate in AV node because SA isn't firing

Hallmark is a short PR interval and p waves are invisible, inverted, or follow the QRS

57

Conduction sequence of Junctional arrhythmias

Av node--ventricles and atria simultaneously

58

Rhythms of Junctional Arry.

Junctional escape: 40-60

Accelerated: 60-100

Tachy: over 100

59

Heart blocks

abnormal slowing or interruption of the conduction of an electrical impulse usually around the AV node

60

Heart blocks conduction sequence

normal but all the impulses may not reach the ventricles in the normal time intervals or may not reach the ventricles at all

61

First Degree heart block

the heart's electrical signals are slowed as they move from the atria to the ventricles (the heart's upper and lower chambers, respectively). This results in a longer, flatter line between the P and the R waves on the EKG (electrocardiogram); A PROLONGED PR INTERVAL

First-degree heart block may not cause any symptoms or require treatmen

62

Second degree heart block

In this type of heart block, electrical signals between the atria and ventricles are slowed to a large degree. Some signals don't reach the ventricles. On an EKG, the pattern of QRS waves doesn't follow each P wave as it normally would.

If an electrical signal is blocked before it reaches the ventricles, they won't contract and pump blood to the lungs and the rest of the body.

63

Second degree block type 1 (Weckenbach)

the electrical signals are delayed more and more with each heartbeat, until the heart skips a beat. On the EKG, the delay is shown as a line (called the PR interval) between the P and QRS waves. The line gets longer and longer until the QRS waves don't follow the next P wave:

64

Second degree block type two

the electrical signals are delayed more and more with each heartbeat, until the heart skips a beat. On the EKG, the delay is shown as a line (called the PR interval) between the P and QRS waves. The line gets longer and longer until the QRS waves don't follow the next P wave

65

Third degree block

FATAL because PR and QRS are not connected at all

66

Ventricular rhythms

hallmark is a wide, bizarre QRS

Ventricles are backup system because AV and SA nodes are not firing

-don’t work for a long time, but can prelong life until interventions are made

Most dangerous and life threatening

67

Ventricular rhythms conduction seq

Abnormal vent. depolarization and retrograde conduction through the system

68

Ventr. Rhythms types

Escape

Tachycardia

Fibrillation

Asystole

69

Ventricular escape

card image

idioventricular, anginal, dying heart

last rhythm before deat

blocks in the SA and AV node

70

Responsibilities for V. Escape

assess for S/S of decreased CO

consider causes

notify provider

notify family (if death expected like hospice)

71

Treatments of V. Escape

Only if symptomatic and unexpected

Treat like symptomatic bradycardia: atropine, pacemaker

72

Ventricular Tachycardia

card image

life threatening

73

Run of V Tach

pt goes in and out of VTach with no symptoms

74

Cause of V Tach

card image

drugs: anything that will speed up heart

sharp blow to ches

central line patient

75

V Tach treatment

card image

amiodarone is anti arryhtmic

also can give amiorarone and epinephrine during CPR once code cart arrives if defibrillation is unsuccessful

76

Nursing Responsibilities to V Tach

if asymptomatic complete steps for any rhythm change

if symptomatic: Call Code Blue (or 911) and Start CPR

77

Treatment of V Tach

For pulseless: Early defibrillation

Drugs

78

Defibrillation

Within 2 minutes

first shock within 3 minutes

EARLY DEFIB to increase chance of living

79

Ventricular Fibrillation

card image

Pt will die if there is no intervention

80

Nursing Responsibilities for V fib

Quickly assess for signs and symptoms of low CO

call a code blue (if pt is not DNR)

Start CPR

Explain to code team the situation and what you have done so far

81

Treatment of V Fib

continue with CPR until defibrillator arrives

treatment of choice for VF if defibrillation

initiate ACLS protocols if you are trained

82

Asystole

card image
83

Responsibilities of Asystole

verify the rhythm is asystole in multiple leads (monitor may read leads off as systole and vice versa)

check patient: pulse, respirations, LCO

verify code status, then call a code and start CPR

84

Treatment of Asystole

DO NOT DEFIBRILATE

-This is not a shockable rhythm

-they are clinically dead

CPR and epinephrine only

-still unlikely that they will come back from this

85

PR Interval

It represents the physiological delay suffered by the stimulus through the Atrioventricular (AV) node. It is measured from the beginning of the P wave until the beginning of the Q or R wave

86

If cardioversion and drugs don't work for Afib...

anticoagulant therapy

-warfarin is drug of choice

Maze procedure: surgical procedure that stops Afib by interrupting ectopic electrical signals that are responsible for dysarrythmia

87

Afib and Flutter clinical significance

results in lowered atrial kick and lowered CO

88

Cause of Junctional Dysrhythmias

associated with CAD, HF, cardiomyopathy, electrolyte imbalance, inferior MI,

digoxin, nicotine, amphetamines, caffeine can also cause

89

Treatment of junctional arrhythmia

atropine if symptomatic

Betablockers, amiodarone

cardioversion not used

90

Adenosine

Monitor EKG continuously

Brief period of asystole is common

observe patient for flushing, dizziness, chest pain

Used primarily for SVT

91

Atropine

for sinus bradycardia

92

amiodarone

anti arrythmic

toxic to veins

93

Digoxin

commonly used for Afib


Related pages


determination of bacterial growth curveorganic functional groups flashcardspyramidal pathwaysdeoxyribonucleotide structureoogenesis humancultural anthropology booksmean of binomial distribution formulapea plants dihybrid crossesgeneration of proton gradients across membranes occurs duringwhat kind of molecule is atptransverse abdominis origindescribe lysosomerhonci lung soundsdefine cephalic regionwhich of the following statements about transcription is correctwhich of the following pairs are mismatchedname a homozygous recessive genetic disorderall of the following are true about color blindness exceptincus and malleusstriations in musclefunction of the cerebral aqueductwhich of the following statements about phospholipids is falseeyeball labeledwhich best describes how an ionic bond formsaccording to the fluid mosaic model of the cell membranelesser omentum anatomye coli in emb agarmale sex organs and their functionschapter 7 photosynthesisantonyms of joybio fungusdefine oxygenated bloodtibialis posterior origin and insertionwhat is antiparallel dnabiotest cardvinblastine is a standard chemotherapeuticdescribe the process of dna replication in eukaryotesoptochin sensitivitymastering biologhow to pronounce numbers in frenchmonetary targeting definitiona dural fold separating the cerebrum from the cerebellumattaches muscle to bonewhat does protostome meanthe olfactory nerve carries impulses for the sense ofhemocytoblast definitiondefine surgical asepsisdaniel webster apushdoes proteus mirabilis ferment lactoseglycogen monomersas informat datebehavior therapy assumes thatnitration of methyl benzoate limiting reagentloose regular connective tissuerainfall in the arctic tundrarecombinant dna technology questionswhat does the term parfocal meanpermeability of dialysis tubingurinary bladder anatomy and physiologyformed of bipolar neuron axonsepinephrine effect on blood glucoseduring which phase of mitosis do the chromatids become chromosomesa large phagocyte found in lymph nodesdiaphragm function in digestionis the cardiac muscle voluntary or involuntarywhere are follicles locatedrhetorical devices flashcardsvoltage gated k channelsnsaid paracetamolroman law consisted of three brancheswhich statement is true regarding the formation of ionic bondswhich of the following cranial nerves carries only sensory informationdescribe systole and diastolehormonal control of testicular functionvocab unit 14examples of inhibitors in chemical reactionssympathetic cranial nervesgenotype ttanatomy and physiology bones test