Professional Documents
Culture Documents
Lichauco, RN,MAN
Records
the hearts electrical activity as waveforms that depict depolarization (contraction) and repolarization (relaxation)
is used to diagnose and monitor certain disorders
It
Allows
1.
decrease in the rate at the SA node decreased excitability of the AV junction fibers Increases the rate at the SA node Increases the force of myocardial contraction
2.
Sympathetic stimulation
1. 2.
3.
A small area of the heart can become more excitable than normal, which causes abnormal heartbeats called ectopy
The
SA node, internodal tracts, AV node, bundle of His, right and left bundle branches, and Purkinje Fiber make up the system that conducts electrical impulses and coordinates chamber contraction.
On a typical EKG grid, 5 small squares, or 1 large square, represent 0.20 seconds of time
a. b.
True False
P wave represents electrical activity associated with original impulse from the SA node and its passage thru the atria Atrial depolarization and contraction of the atria Concave and small; no notching or peaking
QRS Complex Indicates ventricular depolarization or contraction of the ventricles Less than 0.12 sec R waves are deflected positively and the Q and S waves are negative
True False
RA
LA
LL
Lead I RA LA
Lead II
Lead III
LL
300 divided by the number of large squares between regular QRS complexes
2.
6. Determine if T waves are present and have a normal shape, normal amplitude, and the same deflection as the QRS. 7. Determine QT interval duration. Count the small squares between the beginning of the QRS complex and the end of the T wave.
8. Evaluate other components. Note ectopic beats or other abnormalities. Check the ST segment for abnormalities. Look for U wave
What is the rate? Is the rhythm regular? Is there a P wave for every QRS complex? What is the PR interval? What is the QRS interval?
What is the rate? Is the rhythm regular? Is there a P wave for every QRS complex? What is the PR interval? What is the QRS interval?
Term
used when either the rate, rhythm, or contour of the individual waves does not meet normal standards
Classification of arrhythmias: 1. Disturbance of impulse formation according to site of origin 2. Disturbance of conduction abnormal delay or block in the passage of the cardiac impulse from the SA node thru the Purkinje fibers in the ventricle
ECG features: Rate: usually 100-150 bpm Rhythm: regular P waves: Normal PR interval: Normal QRS: Normal
Rate: 40-59 bpm P wave: sinus QRS: normal Conduction: PR normal or slightly prolonged at slower rates Rhythm: regular or slightly irregular
All atrial and ventricular rhythms normal except for missing Complex Normal P wave preceding each QRS complex
Rate: Normal or accelerated P wave: usually have a different morphology than sinus P waves because they originate from an ectopic pacemaker QRS: normal Conduction: normal Rhythm: PACs occur early in the cycle
Rate:
atrial rate usually between 400-650/bpm P wave: not present; only fibrillatory waves QRS: normal Conduction: variable Rhythm: irregularly irregular (HALLMARK)
Rhythm
Atrial: regular Ventricular: typically regular, although cycles may alternate Rate: atrial 250-400bpm ventricular 60-100bpm
wave abnormal, sawtooth appearance or flutter waves of F waves PR interval not measurable QRS duration usually within normal limits T wave not identifiable QT interval not measurable
Atrial and ventricular rhythms regular PR interval > 0.20 second P wave precedes QRS complex QRS complex normal
Atrial rhythm regular Ventricular rhythm irregular PR interval progressively, but only slightly, longer with each cycle until QRS complex disappears (dropped beat); PR interval shorter after dropped beat
Atrial rate regular Ventricular rate slow and regular no relation between P waves and QRS complexes No constant PR interval QRS interval normal
In a third degree heart block, the P waves are married to the QRS complexes
a. b.
True False
Rate: Variable P wave: usually obscured by the QRS,PST or T wave of the PVC QRS: wide> 0.12 sec, bizarre morphology, occurs earlier than expected Conduction: impulse originates below the branching portion of the bundle of His Rhythm: irregular May occur singly, in pairs(couplets, triplets),in patterns (bigeminy, trigeminy, or quadrigeminy), maybe unifocal or multifocal T wave appears differently with QRS
DANGEROUS PVCs:
R-on-T pattern
Bigeminy
Multifocal
Sequential/Couplets
Rate: Usually between 100-250 bpm P wave: obscured QRS: wide and bizarre Conduction: as with PVCs Rhythm: three or more ventricular beats in a row, may be regular or irregular May stop or start suddenly
Torsades de Pointes
Ventricular
rhythm rapid and chaotic QRS complex wide and irregular, no visible P waves
Continue
Potassium
Hypokalemia causes increased cardiac electrical instability, ventricular dysrhythmias, and increased risk of digitalis toxicity In hypokalemia, the electrocardiogram would show flattening and inversion of the T wave, the appearance of a U wave, and sagging of the ST segment
Calcium Hypocalcemia can cause ventricular dysrhythmias, prolonged QT interval, and cardiac arrest Hypercalcemia can cause a shortened QT interval, Av block, tachycardia or bradycardia, digitalis hypersensitivity, and cardiac arrest
Description
Done to determine the size, silhouette, and position of the heart Specific pathological changes are difficult to determine via xray, but anatomical changes can be seen
Implementation
Prepare the patient for x-ray film, explaining the purpose and procedure Remove jewelry
Description
A common noninvasive diagnostic test that evaluates the hearts function by recording the electrical activity
Implementation
Determine the clients ability to lie still, and advise the client to lie still, breathe normally, and refrain from talking during the test Reassure the client that an electrical shock will not occur Document any cardiac medications the client is taking
Description A noninvasive test in which the client wears a Holter monitor and an ECG tracing is recorded continuously over a period of 24 hours or more It identifies dysrhythmias if they occur and evaluates the effectiveness of antidysrhythmics or pacemaker therapy
Implementation
Instruct the client to resume normal daily activities and to maintain a diary documenting activities and any symptoms that may develop
Description
A noninvasive procedure based on the principles of ultrasound It evaluates structural and functional changes in the heart
Implementation
Determine the clients ability to lie still, and advise the client to lie still, breathe normally, and refrain from talking during the test
Assess
indicators of cardiac output and oxygenation, especially changes in level of consciousness. Physical assessment includes:
Rate and rhythm of apical and peripheral pulses Assess heart sounds Blood pressure and pulse pressure Signs of fluid retention
Health
history: include presence of coexisting conditions and indications of previous occurrence Medications
Decreased
Anxiety Deficient
cardiac output
knowledge
Cardiac
Goals
may include eradicating or decreasing the occurrence of the dysrhythmia to maintain cardiac output, minimizing anxiety, and acquiring knowledge about the dysrhythmia and its treatment.
Monitoring
ECG
of medications and assessment of medication effects Adjunct therapy: cardioversion, defibrillation, pacemakers
Anxiety
Use
a calm, reassuring manner. Measures to maximize patient control to make episodes less threatening Communication and teaching
Teaching
Include
self-care
family in teaching
An
electronic device that provides electrical stimuli to the heart muscle Types:
Permanent Temporary
Infection Bleeding
or hematoma formation Dislocation of the lead Skeletal muscle or phrenic nerve stimulation Cardiac tamponade Pacemaker malfunction
Treat
tachydysrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial cells. When cells repolarize, the sinus node is usually able to recapture its role as heart pacemaker. In cardioversion, the current delivery is synchronized with the patients ECG. In defibrillation, the current delivery is unsynchronized.
Ensure good contact between skin and pads or paddles. Use a conductive medium and 20-25 pounds of pressure. Place paddles so that they do not touch bedding or clothing and are not near medication patches or oxygen flow. If cardioverting, turn the synchronizer on. If defibrillating, turn the synchronizer off. Do not charge the device until ready to shock. Call clear three times; follow checks required for clear and ensure that no one is in contact with the patient, bed, or equipment.
device that detects and terminates life-threatening episodes of tachycardia or fibrillation NASPE-BPEG code Antitachycardia pacing