Exam #2 CMS Questions with
Complete Solutions26
Sinus bradycardia - ANSWERS-<60 bpm sinus rhythm - SA node sends slower impulses but
conduction continues normally throughout the heart
- PR regular, QRS regular
interventions:
- assess ABCs
- determine if symptoms are present
- identify/treat underlying cause if symptomatic
Interventions for symptomatic bradycardia - ANSWERS-- oxygen if hypoxemic
- IV fluids
- Atropine 1mg q3-5 mins x3
- if Atropine is ineffective/maximum dosage is met pt will require transcutaneous pacing
- if temporary pacemaker is ineffective at controlling rate, pt will need permanent pacemaker
*alternative option = Dopamine infusion 5-10 mcg/kg/min*
Atropine - ANSWERS-increases HR by blocking parasympathetic action on SA node
- may be contraindicated in cases of MI or 3rd degree block
,Complete (3rd) AV Block - ANSWERS-- separate electrical stimuli trigger atria and ventricle; no
complete conduction
- PR regular, QRS is usually wide
- more P waves than QRS complexes
- *no relationship between P & QRS*
Interventions 3rd degree AV block - ANSWERS-- rule out medication cause
- pacemaker
- apply oxygen (if hypoxemic, maintain pulse ox >92%)
Premature ventricular contractions (PVCs) - ANSWERS-- ectopic foci in the ventricles discharge
and initiate the contraction
- are often due to: hypoxia/acidosis, MI, electrolyte imbalance, stimulants/irritants, medications
Treatment for PVCs - ANSWERS-- correct underlying cause
- asymptomatic patient = monitor only
- symptomatic patient = oxygen (if hypoxemic, maintain pulse ox >92%), Atropine (when HR <60)
or beta blocker (when HR >60)
Ventricular tachycardia - ANSWERS-- an ectopic foci in the ventricles becomes the pacemaker of
the heart
- causes: ischemic heart disease, MI, cardiomyopathy, decreased potassium or mag, valvular
disease, advanced HF, drug toxicity, hypotension, ventricular aneurysm
Treatment for v tach with pulse - ANSWERS-for stable patient = apply oxygen, confirm rhythm
with 12 EKG, Amiodarone 150mg IV infusion over 10 min then drip or Lidocaine 1.0-1.5mg/kg IV
bolus and/or mag IV
, for unstable patient = synchronized cardioversion (100 joules), apply oxygen, may give IV
Amiodarone 150mg, magnesium, or lidocaine
Amiodarone - ANSWERS-- used in v-tach (stable/unstable) and v-fib
- can also be used in atrial tachydysrhythmias
- inhibits adrenergic stimulation --> slows cardiac conduction through sinus node, prolongs
refractory periods, helps SA node to regain/maintain appropriate rhythm
- precautions: use caution in pts with thyroid disease, severe pulmonary and/or liver disease;
monitor BP/HR/s/s pulmonary compromise
Cardioversion process - ANSWERS-- pt MUST have pulse
- moderate sedation and oxygen
- place electrodes pads to chest
- press synchronized mode
- start with low joules
- SA node to take back control of the rhythm
Ventricular fibrillation - ANSWERS-the rapid, irregular, and useless contractions of the ventricles
Ventricular fibrillation interventions - ANSWERS-*Defibrillate*
- electrical shock to stop chaotic asynchronous activity
- goal is to have SA node regain control
- charge to 120-200 joules for biphasic or up to 360 joules for monophasic
Complete Solutions26
Sinus bradycardia - ANSWERS-<60 bpm sinus rhythm - SA node sends slower impulses but
conduction continues normally throughout the heart
- PR regular, QRS regular
interventions:
- assess ABCs
- determine if symptoms are present
- identify/treat underlying cause if symptomatic
Interventions for symptomatic bradycardia - ANSWERS-- oxygen if hypoxemic
- IV fluids
- Atropine 1mg q3-5 mins x3
- if Atropine is ineffective/maximum dosage is met pt will require transcutaneous pacing
- if temporary pacemaker is ineffective at controlling rate, pt will need permanent pacemaker
*alternative option = Dopamine infusion 5-10 mcg/kg/min*
Atropine - ANSWERS-increases HR by blocking parasympathetic action on SA node
- may be contraindicated in cases of MI or 3rd degree block
,Complete (3rd) AV Block - ANSWERS-- separate electrical stimuli trigger atria and ventricle; no
complete conduction
- PR regular, QRS is usually wide
- more P waves than QRS complexes
- *no relationship between P & QRS*
Interventions 3rd degree AV block - ANSWERS-- rule out medication cause
- pacemaker
- apply oxygen (if hypoxemic, maintain pulse ox >92%)
Premature ventricular contractions (PVCs) - ANSWERS-- ectopic foci in the ventricles discharge
and initiate the contraction
- are often due to: hypoxia/acidosis, MI, electrolyte imbalance, stimulants/irritants, medications
Treatment for PVCs - ANSWERS-- correct underlying cause
- asymptomatic patient = monitor only
- symptomatic patient = oxygen (if hypoxemic, maintain pulse ox >92%), Atropine (when HR <60)
or beta blocker (when HR >60)
Ventricular tachycardia - ANSWERS-- an ectopic foci in the ventricles becomes the pacemaker of
the heart
- causes: ischemic heart disease, MI, cardiomyopathy, decreased potassium or mag, valvular
disease, advanced HF, drug toxicity, hypotension, ventricular aneurysm
Treatment for v tach with pulse - ANSWERS-for stable patient = apply oxygen, confirm rhythm
with 12 EKG, Amiodarone 150mg IV infusion over 10 min then drip or Lidocaine 1.0-1.5mg/kg IV
bolus and/or mag IV
, for unstable patient = synchronized cardioversion (100 joules), apply oxygen, may give IV
Amiodarone 150mg, magnesium, or lidocaine
Amiodarone - ANSWERS-- used in v-tach (stable/unstable) and v-fib
- can also be used in atrial tachydysrhythmias
- inhibits adrenergic stimulation --> slows cardiac conduction through sinus node, prolongs
refractory periods, helps SA node to regain/maintain appropriate rhythm
- precautions: use caution in pts with thyroid disease, severe pulmonary and/or liver disease;
monitor BP/HR/s/s pulmonary compromise
Cardioversion process - ANSWERS-- pt MUST have pulse
- moderate sedation and oxygen
- place electrodes pads to chest
- press synchronized mode
- start with low joules
- SA node to take back control of the rhythm
Ventricular fibrillation - ANSWERS-the rapid, irregular, and useless contractions of the ventricles
Ventricular fibrillation interventions - ANSWERS-*Defibrillate*
- electrical shock to stop chaotic asynchronous activity
- goal is to have SA node regain control
- charge to 120-200 joules for biphasic or up to 360 joules for monophasic
