Advanced Dysrhythmia Exam A with Questions and answers

Advanced Dysrhythmia Exam A with Questions and answers Tachydysrhythmias - ANSWERSheart rates 100bpm, a major concern in the adult patient with coronary artery disease. A serious issue as it shortens coronary perfusion time (the amt. of time available for blood to flow through the coronary arteries to the myocardium), initially increase cardiac output and BP (however ,a continued rise in HR decreases the ventricular filling time because of a shortened diastole, decreasing the stroke volume. CO and BP will begin to decrease), and an increase the work of the heart, increasing myocardial oxygen demand. The patient may have: palpitations, chest discomfort (pressure/pain from myocardial ischemia or infarction), restlessness and anxiety, pale, cool skin, syncope ("blackout") from hypotension. -chest discomfort, pressure, or pain which may radiate to the jaw, the back ,or the arm. -restlessness, anxiety, nervousness, confusion -dizziness, syncope -palpitations (tachy) -change in pulse strength, rate, and rhythm -pulse deficit -shortness of breath, dyspnea -tachypnea -pulmonary crackles -orthopnea -S3 or S4 heart sounds -jugular venous distention -weakness, fatigue -pale, cool, skin; diaphoresis -N/V -decreased urine output -delayed capillary refill -hypotension - ANSWERSWhat are key features of sustained tachydysrhythmias and bradydysrhythmias? -assess vital signs at least every 4 hours and as needed. -monitor for cardiac dysrhythmias -evaluate and document the patient's response to dysrhythmias. -encourage patient to notify the RN when chest pain occurs. -assess chest pain (ex: location, intensity, duration, radiation, and precipitating and alleviating factors) -provide antidysrhthmic therapy according to unit policy (ex: anti dysrhythmic medication, cardioversion, or defibrillation) as appropriate. -monitor and document patient's response to antidysrhythmic medications or interventions. -monitor appropriate lab values (ex: cardiac enzymes, electrolyte levels) -monitor patient's activity tolerance and schedule exercise/rest periods to avoid fatigue -observe for respiratory difficulty (ex: shortness of breath, rapid breathing, labored respirations) -promote stress reduction -offer spiritual support to the patient and/or family, as appropriate. - ANSWERSWhat does care for a patient with dysrhythmias look like? Bradydysrhythmias - ANSWERSoccurs when the heart rate is less than 60 bpm. Significant because myocardial oxygen demand is reduced from the slow heart rate which can be beneficial, coronary perfusion time may be adequate because of a prolonged diastole, which is desirable, and coronary perfusion pressure may decrease if the heart rate is too slow to provide adequate cardiac output and blood pressure (this is a serious consequence). Potential complications result if blood pressure is not adequate, these include myocardial ischemia or infarction, dysrhythmias, hypotension, and heart failure. Excitability - ANSWERSthe ability of non-pacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells. Depolarization - ANSWERSoccurs when the normally negatively charged cells within the heart muscle develop a positive charge. Conductivity - ANSWERSthe ability to send an electrical stimulus from cell membrane to cell membrane. As a result, excitable cells depolarize in rapid succession from cell to cell until all cells have depolarized. Ex: the wave of depolarization causes the deflections in the ECG waveforms that are recognized as the P wave and QRS complex. Contractility - ANSWERSthe ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart. In other words, this is the mechanical activity of the heart. AV Node - ANSWERSwhere impulses slow down or are delayed before proceeding to the ventricles. This delay is reflected in the PR segment on the ECG. This slow conduction provides a short delay, allowing the atria to contract and the ventricles to fill. SA Node - ANSWERSthe heart's primary pacemaker. It can spontaneously and rhythmically generate electrical impulses at a rate of 60 100 beats per min and therefore has the greatest degree of automaticity. Purkinje Cells - ANSWERScomposed of the bundle of HIS, bundle branches, and these fibers. Responsible for the rapid conduction of electrical impulses throughout the ventricles, leading to ventricular depolarization and the subsequent ventricular muscle contraction. Semi-Reclined - ANSWERSWhile obtaining a 12-lead ECG, remind the patient be as as still as possible in a ________________________ position, breathing normally. Clea, Dry, Moist - ANSWERSFor continous ECG monitoring, be sure to __________________ skin and clip hairs/shave. Ensure that the electrode placement is _____________ and the gel on each electrode is ______________ and fresh. P Wave - ANSWERSa deflection on an ECG representing atrial depolarization. When the electrical impulse is consistently generated form the SA node, this wave has a consistent shape in a given lead. If an impulse is then generated from a different (ectopic) focus, such as atrial tissue, the shape of this wave changes in the lead, indicating that an ectopic focus has fired. PR Segment - ANSWERSthe isoelectric line from the end of the P wave to the beginning of the QRS complex, when the electrical impulse is traveling through the AV node, where it is delayed.