Exam 1 - Lethal Dysrhythmias

Ppt 3 - pt 2

__Lethal Dysrhythmias:__

o   Heartbeat disturbances - beat formation, beat conduction, or myocardial response to beat

o   Can life threatening due to decreased cardiac output and ineffective tissue perfusion

P-R interval

0\.12-0.20 seconds

QRS segment

0\.06-0.10

duration of QT

0\.36-0.44

what is defribillation

Asynchronous delivery of energy, such as the shock is delivered randomly during the cardiac cycle

when do u use D-FIB

pulseless vtach

pulseless v fib

what is cardioversion

Delivery of energy that is synchronized to the QRS complex

when do u use cardioversion

Persistent unstable tachyarrhythmia in patients with a pulse

what is asystole?

§  Total absence of ventricular electrical activity

\-not shockable

Asystole nursing actions

§  No Pulse – CPR

§  Administer Epi (1:10,000)

§  Identify and treat H’s and T’s

h’s

•Hypovolemia



•Hypoxia



•Hydrogen ion (acidosis)



•Hyper/hypokalemia



•Hypothermia



•Hypoglycemia

t’s

•Toxins



•Tamponade



•Tension pneumothorax



•Thrombosis (Coronary (MI), Pulmonary (PE)

what is PULSELESS ELECTRICAL ACTIVITY (PEA)?

§  Organized electrical activity WITHOUT mechanical heart activity and pulse.

§  Most commonly seen after defibrillation.

\-not shockable

PULSELESS ELECTRICAL ACTIVITY (PEA) nursing actions

§  No pulse – CPR

§  Administer Epi (1:10,000)

§  Identify and treat H’s and T’s

__VENTRICULAR TACHYCARDIA - with pulse nursing action__

·      Cardioversion

·      Administer Amiodarone or Lidocaine

·      __VENTRICULAR TACHYCARDIA - with NO pulse nursing action__

·      No pulse – CPR

·      Defibrillator

·      Administer Amiodarone or Lidocaine

·      Administer Epi (1:10,000)

what is **VENTRICULAR FIBRILLATION?**

§  Ventricle is “quivering” and not contracting = NO CARDIAC OUTPUT

VENTRICULAR FIBRILLATION nursing action

§  No Pulse – CPR

§  Defibrillator

§  Administer lidocaine or amiodarone

§ administer Epi (1:10,000)

\

what is 1st DEGREE HEART BLOCK

§  Prolonged PR interval (> 0.2 seconds)

1st DEGREE HEART BLOCK nursing action

§  Assess symptoms of poor cardiac output

·      Bradycardia

·      Decreased HR

·      Fatigue

·      SOB

§  Administer Atropine if they are symptomatic

§  Asymptomatic – do nothing

§  If pt is unstable - pacing

·      Chest pain

·      Decreased LOC

·      Unstable vitals

what is 2ND DEGREE TYPE 1 HEART BLOCK

§  PR interval increases with each beat until it drops. Pattern repeats.

2ND DEGREE TYPE 1 HEART BLOCK nursing action

§  Assess patient for symptoms of poor cardiac output

·      Bradycardia

·      Decreased HR

·      Fatigue

·      SOB

§  Administer Atropine if they are symptomatic

§  if pt is unstable – pacing

·      Chest pain

·      Decreased LOC

·      Unstable vitals

what is 2nd DEGREE TYPE 2 HEART BLOCK

§  PR interval is consistent, but the QRS will drop unexpectantly.

what is 2nd DEGREE TYPE 2 HEART BLOCK nursing action

§  Assess patient for symptoms of poor cardiac output

·      Bradycardia

·      Decreased HR

·      Fatigue

·      SOB

§  Administer Atropine if they are symptomatic

§  if pt is unstable – pacing

·      Chest pain

·      Decreased LOC

·      Unstable vitals

what is 3rd DEGREE (COMPLETE) HEART BLOCK

§  Dissociation of atria from the ventricles with no impulses conducted through heart. (Atria and Ventricles are divorced).

3rd DEGREE (COMPLETE) HEART BLOCK nursing action

§  ABC

§  Decreased cardiac output

§  Transcutaneous pacing until pacemaker can be placed