EKG interpretation and nursing actions

normal sinus

This is a ___________________________Rhythm

HR:60-100 normal

QRS complex 0.04-.12

PR interval 0.12-0.2

QT interval 0.40-0.44

ekg paper

1 small box

0.04

ekg paper

five small blocks equal

0.2

ekg paper

five large boxes equal

1 second

6 seconds

ekg paper

30 large boxes

P wave is the starting pulse from the ___node? located in the R atrium.

SA

when the ventricals contract

QRS complex

What is happening during the T wave

The heart is resetting

represents atrial depolarization (contraction) usually followed by the QRS

p wave

normal length of p wave?

0.11

Part of the rhythm representing ventricle depolarization (contraction)

QRS complex

Normal length of QRS complex?

0.04-0.12

________interval is the time the impulse takes to move through the atria and the AV node.

It begins at the P wave to the next deflection on the baseline (beginning of QRS)

PR

What is the normal length of the pr interval?

0.12 - 0.2 seconds

__________segment is the early repolarization of the ventricles. An elevation or depression indicates an abnormality.

lower than baseline = ischemia or injury to the heart muscle.

higher than baseline = infarct or death of the cardiac muscle and is considered worse

ST

t wave is

the repolarization of the ventricles (reset) it is concurrent with the end of ventricular systole.

may become peaked in hyperkalemia

length is non specific

QT interval

represents total ventricular activity from ventricular depolarization to repolarization.

measured from the start of the qrs complex to the end of the t wave.

length 0.4-0.44 seconds

should be less than half of the RR interval

0.4-0.44

normal length of qt interval?

u

___wave is seldom seen.

it represents the repolarization of the Purjinkie fibers

indicates hypokalemia

it is part of ventricular repolarization

sinus bradycardia

what rhythm is this?

Rate is less than 60

rhythm is regular

P wave is present

QRS is 0.04-0.12-normal

PR is 0.12-0.2 normal

causes: meds-BETA BLOCKERS, digoxin, narcotics, athletes.

S/S: dizzy, tired, syncope, orthostatic hypotension

TX: take time to change positions, drink caffiene, pace maker, increase fluids, decrease/DC meds

for a SYMPTOMATIC patient: give atropine

sinus tachycardia

what rhythm is this?

rate is above 100bpm

P waves present

PR is 0.12-0.2 normal

QRS is 0.04-0.12-normal

causes: anxiety, stress, shock, infections, steroids, epinephrine, pain, fever, caffeine, too much lasix.

TX: no caffeine, control anxiety, treat cause of fever. Medication: beta blockers.

adenosene is a short term fix.

atrial flutter

what rhythm is this?

known as the saw tooth strip

Atrial rate is increased - can be regular or irregular

P waves: fluttering, have more than one (they are all the same)

PR is variable, can be WNL 0.12-0.2 normal

QRS: 0.04-0.12-normal

QT: 0.4-0.44 seconds normal

TX: calcium channel blockers, diltelizem, cardioversion

cardioversion

_____________________ is a controlled shock. Done when the patient is awake and has vital signs. You shock them the ventricles squeeze

atrial fibrillation

what rhythm is this?

rate: can vary widely

Rhythm: irregular

P waves are abnomral/not present

PR:0.12-0.2 normal

QT:0.4-0.44 seconds normal

QRS:0.04-0.12-normal

causes: MI, CHF, CAD, alcoholism, hyperthyroidism, hereditary, caffeine

TX: digoxin, amiodirone, cardizem, cardioversion

can cause blood clots at this disorder causes the atria to quiver and hold blood in, place client on anticoagulant therapy

supraventricular tachycardia

what rhythm is this?

rate 150-250 plus

rhythm: regular

P waves: can have, however can be unable to determine

PR: unable to measure

QRS: 0.04-0.12-normal

causes: caffiene, stress, anxiety, tobacco. Cardiac output is decreased

TX: bear down to slow heart rate (vasal vagal Maneuver)

meds: adenosene to slow down and use as a diagnostic

pvc

what rhythm is this?

indicates that the ventricles are irritated and decide to contract on their own -just one or a couple is usually not a concern

rate: variable

P waves: none

PR is wide

causes: caffeine, energy drinks, MI, Hypokalemia, hypoxia

tx: fix underlying cause-remove caffiene, energy drinks, 02 etc.

ventricular tachycardia

what rhythm is this?

this is a lethal/dying rhythm

rate 100-250

rhythm regular

p waves absent

PR absent

QRS is large, bizarre

patient could be awake, or have no pulse. if you see this, you need to check patient first to see if true.

causes: MI, CHF, cardiomyopathy, dysrythmias,

TX: cardioversion when the patient has a pulse

CPR and shock with no pulse.

can get defibrilator and use antiarrhymics

ventricular fibrillation

what rhythm is this?

no pulse -lethal

rhythm is chaos

P waves absent

PR absent

QRS absent

QT absent

cause: MI, Heart procedures

TX: CPR, SHOCK

asystole

what rhythm is this?

no electrical activity at all in the heart.

cannot shock as their is no electrical activity in the heart to "reset"

TX: epinephrine, CPR

4-8

how many liters is a normal cardiac output?

HR * SV

heart rate times stroke volume

this measures the amount of blood ejected in one minute from the heart

how to measure to determine cardiac output

decreased cardiac output

How will a decreased heart rate effect cardiac output?

right

right or left sided heart failure signs?

palpable/auscultated dysrythmia

weight gain

distended neck veins

enlarged liver

ankle edema

left

right or left sided heart failure signs?

SOB

palpitations/tachycardia

cough with frothy pink sputum

fatigue/weakness

weight gain, fluid retention

syncope

lung crackles decreased base lung sounds

atropine

medication that Temporarily increases heart rate

epinephrine

this medication is the initial medication of choice during CPR when an IV line has been established and the patient has been intubated. it increases the heart rate

adenosine

medication that slows conduction through the AV node.

defibrillation

defined as the delivery of an electrical shock to the heart so that it completely depolarizes cardiac cells in an effort to terminate ventricular fibrillation.

used in V-fib/V-tach with no pulse.

The patient will be unresponsive, breathless, and pulseless. The nurse should call for help on finding an unresponsive patient. The individual should be defibrillated as soon as the machine arrives at the patient's bedside. Cardiopulmonary resuscitation should be initiated before the defibrillator arrives