Rhythm Recognition and Nursing Priorities

Vocabulary practice flashcards covering ECG fundamentals, rhythm recognition, and nursing clinical priorities.

The Rule That Protects The Patient

The clinical principle stating "Treat the patient, not the monitor," requiring bedside evaluation and pulse verification because an ECG strip displays electrical activity only.

SA Node

The dominant pacemaker of the heart operating at an intrinsic rate of $60\text{--}100\,\text{beats/min}$.

AV Junction

A backup pacemaker system of the heart operating at an intrinsic rate of $40\text{--}60\,\text{beats/min}$.

Purkinje System

A backup pacemaker system of the heart operating at an intrinsic rate of $20\text{--}40\,\text{beats/min}$.

P Wave

An ECG feature representing atrial depolarization; expected to be upright, rounded, uniform, and positioned before each QRS complex in sinus rhythm.

PR Interval

An ECG measurement representing atrial depolarization plus AV nodal delay, normally measuring $0.12\text{--}0.20\,\text{sec}$.

QRS Complex

An ECG feature representing ventricular depolarization, usually lasting $0.04\text{--}0.10\,\text{sec}$, with a duration of $0.12\,\text{sec}$ or more considered wide.

T Wave

An ECG feature representing ventricular repolarization that follows the QRS complex.

QT Interval

An ECG measurement representing total ventricular depolarization and repolarization; it is rate dependent, and a prolonged QT increases torsades risk.

Normal Sinus Rhythm

A rhythm with a rate of $60\text{--}100\,\text{beats/min}$, regular atrial and ventricular rhythm, normal consistent P wave before every QRS, PR interval of $0.12\text{--}0.20\,\text{sec}$, narrow QRS, and a $1:1$ P:QRS ratio.

Sinus Bradycardia

A cardiac rhythm meeting sinus criteria with a rate below $60\,\text{beats/min}$, featuring regular rhythm and normal P waves before every narrow QRS complex.

Sinus Tachycardia

A cardiac rhythm meeting sinus criteria with a rate above $100\,\text{beats/min}$ (often below $150\,\text{beats/min}$), usually serving as a response to an underlying cause.

Supraventricular Tachycardia (SVT)

A rapid, regular rhythm typically at $150\text{--}250\,\text{beats/min}$ with a narrow QRS complex and P waves that are frequently buried in preceding T waves.

Adenosine

A medication given by rapid IV push followed by a saline flush in ordered algorithms for regular narrow-complex tachycardia, which may induce brief flushing, chest pressure, or a pause.

Atrial Flutter

A dysrhythmia characterized by an atrial rate of $250\text{--}400\,\text{beats/min}$, regular sawtooth F waves, and conduction ratios often at $2:1$, $3:1$, or $4:1$.

Atrial Fibrillation

An irregularly irregular rhythm with chaotic atrial activity, no true P waves, fibrillatory baseline activity, an unmeasurable PR interval, and high stroke risk.

Pulse Deficit

A discrepancy between apical and radial pulse rates occurring when peripheral beats are ineffective, commonly assessed in atrial fibrillation.

Ventricular Tachycardia (VT)

A wide-complex ventricular rhythm usually at $100\text{--}200\,\text{beats/min}$ defined by three or more consecutive bizarre QRS complexes with absent or unrelated P waves.

Torsades de Pointes

A rapid, irregular polymorphic ventricular tachycardia associated with a prolonged QT interval, where QRS complexes appear to twist in amplitude and axis around the baseline.

Ventricular Fibrillation (VF)

A chaotic, pulseless cardiac arrest rhythm with no identifiable P waves, QRS complexes, or T waves and no effective ventricular contraction.

Asystole

A nonshockable cardiac arrest rhythm characterized by the total absence of ventricular electrical activity, presenting as a near-flat line with no QRS complexes.

Synchronized Cardioversion

An electrical shock timed specifically to the R wave, indicated for persistent unstable tachyarrhythmias with a pulse.

Defibrillation

An unsynchronized electrical shock delivered immediately during cardiac arrest for shockable rhythms.

Shockable Arrest Rhythms

Cardiac arrest rhythms requiring high-quality CPR and immediate unsynchronized defibrillation, consisting of ventricular fibrillation and pulseless ventricular tachycardia.

Nonshockable Arrest Rhythms

Cardiac arrest rhythms where shocking is ineffective, requiring CPR, early epinephrine, and identification of reversible causes, consisting of asystole and pulseless electrical activity (PEA).

Normal Sinus Rhythm

An ECG rhythm characterized by an evenly spaced normal beat, requiring no treatment other than continued monitoring, and caused by being healthy.

Bradycardia

A heart rhythm below $60/\text{min}$, often caused by vagal maneuvers (bearing down) or medications like Calcium Channel Blockers (CCB) and Beta Blockers; remembered by the 'BRADY Bunch' slow times.

Atropine (in Bradycardia)

A medication administered for Bradycardia ONLY if the patient is symptomatic showing signs of low perfusion (pale, cool, clammy).

Ventricular Fibrillation (V Fib)

A chaotic, squiggly ECG rhythm without QRS complexes described as 'flopping', caused by untreated V Tach, post-MI, electrolyte imbalances, or proarrhythmic medications.

V Fib Treatment Protocol

Immediate defibrillation without synchronization (stopping CPR to shock before giving drugs), followed by administration of LAP drugs (Lidocaine, Amiodarone, Procainamide).

LAP Mnemonic

A memory trick for antiarrhythmic medications used in Ventricular Fibrillation: Lidocaine, Amiodarone, and Procainamide.

Ventricular Tachycardia (V Tach)

A cardiac rhythm characterized by wide, bizarre QRS complexes forming a 'tombstone pattern', caused by post-MI, hypoxia, low potassium, or low magnesium.

V Tach with No Pulse

A pulseless cardiac emergency treated with immediate unsynchronized defibrillation without delay (D - Dead, D - Defib, D - Don't wait).

V Tach with Pulse

A pulsed ventricular rhythm treated with synchronized cardioversion and sedation after counting a pulse (C - Count a pulse, C - Cardiovert).

Atrial Fibrillation (A Fib)

A chaotic atrial rhythm with no P waves ('FloPPing'), caused by valvular disease, heart failure, pulmonary HTN, COPD, or post-heart surgery.

Atrial Flutter (A Flutter)

An atrial dysrhythmia characterized on an ECG by a classic 'sawtooth' pattern (A FluTTer = sawTooTh).

A Fib / A Flutter Treatment

Management including cardioversion (after TTE to rule out clots), Digoxin for deep contractions, and Warfarin anticoagulation.

Digoxin ATP Checklist

Pre-administration safety checks: A - check Apical pulse is at least $60$; T - check Toxicity (max $2.0$ level) for visual disturbances, N/V, anorexia; P - check if Potassium is below $3.5$ (higher risk for toxicity).

Warfarin Management

Anticoagulant therapy for A Fib / A Flutter requiring monitoring of INR, Vitamin K as the antidote, and maintaining moderate intake of green leafy vegetables.

Supraventricular Tachycardia (SVT)

A 'Super Fast' heart rhythm caused by stimulants, strenuous exercise, hypoxia, or heart disease.

SVT Treatment Escalation

Interventions progressing from vagal maneuvers (bearing down like a bowel movement, ice cold stimulation), to Adenosine (rapid push & flush), to synchronized cardioversion.

Adenosine

A medication administered as a RAPID PUSH followed by a normal saline flush for SVT, which may cause the heart rate to temporarily stop.

Elective Cardioversion Medication Hold Rule

NCLEX rule requiring Digoxin to be held for $48\text{-hours}$ prior to elective cardioversion for SVT due to increased ventricular irritability.

Unstable SVT Priority Action

Synchronized cardioversion for a client with SVT displaying severe instability (e.g., HR $200$, BP $78/40$, RR $30$).

Torsades de Pointes

A polymorphic ventricular tachycardia characterized by a 'tornado' pattern on ECG, caused by post-MI, hypoxia, or low magnesium.

Magnesium Sulfate

The treatment of choice for Torsades de Pointes; remembered by the mnemonic 'Magnesium Mellows out the heart'.

Asystole

A flatline ECG rhythm defined by a complete lack of QRS complexes, remembered by 'Assist Fully! … patient is flatlined'.

Asystole Treatment Protocol

Resuscitation consisting of Epinephrine, Atropine, and CPR, with absolute contraindication to defibrillation (NO shock).

P Wave (NCLEX Interpretation)

The ECG waveform representing Atrial rhythm.

QRS Wave (NCLEX Interpretation)

The ECG waveform representing Ventricular rhythm.

Chaotic or Unorganized (NCLEX Key Term)

The NCLEX descriptor used to identify Fibrillation; 'chaotic rhythm with no P waves' indicates Atrial Fibrillation, while 'CHAOTIC rhythm without QRS complexes' indicates Ventricular Fibrillation.

Bizarre (NCLEX Key Term)

The NCLEX descriptor used to identify Tachycardia, such as 'bizarre rhythm with wide QRS complex' indicating Ventricular Tachycardia.

Sawtooth (NCLEX Key Term)

The NCLEX descriptor used exclusively to identify Atrial Flutter.

Normal sinus rhythm

Bradycardia

Ventricular fibrillation (V Fib)

ventricular tachycardia (V Tach)

Atrial Fibrillation (A Fib)

Atrial Flutter (A Flutter)

Supraventricular tachycardia (SVT)

Torsades de pointes

Asystole (Flatline)