Dysrhythmias Exam 2 Critical Care

What are the s/s of sinus Brady?

Syncope, dizziness, chest pain, pallor cool and clammy,

What are causes of sinus Brady?

Electrolyte imbalance, hypoglycemia, hypothermia, hypothyroidism, toxins, meds like beta blockers, sleep

What are treatments of sinus Brady?

Stable and symptomatic=atropine

Unstable and symptomatic= transcutaneous pacing (temporary pacemaker)

Stable and asymptomatic= monitor

What constitutes unstable in sinus Brady?

Assess LOC, low BP, decreased urine out put, low map, diaphoretic

What are risks associated with sinus Brady?

Low cardiac output

Nursing interventions of sinus bradycardia?

give O2 if needed, assess VS

What are causes of sinus tach?

Meds, stress/anxiety, electrolytes imbalances, hyperthermia, fever, stimulant drugs, htn, alc, caffeine, nicotine

What are treatments of sinus tach?

Treat cause of it

What are risks associated with sinus tach?

Reduced cardiac output put causing low O2, can lead to MI ischemia

Nursing interventions for sinus tach?

Check VS, treat causes acetaminophen for fever, stop stimulants, desires

What are causes of supraventricular tach?

Spontaneous usually, electrolyte imbalance, stimulants, medications,

STRESS, ATHEROSCLEROSIS

What are s/s of supraventricular tach?

Syncope, dizziness, chest pain, bounding pulses,

TIGHTNESS IN THROAT, FATIGUE, STRESS

What are treatments of supraventricular tachycardia?

Vagal maneuver, adenosine 2x, cardio version

If stable and symptomatic= vagal maneuver if it doesn’t work the adenosine x2 if it doesn’t work then cardiovert

If unstable and symptomatic= cardiovert immediately

What are risks associated with supraventricular tachycardia?

Decreased perfusion causing MI

Nursing interventions of supraventricular tach ?

Vagal maneuver, cardio version, adenosine

What is the difference between LBBB and RBBB? What does it looks like?

Right: caused by congenital heart defects, looks like an M

Left: caused by CAD, htn, aortic valve disease, cardiomyopathy, looks like a W

Bunny ears!! On qrs

What are s/s of PVC?

ONLY NON LETHAL, dizziness, palpitations, weakness, and hypotension

Treatments of PVC?

lidocaine/procainamide, treat the causes

Types of PVCs

Bigeminy: every other beat

Trigeminy: every 3rd beat

Quadreminy: every 4th breath

Run: 3 or more

Couplet: 2 in a row

What are s/s of supraventricular tachycardia

Syncope, chest pain, dizziness, sob, bounding pulses

Causes of supraventricular tachycardia?

Stimulants, hypoxia/hypokalemia, stress, atherosclerosis

Treatments of svt?

Adenosine, vagal maneuvers, cardio version

Risks associated with supraventricular tachycardia?

Low cardiac output and clots

Nursing interventions

Check BP, HR, LOC,

What are signs and sx of atrial flutter?

Syncope, anxiety, angina, sob, palpitations, weakness

Causes of atrial flutter?

COPD/emphysema, bradycardia, heart valve abnormalities, ventricular hypertrophy, cardiomyopathies

Treatments of atrial flutter?

Amiodarone which helps regulate contraction, beta blockers and CCB to help lower HR, anticoagulants to prevent clots, cardio version if unstable

Risk of developing what from a flutter?

Clots, and low cardiac output

Nursing interventions for a flutter

Checking for stability: check HR, BP, O2, IV, prepare cardio version

How is a fib read on an ekg?

No distinction of p wave and is a little crazy before QRS complex, irregular rhythm, tightness in chest

What are s/s of a fib?

Syncope, sob, chest pain, irregular rhythm, fatigue, tightness in chest

What are causes of a fib?

COPD or emphysema, problems w SA node, valve problems, rheumatic fever, pericarditis, htn hyperthyroidism, hypoglycemia, chef

What are treatments of a fib?

Amiodarone helps regulate rhythm, digoxin is specifically for a fib, ccb, beta blockers, anticoagulants, cardio version

What are you at risk of developing from a fib?

Clots CVA or PE, low cardiac output

What does a first degree heart block look like and what are the treatments?

Prolonged PR interval (over 0.2)

No treatment, usually benign

What is a 2nd degree type I heart block and what does it look like?

Electrical signals from the atria to ventricles are increasingly delayed until it is blocked

LOOKS LIKE: longer, longer, longer, DROP it’s a wenckebach!!

What are treatment options for 2nd degree type I (wenckebach)?

If symptomatic and bradycardic, give atropine

Can give a pacemaker if severe

What is a 2nd degree type II heart block and what does it look like?

Some electrical signals from atria to ventricles are blocked

PR is prolonged and there are intermittent dropped beats

Treatment for 2nd degree type II mobitz?

If unstable, transcutaneous pacing and then pacemaker

What is a 3rd degree heart block and what does it look like?

Complete disruption of signals from atria and ventricles causing no communication between P and QRS waves

Ps and QRSs are all over the place

Treatment for a 3rd degree heart block?

Transcutaneous pacing and then a permanent pace maker

What is torsades?

A type of ventricular tachycardia

Treatment of torsades?

Magnesium sulfate to correct arrhythmia

WITH PULSE: Cardiovert

NO PULSE: CPR and epi

Treat the cause such as electrolyte imbalances, DC QT prolongation rx