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Atrial Fibrillation |
No p wave; QRS present; no T wave
Rhythm regular; any rate; >100 is uncontrolled
Tx: BBS, CCB, cardioversion, adenosine
Cause: occur in healthy or those with cardiac disturbances (excess alcohol, heart failure, RHD, HTN, hyperthyroidism, post-op)
Atrial "Kick" decreases CO by 15-30% and increases risk of Mi and HF
Pt at increased risk of thromboembolic event, usually on coumadin or ASA
Nsg Impl: observe s/s dec CO and embolic events |
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Once the wave of depolarization reaches the AV node, there is a pause before the impulse penetrates the AV node |
This pause allows the blood from the atrium to pass thru the AV valves (mitral and tricuspid) and make the S1 or "LUB" sound. |
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Sinus Bradycardia |
P wave precedes QRS; QRS present; T wave follows QRS
Rhythm is regular; Rate is 40 - 60 bpm
Treatment: generally, no symptoms = no treatment
if symptomatic: "if you are slow, atropine will make you go" Permanent pacemaker insertion, or rarely, Isuprel
Cause: inferior wall MI, IICP, Addisons ds, hypothermia, vagal stim, digoxin, Beta blockers,
Nursing Implications: observe for s/s decreased CO |
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SA node |
the hearts natural pacemaker...located in uppper wll of the right atrium (hence sinus rhythm) |
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Sinus tachycardia |
P precedes QRS; QRS present; T wave after QRS
Rhythm regular
Rate greater than 100
Tx: identify cause and fix
Cause: normal response to SNS and to anything that increases metabolic rate (fever, fear, exertion, alcohol, caffeine, nicotine, atropine, catecholamines, MI, PE, heart failure, hypoxemia, anemia, hypovolemia, thyrotoxicosis, pain)
Nsg Implications: watch for HTN or increased or decreased CO |
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Pacemaker Malfunction - Undersensing |
threshhold too low, wire dislodged, pt own voltage too low,
tx: increase sensitivity, CXR to check lead placement, reposition pt to left side |
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ST segment |
usually flat with baseline, reflects a pause |
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Post-insertion guidlines for pacemaker |
*Limit mobility 1st 24 hours, obs site for hematoma, inf, HR, rhythm, V/S
*Avoid electromagnetic fields, wear ID tag with pacemaker info, take pulse QD, keep all appts, monitor battery function |
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T wave represents |
ventricular rpolarization, aortic and pulmonic valves close = S2 or "dub" sound |
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Ventricular Tachycardia |
No P wave
QRS present (wide)
No T wave
Rhythm regular
Rate varies
Tx: If pt alert-Lidocaine first; if pt out, shock them (other tx- AICD, EPS studies, Ablation)
Cause: CAD, Mi, cardiomyopathy, electrolyte imbalance (esp K and Mg)
Nsg Impl: Medical emergency! obs s/s dec CO |
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Normal sinus rhythm |
P wave precedes each QRS
QRS present
T wave present after each QRS
Rhythm is regular
Rate is between 60 and 100
Treatment: none
Cause: none |
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On the EKG recording the P wave represents what? |
Aprial contraction and depolarization |
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Pacemaker malfunction - loss of capture |
milliamps too low, wire dislodged, loose connection
Tx: increase milliamps, CXR to check lead position, reposition pt to left side, ensure connections are tight |
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QRS on the EKG tracing |
represents ventricular contraction. |
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Atrial Flutter |
More than one P wave
QRS present
Can't see T wave
Rhythm usually regular
Rate: Ventricular rate normal, atrial rate 250-300
Tx: same as A fib
Cause: Heart ds (rheumatic, coronary, HF, pericarditis, PE)
Nsg Impl: obs s/s dec CO |
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Ventricular Fibrillation |
No P waves; No "regular" QRS; No T waves
Rhythm irregular;Rate can't count it
Tx: CPR, shock 'em, shock 'em again, now harder
Cs: Multiple ectopic foci in ventricles causes disorganized fibrillation to ventricles
Remember: no contractions = no CO
Nsg Impl: most common cause of sudden cardiac death - treat quickly |
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Premature Ventricular Contractons |
Ectopic beat originating in ventricles below the bundle of His. It comes before the next expected beat.
Associated with stimulante, caffeine, alcohol, isuprel, diseases, HF, AMI, CAD
May be unifocal or multifocal
Tx: if >6/minute=Lidocaine |
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Asystole |
No P wave; No QRS; No T wave
Rhythm: none; Rate: none
Tx: CPR and 2 for TEA in asystole (transcutaneous pacing, epinephrine, atropine)
Cs: hypoxia, hyperkalemia, hypokalemia, acidosis, drug overdose, hypothermia
Nsg Impl: Medical emergency (no contractions = no CO); treat underlying cause (NAVEL-narcan, atropine, valium, epinephrine, lidocaine) |
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