Questions and Answers
What effect does atrial fibrillation have on cardiac output?
Loss of the atrial kick can decrease cardiac output by as much as 25%.
Atrial fibrillation on an EKG lacks what normally seen feature?
P waves are absent
What lab tests do we anticipate for a patient diagnosed with atrial fibrillation who is taking digitalis and has experienced nausea and vomiting?
Serum electrolytes, particularly potassium and magnesium. Also a digitalis level.
Name three dysrhythmias that can occur as a result of digitalis toxicity.
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What interventions and medications would you anticipate for asystole?
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Loss of capture is noted on an EKG when pacemaker spikes are not followed by what feature?
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On an EKG, when a QRS complex is absent following pacemaker spikes, this is called what?
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Which set of electrodes has the greatest effect on normal cardiac function?
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During the plateau phase, which channel is open?
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During which period can a stronger than normal stimulus produce depolarization?
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What information about a PR interval greater than 0.20 seconds is correct?
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Ventricular depolarization is reflected in which component?
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What component of the ECG may show changes associated with the presence of cardiac ischemia?
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Which nursing interventions are important to address during the care of the patient on ECG monitoring? (Select all that apply)
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Frequent causes of dysrhythmias in high-acuity patients include which conditions? (Select all that apply)
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Hypocalcemia results in which ECG abnormality?
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Hypokalemia results in which ECG abnormality?
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Injured and infarcted areas of myocardium have which effect on action potentials and electrical activity? (Select all that apply)
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Sinus bradycardia originates from which area of the heart?
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Atropine can be used to treat sinus bradycardia because it has what effect on the heart?
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Sinus tachycardia may result from which factors? (Select all that apply)
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Decreasing levels of consciousness associated with sinus dysrhythmias indicates what occurrence?
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Atrial dysrhythmias produce symptoms of lightheadedness or angina for which reason?
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Which of the following are characteristics of premature atrial contractions (PACs)? (Select all that apply)
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Which of the following are ECG characteristics of atrial fibrillation? (Select all that apply)
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Atrial flutter typically has what atrial rate?
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Junctional tachycardia is classified as a junctional rhythm with what rate?
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What statement correctly describes the P wave in a junctional rhythm?
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What is the rate of an accelerated junctional rhythm?
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What interventions of junctional rhythms may be performed? (Select all that apply)
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PVCs are frequently associated with which underlying problem?
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Which statement is correct regarding ventricular tachycardia?
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Which of the following is considered a 'short run' of ventricular tachycardia?
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Which statement is correct regarding the ECG pattern seen in ventricular fibrillation?
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The treatment of choice in ventricular fibrillation is which of the following?
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After the patient has converted from ventricular fibrillation and has a pulse, which interventions should be initiated?
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Which of the following may produce blocks in impulse conduction?
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What characterizes first degree AV heart block?
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Treatments for second degree heart block may include which treatments? (Select all that apply)
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Complete heart block is characterized by which ECG change?
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Beta blockers (Class II agents) may produce which of the following side effects?
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Which statement about the difference between cardioversion and defib is correct?
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Nursing responsibilities in administering antidysrhythmic agents include? (Select all that apply)
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Nursing responsibilities surrounding cardioversion include which actions? (Select all that apply)
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Which statement correctly describes an epicardial pacing device?
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Failure to sense means which of the following?
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The phrase 'failure to capture' refers to which of the following?
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When should patients with an ICD device contact their healthcare provider?
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What is the normal range for right ventricular systolic pressure?
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Study Notes
Atrial Fibrillation and Cardiac Output
- Loss of atrial kick leads to a potential 25% decrease in cardiac output.
- EKG shows absent P waves, indicating irregular atrial activity.
Digitalis and Atrial Fibrillation
- Monitor serum electrolytes (potassium and magnesium) and digitalis levels in patients experiencing nausea and vomiting.
- Digitalis toxicity can cause dysrhythmias, including atrial tachycardia, AV blocks, junctional, and ventricular dysrhythmias.
Interventions for Cardiac Emergencies
- For asystole, perform CPR and administer atropine and epinephrine.
- Loss of capture on EKG is noted when pacemaker spikes do not lead to a QRS complex.
Cardiac Ionic Influencers
- Sodium and potassium have the greatest effect on cardiac function.
- Calcium channels are open during the plateau phase of action potentials.
Refractory Periods
- A stronger stimulus can induce depolarization during the relative refractory period.
- A PR interval greater than 0.20 seconds indicates conduction delay.
Cardiac Electrical Activity Indicators
- Ventricular depolarization is represented by the QRS complex.
- T wave changes can indicate cardiac ischemia.
ECG Monitoring Best Practices
- Use clean or disposable lead wires and rotate electrode sites to prevent skin irritation.
- Record ECG strips upon rhythm changes for analysis.
Causes of Dysrhythmias
- High-acuity patient dysrhythmias may arise from degenerative conduction changes, electrolyte imbalances, congenital heart defects, and myocardial ischemia.
ECG Abnormalities from Electrolyte Changes
- Hypocalcemia results in prolonged QT interval; hypokalemia can lead to delayed conduction.
- Injured myocardium does not conduct or generate action potentials.
Sinus Rhythms and Conduction
- Sinus bradycardia originates from the sinoatrial node, and atropine blocks the parasympathetic nervous system to treat it.
- Sinus tachycardia can occur due to anxiety, pain, or fever.
Symptoms of Atrial Dysrhythmias
- Diminished cardiac output from atrial dysrhythmias can cause lightheadedness or angina.
Premature Atrial Contractions
- PACs feature premature P waves, a generally regular underlying rhythm, and the presence of a noncompensatory pause.
Atrial Flutter and Junctional Rhythms
- Atrial flutter presents with an atrial rate between 250-350 BPM; junctional tachycardia exceeds 100 BPM.
- Junctional rhythms may have P waves appearing anywhere relative to QRS complexes.
Ventricular Dysrhythmias
- PVCs are often linked to hypokalemia; ventricular tachycardia is defined by three or more consecutive PVCs.
- Ventricular fibrillation is chaotic, lacking recognizability in its patterns.
Treatment Protocols
- Defibrillation is the primary treatment choice for ventricular fibrillation.
- Post-conversion care includes continuous infusion of the last effective drug.
AV Heart Blocks
- First-degree AV block is indicated by a consistent PR interval exceeding 0.20 seconds.
- Treatments for second-degree heart block may include pacemakers and atropine.
Judicial Use of Beta Blockers
- Side effects of beta blockers may include wheezing.
Cardioversion vs. Defibrillation
- Cardioversion is synchronized, while defibrillation delivers unsynchronized shocks.
Patient Care Responsibilities
- Ensure continuous IV drips for antidysrhythmic agents use an infusion pump; monitor vital signs and ECG strips before, during, and after administration.
- In cardioversion, assure synchronization, inform the patient, and obtain informed consent.
Pacing Devices
- Epicardial pacing devices are placed during open-heart surgery.
- Failure to sense occurs when the pacing device fails to capture natural depolarization in the heart rhythm.
General Heart Health
- Right ventricular systolic pressure range should be monitored regularly for clinical assessments.
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Description
Test your knowledge on Chapter 8 related to atrial fibrillation through this flashcard quiz. Explore the effects of atrial fibrillation on cardiac output and recognize key features seen in EKG readings. Analyze patient scenarios to deepen your understanding of the condition.
