CC SkillsDay_teleSp24 (1) PDF - Cardiac Conduction & Dysrhythmias

Conduction Disturbances NUR442 for Fall 2024  ANATOMY SA node 60-100 AV node 40-60 His Purkinge Fibers 20-40 https://www.bing.com/images/search?q=conduction+system+of+the+heart&view=detailv2&&id=B378...

Conduction Disturbances NUR442 for Fall 2024  ANATOMY SA node 60-100 AV node 40-60 His Purkinge Fibers 20-40 https://www.bing.com/images/search?q=conduction+system+of+the+heart&view=detailv2&&id=B3781D2221C00ECB2A8C60591061C72042857BCE&selectedIndex=2&ccid=mrd1%2bxNO&simid=608027392535102428&thid=JN.ElueGAC18kJ%2b52reoE9lhw&ajaxhist=0 Cardiac Conduction Intervals PR Interval 0.12 – 0.20 seconds QRS 0.06-0.12 seconds QTc QT interval calculated Lengthened if > 0.47 seconds How to measure?  Dysrhythmias – Classified by site of origin Sinus Node Atrial dysrhythmias AV Node AV node blocks Ventricular To analyze the cardiac rhythm, systematically examine the following features: 1. Rate Normal (60-100) Bradycardia (< 60) Tachycardia (>100) 2. Rhythm Regular - SINUS Irregular 3. P waves One P wave for every QRS ATRIAL More P waves than QRS Less P waves than QRS No P waves 4. PR Interval Normal (0.12 – 0.20 seconds) AV BLOCKS Prolonged (> 0.20 seconds) 5. QRS Complex Normal (0.06 – 0.12 seconds) VENTRICULAR Prolonged (> 0.12 seconds) Adapted from AJCC/ECG Analysis  Normal Sinus Rhythm Rate Rhythm: P waves: PRI QRS QTc Treatment  Normal Sinus Rhythm 78 Rate 60-100 Rhythm: regular P waves: present PRI normal QRS normal QTc normal Treatment Assessment  SINUS BRADYCARDIA Rate < 60 Rhythm: regular P waves: present PRI normal QRS normal Causes Treatment  SINUS BRADYCARDIA Rate < 60 Rhythm: regular P waves: present PRI normal QRS normal Causes Medications*** Also, opioids Treatment Atropine  SINUS TACHYCARDIA Rate >100 Rhythm: regular P waves: present PRI normal QRS normal Causes Treatment  SINUS TACHYCARDIA Rate >100 Rhythm: regular P waves: present PRI normal QRS normal Causes Fever, stimulants, hypovolemic shock, emotions, exercise Treatment Treat the cause  Atrial Dysrhythmias Supraventricular Tachycardia (SVT) Atrial Flutter Atrial Fibrillation (Controlled vs Uncontrolled)  Supraventricular Tachycardia (SVT) An irritable focus within the atria fires repetitively at a rapid rate and overrides the sinus node for control of the heart Rate >150 Rhythm: regular P waves: present PRI Shortened QRS Can be shortened Causes Anxiety, stimulants, hyperthyroidism Treatment Valsalva Maneuver, Adenosine  Atrial Flutter Single irritable focus in the atrium Rate Atrial rate high, ventricular rate normal Rhythm: Regular P waves: Not present, replaced by F waves PRI Not present QRS Regular Causes Heart and lung problems Treatment Usually happens with atrial fibrillation and tx is the same ATRIAL FIBRILLATION Controlled Atrial Fibrillation Uncontrolled Atrial Fibrillation  ATRIAL FIBRILLATION Most common dysrhythmia Common causes-aging & CAD Problem Treatments Procedures Rate Control for Medications n/a uncontrolled a fib 1. 2. 3. Rhythm Control Medications Cardioversion 1. Clots 1. Watchman Procedure https://www.youtube.com/watch?v=jffGNtcpLQU 2. Watchman Procedure new in 10th edition  ATRIAL FIBRILLATION Most common dysrhythmia Common causes-aging & CAD Problem Treatments Procedures Rate Control for Medications n/a uncontrolled a fib Digoxin BB CCB Rhythm Control Medications Cardioversion. Amiodarone Clots Heparin Watchman Procedure Coumadin https://www.youtube.com/watch?v=jffGNtcpLQU Watchman Procedure new in 10th edition  Atrioventricular Blocks FIRST-DEGREE AV BLOCK Second-degree AV Block – Type 1 – Type 2 THIRD-DEGREE AV BLOCK FIRST-DEGREE AV BLOCK Rate Normal or may be slow Rhythm: regular P waves: present PRI Prolonged, >0.20 QRS Normal Causes Aging, CAD, medications Treatment No treatment as tolerated well  Second-degree AV block Second-degree Type I or Mobitz Type I or Wenckebach Second-degree Type II or Mobitz Type II Causes-Aging, CAD, Medications Symptoms-Usually well tolerated unless underlying bradycardia or frequent dropped beats Treatment-Discontinue drugs that may cause, Atropine for type II but does not work in Type II, Consider pacemaker if symptomatic THIRD-DEGREE AV BLOCK Rate Slow Rhythm: P waves regular and QRS regular but are independent P waves: Present but do not match with QRS PRI Not measurable QRS Normal or wide Causes CAD, MI Treatment Temporary pacing, then permanent pacemaker Pacemakers Treats symptomatic bradycardia from AV Block Read about nursing care in Lewis! Temporary Pacemakers Permanent Pacemakers Temporary-transcutaneous and transvenous Permanent-epicardial Find the PACEMAKER SPIKES  VENTRICULAR ARRYTHMIAS Ventricular Tachycardia Torsades de Pointes Ventricular Fibrillation  VENTRICULAR TACHYCARDIA Rate Fast Rhythm: Regular P waves: Not present PRI Not measurable QRS Wide and bizarre Causes Idiopathic, ischemia, MI, electrolyte imbalances, hypoxia, CHF, drug toxicity, stimulants, caffeine, stress, anxiety Treatment See next slide Treatment of Ventricular Tachycardia No pulse Pulse Treat like V-Fib Symptomatic Activate code Oxygen CPR Cardioversion Defibrillation Medications such as Medications amiodarone Epinephrine Electrolyte replacement (Amiodarone) Oxygen Asymptomatic ACLS protocol Notify provider and assess the patient Polymorphic Ventricular Tachycardia~ Often related to long QT Syndrome Treatment is intravenous magnesium  Ventricular Fibrillation Rate Not measurable Rhythm: Irregular P waves: Not present PRI Not measurable QRS Wide and bizarre Causes Ischemia, MI, acidosis, hypoxia, electrolyte imbalance, drug toxicity, ventricular aneurysm, electrocution, cardiomyopathy, drug overdose (H’s and T’s) Treatment CPR, defibrillation, epinephrine, (amiodarone), ACLS protocol  Other Lethal Arrhythmias NON-Shockable Rhythms Asystole Pulseless Electrical Activity Normal Sinus Rhythm Pulseless Electrical Activity