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med Surg II exam 1
- Course
- Med-sure II (NSG223)
- Institution
- Herzing University
focused study guide on key points for the med-sure II exam 1, I received an A :)
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FOCUS POINTS EXAM 1 CARDIACDysrhythmias
➔ Abnormal cardiac rhythms
➔ Problem with the rate or rhythm of your heartbeat caused by changes in your hearts
normal sequence of electrical impulses
➔ Many different types, umbrella term
Sinus Rhythm
➔ Means normal heart rhythm
➔ Sinus node fires 60-100 bpm
➔ Follows normal conduction patterns
➔ Ventricular depolarization = QRS complex
◆ QRS Complex represents ventricular depolarization
➔ Ventricular repolarization = QT interval
➔ P to QRS ratio is 1:1
CARDIAC MONITORING
Electrocardiogram
➔ Graphic tracing of electrical impulses produced by the heart
➔ Waveforms of ECG represent activity of charged ions across membranes of
myocardial cells
➔ Monitors the heart rhythm for problems
➔ Sensors (electrodes) are tapped to the chest and measure the electrical signals that
tell the heart to beat
➔ Signals are shown as waves on a computer monitor or printout
12-Lead ECG
➔ 12 recording leads
➔ 6 leads measure electrical forces in the frontal plane
➔ 6 leads measure electrical forces in the horizontal plane (precordial leads)
➔ 12 electrodes placed on the chest/arms/legs to accurately capture electrical activity
CARDIAC MONITORING NURSING INTERVENTIONS
Lead Placement
➔ CNA can NOT shave patients chest for lead placement, only the RN can or for
any testing purposes
Avoiding artifact (2 electrodes needed to avoid movement misreadings which can cause
false alarms)
➔ Use proper skin preparation
➔ Assess for allergic responses to adhesive or gel
➔ Rotate electrode placement to reduce skin breakdown
➔ Proper placement
➔ 2 leads should be selected that provide the best tracing for dysrhythmia
monitoring (usually lead II and the chest lead V1)
➔ Make sure its functioning properly
➔ Individualize ECG alarm
◆ Patients with A.FIB - turn off irregular HR alarm
◆ Keeping on leads to alarm fatigue
◆ Bradycardia / tachycardia alarms should be slightly adjusted
➔ Remove electrodes during MRI
, ➔ If patient is scheduled for a device implant, such as a pacemaker, electrodes
should NOT be placed over an incision, planted device, open wounds, or
inflamed skin
Telemetry Monitoring
➔ Observation of HR and rhythm at a distant site
➔ Two types
◆ Centralized monitoring system - technician watching, decreases alarm fatigue
◆ Sophisticated alarm system - more effective alarms, filters out nuisance
alarms
● Alerts ischemia, abnormalities
● Fatigued watching for 4+ hours
➔ Portable device that continuously monitors patients ECG, RR, and/or SPO2 while
automatically transmitting information to a central monitor
CARDIAC MONITORING NURSING ASSESSMENT
Evaluation of Dysrhythmias
➔ Holter monitoring
➔ Event recorder monitoring
➔ Exercise treadmill testing
◆ Cardiac stress test
● Contraindicated 48 hours after heart attack (MI)
● Wear comfortable clothing (clothes & sneakers for exercise)
● Dont eat/drink 3 hr prior (fast for 3 hr)
● Report chest pain (describe to report this)
● Do not smoke tobacco prior (and caffeine, avoid stimulants)
◆ Evaluation of cardiovascular system response to stress
◆ Patient walks on treadmill or pedals on bike and RN monitors with 2 or more
ECG leads for HR, rhythm, ischemic changes; BP, skin temp, physical
appearance, perceived exertion, and symptom changes (chest pain, dyspnea,
dizziness, leg cramping, fatigue)
➔ Signal-averaged ECG
➔ Electrophysiologic study
CARDIAC MONITORING PROCEDURE
RHYTHM STRIP ANALYSIS
➔ Normal sinus rhythm: 60-100
➔ When examining electrocardiogram (ECG) rhythm strip to learn more about patients
dysrhythmia, classify it, then treat it accordingly
SINUS BRADYCARDIA & TACHYCARDIA
Sinus Bradycardia
➔ Sinus node fires less than 60 bpm
➔ Noram rhythm is aerobically trained athletes and during sleep (athletes can have
lower HR around 40)
Sinus Tachycardia
➔ Discharge rate from the sinus node is increased as a result of vagal inhibition and is
over 100 bpm
➔ Clinical associations
◆ Associated with physiologic stressors
● Exercise, caffeine, pain, hypovolemia, myocardial ischemia, heart
failure, fever
, ➔ Clinical significance
◆ Dizziness & hypotension d/t decreased CO2
◆ Increased myocardial oxygen consumption may lead to angina
➔ Treatment
◆ Determined by underlying cause
● Beta blocker to reduce HR & myocardial oxygen consumption
● Antipyretics to treat fever
● Analgesics to treat pain
PAC, A-FIB, & A FLUTTER
Premature Atrial Contraction
➔ Extra heartbeat that begins in one of the heart's atria
➔ Premature = early extra beat
➔ Feels like a fluttering in your chest, fatigue after activity, SOB, angina, dizziness
➔ Contraction originating from ectopic focus in atrium in location other than SA node,
travels across atria by abnormal pathway creating a distorted P wave, may be
stopped or delayed or conducted normally at AV node
➔ Frequent (more than 6/min)
Atrial Flutter
➔ Condition where atria beats too quickly
➔ Beats regular just too fast
◆ Ex: 4 atria beats and 1 ventricular beat
➔ Atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter
waves, originates for a single ectopic focus
➔ atrial rate :200-400 bpm
Atrial Fibrillation
➔ Atria beats irregularly
➔ Atrial rate: 350-600 bpm
➔ Patients with uncontrolled a.fib are at risk for thrombi
◆ Blood sits here and clots
◆ Patients put of Heparin (45-70 gtts is the therapeutic range)
➔ When patient has a.fib alarm will alert often, turn this off but continue to
monitor
◆ Monitor consistently gose off
◆ Turn this off to avoid alarm fatigue
➔ A.Fib risk factors: patients more likely to have a.fib
◆ Hypertension, stroke, chronic CHF, diabetes
Premature Ventricular Contraction
➔ Extra heartbeat that begins in 1 of the ventricles
➔ Causes feeling of flutter / skipping a beat
Ventricular Tachycardia
➔ Life-threatening d/t decreased CO2 and possibility of deterioration to ventricular
fibrillation (heart can stop)
➔ Ventricles beat rapidly
➔ Dizzy, SOB, angina
➔ Symptomatic wide QRS tachycardia
◆ Give amiodarone, procainamide, adenosine, sotalol
● Highly toxic to lungs and renal tissue
● Get baseline pulmonary function test
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