Cardiac Rhythms and Dysrhythmias Part 2 Questions With Complete Solutions

Third Degree Heart Block correct answer: Occurs when atrial impulses are completely blocked at the AV node and fail to reach the ventricle; atria and ventricles are controlled by different and independent pacemakers Third Degree Heart Block Causes correct answer: inferior or anteroseptal MI Third Degree Heart Block Clinical Manifestations correct answer: dizziness, syncope, fatigue, exercise intolerance, HF Third Degree Heart Block ECG Rate correct answer: atrial 60-100 bpm; ventricular 15-60 bpm Third Degree Heart Block ECG P:QRS correct answer: no relation between P waves and QRS complexes; independent rhythms Third Degree Heart Block Nursing Management correct answer: immediate pacemaker therapy Ventricular Fibrillation correct answer: Extremely rapid, chaotic ventricular depolarization; heart does not pump Ventricular Fibrillation Death correct answer: death will follow within 4 minutes if the rhythm is not recognized and terminated and an effective perfusing rhythm reestablished Ventricular Fibrillation Causes correct answer: severe myocardial ischemia or infarction; digitalis toxicity; hypothermia; hypo and hyperkalemia; metabolic acidosis Ventricular Fibrillation Clinical Manifestations correct answer: absence of a palpable or audible pulse, LOC, stop breathing Ventricular Fibrillation ECG Rate correct answer: too rapid to count Stable Ventricular Tachycardia correct answer: pt has a pulse; treat with cardioversion Unstable Ventricular Tachycardia correct answer: pt does not have a pulse; treat with defibrillation Ventricular Fibrillation ECG Rhythm correct answer: grossly irregular Ventricular Fibrillation Nursing Management correct answer: immediate defibrillation Ventricular Tachycardia correct answer: Rapid ventricular rhythm defined as three or more consecutive PVCs Ventricular Tachycardia Causes correct answer: MI, valvular disease, rheumatic disease, cardiomyopathy, anorexia, metabolic disorders Ventricular Tachycardia Clinical Manifestations correct answer: SOB, fluttering sensation, sustained VT (hypotension, weak or nonpalpable pulses, LOC) Ventricular Tachycardia ECG Rate correct answer: 100-250 bpm Ventricular Tachycardia ECG P:QRS correct answer: P waves usually not identifiable Ventricular Tachycardia Nursing Management: If no pulse correct answer: treat as VF; CPR if need, followed by advanced cardiac life support algorithm Ventricular Tachycardia Nursing Management correct answer: possible administration of DC cardioversion or IV procainamide, lidocaine, or a class III antidysrhythmic agent if hemodynamic instability accompanies; surgical ablation or antitachycardia pacing with an ICF for repeated episodes Atrial Fibrillation correct answer: Characterized by disorganized atrial activity without discrete atrial contractions Atrial Fibrillation and Atrial Flutter Risks correct answer: high risk of stroke Atrial Fibrillation Causes correct answer: HF, rheumatic, CAD, HTN, hyperthyroidism Atrial Fibrillation Clinical Manifestations correct answer: hypotension, SOB, fatigue, angina, peripheral pulses are irregular and of variable strength Atrial Fibrillation ECG correct answer: P waves are replaced by chaotic, fibrillatory waves; ventricular rate varies and the rhythm is usually irregular Atrial Fibrillation Risk correct answer: increases the risk of thromboembolism; organ infarction may occur; incidence of stroke is high Atrial Fibrillation Nursing Management correct answer: synchronized cardioversion; medications to reduce ventricular response rate (metoprolol, diltiazem, or digoxin); anticoagulant therapy to reduce risk of clot formation and stroke