Telemetry Exam 68 Questions with Verified Answers,100% CORRECT

Telemetry Exam 68 Questions with Verified Answers Cardiac conduction - CORRECT ANSWER ECG components - CORRECT ANSWER Heart auscultation - CORRECT ANSWER All people enjoy time magazine Aortic, pulmonic, Erb's point, tricuspid, mitral P wave - CORRECT ANSWER P wave= time for passage of the electrical impulse through the atrium causing atrial depolarization (contraction) Normal: 0.06-0.12 sec (remember, p for preteen: 6-12) What is a source of possible variation in P wave? - CORRECT ANSWER disturbance in conduction w/in atria PR interval (PRI) - CORRECT ANSWER -Measured from beginning of P wave to beginning of QRS complex -Represents time for impulse to spread thru atria, AV node, bundle of His, bundle branches, and Purkinje fibers (to point immediately preceding ventricular contraction) Normal: 0.12-0.20 sec What is a source of possible variation in PRI? - CORRECT ANSWER Disturbance in conduction- usually in AV node, bundle of His, or bundle branches but could also be in atria Normal duration of Q wave - CORRECT ANSWER 0.03 sec What is a source of possible variation in QRS complex? - CORRECT ANSWER MI may result in pathologic wide (=0.03 sec) and deep Q wave QRS interval - CORRECT ANSWER -Measured from beginning to end of QRS complex -Represents time for depolarization (contraction) of both ventricles (systole) Normal: 0.12 sec What is a source of possible variation in QRS interval? - CORRECT ANSWER Disturbance in conduction in bundle branches or ventricles ST segment - CORRECT ANSWER -Measured from S wave to beginning of T wave -Represents time btwn ventricular depolarization and repolarization (diastole) -Should be isoelectric (flat) Normal: 0.12 sec What is a source of possible variation in ST segment? - CORRECT ANSWER Disturbances (elevation or depression) usually d/t ischemia, injury or infarction T wave - CORRECT ANSWER -Represents time for ventricular repolarization -Should be upright Normal: 0.16 sec What is a source of possible variation in T wave? - CORRECT ANSWER Disturbances (tall, peaked; inverted) usually d/t electrolyte imbalances, ischemia, or infarction QT interval - CORRECT ANSWER -Measured from beginning of QRS complex to end of T wave -Represents time for entire electrical depolarization and repolarization of the ventricles Normal: 0.34-0.43 sec Common cardiac causes of dysrhythmias - CORRECT ANSWER -Accessory pathways -Cardiomyopathy -Conduction defects -HF -Myocardial ischemia/infarction -Valve disease Miscellaneous causes of dysrhythmias - CORRECT ANSWER -Acid-base imbalances -alcohol -caffeine -tobacco -connective tissue disorders -medication effects or toxicity -electric shock -electrolyte imbalance -emotions -herbal supplements -hypoxia -metabolic conditions -near-drowning -sepsis, shock -toxins Dysrhythmia assessment findings - CORRECT ANSWER -irregular rate/rhythm, tachy, brady -decreased or increased BP -decreased O2 sat -pain: chest, neck, shoulder, back, jaw, arm -dizziness, syncope -dyspnea -extreme restlessness, anxiety -decreased level of consciousness, confusion -feeling of impending doom -numbness/tingling of arms -weakness and fatigue -cold, clammy skin -diminished peripheral pulses -diaphoresis -pallor -palpitations -n/v Dysrhythmia initial interventions - CORRECT ANSWER -ensure ABCs -admin O2 via nasal cannula/non-rebreather -obtain BL vitals including O2 sat -obtain 12-lead ECG -initiate continuous ECG monitoring -ID underlying rate/rhythm -ID dysrhythmia -establish IV access -obtain BL lab values (e.g. CBC, electrolytes) Dysrhythmia ongoing monitoring - CORRECT ANSWER -monitor vital, LOC, O2 sat, cardiac rhythm -anticipate need for antidysrhythmia drugs and analgesics -anticipate need for intubation if resp distress present -prepare to initiate ACLS (e.g. CPR, defib, transcutaneous pacing) Normal sinus rhythm ECG - CORRECT ANSWER -60-100 bpm, regular -nl P wave -nl PRI -nl QRS complex Sinus bradycardia ECG - CORRECT ANSWER - 60 bpm, regular -nl P wave -nl PRI -nl QRS complex Sinus bradycardia: symptoms and treatment - CORRECT ANSWER -Can be nl for some pts (athletes, sleep, meds) -Symptoms: pale/cool skin, hypotension, weakness, angina, dizziness/syncope, confusion/disorientation, short of breath -Give Atropine (anticholinergic) to increase HR -If Atropine insufficient, use transcutaneous pacing, dopamine, or epinephrine -May need permanent pacemaker -If d/t meds, may need to decrease or hold Sinus tachycardia ECG - CORRECT ANSWER -101-200 bpm -nl P wave -nl PRI -nl QRS complex Sinus tachycardia: causes, symptoms, and treatment - CORRECT ANSWER -Assoc. w/ physiologic/psych stressors, drugs, OTC cold meds -Symptoms: dizziness, dyspnea, hypotension d/t decreased CO; angina or increased size of infarction in CAD or MI -Underlying cause guides tx: pain mgmt; vagal maneuvers; beta blockers, adenosine, CCBs; synchronized cardioversion in unstable pts Premature atrial contraction (PAC) ECG - CORRECT ANSWER -usually 60-100 bpm, *irregular* -*abnl shaped P wave* -*pause (compensatory phase) after premature beat* -nl PRI -nl QRS complex (usually) Ventricular bigeminy ECG - CORRECT ANSWER Every other beat is a PVC Ventricular bigeminy - CORRECT ANSWER Premature atrial contraction (PAC) - CORRECT ANSWER Paroxysmal supraventricular tachycardia (PSVT) ECG - CORRECT ANSWER -150-220 bpm, regular -abnl shaped P wave, may be hidden in preceding T wave -nl or shortened PRI -nl QRS complex (usually) Paroxysmal supraventricular tachycardia (PSVT) - CORRECT ANSWER Atrial flutter ECG - CORRECT ANSWER -atrial: 200-350 bpm, irregular -ventricular: or 100 bpm, regular or irregular -Flutter (F) waves in place of P waves (sawtooth pattern); more flutter waves than QRS complexes -PRI not measurable -nl QRS complex (usually) Atrial flutter: causes, symptoms, and treatment - CORRECT ANSWER -Assoc. w/ CAD, HTN, mitral valve d/o, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism, use of meds like digoxin/quinidine/epinephrine -Symptoms: decreased CO that can lead to HF; increased risk of thrombus formation in atriastroke -treatment: slow ventricular response w/ CCBs, beta blockers; electrical cardioversion in emergency/electively; meds to convert to or maintain sinus rhythm; *radiofrequency catheter ablation is tx of choice* Atrial fibrillation ECG - CORRECT ANSWER -atrial: 350-600 bpm, irregular -ventricular: can be 100 bpm (controlled ventricular response) or 100 bpm (rapid/uncontrolled ventricular response), irregular -Fibrillatory (F) waves, no P waves -PRI not measurable -QRS complex nl (usually) Atrial fibrillation: causes, symptoms, and treatment - CORRECT ANSWER -Usually in pts w/ underlying heart disease; can develop acutely w/ etoh intoxication, hyperthyroidism (thyrotoxicosis), caffeine, electrolyte disturbance, stress, cardiac surgery -S+S: decreased CO, thrombi form in atria d/t blood stasis, increased risk of stroke -Treatment: control ventricular rate, prevent stroke (anticoag therapy if 48 hrs; use for 3-4 weeks before cardioversion and several weeks after)(could do transesophageal echo to r/o clots and go ahead w/ cardioversion also), convert to sinus rhythm if possible (can use meds or electrical cardioversion), long term anticoag therapy if rhythm cannot be converted, radiofrequency ablation or Maze procedure if all else fails Junctional dysrhythmias ECG - CORRECT ANSWER -40-180 bpm, regular -P wave inverted; may be hidden in QRS complex -PRI variable -QRS complex usually nl Junctional dysrhythmias - CORRECT ANSWER First-degree AV block ECG - CORRECT ANSWER -nl and regular rate/rhythm -nl P wave -PRI 0.20 sec -nl QRS complex First-degree AV block: causes, symptoms, and treatment - CORRECT ANSWER -Assoc. w/ MI, CAD, rheumatic fever, hyperthyroidism, electrolyte imbalances, vagal stim, meds like beta blockers -Symptoms: asymptomatic, usually not serious but could indicate higher degrees of block -Treatment: no tx, could change potential cause (e.g. meds); monitor for more serious issues Second-degree AV block type I ECG (AKA Mobitz I, Wenckebach heart block) - CORRECT ANSWER -atrial r/r: nl and regular rate/rhythm -ventricular r/r: slower, *bradycardia and irregular* -nl P wave -*progressive lengthening of PRI until QRS dropped* -*nl QRS width w/ pattern of one blocked/missing QRS complex* -*PRI varies and RRI varies- very very Venckebach* Second-degree AV block type I: causes, symptoms, and treatment - CORRECT ANSWER -Assoc w/ beta blockers, digoxin; CAD and other diseases that cause slow AV conduction. Usually result of myocardial ischemia or inferior MI- usually transient/well tolerated but can be sign of something worse (e.g. complete block) -Treatment for symptomatic (more likely when shock, hypotension, HF present): atropine to increase HR, temporary pacemaker (esp w/ MI) -If asymptomatic: monitor closely with TCP nearby Second-degree AV block type II ECG (AKA Mobitz II heart block) - CORRECT ANSWER -atrial r/r: usually nl and regular rate/rhythm -ventricular r/r: *slower* and regular or irregular -more P waves than QRS complexes -nl or prolonged *PRI- does NOT vary* -*widened QRS (usually 0.12 sec), preceded by =2 P waves w/ blocked QRS complex* Second-degree AV block type II - CORRECT ANSWER -Assoc w/ CAD, rheumatic heart disease, anterior MI, drug toxicity -Often progresses to 3rd degree, poor prognosis -reduced HR can lead to decreased COhypotension and myocardial ischemia -Treatment: temporary pacemaker until pt is symptomatic, then permanent pacemaker Third-degree AV block (complete heart block) ECG - CORRECT ANSWER -atrial r/r: regular but may appear irregular d/t P waves hidden in QRS complexes -ventricular r/r: *20-60 bpm* depending on site of block, regular -nl P waves but no relationship w/ QRS complex -*PRI varies* -*nl or widened QRS complex, no relation to P waves* -*RRI does NOT vary* Third-degree AV block (complete heart block) - CORRECT ANSWER -Assoc w/ severe heart disease (CAD, MI, myocarditis, cardiomyopathy) and some systemic diseases like scleroderma -Results in reduced CO w/ ischemia, HF, shock -Severe bradycardia can result in syncope or periods of asystole -Tx for symptomatic pts: TCP until temporary pacemaker can be placed; atropine, dopamine, epinephrine to increase HR/support BP; permanent pacemaker ASAP Premature ventricular contraction (PVC) ECG - CORRECT ANSWER -contraction from ectopic focus in the ventricles=premature QRS, wide/distorted-underlying rhythm can be any rate, regular or irregular- PVCs occur @ variable rates -P wave not usually visible- hidden in PVC -PRI not measurable - QRS complex wide/distorted -Can appear different (multifocal) or the same (unifocal) Premature ventricular contraction (PVC) - CORRECT ANSWER -Associated w/ stimulants like caffeine, etoh, nicotine, aminophylline, epinephrine, digoxin, isoproterenol; electrolyte imbalances; hypoxia; fever; exercise; emotional stress -Assoc w/ MI, mitral valve prolapse, HF, CAD -Usually not harmful w/ healthy heart -w/ heart disease, could cause decreased CO leading to angina/HF depending on freq -Assess apical/radial pulse (PVC does not create enough force to create peripheral pulse, can lead to pulse deficit) -Tx cause of PVCs (e.g. O2 for hypoxia, remove stimulant, electrolyte replacement); assess hemodynamic status to determine need for drug therapy (beta blockers, amiodarone) Ventricular tachycardia ECG - CORRECT ANSWER -*150-250 bpm, regular or irregular* -P wave not usually visible -PRI not measurable -QRS complex wide/distorted Ventricular tachycardia - CORRECT ANSWER -when there are 3 or more consecutive PVCs (ventricle takes over as pacemaker) -Monomorphic (same), polymorphic (varied), Torsades de pointes (oscillates, see pic) -Torsades de pointes assoc w/ prolonged QT of underlying rhythm -sustained (30sec) or nonsustained (30sec) -Life threatening d/t decreased CO and poss of v-fib Accelerated idioventricular rhythm ECG - CORRECT ANSWER -40-100 bpm, regular -P wave not usually visible -PRI not measurable -QRS wide/distorted Accelerated idioventricular rhythm - CORRECT ANSWER Ventricular fibrillation ECG - CORRECT ANSWER -HR not measurable, irregular -absent P waves -PRI not measurable -QRS not measurable Ventricular fibrillation - CORRECT ANSWER -Firing of multiple ectopic foci in ventricles, severe derangement -Ventricles quivering, NO CO, LETHAL -occurs w/ acute MI, myocardial ischemia, HF, cardiomyopathy -Can happen w/ cardiac pacing/cath procedures that could stim ventricles -Can occur w/ coronary reperfusion after thrombo therapy; electrical shock, hyperkalemia, hypoxemia, acidosis, drug toxicity -UNRESPONSIVE, APNEIC, PULSELESS- w/out rapid tx, will NOT recover -Tx= CPR and ACLS, defib ASAP, meds (epinephrine, vasopressin) Asystole - CORRECT ANSWER -Total absence of ventricular electrical activity, sometimes p waves -UNRESPONSIVE, APNEIC, PULSELESS -LETHAL, needs immediate tx -V-fib may masquerade as asystole -Prognosis very bad, generally cannot be resuscitated -result of adv cardiac disease, severe conduction disturbance, end stage HF -Tx= CPR, ACLS, epi, vasopressin, intubation Pacemaker spike - CORRECT ANSWER Defibrillation - CORRECT ANSWER Synchronized cardioversion - CORRECT ANSWER Normal potassium - CORRECT ANSWER 3.5-5 Nl magnesium - CORRECT ANSWER 1.5-2.5 Nl sodium - CORRECT ANSWER 135-145 Nl total calcium - CORRECT ANSWER 8.6-10.2 Nl ionized calcium - CORRECT ANSWER 4.6-5.3 Nl bicarb - CORRECT ANSWER 22-26 Nl chloride - CORRECT ANSWER 96-106 Nl phosphate - CORRECT ANSWER 2.4-4.4 Troponin I (cTnI) levels - CORRECT ANSWER Negative= 0.5 ng/mL Suspicious for injury= 0.5-2.3 Positive for injury= 2.3 normal Troponin T (cTnT) - CORRECT ANSWER 0.1 ng/mL