Telemetry Exam 77 Questions with Verified Answers,100% CORRECT

Telemetry Exam 77 Questions with Verified Answers EKG 5 steps - CORRECT ANSWER 1. what is the rate? 2.Is the R-R interval regular or irregular? 3.Is the P wave before each QRS complex? 4.IS the PR interval less or equal to 0.20 seconds? the QRS complexes narrow or wide? Telemetry - CORRECT ANSWER -Monitors patient's heart rate and rhythm -Doctor order is needed -leads need gel for conduction, change q24hr 12-lead EKG - CORRECT ANSWER -Snapshot in time -Diagnostic tool -doctor order needed 12 lead EKG shows the heart ___ - CORRECT ANSWER -12 views of heart -structural change/damage, ischemia, infarction, enlarged cardiac chambers, electrolyte imbalance, drug toxicity Holter monitor - CORRECT ANSWER -24-72hrs EKG -teach to diary activity and Sx -remove for shower/bath Normal sinus Rhythm - CORRECT ANSWER -Rate: 60-100 -R-R: regular -P wave before QRS -PR interval: 0.12-0.20 -QRS complex: narrow, less than 0.12 Normal PR interval - CORRECT ANSWER less than 0.20 QRS complex normal width - CORRECT ANSWER 0.12 (less than 3 boxes) P wave shows the heart's ___ - CORRECT ANSWER atrial contraction QRS complex shows the Heart's ___ - CORRECT ANSWER ventricular contraction Little box and big box time - CORRECT ANSWER little: 0.04, big 0.20 Sinus bradycardia and tachycardia give symptoms when? what are those Sx? - CORRECT ANSWER -Cardiac output is compromised -hypotension, pale/cool skin, weakness, angina, dizzy & Syncope, SOB Sinus bradycardia and Tx - CORRECT ANSWER -Rate: less than 60 -R-R: regular -P before QRS -P-R: 0.12-0.20 -QRS: less than 0.12 narrow TX: atropine Causes for sinus bradycardia - CORRECT ANSWER -Meds: beta blocker/ calcium channel blockers/ Digoxin -lower metabolic need ( hypothyroidism, sleep athlete) -Vagal stimulation(suction, vomit, stain BM or pain) -hypoexmia -hypothermia -Inferior wall MI -SA node, HF, ICP Sinus Tachycardia and Tx - CORRECT ANSWER -Rate: 100-150 -R-R: regular -P before QRS -P-R interval 0.12-0.20 -QRS: narrow 0.12 -Tx: beta blockers Sinus tachycardia Vs. SVT - CORRECT ANSWER sinus tachycardia still has a P Wave! Sinus tachycardia causes - CORRECT ANSWER 1. Increased demand: stress, pain, fever, caffeine, drugs, meds(theophylline, atropine, hyperthyroidism) ased supply: compensate for low CO(low b/p means hypovolemia), anemia Supra ventricular tachycardia (SVT) - CORRECT ANSWER -rate: 150-220 -R-R regular -QRS complex: narrow, 0.12 *P is hidden* -P-R interval: can't be measured QRS narrow means - CORRECT ANSWER problem is atrial QRS wide means - CORRECT ANSWER problem is ventricular Avoid causes for SVT: - CORRECT ANSWER caffeine, sleep deprivation, stress, smoking until doctor Tx Atrial flutter - CORRECT ANSWER (Saw tooth pattern) -flutter, flutter ,ventricle -Too many P waves(atria response) -Rate: 120-150 -R-R: normal -QRS: narrow 0.12 -PR: can't measure Atrial flutter cause - CORRECT ANSWER -SA node sending too many messages= too many P waves -Coronary artery disease -structure problems -heart failure -geriatric atrial fibrillation (a-fib) - CORRECT ANSWER -atria is unorganized -quiver, quiver, then ventricle responds -Rate 80-120 -**R-R:irregular -P wave: doesn't have -P-R: none QRS: narrow 0.12 A fib Sx and Tx - CORRECT ANSWER -doesn't feel good, low stamina, dyspnea on excretion, can't tolerate activity -Tx: rate control meds, Blood thinner (pooling/clots) PT can flip out of Afib, flutter, SVT into regular rhythm at anytime? - CORRECT ANSWER True Afib/flutter complications - CORRECT ANSWER blood pooling: clots, stroke, PE Premature Ventricular contractions (PVC) - CORRECT ANSWER -Extra ventricular kick -most common -intermediate is normal but frequent(every other beat or 6 in a row) more serious Extra kick in PVC is - CORRECT ANSWER only eletrical current from bundle of his causing contraction not a QRS Premature Ventricular contractions (PVC) causes: - CORRECT ANSWER electrolyte imbalance (potassium, magnesium)for frequent PVC, after MI b/c dead tissue bee w/ currents & contract Ventricular Tachycardia (Vtach) - CORRECT ANSWER -Tombstone -*Only bottom ventricles responding* to electrical interval -Rate: 150-200 -R-R: regular -P wave: none, PR: none -QRS: wide -can flip in and out of normal rhythm Ventricular tachycardia (Vtach) interventions and Sx - CORRECT ANSWER -Sx: unresponsive or normal pt -Run and Assess for verbal response/shake pt -check pulse- code blue & CPR Ventricular Tachycardia (Vtach) Causes - CORRECT ANSWER -Electrolyte (potassium and magnesium), Big MI, heart failure Ventricular Fibrillation - CORRECT ANSWER -*Unorganized rhythm* (like A-fib) -Only have electrical current to heart -No P wave, QRS, R-R -can progress to from Vtach Ventricular fibrillation Sx and Tx - CORRECT ANSWER -Sx: gray, unresponsive, no pulse -Tx: CPR/compressions, Defibrillate (shock -Nclex-- shock but fr compressions till shock Asystole and Interventions - CORRECT ANSWER -no pulse/response, no electrical current -mandatory CPR until electrical current -no shock? Pulseless electrical activity (PEA) - CORRECT ANSWER -Any rhythm that has electrical conduction on screen but no pulse( no muscle response but electrical current is fine) Pulseless electrical activity (PEA) interventions and causes - CORRECT ANSWER -Causes: MI, end of life (DNR), Struck by lightning -Call code blue Artifact - CORRECT ANSWER -nothing!! maybe Pt is moving Heart block and risk - CORRECT ANSWER -Block/ delay in normal conduction pathway -Delay cause by AV conduction -risk for if Pt has MI or heart failure hx Heart block 1st degree - CORRECT ANSWER -block/delay in normal conduction pathway -common /benign -**PR interval:more than 0.20 ** Heart block second degree type 1 - CORRECT ANSWER -Wenckebach -longer, longer, longer, must be a wenckebach -Delay increasing in AV node to where an **entire QRS complex is dropped** -caused by: beta blockers and calcium channel blockers Heart block second degree type 2 and Tx - CORRECT ANSWER -Symptomatic patient because more QRS complex dropped= LOW HR -P-P interval are normal -Tx: Pacemaker Heart block 3rd degree and Tx - CORRECT ANSWER -P wave and QRS complex are not talking -QRS: Wide(like ventricular) -Symptomatic Pt -Tx: pacemaker Bundle branch block (BBB) - CORRECT ANSWER -delay in conduction of bundles to tell ventricles to contract causing **QRS complex to be WIDE** -QRS: wider than 0.12 -caused by heart attack/MI Sinus Arrhythmia - CORRECT ANSWER -R-R interval: not normal/irreg. -everything else normal -Asymptomatic Pt -caused by: moving patient or taking a breathe Management of Dysrhythmias (assessment ?'s) - CORRECT ANSWER -Is the patient symptomatic? -Vital signs? Focused assessment? -Continuous telemetry (small picture -12 lead EKG (whole heart/diagnostic) -check labs -apply oxygen -IV patency, fluid bolus SA node, AV node , Bundle of his: heart rate - CORRECT ANSWER -SA node: pacemaker of heart 60-100 -AV node: take over 40-60 -Bundle of his: take over 20-40 Bundle of his taking over HR causes QRS complex to be : - CORRECT ANSWER Wide Slow rhythms (sinus bradycardia) Sx: - CORRECT ANSWER -Fatigue, SOB, low b/p, dizzy -confusion/disorientation if prolonged Is pt hemodynamically compromised? - CORRECT ANSWER check VS if low b/p and lower than baseline HR w/ Sx= yes Slow rhythms (sinus bradycardia) interv. and Treatment: - CORRECT ANSWER -Is pt hemodynamically compromised? check VS -Tx: vagal response to cause HR drop (bear down/BM) **IF HR is low and hemodynamically compromised give Atropine 0.5mg IVP quickly to bring up HR*** -Pacemaker Transcutaneous pacemaker - CORRECT ANSWER -Temporary, emergency use to stabilize patient until transvenous is started -current goes through skin with defibrillator pads sandwiched -painful= give pain meds Transvenous pacemaker - CORRECT ANSWER -temporary, wires travel femoral or jugular vein and currents pace heart to contract -minimal/no pain epicardial pacemaker - CORRECT ANSWER post cardiothoracic surgery, -specific to open heart surgery to ensure heart wakes up and AV/SA nodes -nurse can't pull wires out of chest Permanent pace maker - CORRECT ANSWER -Uses: regulate rhythm (as needed) -for Pt who have heart attack, heart failure -Lead can sit in Atria(SA node problem) or ventricle( HF stretch or ventricle coordination) -Pt doesn't feel pain -Cardiologist inserts at surgical lab -Can also be used for fast rhythm to overpace Post opp pacemaker nursing interventions - CORRECT ANSWER -assess bleeding/swelling (at dressing site and around back -Check radial pulse on same side(ensure there is distal perfusion) -chest x-ray: placement of battery/wires -Incision/infection: fever, redness, discharge -Pacemaker interrogation Pacemaker teaching - CORRECT ANSWER 5-7 days postopp: don't get incision wet, don't raise elbow above shoulder, no heavy lifting on insertion side Fast rhythm Treatments (A-fib, atrial flutter, SVT, Vtach w/ pulse) - CORRECT ANSWER -Vagal maneuvers: drop HR, bear down/BM/cough, blow into syringe(SVT) help SA node reset ***noninvasive -Meds -Cardioversion -Catheter ablation Cardioversion - CORRECT ANSWER -Tx for fast rythems -Resets the heart and resynchronize the PT current rhythm(SA node) with a shock -Sedate patient with Propoval -Defibrillator on heart sandwiched pads for shock -***Invasive, done if vagal and meds didn't work -needed 2-3 times= hassle Catheter ablation - CORRECT ANSWER -destroys extra pathways the abnormal rhythm travels down -Heat/cold is used -MD goes though femoral vein & puts pressure when removing -**Invasive , usually needed more than once -A fib and flutter most frequent needed antiarrhythmic meds - CORRECT ANSWER -betablocker (metoprolol) -Adenosine -calcium channel blockers: Diltazem*** -Dignoxin -amiodarone -lidocaine -magnesium Beta blocker uses and dose - CORRECT ANSWER -Slows HR -Metoprolol: 5mg over 1-2min IVP q 5min for 3 doses Max -Uses: SVT, a-fib and flutter, tachycardia Adenosine - CORRECT ANSWER -**only for SVT**, stop patients heart and given rapidly -1st dose is 6mg with full flush, wait 5min and second dose is 12mg with full flush(short half life=give fast) -Pt is hooked up to crash cart and has pads on before giving -teach: will feel weight on chest Calcium channel blockers - CORRECT ANSWER -A-fib and flutter when rate is rapid 120-150 -Diltazem (drip 5-15mg/hr) -if Hr didn't return to normal rythem= Cardioversion -if Hr returned to norm: give PO for maintenance -if permenant a-fib/flutter: ablation for permeant relief Digoxin - CORRECT ANSWER for a-fib and flutter Amiodarone - CORRECT ANSWER a-fib, v-tach with or without pulse *can damage liver Lidocaine - CORRECT ANSWER -given during code blue , if helps for Vtach keep giving -if has pulse can start on drop or amiodarone Implant cardioveter defibrillator (ICD) - CORRECT ANSWER -detects abnormal rhythm and regulate or shocks to normal rhythm, can have 1 lead in right ventricle and 1 in left -requires: Vtach, V-fib, risks if already had episode, EF less than 35% (heart failure), multiverses heart disease, large MI -Same Postopp care as pacemaker -teach: report shock to MD Ejection fraction - CORRECT ANSWER how much heart pumps per beat ICD vs. pacemaker - CORRECT ANSWER more ventricular electric problems vs. pacemaker for top and bottom of heart whenever HR is low Ventricular doesn't need vagal maneuvers (T/F) - CORRECT ANSWER true, amioderone or lidocaine can be tried but ICD needed Tx for dead rhythms (V-fib, Vtach, systole, PEA) - CORRECT ANSWER -V-fib and Vtach without pulse: CPR and defibrillate -asystole: CPR until electrical rythem -PEA: CPR until get pulse After defibrillation continue CPR (T/F) - CORRECT ANSWER True, don't check pulse -5cycles q 2 min Synchronized Cardioversion - CORRECT ANSWER -A-flutter -A-fib -Vtach w/ pulse -SVT (synchronized= defibrillator button match rythem for shock) If defibrillator not synchronized : - CORRECT ANSWER make rythem worse Vtach or Vfib Pacemaker Temp/emergancy - CORRECT ANSWER -symptomatic bradycardia -symptomatic heart block