N471 CORRECT FINAL EXAMS QUESTIONS AND
ANSWERS SURE A+
✔✔Why do people have heart blocks? - ✔✔Six sinus syndrome
- Something is wrong with the sinus node → go into heart block
Certain medications
MI (inferior MI)
- Ventricular MI: Vfib and other lethal rhythms
✔✔EKG Analysis - ✔✔Analyze p wave
- Present? How many?
- P waves regular?
Analyze QRS ( R waves)
- Present ? How many?
R waves regular?
Determine heart rate
Measure PR interval
Measure QRS duration
Measure QT interval
Interpret rhythm
✔✔Defibrillation vs Cardioversion - ✔✔The timing of the delivery of electrical current!!
In cardioversion, the delivery of the electrical current is synchronized with the patient's
electrical events; in defibrillation, the delivery of the current is immediate and
unsynchronized
✔✔Defibrillation/AED - ✔✔Turn on & Apply Multifunction Pads to patient
Determine rhythm
Is it V-fib or pulseless V-Tach ? (ONLY SHOCKABLE RHYTHMS!!)
Select appropriate joules
- Biphasic 120-200 (depending on manufacturer)
- Monophasic stackable 200, then 200-300, then 360 (not seen as often)
,If no physician or qualified personnel available, use AED mode
BLS/CPR should be initiated ASAP and should only be interrupted when absolutely
necessary (<10 seconds)
✔✔Sudden Cardiac Death - ✔✔Fatal if not treated w/ a defibrillator
Life Vest that they put on people if they suffered form a sudden cardiac death
Used for cardiac testing
ICD: internal cardiac defibrillator
- May put on life vest before surgically implanting ICD
Life vest is a wearable defibrillator and is noninvasive
- Garment = worn under clothing
- Monitor = around waist or on shoulder strap; monitors hearts and arrhythmias and
when treatment is needed
Therapy pads give treatment shocks to heart when necessary
Life vest automatically spills out blue gel
Blue gel improves effectiveness of shocks and protects the skin
Life vest can give additional shocks as necessary
Pt wears it and calls physician to go to ER
✔✔Synchronized Cardioversion - ✔✔Electrical charge is synchronized with the QRS of
the patient's heart rhythm R waves marked
Patient placed on monitor with physician and emergency equipment at bedside
- Have to have crash cart and IV
Once pads are on, set defibrillator to synch, select proper electrical setting (MD
determines amount of energy, often start at 100 joules)
Pre-medicate patient if able
- Want to give them a relaxer first with sedation and pain medication
Treatment of: unstable SVT, V-Tach with a pulse, A-Fib & A-Flutter
- Before you cardioversion afib and aflutter they need to have a transesophageal
echocardiogram where ur looking around the heart for a clot
✔✔What is a pacemaker? - ✔✔= A device designed to assist in stimulating the heart
when the heart's intrinsic pacemaker is not working
Too slow or impulses are blocked from reaching the ventricles.
Indications:
- Sick sinus rhythms
- 3rd degree heart block
- 2nd degree heart block
Modes:
,- Fixed (rare)
- Pacemaker will kick in only when it's needed
- Goes by timing
- If P or QRS doesn't come in when it should, it will kick in
- Demand (most common)
✔✔Types of Pacemakers - ✔✔Temporary
External/transcutaneous (apply pads)
Internal
- Transvenous (put pacemaker wire in ventricle)
- Epicardial (leads sticking out of chest in open heart surgery)
Permanent
✔✔Pacemaker Considerations - ✔✔What kind of pacemaker is it?
Manufacturer?
Is it functioning as it should?
Does it need interrogation?
- If rhythm isn't pacing when it should be or it looks weird → call the tech
- Puts a device on the pacemaker and it sends the info to the computer and they can fix
it
Potentially no MRIs
- D/t the metal interfering
✔✔Pacemaker Nursing Care - ✔✔Transcutaneous
- Set monitor to pace, set rate & MA (milliamps we want), ensure capture, inspect skin,
medicate prn
Transvenous
- Set rate & MA, ensure capture, ensure connections, keep pacer box within reach,
inspect site
Epicardial
- Set rate & MA, ensure capture, ensure connections secure, keep pacer box within
reach, inspect site, DC asap usually day 3-5
Permanent
- Immobilize arm first 24-48hrs
- Monitor site for infection
- Monitor HR & b/p (teach pt)
✔✔Micra Pacemaker - ✔✔Micra is about one inch long and one-quarter of an inch wide
Single chamber can operate VVI & VVIR
Implanted into right ventricle septum self contained no wires
, Inserted via percutaneous femoral approach
MRI compatible
Indication
- Symptomatic bradycardia
- Single chamber pacer
- Afib/Aflutter
Works:
- Senses the patient's own rhythm using a "sensing circuit"
- Not going to pace unless the patient needs to be paces
- It sends out electrical signals using an "output circuit"
- Acts like your own SA nodes
✔✔Pacemaker Terminology: Sensitivity - ✔✔= the pacemaker's ability to sense a
patient's intrinsic rhythm or when natural depolarization is occurring
The sensitivity number represents the minimum size, in millivolts, of an electrical signal
that will be detected by the pacemaker
The higher the sensitivity (number) the less likely the pacemaker will "see"/sense the
patients rhythm
The lower the sensitivity the more likely "see"/sense the pts intrinsic rhythm
✔✔Pacemaker Terminology: Output - ✔✔= The electrical stimulus or energy generated
by a pulse generator. Intended to trigger a depolarization in the chamber of the heart
being paced
✔✔Pacemaker Code - ✔✔*PaSeR*
- First Letter = Chamber Pa*ced
- Second Letter = Chamber Se*nsed
- Third Letter = R*esponse to sensing
✔✔Atrial Pacemaker - ✔✔Paces at beginning of P wave
Spiking before the atrium
Machine helps marks spikes
✔✔Demand Ventricular Pacing - ✔✔Spikes are before the QRS interval
- Spikes are on the ventricle and not on the P wave
Will make the QRS wide
Ventricular pace
- NO P wave
ANSWERS SURE A+
✔✔Why do people have heart blocks? - ✔✔Six sinus syndrome
- Something is wrong with the sinus node → go into heart block
Certain medications
MI (inferior MI)
- Ventricular MI: Vfib and other lethal rhythms
✔✔EKG Analysis - ✔✔Analyze p wave
- Present? How many?
- P waves regular?
Analyze QRS ( R waves)
- Present ? How many?
R waves regular?
Determine heart rate
Measure PR interval
Measure QRS duration
Measure QT interval
Interpret rhythm
✔✔Defibrillation vs Cardioversion - ✔✔The timing of the delivery of electrical current!!
In cardioversion, the delivery of the electrical current is synchronized with the patient's
electrical events; in defibrillation, the delivery of the current is immediate and
unsynchronized
✔✔Defibrillation/AED - ✔✔Turn on & Apply Multifunction Pads to patient
Determine rhythm
Is it V-fib or pulseless V-Tach ? (ONLY SHOCKABLE RHYTHMS!!)
Select appropriate joules
- Biphasic 120-200 (depending on manufacturer)
- Monophasic stackable 200, then 200-300, then 360 (not seen as often)
,If no physician or qualified personnel available, use AED mode
BLS/CPR should be initiated ASAP and should only be interrupted when absolutely
necessary (<10 seconds)
✔✔Sudden Cardiac Death - ✔✔Fatal if not treated w/ a defibrillator
Life Vest that they put on people if they suffered form a sudden cardiac death
Used for cardiac testing
ICD: internal cardiac defibrillator
- May put on life vest before surgically implanting ICD
Life vest is a wearable defibrillator and is noninvasive
- Garment = worn under clothing
- Monitor = around waist or on shoulder strap; monitors hearts and arrhythmias and
when treatment is needed
Therapy pads give treatment shocks to heart when necessary
Life vest automatically spills out blue gel
Blue gel improves effectiveness of shocks and protects the skin
Life vest can give additional shocks as necessary
Pt wears it and calls physician to go to ER
✔✔Synchronized Cardioversion - ✔✔Electrical charge is synchronized with the QRS of
the patient's heart rhythm R waves marked
Patient placed on monitor with physician and emergency equipment at bedside
- Have to have crash cart and IV
Once pads are on, set defibrillator to synch, select proper electrical setting (MD
determines amount of energy, often start at 100 joules)
Pre-medicate patient if able
- Want to give them a relaxer first with sedation and pain medication
Treatment of: unstable SVT, V-Tach with a pulse, A-Fib & A-Flutter
- Before you cardioversion afib and aflutter they need to have a transesophageal
echocardiogram where ur looking around the heart for a clot
✔✔What is a pacemaker? - ✔✔= A device designed to assist in stimulating the heart
when the heart's intrinsic pacemaker is not working
Too slow or impulses are blocked from reaching the ventricles.
Indications:
- Sick sinus rhythms
- 3rd degree heart block
- 2nd degree heart block
Modes:
,- Fixed (rare)
- Pacemaker will kick in only when it's needed
- Goes by timing
- If P or QRS doesn't come in when it should, it will kick in
- Demand (most common)
✔✔Types of Pacemakers - ✔✔Temporary
External/transcutaneous (apply pads)
Internal
- Transvenous (put pacemaker wire in ventricle)
- Epicardial (leads sticking out of chest in open heart surgery)
Permanent
✔✔Pacemaker Considerations - ✔✔What kind of pacemaker is it?
Manufacturer?
Is it functioning as it should?
Does it need interrogation?
- If rhythm isn't pacing when it should be or it looks weird → call the tech
- Puts a device on the pacemaker and it sends the info to the computer and they can fix
it
Potentially no MRIs
- D/t the metal interfering
✔✔Pacemaker Nursing Care - ✔✔Transcutaneous
- Set monitor to pace, set rate & MA (milliamps we want), ensure capture, inspect skin,
medicate prn
Transvenous
- Set rate & MA, ensure capture, ensure connections, keep pacer box within reach,
inspect site
Epicardial
- Set rate & MA, ensure capture, ensure connections secure, keep pacer box within
reach, inspect site, DC asap usually day 3-5
Permanent
- Immobilize arm first 24-48hrs
- Monitor site for infection
- Monitor HR & b/p (teach pt)
✔✔Micra Pacemaker - ✔✔Micra is about one inch long and one-quarter of an inch wide
Single chamber can operate VVI & VVIR
Implanted into right ventricle septum self contained no wires
, Inserted via percutaneous femoral approach
MRI compatible
Indication
- Symptomatic bradycardia
- Single chamber pacer
- Afib/Aflutter
Works:
- Senses the patient's own rhythm using a "sensing circuit"
- Not going to pace unless the patient needs to be paces
- It sends out electrical signals using an "output circuit"
- Acts like your own SA nodes
✔✔Pacemaker Terminology: Sensitivity - ✔✔= the pacemaker's ability to sense a
patient's intrinsic rhythm or when natural depolarization is occurring
The sensitivity number represents the minimum size, in millivolts, of an electrical signal
that will be detected by the pacemaker
The higher the sensitivity (number) the less likely the pacemaker will "see"/sense the
patients rhythm
The lower the sensitivity the more likely "see"/sense the pts intrinsic rhythm
✔✔Pacemaker Terminology: Output - ✔✔= The electrical stimulus or energy generated
by a pulse generator. Intended to trigger a depolarization in the chamber of the heart
being paced
✔✔Pacemaker Code - ✔✔*PaSeR*
- First Letter = Chamber Pa*ced
- Second Letter = Chamber Se*nsed
- Third Letter = R*esponse to sensing
✔✔Atrial Pacemaker - ✔✔Paces at beginning of P wave
Spiking before the atrium
Machine helps marks spikes
✔✔Demand Ventricular Pacing - ✔✔Spikes are before the QRS interval
- Spikes are on the ventricle and not on the P wave
Will make the QRS wide
Ventricular pace
- NO P wave
