11/17/23, 8:43 AM NUR 213 Final Exam Review - Google Docs
Dysrhythmias & ACS
● EKG Basics
○ CO (SVxHR)
○ <Sweet Apples Have Big Price=
■ SA Node (60-100 bpm)
■ AV node (40-60 bpm)
■ HIS Bundle
■ Bundle Branches
■ Purkinje fibers (pacemaker cells contract 20-40 bpm)
○ PQRST
■ P = atria squeeze/contract… depolarize. Sends out a charge.
■ QRS = Ventricles squeeze… depolarize/contract. Send out a charge.
■ T = Ventricles relax/repolarizing/refilling with blood
○ How to count the BPM on a strip?
■ Count the peaks and multiply by 10
○ Boxes
■ PR interval 0.12-0.20 seconds
■ QRS < 0.12 seconds
● Normal Sinus Rhythm (NSR)
○ 60-100 BPM
● Normal Sinus Tachycardia (ST)
○ >100 BPM
○ Causes anxiety, pain, drugs, etc.
○ Vagal maneuver (bear down or carotid massage)
○ B-Blockers (LOL drugs)
○ Calcium Channel Blockers (Diltiazem)
● Normal Sinus Bradycardia (SB)
○ < 60 BPM
○ If showing s/sx of low O2 then treat causes
○ Stop drugs that decrease HR (BBlockers, Digoxin)
○ Atropine (increases HR)
● Atrial Fibrillation (AF)
○ Usually >100 BMP and irregular rhythm with no P wave
○ Uncoordinated electrical activity in the atria
○ Rapid firing of the atria leads to pooling of blood
○ RISK FOR CLOTS (MI, PE, CVA, DVT)
○ The main pacemaker (SA Node) loses control, AV node as back-up
○ Causes: heart surgery, pulmonary HTN, stimulants/alcohol, hyperthyroidism
○ S/Sx: all stem from low O2, low CO… chest pain, low O2 sat, lethargy/fatigue,
anxiety, palpitations, SOB/dyspnea, elevated HR, dizziness/syncope
○ Interventions: anticoagulants (Warfarin. Watch INR 2.5-3.5. Watch green leafy
veggies with this drug.), B-Blockers, Cardiac Ablation (burns erratic cells),
Digoxin (Do not administer if <60BPM, listen to apical for one min. Helps get a
about:blank 1/19
,11/17/23, 8:43 AM NUR 213 Final Exam Review - Google Docs
deeper contraction and slows the HR. Monitor visual changes for toxicity. Low K+
increases the risk for toxicity.), Electrocardioversion (50-200 joules. Mini shock
that is in sequence with rhythm)
● Atrial Flutter
○ Looks like birds fluttering on the EKG strip
○ fast, saw-toothed flutter, regular rhythm
○ The rate is usually 75-150 BPM
○ Causes: lung problems (COPD), cardiac problems (pulmonary HTN/HF, valvular
disease, hyperthyroid crisis), CABG (bypass surgery)
○ S/Sx: signs of low O2 (chest pain, low O2 sat, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, dizziness, EVEN HR & Rhythm)
○ Interventions: exactly like A-Fib! Anticoagulants, beta-blockers, calcium channel
blockers, digoxin, cardioversion
● Supraventricular Tachycardia (SVT)/(PSVT)
○ 150-200 BPM
○ Episodes of rapid HR that starts in a part of the heart that is above the ventricles
○ The Main pacemaker fires but the problem is somewhere in the AV node area…
instead of going into the ventricles it goes right back into the atria and essentially
doubles the HR
○ Regular rhythm - just really fast
○ Causes: Stimulants, sepsis, stress, CAD (narrowing of arteries), CHF,
Myocarditis, COPD
○ S/Sx: all stem from low O2 (chest pain, low SpO2, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, elevated HR, dizziness/syncope
○ Interventions: Use NON-Drug interventions FIRST!! Vagal maneuvers. If that
does not work, Adenosine!!! If drugs don't work, cardiac ablation or
electro-cardioversion
● Premature Ventricular Contraction (PVC)
○ Bigeminy, trigeminy… unifocal or multifocal.
○ Contractions occur early before normal impulses.
○ Irregular rhythm, wide and bizarre-looking.
○ Causes: Stimulants (caffeine, nicotine/cigarettes, alcohol), sepsis, stress,
electrolyte imbalances
○ S/Sx are usually absent. If there are multiple in a row, the pt might say it feels like
their heart is skipping a beat.
○ Interventions: TREAT THE CAUSE, digoxin, correction of electrolytes,
LIDOCAINE or AMIODARONE
● Ventricular Tachycardia (VT)
○ Deadly rhythm
○ Shock ONLY if in pulseless VT
○ SA and AV nodes lose control as main pacemakers
○ There is zero cardiac output
○ 100-250 BPM
○ Regular rhythm that looks like tombstones
about:blank 2/19
, 11/17/23, 8:43 AM NUR 213 Final Exam Review - Google Docs
○ Cause: dysfunctional contraction of the heart, drugs/stimulants, medication
toxicity (digoxin), electrolyte imbalances (low Mg or K), Hx of cardiac injury
○ S/Sx: Signs of low cardiac output (low O2)
○ Interventions: assess the patient first if you see this rhythm on the monitor…
○ If the pt has a pulse, administer amiodarone to stabilize the rhythm. Then
possible cardioversion. If the pt has no pulse, START CPR and get the crash
cart! Defib, lidocaine, amiodarone, follow with ACLS.
● Ventricular Fibrillation (VFib)
○ The only rhythm we SHOCK! Defib for V-Fib!
○ A CHAOTIC pattern of electrical activity in the ventricles
○ There is no real contraction, no cardiac output, no O2 getting to the rest of the
body
○ Causes: cardiac injury (CAD, MI), medication toxicity (digoxin), electrical
imbalances (untreated VT, acid-base imbalances, electrolyte imbalances)
○ S/Sx: Unconscious (if not unconscious they will have signs of low O2)
○ Interventions: start CPR and defibrillation (200-360 joules), epinephrine
(increases HR, increases BP), if this doesn't work, give Lidocaine (relax
ventricles so they can contract), amiodarone (stabilize rhythm), Mag-Sulfate
(calm the ventricles)
● ACS ( Unstable angina, MI, STEMI, NSTEMI)
○ A blockage causes the heart muscle cells to suffocate. Ultimately leads to tissue
ischemia (death)
○ A plaque can rupture and occlude the vessels
○ Causes: Stress, stimulants, obesity, arteriosclerosis, diabetes & HTN, diet (high
Cholesterol), more common in African American males
○ ACS = UNSTABLE angina or MI
○ Unstable angina is unrelieved with rest
○ <Sudden… crushing… radiating=
○ Jaw pain, left arm pain, heartburn, SOB, N/V, ABD pain, diaphoresis, pale/cool
skin
○ Diabetic (r/t neuropathy) patients and women often go unnoticed!
○ Diagnostics: ST elevation and depression, Troponin labs (this is the gold
standard) OVER 0.5 indicates TRAUMA!, CK, CK-MB, CRP are also tested but
not as important as troponin
○ Treatment: door to cath lab within 45 minutes or less!, angioplasty (visualize and
move the blockage), CABG or stent, or endarterectomy
○ Stress test: (exercise or pharmacological) looks for ST changes. Stop for chest
pain or ST changes!
● MI treatments
○ First thing get an EKG
○ O2, aspirin, NTG, morphine
○ Cath lab (remember it uses contrast dye which is hard on the kidneys) &
fibrinolytic (TPA and -ase ending drugs)
○ Stop metformin 48 hours before/after
about:blank 3/19
Dysrhythmias & ACS
● EKG Basics
○ CO (SVxHR)
○ <Sweet Apples Have Big Price=
■ SA Node (60-100 bpm)
■ AV node (40-60 bpm)
■ HIS Bundle
■ Bundle Branches
■ Purkinje fibers (pacemaker cells contract 20-40 bpm)
○ PQRST
■ P = atria squeeze/contract… depolarize. Sends out a charge.
■ QRS = Ventricles squeeze… depolarize/contract. Send out a charge.
■ T = Ventricles relax/repolarizing/refilling with blood
○ How to count the BPM on a strip?
■ Count the peaks and multiply by 10
○ Boxes
■ PR interval 0.12-0.20 seconds
■ QRS < 0.12 seconds
● Normal Sinus Rhythm (NSR)
○ 60-100 BPM
● Normal Sinus Tachycardia (ST)
○ >100 BPM
○ Causes anxiety, pain, drugs, etc.
○ Vagal maneuver (bear down or carotid massage)
○ B-Blockers (LOL drugs)
○ Calcium Channel Blockers (Diltiazem)
● Normal Sinus Bradycardia (SB)
○ < 60 BPM
○ If showing s/sx of low O2 then treat causes
○ Stop drugs that decrease HR (BBlockers, Digoxin)
○ Atropine (increases HR)
● Atrial Fibrillation (AF)
○ Usually >100 BMP and irregular rhythm with no P wave
○ Uncoordinated electrical activity in the atria
○ Rapid firing of the atria leads to pooling of blood
○ RISK FOR CLOTS (MI, PE, CVA, DVT)
○ The main pacemaker (SA Node) loses control, AV node as back-up
○ Causes: heart surgery, pulmonary HTN, stimulants/alcohol, hyperthyroidism
○ S/Sx: all stem from low O2, low CO… chest pain, low O2 sat, lethargy/fatigue,
anxiety, palpitations, SOB/dyspnea, elevated HR, dizziness/syncope
○ Interventions: anticoagulants (Warfarin. Watch INR 2.5-3.5. Watch green leafy
veggies with this drug.), B-Blockers, Cardiac Ablation (burns erratic cells),
Digoxin (Do not administer if <60BPM, listen to apical for one min. Helps get a
about:blank 1/19
,11/17/23, 8:43 AM NUR 213 Final Exam Review - Google Docs
deeper contraction and slows the HR. Monitor visual changes for toxicity. Low K+
increases the risk for toxicity.), Electrocardioversion (50-200 joules. Mini shock
that is in sequence with rhythm)
● Atrial Flutter
○ Looks like birds fluttering on the EKG strip
○ fast, saw-toothed flutter, regular rhythm
○ The rate is usually 75-150 BPM
○ Causes: lung problems (COPD), cardiac problems (pulmonary HTN/HF, valvular
disease, hyperthyroid crisis), CABG (bypass surgery)
○ S/Sx: signs of low O2 (chest pain, low O2 sat, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, dizziness, EVEN HR & Rhythm)
○ Interventions: exactly like A-Fib! Anticoagulants, beta-blockers, calcium channel
blockers, digoxin, cardioversion
● Supraventricular Tachycardia (SVT)/(PSVT)
○ 150-200 BPM
○ Episodes of rapid HR that starts in a part of the heart that is above the ventricles
○ The Main pacemaker fires but the problem is somewhere in the AV node area…
instead of going into the ventricles it goes right back into the atria and essentially
doubles the HR
○ Regular rhythm - just really fast
○ Causes: Stimulants, sepsis, stress, CAD (narrowing of arteries), CHF,
Myocarditis, COPD
○ S/Sx: all stem from low O2 (chest pain, low SpO2, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, elevated HR, dizziness/syncope
○ Interventions: Use NON-Drug interventions FIRST!! Vagal maneuvers. If that
does not work, Adenosine!!! If drugs don't work, cardiac ablation or
electro-cardioversion
● Premature Ventricular Contraction (PVC)
○ Bigeminy, trigeminy… unifocal or multifocal.
○ Contractions occur early before normal impulses.
○ Irregular rhythm, wide and bizarre-looking.
○ Causes: Stimulants (caffeine, nicotine/cigarettes, alcohol), sepsis, stress,
electrolyte imbalances
○ S/Sx are usually absent. If there are multiple in a row, the pt might say it feels like
their heart is skipping a beat.
○ Interventions: TREAT THE CAUSE, digoxin, correction of electrolytes,
LIDOCAINE or AMIODARONE
● Ventricular Tachycardia (VT)
○ Deadly rhythm
○ Shock ONLY if in pulseless VT
○ SA and AV nodes lose control as main pacemakers
○ There is zero cardiac output
○ 100-250 BPM
○ Regular rhythm that looks like tombstones
about:blank 2/19
, 11/17/23, 8:43 AM NUR 213 Final Exam Review - Google Docs
○ Cause: dysfunctional contraction of the heart, drugs/stimulants, medication
toxicity (digoxin), electrolyte imbalances (low Mg or K), Hx of cardiac injury
○ S/Sx: Signs of low cardiac output (low O2)
○ Interventions: assess the patient first if you see this rhythm on the monitor…
○ If the pt has a pulse, administer amiodarone to stabilize the rhythm. Then
possible cardioversion. If the pt has no pulse, START CPR and get the crash
cart! Defib, lidocaine, amiodarone, follow with ACLS.
● Ventricular Fibrillation (VFib)
○ The only rhythm we SHOCK! Defib for V-Fib!
○ A CHAOTIC pattern of electrical activity in the ventricles
○ There is no real contraction, no cardiac output, no O2 getting to the rest of the
body
○ Causes: cardiac injury (CAD, MI), medication toxicity (digoxin), electrical
imbalances (untreated VT, acid-base imbalances, electrolyte imbalances)
○ S/Sx: Unconscious (if not unconscious they will have signs of low O2)
○ Interventions: start CPR and defibrillation (200-360 joules), epinephrine
(increases HR, increases BP), if this doesn't work, give Lidocaine (relax
ventricles so they can contract), amiodarone (stabilize rhythm), Mag-Sulfate
(calm the ventricles)
● ACS ( Unstable angina, MI, STEMI, NSTEMI)
○ A blockage causes the heart muscle cells to suffocate. Ultimately leads to tissue
ischemia (death)
○ A plaque can rupture and occlude the vessels
○ Causes: Stress, stimulants, obesity, arteriosclerosis, diabetes & HTN, diet (high
Cholesterol), more common in African American males
○ ACS = UNSTABLE angina or MI
○ Unstable angina is unrelieved with rest
○ <Sudden… crushing… radiating=
○ Jaw pain, left arm pain, heartburn, SOB, N/V, ABD pain, diaphoresis, pale/cool
skin
○ Diabetic (r/t neuropathy) patients and women often go unnoticed!
○ Diagnostics: ST elevation and depression, Troponin labs (this is the gold
standard) OVER 0.5 indicates TRAUMA!, CK, CK-MB, CRP are also tested but
not as important as troponin
○ Treatment: door to cath lab within 45 minutes or less!, angioplasty (visualize and
move the blockage), CABG or stent, or endarterectomy
○ Stress test: (exercise or pharmacological) looks for ST changes. Stop for chest
pain or ST changes!
● MI treatments
○ First thing get an EKG
○ O2, aspirin, NTG, morphine
○ Cath lab (remember it uses contrast dye which is hard on the kidneys) &
fibrinolytic (TPA and -ase ending drugs)
○ Stop metformin 48 hours before/after
about:blank 3/19
