Cardiac Dysrhythmias Part 2 Questions With 100%Verified Answers

Describe a pacemaker code - correct answer...The standardized code consists of up to 5 letters- 1st letter- identifies which chamber(s) of the heart are paced by the pacemaker- "A" refers to atrium, "V" to ventricle, and "D" to both atrium and ventricle (also called "dual") ***There are many types of permanent pacemakers available. To facilitate and standardize communication about the types of pacemakers and pacemaker functions, a standardized coding system was developed through the work of the North American Society of Pacing and Electrophysiology and the British Pacing and Electrophysiology Group. Describe an implantable cardioverter defibrillator (ICD) - correct answer...An electrical device used in the treatment of tachydysrhythmias Capable of identifying and terminating life-threatening ventricular dysrhythmias Describe biphastic and monophastic defibrillators - correct answer...MONOPHASIC DELIVERS IMPULSE IN ONE DIRECTION; BIPHASIC DELIVERS IMPULSE IN TWO DIRECTIONS; BIPHASIC CAN LEAD TO SUCCESSFUL SHOCK AT LOWER ENERGY WITH FEWER POST SHOCK ECG ABNORMALITIES DEFIBRILLATION IS MOST EFFECTIVE WHEN MYOCARDIAL CELLS ARE NOT ANOXIC AND ACIDOTIC SO DO IT QUICK. SHOCK DEPOLARIZES AND THE AFTER REPOLARIZATION HOPEFULLY SA NODE TAKES OVER Describe biphastic and monophastic shocking - correct answer...Biphasic-goes in two directions- hits heart and goes both ways in the conduction system Monophasic- one direction, requires higher number of Joules (can go all the way up to 200 Joules) Describe epicardial wires - correct answer...Epicardial invasive temporary pacing- applied by using a transthoracic approach; the lead wires are loosely threaded on the epicardial surface of the heart after cardiac surgery **Often prophylactic after heart surgery Describe how you treat a stable tachycardic pt with a wide QRS that is regular (probably v tach with a pulse) - correct answer...If VT or uncertain rhythm, give amiodarone 150 mg IV over 10 minutes. Repeat as needed if VT recurs Also give calcium chloride 1 gram IV Alternative to amiodarone is lidocaine 1-1.5 mg/kg IV every 3-5 minutes for total of 3 doses Prepare for synchronized cardioversion (bc they have a pulse) Consider expert consultation **Lidocaine can cause confusion in older people Describe modes of failure (failure to pace) - correct answer...Occurs when the pacemaker should deliver a pacing impulse but does not **ON ECG TRACING, FAILURE TO PACE IS CHARACTERIZED BY A PROLONGED INTERVAL BETWEEN 2 BEATS THAT EXCEEDS THE TIMING INTERVAL FOR THE LOW RATE LIMIT. Describe modes of failure (failure to sense) - correct answer...Occurs when the pacemaker fires randomly at any point during the cardiac cycle instead of at the indicated or appropriate time **THE PACEMAKER FAILS TO DETECT PREVIOUS ELECTRICAL ACTIVITY, AND THE PACEMAKER FIRES INAPPROPRIATELY. THE ECG TRACING SHOWS RANDOM PACEMAKER SPIKES APPEARING THROUGHOUT THE ECG TRACING. CAN CAUSE VT. CAUSED BY FIROSIS AROUND TIP OF PACING LEAD, BATTERY FAILURE, SENSING SET TOO HIGH, DISLODGEMENT OF ELECTRODE Describe pacemaker spikes - correct answer...When a pacing stimulus is delivered to the heart, a spike (straight vertical line) is seen on the monitor or ECG strip If the electrode is in the ventricle, the spike is in front of the QRS complex If the electrode is in the atrium, the spike is before the P wave If the electrode is in both the atrium and the ventricle, the spike is before both the P wave and QRS complex **The spike should be followed by a P wave indicating atrial depolarization, or a QRS complex indicating ventricular depolarization; this pattern is referred to as "capture", indicating that the pacemaker successfully depolarized, or captured, the chamber Describe pacemakers - correct answer...A temporary or permanent device that provides electrical stimulation and maintains the heart rate when the client's intrinsic pacemaker fails to provide a perfusing rhythm **Ch 10 ECG book Describe permanent pacemakers - correct answer...Pulse generator is internal and surgically implanted in a subcutaneous pocket under the clavicle, over pectoral muscle on patient's non-dominant side The leads are passed transvenously via the cephalic, subclavian, or jugular vein to the endocardium on the right side of the heart (RA and one or both ventricles)