NURS 424: Exam 2
What are risk factors for dysrhythmias?
- Myocardial infarc on (MI)
- Acid base imbalances/Hypoxia
- Electrolyte imbalances
- Anemia
- Stress
- Anxiety
- Excessive s mulants:
*Caffeine
*Nico ne
What is hemodynamics?
Hemodynamics refers to the study of the forces that aid in circula ng blood throughout the
body
If any of these forces are compromised, the cardiovascular system is affected
How is the hemodynamic status of a client monitored?
- Blood pressure
- Pulse
- Urine output
- Mental status
- Cardiac output
*A devia on from the client's normal values may indicate hemodynamic compromise
What are the immediate concerns with dysrhythmias?
,- Maintaining perfusion
- Fluid/Electrolyte balance
- Prevent clo1ng (coagula on)
What is a pulse deficit?
Apical pulse differs from the radial pulse rate
What does a pulse deficit indicate?
A pulse deficit indicates that the heart is not pumping adequately to achieve op mal
perfusion to the body
An cholinergic:
- Mechanism of ac on
Atropine is an an cholinergic drug that blocks the cholinergic and parasympathe c
s mula on of the heart, resul ng in an increased heart rate
A4er IV bolus infusion, when should the effects of atropine be seen?
The effect should be seen within 1-2 minutes of the IV bolus administra on
What is atropine the first-line drug for?
Symptoma c bradycardia of any origin
What dosage of atropine is typically infused (IV bolus)?
0.5 mg IV boluses repeated every 3-5 minutes to a total dose of 3 mg (six 0.5 mg doses)
*Doses of less than 0.5 mg boluses may further slow down the heart rate and should be
avoided
If IV access is not available, how can atropine be administered?
- Endotracheal tube
- Intraosseous cannula on (into a long bone)
Atropine:
- Side Effects
- Blurred vision
- Mouth dryness
- Urinary reten on
,- Increased intraocular tension
When is an external temporary pacemaker commonly used?
Emergency situa ons for clients with:
- Unstable bradycardia (hemodynamic compromise)
- Second-degree type II AV block (Mobitz II)
- Third-degree AV block (Complete heart block)
U lized as an emergency measure in bradyarrhythmias with no response to medica ons,
such as:
- Atropine
- Epinephrine
In external temporary pacing/transcutaneous pacing, where are the pacing pads placed on
the client?
- Anterior (-): Placed le4 of sternum
- Posterior (+):
*Le4 of the thoracic spine, opposite the anterior pad
*Along the le4 axilla near the boAom of the rib cage
What does electrical capture indicate?
Electrical capture indicates that the electrical impulse from the pacemaker successfully
caused depolariza on so that on the ECG:
a.) The pace spike is followed by a QRS complex
b.) The QRS complex is wide
c.) The t-wave is deflected in the opposite direc on of the QRS complex
How is mechanical capture determined?
Mechanical capture is determined by the presence of pulse, indica ng cardiac output
When assessing for mechanical capture, the registered nurse (RN) should auscultate the
client's apical heart beat rather than a distal pulse
In regard to external temporary pacing/transcutaneous pacing, what is the nurse's role?
- Apply the pacer pads
- Analgesics or seda ves should be given as prescribed to provide comfort
- Push the pacer buAon
, - Select synchronous (demand) pacing se1ng
When are permanent pacemakers u lized?
The permanent pacemaker is used to resolve dysrhythmias that are not temporary, such as:
- Third-degree AV block
- Sick sinus syndrome (SSS)
What is the collabora ve care for unstable clients with 2nd-degree AV block Type II?
- Oxygen
- IV access
- 12-lead ECG (confirma on)
- Immediate temporary pacing
- Atropine 0.5 mg IV may be considered while wai ng for the pacer, but its administra on
should not delay temporary pacing
- If temporary pacing is ineffec ve, prepara ons should be made for a permanent
pacemaker, and expert consulta on should be obtained
What is the collabora ve care for unstable clients with 3rd-degree AV block?
- Oxygen
- IV access
- 12-lead ECG (confirma on)
- Immediate temporary pacing
- Atropine 0.5 mg IV may be given, while awai ng the pacemaker, to a total of 3 mg
- Epinephrine or dopamine infusion may also be considered while awai ng the pacemaker or
if the pacing is ineffec ve
- If temporary pacing is ineffec ve, the nurse should prepare for permanent pacemaker
inser on
What are risk factors for dysrhythmias?
- Myocardial infarc on (MI)
- Acid base imbalances/Hypoxia
- Electrolyte imbalances
- Anemia
- Stress
- Anxiety
- Excessive s mulants:
*Caffeine
*Nico ne
What is hemodynamics?
Hemodynamics refers to the study of the forces that aid in circula ng blood throughout the
body
If any of these forces are compromised, the cardiovascular system is affected
How is the hemodynamic status of a client monitored?
- Blood pressure
- Pulse
- Urine output
- Mental status
- Cardiac output
*A devia on from the client's normal values may indicate hemodynamic compromise
What are the immediate concerns with dysrhythmias?
,- Maintaining perfusion
- Fluid/Electrolyte balance
- Prevent clo1ng (coagula on)
What is a pulse deficit?
Apical pulse differs from the radial pulse rate
What does a pulse deficit indicate?
A pulse deficit indicates that the heart is not pumping adequately to achieve op mal
perfusion to the body
An cholinergic:
- Mechanism of ac on
Atropine is an an cholinergic drug that blocks the cholinergic and parasympathe c
s mula on of the heart, resul ng in an increased heart rate
A4er IV bolus infusion, when should the effects of atropine be seen?
The effect should be seen within 1-2 minutes of the IV bolus administra on
What is atropine the first-line drug for?
Symptoma c bradycardia of any origin
What dosage of atropine is typically infused (IV bolus)?
0.5 mg IV boluses repeated every 3-5 minutes to a total dose of 3 mg (six 0.5 mg doses)
*Doses of less than 0.5 mg boluses may further slow down the heart rate and should be
avoided
If IV access is not available, how can atropine be administered?
- Endotracheal tube
- Intraosseous cannula on (into a long bone)
Atropine:
- Side Effects
- Blurred vision
- Mouth dryness
- Urinary reten on
,- Increased intraocular tension
When is an external temporary pacemaker commonly used?
Emergency situa ons for clients with:
- Unstable bradycardia (hemodynamic compromise)
- Second-degree type II AV block (Mobitz II)
- Third-degree AV block (Complete heart block)
U lized as an emergency measure in bradyarrhythmias with no response to medica ons,
such as:
- Atropine
- Epinephrine
In external temporary pacing/transcutaneous pacing, where are the pacing pads placed on
the client?
- Anterior (-): Placed le4 of sternum
- Posterior (+):
*Le4 of the thoracic spine, opposite the anterior pad
*Along the le4 axilla near the boAom of the rib cage
What does electrical capture indicate?
Electrical capture indicates that the electrical impulse from the pacemaker successfully
caused depolariza on so that on the ECG:
a.) The pace spike is followed by a QRS complex
b.) The QRS complex is wide
c.) The t-wave is deflected in the opposite direc on of the QRS complex
How is mechanical capture determined?
Mechanical capture is determined by the presence of pulse, indica ng cardiac output
When assessing for mechanical capture, the registered nurse (RN) should auscultate the
client's apical heart beat rather than a distal pulse
In regard to external temporary pacing/transcutaneous pacing, what is the nurse's role?
- Apply the pacer pads
- Analgesics or seda ves should be given as prescribed to provide comfort
- Push the pacer buAon
, - Select synchronous (demand) pacing se1ng
When are permanent pacemakers u lized?
The permanent pacemaker is used to resolve dysrhythmias that are not temporary, such as:
- Third-degree AV block
- Sick sinus syndrome (SSS)
What is the collabora ve care for unstable clients with 2nd-degree AV block Type II?
- Oxygen
- IV access
- 12-lead ECG (confirma on)
- Immediate temporary pacing
- Atropine 0.5 mg IV may be considered while wai ng for the pacer, but its administra on
should not delay temporary pacing
- If temporary pacing is ineffec ve, prepara ons should be made for a permanent
pacemaker, and expert consulta on should be obtained
What is the collabora ve care for unstable clients with 3rd-degree AV block?
- Oxygen
- IV access
- 12-lead ECG (confirma on)
- Immediate temporary pacing
- Atropine 0.5 mg IV may be given, while awai ng the pacemaker, to a total of 3 mg
- Epinephrine or dopamine infusion may also be considered while awai ng the pacemaker or
if the pacing is ineffec ve
- If temporary pacing is ineffec ve, the nurse should prepare for permanent pacemaker
inser on
