Telemetry & ECG Exam 110 Questions with Verified Answers,100% CORRECT

Telemetry & ECG Exam 110 Questions with Verified Answers Mechanical & Electrical Activity - CORRECT ANSWER - Correlation between the electrical and mechanical functions of the heart - Electrical activity stimulates t ...

Telemetry & ECG Exam 110 Questions with Verified Answers Mechanical & Electrical Activity - CORRECT ANSWER - Correlation between the electrical and mechanical functions of the heart - Electrical activity stimulates the heart to contract - Electrocardiogram (ECG) show both functions - Electrical pulse= action potntial Cardiac Monitoring - CORRECT ANSWER - Used to diagnose dysrhythmias, chamber enlargement, MI/myocardial ischemia, monitor effects of electrolyte imbalances of medication administration - Electrical activity can be monitored by an ECG lead, ambulatory, or telemetry Electrodes in continuous monitoring or telemetry - CORRECT ANSWER - Use 2-4 electrodes - Create an imaginary line (called a lead) that serves a reference point from which the electrical activity is viewed - Lead is like an eye of a camera, it has a narrow peripheral view, looking at only the electrical activity directly in front of it Electrocardiography - CORRECT ANSWER - The end product of which is a electrocardiogram - Can view the electrical impulse that travels through the heart - Each [hase of the cardiac cycle is reflected by specific waveforms on the screen of a cardiac monitor or on a strip of ECG graph paper (so it represents function of the hearts conduction system) ECG can show... - CORRECT ANSWER - Ischemia - Infarction - Enlarged cardiac chambers, electrolyte imbalances - Drug toxicity Placing EKG Electrodes - CORRECT ANSWER - 4th intercostal space to the right of sternum - 4th intercostal space to the left of sternum halfway between v2 & v4 - Left midclavicular line in the 5th ICS - Left anterior axillary line in 5th ICS - Left midaxillary line in the 5th ICS Placing Telemetry Electrodes - CORRECT ANSWER - Place top right (RA), middle right (V), and lower right (RL) - Place top left (LA) and lower left (LL) - Clean skin and clip hair as necessary Conductivity - CORRECT ANSWER Transmit electrical impulses across cell membranes and from cell to cell Contractility - CORRECT ANSWER A/V muscle cells shorten fiber lengths to propel blood forward during contraction Automaticity - CORRECT ANSWER Ability of cardiac cells to initiate an impulse (primary pacemaker cells) Excitability - CORRECT ANSWER Ability to respond to stimulus and then depolarize Refractoriness - CORRECT ANSWER Cells unable to respond to stimulus until recovered from previous stimulus (repolarization) Cells capable of initiating pace of heart - CORRECT ANSWER Although the SA and AV nodes ordinarily initiate the pacing of the heart, all of the cells have the capability of doing so Depolarization - CORRECT ANSWER - Normally negatively charged cells developing a positive charge - Produces mechanical contractions P Wave - CORRECT ANSWER - Atrial depolarization (contraction) - SA node fired PR Interval - CORRECT ANSWER - Beginning of P wave to the end of PR interval - Atrial depolarization - AV delay and travel time to purkinje fivers - 0.12-0.20 - 3-5 little dots QRS Complex - CORRECT ANSWER - Ventricle depolarization (contraction) - Time required for depolarization of both ventricles - 0.04-0.10 ST Segment - CORRECT ANSWER - Early ventricular repolarization - Should not be elevated more than 1 mm (1 line above) - Should not be depressed more than 0.5 mm below (1/2 line below) Elevated ST Segment indicates... - CORRECT ANSWER - MI - Use STEMI or NSTEMI Depressed ST Segment indicates... - CORRECT ANSWER Ischemia QT Interval - CORRECT ANSWER - Ventricular depolarization and repolarization - May be prolonged with some medications & can be a dangerous sign Each box on a telemetry is how many seconds? - CORRECT ANSWER 0.2 Each small line/dot on a telemetry is how many seconds? - CORRECT ANSWER 0.04 Step 1 of Rhythm Strip Analysis - CORRECT ANSWER - Determine regularity of R waves - Determine underlying rhythm (regular or irregular) - "March it Across) or calipers Step 2 of Rhythm Strip Analysis - CORRECT ANSWER Calculate the ventricular rate Ways to calculate ventricular rate - CORRECT ANSWER - 6 second method - Rule of 1500's 6 Second Method - CORRECT ANSWER - Used with regular and irregular rhythms - Get a 6 second strip and could the number of R waves (the whole QRS must fit) - Multiply this number by 10 Rule of 1500's - CORRECT ANSWER - *Only used for regular rhythms* - Count the # of small squares between 2 consecutive R waves and divide the number into 1500 Step 3 of Rhythm Strip Analysis - CORRECT ANSWER - Assess the P waves - Present? - 1 P for every QRS (1:1) - Are they all the same? Step 4 of Rhythm Strip Analysis - CORRECT ANSWER - Measure of the PR interval - Normal is 0.12-0.20 seconds - Consistent? - Pattern? Step 5 of Rhythm Strip Analysis - CORRECT ANSWER - Measures the QRS complex - Normal is less than 0.12 seconds - Are they all the same? Normal Sinus Rhythm - CORRECT ANSWER - Heart rate of 60-100 bpm - Regular Rhythm - Pwave before each QRS and are identical - PR interval is 0.12-.20 - QRS is less than .12 Cardiac Dysrhythmias - CORRECT ANSWER - Heartbeat disturbances (beat formation and/or conduction) - Dysrhythmia and arrhythmia are used interchangeably - However, in reality, dysrhythmia means abnormal where as arrhythmia means absent Dysrhythmia Classification - CORRECT ANSWER - Classified by site of origin - SA node, Atrial, AV node, or ventricular Causes of Dysrhythmias can be related to.. - CORRECT ANSWER - Cardiac - Pulmonic - Other (disease-related, meds, lifestyle, etc.) Common causes of Dysrhythmia - CORRECT ANSWER - HF - MI - Conduction defects - Caffeine - Electric shock - Electrolyte imbalances (K+) - Hypoxia - Acidosis - Hypoglycemia - Hypothermia - Clots - Trauma Dangers of Dysrhythmias - CORRECT ANSWER - Potential for progression (benign or life threatening) - Hemodynamic status impact (what's it doing to cardiac output, HR X SV) - Blood clots What is a life threatening Dysrhythmia? - CORRECT ANSWER - If decreased cardiac output and ineffective tissue perfusion - Sometimes symptoms of dysrhythmias in the older adult may be present only with increased activity Treatments of Each Dysrhythmia - CORRECT ANSWER - Continued monitoring - Pacemaker - Cardioversion - Defibrilation - Meds What should you do for a new dysrhytmia? - CORRECT ANSWER - Check both the pulse and the blood pressure to determine if the pt is tolerating the rhythm - Some patients lead perfectly normal lives with abnormal rhythms Meds for Dysrhythmias - CORRECT ANSWER - amiodarone - adenosine - atropine - epinephrine - dofetilide - coumadin - diliazem - sotalol Electrolytes to Consider - CORRECT ANSWER - Potassium - Sodium - Calcium - Magnesium Findings in Sinus Tachycardia - CORRECT ANSWER - >100 bpm - Regular rhythm - P Wave identical and before each QRS interval - PR interval .12-.20 - QRS interval <.12 seconds Sinus Tachycardia - CORRECT ANSWER - Normal in children and infants, but not in adults - May be compensatory response to a decreased CO or BP - Coronary artery blood flow occurs during diastole and the shorter the diastolic time, the less coronary artery perfusion time, thus sustained high rates decrease coronary perfusion time and can Causes of Sinus Tachycardia - CORRECT ANSWER - Anxiety - Pain - Fever - Anemia - Meds Dangers of Sinus Tachycardia - CORRECT ANSWER - fatigue - weakness - SOB (orthopnea) - JVD - decreased O2 sat - decreased BP Treatment of Sinus Tachycardia - CORRECT ANSWER - Identify cause and treat it - These indicate the patient is decompensating and not tolerating the increased heart rate - Goal is to return heart rate to normal Findings in Sinus Bradycardia - CORRECT ANSWER - <60 BPM - Regular rhythm - P wave identical before each QRS code - PR interval .12-.20 seconds - QRS <.12 seconds Causes of Sinus Bradycardia - CORRECT ANSWER - Parasympahetic nervous system dominance with excessive vagal stimulation (valsalva maneuver stimulates the vagus nerve which slows down the heart) - Hypoxia, MI, beta blockers, calcium channel blockers, sick sinus syndrome (sinus node worn out need to put in pace maker), and atheletes Dangers of Sinus Bradycardia - CORRECT ANSWER May lead to myocardial ischemia, which can lead to an MI or HF Symptoms of Sinus Bradycardia - CORRECT ANSWER - Restlessness - Anxiety - Dizziness - Dyspnea - Weakness - Hypotension - Pale, cool skin - If there are no symptoms, then we don't treat this Treatment of Sinus Bradycardia - CORRECT ANSWER - atropine - Bolus of fluid - Pacemaker placement - Beta blockers blocks response to sympathetic nervous system if heart rate low may hold medication for the day - If a pt is on a beta blocker, has a low pulse, and is often dizzy or weak, we may need to adjust the dosage Atropine - CORRECT ANSWER - Cholinergic blocking effects on the heart - Effects smooth muscles of bronchi and intestines - May be used for sinus bradycardia - Increases heart rate - Basically, this speeds up the heart so we can get better cardiac output Atrial Fibrillation - CORRECT ANSWER - Most common dysrhythmia in the US - SA node is firing but there are other areas of the myocardium that are firing - Seen with clotting in the atrium, stokes, heart attacks, heart failure, post MI - Irregular pulse harder to feel - Controlled vs uncontrolled Causes of atrial fibrillation - CORRECT ANSWER - MI - HF - Rheumatic heart disease - Post bypass surgery - Old age What does the tele look like in atrial fibrilation? - CORRECT ANSWER - R to R is irregular - No p waves - PR interval is absent - QRS is normal - Multiple, rapid impulses from many atrial foci - Atrial depolarization is disorganized and chaotic - No atrial contraction with some impulses getting through for irregular ventricular responses New onset Atrial Fibrillation - CORRECT ANSWER -Fatigue - Weakness - SOB - Anxiety - Syncope - Palpitations - Chest Discomfort Uncontrolled Atrial Fibrillation - CORRECT ANSWER Prevents proper and effective atrial contraction for ventricular filling, thereby decreasing ventricular filling and decreasing CO Dangers of Atrial Fibrillation - CORRECT ANSWER Can lead to formation of multiple thrombi in the cardiac chambers which can be thrown in the circulation and travel to the lungs Treatment of Atrial Fibrillation - CORRECT ANSWER - Aimed to decreasing formation of clots or conversion to NSR - Coumadin, calcium channel blockers - Synchronized cardioversion (synchronized electric shock) (long term atrial fibrillation is not likely to respond to cardioversion) diltiazem (Cardizem) - CORRECT ANSWER - Indicated for temporary control of rapid ventricular response with atrial fibrillation - Also used for PSVT (paroxysmal supra ventricular tachyardia) - Slows conduction - Calcium channel blocker- blocks Ca+ from going across channel and slow down the heart rate - IV drip Warfarin - CORRECT ANSWER - Almost everyone in AFib is on a blood thinner to prevent clots; it's rat poison Normal INR - CORRECT ANSWER 1.0 INR and Coumadin - CORRECT ANSWER 2-3 INR not going to throw clots therapeutic INR dofetilide (Tikosyn) - CORRECT ANSWER - Class III - Indicated for conversion of atrial fibrillation to NSR - Must be initiated in the hospital as can cause serious toxicity - Dosage adjustment needs hospitilization as well Atrial Flutter - CORRECT ANSWER - PICTURE WILL BE ON TEST - CANT SEE A P WAVE- IT LOOKS LIKE A SAWTOOTH - Most of the impulses from the SA node are being blocked at the AV node - Often is a regular rhythm with a "saw tooth" appearance - P waves are called F waves, or flutter waves and the P waves are actually buried in the strip and you can't see them - There are a lot of atrial contractions Causes of Atrial Flutter - CORRECT ANSWER - Rheumatic heart disease - HF - AV valvular problems - Post op bypass surgery Dangers of Atrial Flutter - CORRECT ANSWER - Only if patient is symptomatic - verapamil and cardioversion are used for treatment Paroxysmal Supraventrical Tachycardia (PSVT) - CORRECT ANSWER - COME AND GO SPONTANEOUSLY (Paroxysmal) - Rate of 170-280 - QRS is normal because the impulse is generated above the ventricles - Above the ventricles Causes of PSVT - CORRECT ANSWER - Thyroid disease - Cocaine - Heart failure - PE - Pneumonia Dangers of PSVT - CORRECT ANSWER - Decrease CO dramatically Treatment of PSVT - CORRECT ANSWER - Calcium channel blocker IV push - EP Study done - Try vagal maneuver- bear down to stimulate sympathetic nervous system EP Study - CORRECT ANSWER - Electrophysiological study is done to performed to determine the area of the heart causing the dysrhythmia - Ablation of the area is possible to destroy cause adenosine (Adenocard) - CORRECT ANSWER - Slows conduction time through the AV node (slows rapid heart rate, patient flat lines and gets their SA node working again) - Useful when verapamil has failed to convert - IV - Causes asystole for a period of seconds - Very short half life of less than 10 seconds Heart Blocks - CORRECT ANSWER - Electrical impulse is blocked at the AV node - 1st, 2nd, and 3rd degree blocks - PR interval is not consistent - May be benign or need to be treated Premature Atrial Contraction (PAC) - CORRECT ANSWER - Early beats that occur when a cardiac cell other than the SA node or AV node fires before another beat is expected - This cardiac cell is irritable and fires on impulse - May be symptomatic or not - Will have a P wave that is differently shaped from the normal P wave - Too many could be a forewarning of lethal arrhythmia (V tach or V fib) Cause of PAC - CORRECT ANSWER - Stress - Infection - Caffeine - Nicotine - Could be a precursor to atrial fibrillation if there are a lot of them PAC Characteristics - CORRECT ANSWER - Have a wide characteristic QRS which is very distinctive - It is wide because the impulse is originating in the ventricles - Common in older folks, post MI, HF, caffeine ingestion, or hypokalemia Treatment of PAC - CORRECT ANSWER - May not need treatment - Lidocaine suppresses the irritability Premature Ventricular Contraction (PVC) - CORRECT ANSWER - When the heart skips a beat - Different types: Bigeminal, multifocal, and triplet Bigeminal PVC - CORRECT ANSWER Seen in every other one Multifocal PVC - CORRECT ANSWER Seen in different areas of ventricles Triplet PVC - CORRECT ANSWER Occur in groups of three Ventricular Tachycardia (V Tach) - CORRECT ANSWER - "Lethal" arrhythmia - Repetitive firing of an irritated ventricular ectopic focus - Regular rhythm and a rapid rate - Only able to determine ventricular rate - Wide complexes - No P waves - Often seen before pt goes into v fib - CO drops because of the shortened ventricular firing time and loss of atrial kick Causes of V tach - CORRECT ANSWER - MI - Heart Disease - K+ imbalance - Digoxin Toxicity What do you do when there is V tach with no pulse? - CORRECT ANSWER defibrillation Treatment of Vtach - CORRECT ANSWER - Epinephrine - Amiodarone - Magnesium Ventricular Fibrillation - CORRECT ANSWER - HR 200-600 - Extremely irregular rhythm - No P wave - Fibrillatory baseline QRS - No discernable P-QRS-T complex - No coronary, cerebral, or system perfusion Causes of Ventricular Fibrillation - CORRECT ANSWER - Full cardiac arrest - Chaotic electrical activity - Happens with MI, potassium, and magnesium abnormalities - Rapidly fatal 3-5 minutes if no treatment Treatment for Ventricular Fibrillation - CORRECT ANSWER - CPR - *Defibrillation* - Epinephrine - Amiodarone - *Magnesium* amiodarone (Cordarone) - CORRECT ANSWER - Prolong the myocardial action potential - Used in patients who have had an episode of V-tach in the past - Adverse side effects: fatigue, abnormal liver function test, hypo or hyperthyroidism, photosensitivity (Pulmonary toxicity can lead to pulmonary fibrosis; progressive dyspnea and cough, damage to the alveoli) - Blocks alpha and beta adrenergic receptors of the SNS - Take with food if GI upset sotalol - CORRECT ANSWER - Another potent antidysrhythmic that works the same way as amiodarone (Cordarone) What is one of the most effective drugs for managing sustained V tach or V fib? - CORRECT ANSWER amiodarone (Cordarone) - May also be used for afib that is refractory to other treatment Why does amiodarone effect the thyroid? - CORRECT ANSWER It has iodine sotalol (Betapace) - CORRECT ANSWER - Indicated for life threatening v tach or v fib or A fib or A flutter resistant to other drug therapy - Also exerts beta blocker effects on the conduction system (slows the heart rate) Epinephrine - CORRECT ANSWER - Vasoactive catecholamine - Acts directly on both of the alpha and beta adrenergic receptors - Raises blood pressure - Increases force of contraction and heart rate - Onset of action: less than 2 minutes - Half life: Less than 5 minutes - Duration: 5-30 minutes Adverse Effects of Antidysrhythmic Drugs - CORRECT ANSWER - Hypotension - Bradycardia - Dizziness - Dyspnea - Weakness Implementation of Antidysthythmics - CORRECT ANSWER - Monitor VS - Monitor telementry - Monitor: angina, dizziness, diarrhea, GI upset, and constipation Cardioversion vs Defibrillation - CORRECT ANSWER Cardioversion is elective and defibrillation if emergent Cardioversion - CORRECT ANSWER - Delivery of electric shock to terminate a disturbance in the rhythm - It is synchronized to the QRS complex because if it lands on the T wave, it could put the patient into vfib - Done for a fib - May do a TEE to make sure there are no clots in the atrium which could be discharged into the vascular system - Pt must be on anticoagulated for 4-6 prior to cardioversion to prevent dislodgement of thrombi - Pts are sedated and all staff must be away from shock - Active the synchronizer putton - Defibrillate if pt goes into vfib - Monitor pt for postprocedure rhythm, number of cardioversion attempts, client's condition and state of consciousness and skin condition under the electrodes Defibrillation - CORRECT ANSWER - Stops all electrical activity, allowing the SA node to take over and reestablish a perfusing rhythm Pacemakers - CORRECT ANSWER - Battery-operated device that electrically stimulates the heart when the natural pacemaker of the heart fails to maintain an acceptable rhythm - Wires from the pulse generator (which also houses the battery) attach to the myocardial muscle - Temporary: Often used during and immediately following open heart surgery - Demand pacer: Sense's client's own beats and impulse is generated if the rate gets too low - Teach pt how to check pulse, follow up care, and avoidance of MRI ICD - CORRECT ANSWER - Implantable cardioverter defibrillator - Sit down Pacemakers and ICD - CORRECT ANSWER - Function: Sick sinus syndrome (SSS) (is a group of dysrhythmias presumably caused by a malfunction of the sinus node, the heart's primary pacemaker) - Telemetry: Pacer spikes & Capture Care of the patient when a pacemaker is inserted - CORRECT ANSWER - Monitor the site for redness, swelling, and drainage just like any other surgical incision Asystole - CORRECT ANSWER - Ventricular standstill - Complete absence of any rhythm - No electrical impulses, depolarization, CO, pulse, or BP - Full cardiac arrest Pulseless Electrical Activity (PEA) - CORRECT ANSWER - There is still some electrical activity but no cardiac output - Treat the cause - Give Epi - No defibrillation What could be a cause could show v fib that's not actually v fib? - CORRECT ANSWER - Artifact - Disconnected lead - Patient movement - Electrical interference What would show a massive T wave? - CORRECT ANSWER MI What would be an inverted T wave? - CORRECT ANSWER - Ischemia precursor to an MI