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Dysrhythmia (question and answer) 2023, Exams of Nursing

Dysrhythmia (question and answer) 2023

Typology: Exams

2022/2023

Available from 07/10/2023

yerisamson
yerisamson 🇺🇸

41 documents

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1.
Atrial Flutter. Note the sawtooth baseline, no definable P wave.
Treatment: Correct any metabolic derangement or electrolyte imbalance then use
Antidsyrhythmics. Usually Amiodarone, Digoxin, beta blocker (Metoprolol, Toprol) or calcium
channel blocker (Diltiazem, Cardizem) for rate control and control of the aberrant atrial impulse.
If severely elevated and symptomatic may need synchronized cardioversion.
Rememberall atrial flutter and atrial fibrillation patients must be anticoagulated to prevent
throwing a clot when they go back into regular rhythm. This means Heparin, Coumadin and/or
antiplatelet like Aspirin and Clopidogrel (Plavix).
2.
Supraventricular tachycardia (SVT). Rate >200
Treatment: Attempt Valsalva maneuver usually once. Then Adenosine 6mg IV slow push.
Adenosine WILL CAUSE ASYSTOLE briefly. Half life is 10 seconds. If no response after first dose,
may repeat with Adenosine 12mg IV slow push. Again, asystole. Monitor closely.
3.
Atrial Fibrillation (afib). No P wave, irregular rate.
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Treatment: same as atrial flutter.

Sinus bradycardia. Rate 40 Treatment: if symptomatic, Atropine 0.5mg IV push. May repeat up to a total dose of 3mg. If atropine fails to increase the rate, you will then proceed on to transcutaneous pacing and the patient will likely need to have a permanent pacemaker placed.

Sinus Tachycardia. P, QRS all normal. Rate 120 Treatment: address underlying cause if new. Usually dehydration, stress, pain, blood loss, fever, etc. If symptomatic, can treat with IV beta blocker (Metoprolol, Toprol) or IV calcium channel blocker (Diltiazem, Cardizem)

Premature Atrial Complex (PAC), (if the irregularity is before the QRS it’s an atrial problem)

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Ventricular Tachycardia (Vtach). Wide QRS complexes on top of each other. Treatment: Check pulse, start CPR, perform defibrillation.

First degree heart block. Note how long the PR interval is (distance between the P and the QRS). There’s the block/conduction delay. Treatment: correct underlying metabolic issue, stop QT prolonging agents or pro-dysrhythmics.

Second degree heart block type 1. (Wenkebach)…increasing length of the PR interval leading to a dropped beat. (longer, longer, longer, drop then you have a Wenkebach!) Treatment: correct underlying metabolic issues, stop QT prolonging agents or prodysrhythmics. If symptomatic may need antidysrhythmic such as Digoxin or amiodarone. If slow rate, may need IV atropine or transvenous or transcutaneous pacemaker with long-term pacemaker placement.

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Second degree heart block type 2. P’s without partners. Most are paired but a few are solo. Treatment: Correct underlying metabolic issues. Treatment for a Mobitz type II involves initiating pacing as soon as this rhythm is identified. Type II blocks imply structural damage to the AV conduction system. This rhythm often deteriorates into complete heart block. These patients require transvenous pacing until a permanent pacemaker is placed

3 rd^ degree heart block. P’s are independent of any QRS complex and the ventricular rate is slow. Treatment: IV atropine to attempt to improve rate but only after patient has transcutaneous pacing pads placed in case it fails. Transcutaneous pacing is the treatment of choice for any symptomatic patient. All patients who have third-degree atrioventricular (AV) block (complete heart block) associated with repeated pauses, an inadequate escape rhythm, or a block below the AV node (AVN) should be stabilized with temporary pacing

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