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J. Tucker, RN, MSN/Ed Dysrhythmia Study Guide Nur1229 STUDY GUIDE – DYSRHYTHMIAS WELCOME TO EKG WORLD!!! This information is fun and easy to learn, but you must come to class prepared! This study guide should help you focus your reading so I am making it required. I will be collecting them at the beginning of class. READING ASSIGNMENT Chapter 26 in Brunner – under Types of Dysrhythmias Normal sinus rhythm Sinus bradycardia Sinus tachycardia Atrial fibrillation Premature ventricular complexes Ventricular tachycardia Ventricular fibrillation Ventricular Asystole Third-degree atrioventricular block Chapter 26 in Brunner – under Adjunctive Modalities Cardioversion and Defibrillation Pacemaker therapy o Design and types o Complications of pacemaker use Implantable Cardioverter Defibrillator o Nursing management o Chart 26-2 GLOSSARY – STUDY QUESTIONS How are dysrhythmias diagnosed? Explain the normal electrical conduction in the heart. 1 How does the sympathetic nervous system affect the cardiovascular system? How does the parasympathetic nervous system affect the cardiovascular system? What is an electrocardiogram? What are the different types of an ECG? J. Tucker, RN, MSN/Ed Dysrhythmia Study Guide Nur1229 Why is it important to analyze an ECG waveform? What is measured on the horizontal axis of an ECG? What is measured on the vertical axis of an ECG? What is a positive deflection on an ECG waveform? What is a negative defection on an ECG waveform? P waves o What does a P wave represent? o What do they look like? QRS complex o What does the QRS complex represent? o Do all QRS complexes have all three waveforms? o What is the first negative deflection after the P wave? o What is the first positive deflection after the P wave? o What is the first negative deflection after the R wave? o How is it measured? o What is the normal range? T wave o What does it represent? o What does it follow? U wave o What does it represent? o What other circumstances might make the U wave visible on an ECG waveform? o What does it follow? o What does it look like in relation to the P wave? ST segment o What does it represent? o When does it start and end? o Is the ST segment isoelectric? What does this mean? o What does it indicate if the ST segment is not isoelectric? Determining the heart rate on an ECG o R to R method (define) o 6 second method (define) 2 J. Tucker, RN, MSN/Ed Dysrhythmia Study Guide Nur1229 Determining the heart rhythm on an ECG o Regular (describe) o Irregular (describe) Analyzing the ECG o Chart 27-2 (review) What does the nurse need to assess when caring for a client with a dysrhythmia? What are the nursing interventions for a client with a dysrhythmia? When would a pacemaker be indicated? What are two types of pacemakers? What is the most common complication after pacemaker insertion? o 3 How would the nurse know this complication was occurring? What other complications can occur? Why are cardioversion and defibrillation used? What type of dysrhythmia indicates the need for these? What are two differences between cardioversion and defibrillation? What are two safety measures that need to be observed when cardioverting or defibrillating a client? Cardioversion o What is cardioversion? o o What is the defibrillator set to? What does the synchronized mode prevent? o Why is the T wave called the “vulnerable period”? J. Tucker, RN, MSN/Ed Dysrhythmia Study Guide Nur1229 o Defibrillation o When is defibrillation performed? For what type of dysrhythmia? o o 4 What are the nursing assessments and interventions when a client is being cardioverted? How many times do you defibrillate a client? What should happen if defibrillation is unsuccessful? What is an implantable Cardioverter/defibrillator (ICD)? What type of dysrhythmia are ICDs used for? What complications can occur following ICD insertion? What are the nursing interventions following an ICD insertion? What does the nurse need to teach the client following ICD insertion? J. Tucker, RN, MSN/Ed Dysrhythmia Study Guide Nur1229 TEST YOUR KNOWLEDGE AND FILL IN THE BLANKS Electrical stimulation is called _________________________________. Mechanical contraction is called________________________________. Electrical relaxation is called____________________________________. Mechanical relaxation is called__________________________________. Depolarization is to _____________________ as _______________________ is to diastole. NORMAL ELECTRICAL CONDUCTION The electrical impulse originates in the ________________ which is located in the _______________. The normal rate ranges from __________ to _______________ times a minute in the adult. The electrical impulse then travels through the _______________ to the _________________. This electrical stimulation of the muscle cells cause ______________ ______________. The electrical impulse then travels quickly through the ventricular muscle through the _________________ ___ __________________, to the right and left _____________________ _____________________, and the _______________ fibers. This electrical stimulation of the muscle cells cause _______________ ______________. 5