Chapter 8
HEART BLOCK DYSRYTHMIAS
Which of the following statements best describes 1st� heart block?
The electrical current is delayed or blocked a long normal conduction pathway is at or about the AV junction
What is the cause of a heart block dysrhythmia?
The electrical current has difficulty traveling down to normal conduction pathway
Which of the following statements best describes 1st� heart block
The electrical current is delayed or blocked along a normal conduction pathway at or above the AV junction
Which heart block rhythm has a CONSTANT PR interval that measures greater than 0.20 second?
First-degree AV block
Which heart block has regular P-P, R-R intervals that BOTH occur at the SAME rate?
First Degree heart block
The observation guidelines used to assess the blood supply to the viral organs of the body to maintain normal function are called:
Cardiac output parameters
What symptom would you observe in a patient with first degree AV block?
The patient should have NORMAL cardiac output and NO symptom
An impulse that occurs too soon after the preceding impulse, causing a period when no other impulses can occur on the VENTRICLES, is known as:
Blocked or non-conductive impulse
Which heart blocks are the only blocks with an irregular VENTRICULAR response?
Second heart blocks
Which of the following heart block dysrhythmia is identified by repetitious prolonging PR interval pattern after each blocked QRS complex?
Second degree heart block type 1
Which of the following is a characteristic of P-P intervals in all heart block dysrhythmia?
Regular
Second degree heart block type one is usually due to
Inflammation around the AV node
Frequent NONconducted QRS complexes I'll likely to cause sign of
Low cardiac output
With second degree AV block type 1
Not all of the P waves are followed by a QRS complex. P-P regular and R-R irregular
Which heart block dysrhythmia is known as "classical heart block"?
second degree AV block, type type 2
Which of the following heart block dysrhythmia is identified by missing QRS complexes and a consistent PR interval of measurement?
Second degree AV block, type 2
With second-degree AV block, type two
The PV's are all the same
Which of the following rhythm has a constant PR interval for all conducted beats?
Second - degree AV block type 2
Which type of heart block tends to progress quickly to third degree AV block or complete heart block?
Second - degree AV block type two
How do you distinguish between 2nd degree AV block type one and type two?
With type two, the PR intervals are constant
Which heart block dysrhythmia is highly unstable and considered a critical condition?
Second - degree AV block type two
FW report the second - degree AV block type two to a licensed practitioner you should prepare for
A code blue situation and application of a temporary pacemaker
When do you use the mnemotic "Lengthen, Lenthen, drop equals Wenckebsck"?
To determine the difference between a Second - degree type one or type two heart block.
Which heart block dysrhythmia is known as complete heart block (CHB)?
3rd degree AV block
Which of the following heart block dysrhythmias is identified by regular P-P and R-R intervals that are firing at two this distinctly different rate?
3rd� AV block
In which heart block dysrhythmia would be patient probably be unconscious and require immediate medical intervention
3rd� AV block
QRS complexes I measure 0.12 second or greater with a rate between 20 to 40 BPM indicate that there impulses causing ventricular depolarization are coming from the?
Purkinje fibers
That condition in which the atria and ventricles are electrically separated from one another is often referred to as
AV dissociation
1st� heart block, 2nd� heart block type one and two, and 3rd� AV block rates
1st�, second-degree type one and two are 60 to 100 BPM, except 3rd�, which is 20 to 40 BPM
Your responsibilities to care for a patient with complete heart block include
Observing the patient for symptom of low cardiac output, reporting any signs and symptoms to the licensed practitioner, initiating emergency procedures if needed.
In which heart block dysrhythmia are all electrical and impulses originating above the ventricles blocked and prevented from reaching the ventricles?
3rd degree AV block
With first degree heart block
The PR intervals are greater than 0.20 seconds in duration
In which of the heart block dysrhythmia are there more P waves than QRS complexes?
All type of heart blocks, except 1st� heart block
In 30� AV block if the impulse causing ventricular depot relation is coming from baby Junction the rate will be
60 to 100 bpm
What indicates whether the heart block is low, in the bundle of His, or higher, in the area of the AV tissue?
The ventricular rate and QRS configurations
Which heart block dysrhythmia has a PR interval that gets progressively longer until the QRS is dropped, and after the blocked beat, the cycle starts again?
2nd� AV block type one
What is the heart rate range for 1st� heart block
60 to 100 bpm
Who first discovered the two different types of second degree heart block?
Dr. Woldemar Mobitz
CHAPTER 9
RHYTHMS ORIGINATING FROM THE VENTRICLES
The ventricle pacemaker cells are found at;
The purkinje fibers
The inherence rate of the purkinje network is
20 to 40 beats per minute
In all ventricular dysrhythmias, P-P intervals are
Missing
QRS complexes that measures 0.12 second or greater with a rate between 20 to 40 bpm indicate that the impulses causing ventricular depolarization are coming from the
Purkinje fibers
Ventricular rhythms occurring within the range of purkinje fibers are referred to as
Ventricular escape rhythms
Ventricular rhythms occur because
Higher pacemaker sites within the heart have failed, the rate of automaticity from this portion of the heart is faster, this portion of the heart takes over the primary pacemaker within the heart
Which of the following is correct statement about premature ventricular complexes or PVCs?
PVCs maybe unifocal or multifocal in origin
Which of the following is caused by etopic impulse that occurs early in the cycle and originates from the ventricles?
PVC
PVCs can occur due to hypoxic states. What must be done to determine what is causing a patient's PVCs?
Draw blood sample to evaluate a hypoxic state
Isystole, ventricular fibrillation, and ventricular tachycardia are found in patient requiring immediate emergency intervention EXCEPT
Prematurely Ventricular contraction PVC
What are PVCs that occur in varied shapes and forms called?
Multifocal
PVCs that have an early complex and have a similar shape, suggesting that only one irritable focus is present, is called
Unifocal PVCs
PVCs that occurred doing the normal R-R interval without interrupting the normal cycle are known as
Interpolated
A PVC that occurs on the T wave for doing the vilnerable read off the ventricle refreactory period is called
R on T PVC
To PVCs back to back or called
coupling
More than 6 to 7 PVCs Per minute are called
Frequent PVCs
What is the cause of agonal rhythms?
Failure off all pacemakers of the heart
Which ventricular dysrhythmias has a heart rate less than 20 bpm?
Agonal
Which ventricular dysrhythmia has a heart rate between 20 and 40 bpm
Idioventricular rhythm
What is the primary difference between idioventricular rhythm and accelerated idioventricular rhythm ?
The heart rate
What is the heart rate for accelerated idioventricular rhythm?
40 to 100 bpm
Agonal rhythm rate
Less than 20 bpm
Idioventricular rhythm rate
22 to 40 bpm
Celebrated idioventricular rhythm
42 to 100 bpm
Ventricular fibrillation rate
Atrial and ventricular rates cannot be determined or identified
Which ventricular dysrhythmias occurs when three or more PVCs occur in a row and the ventricular rate is greater than 100 bpm?
Ventricular tachycardia
Should you do if you recognize ventricular tachycardia on the ECG monitor?
Notify a licensed practitioner immediately, initiate emergency protocol if the patient is unresponsive, save the rhythm strips to document the changes in rhythm
What percentage of patients with ventricular tachycardia become unconscious immediately?
50%
Ventricular fibrillation is typically described as
chaotic
Every patient experiencing ventricular fibrillation will be
Unconscious, apneic, and pulseless
Your patient is talking, he or she is not in ventricular fibrillation. What could be causing what appears to be ventricular fibrillation on a monitor?
Poorly attach or dried out electrodes, broken lead wires, excessive patient movement.
What is the difference between ventricular tachycardia and ventricular fibrillation?
Ventricular tachycardia has three or more PVCs and rate is greater than 100 bpm; ventricular fibrillation has no P wave and an early QRS complex that is wife and bizarre in appearance
Which ventricular dysrhythmias is often called "The straight of flatline" of rhythm?
Asystole
How are agonal rhythm and asystole rhythm the SAME?
Both have an absence P waves,
In both rhythms the patient will be unconscious,
Both rhythms a life-threatening and require basic and advanced life support
What symptom would a patient in asystole exhibit?
Unconsciousness and apnea
Apnea is the absence of
Breathing
What factors are important regarding crash carts?
The crash cart must be nearby and ready to go, the crash cart must be well-stocked with emergency supplies, their emergency equipment on the crash cart must be functioning properly
In which ventricular dysrhythmia are the ventricle walls quivering preventing any movement of blood out of the ventricles, resulting in no cardiac out put?
Ventricular fibrillation
The fastest electrical activity in the heart controls heart rate
True
Ventricular complexes and rhythms share a conspicuous morphologic similarity, normal P waves, and normal or wide QRS complexes.
False
PVCs called "escape beats," often occur when the heart rate is less than 60 bpm. This is the heart's effort to pick up the rate
True
Asystole must always be confirmed in at least one lead to rule out any other dysrhythmias
False
P-P intervals are a constant in all ventricular dysrhythmia
False
Some patients may complaint of " thumping or skipping" sensation with each PVC.
True
In Ventricular fibrillation, the ventricles are essentially in a continuous contraction-relaxation patterns, and no period of delay exists between depolarization.
True
With ventricular fibrillation, the entire myocardium is quivering similar to a bowl of Jell-O when shaken
True
Ventricular fibrillation is always a CODE BLUE situation
True
Doing an emergency, family, friends and other patients with me apprehensive curious regarding the situation. You should calmly explain that there is emergency and escort individuals out of the immediate area
True
Agonal rhythm is considered the last semblance of ordered electrical activity in a heart
True
Analysis of the P wave is particularly important with an agonal rhythm
False
Idioventricular rhythm occurs when those sinoatrial and junctional pacemakers failed to initiate an impulse
True
In idioventricular rhythms, the R-R interval is irregular
False
Atrial rate cannot be determined in Idioventricular rhythm's because of the absence of atrial the deporalization
True
Accelerated idioventricular rhythm is simply a faster Idioventricular rhythm
True
Due to the speed of accelerated idioventricular rhythm, the QRS complexes in this rhythm do not have the classic ventricular "wide and bizarre" appearance.
False
CHAPTER 10
Pacemaker Rhythms and Bundle Branch Block
When is a ventricular pacemaker used?
When conduction in the ventricles is not working properly, to stimulate the ventricles to contract
What is atrial pacemaker used alone?
When the conduction system from the AV node through the VENTRICLES is intact and functioning
What is the advantage of Atrioventricular ventricular pacing?
It mimics the normal cardiac conduction system and allows the atria to contract completely the prior to VENTRICLES To allow for an ATRIAL kick
What portion of the heart do electronic peacemakers mimic?
SA node
If the electronic pacemaker a set to 72 bpm and AV node is firing at 58 bpm, what is the patient's heart rate?
72 bpm
What type of pacemaker is used for patients with heart failure?
Atriobiventricular pacemaker
What terms refers to the ability of the heart muscles to respond to electrical stimulation and depolarize the myocardial tissue
Capture
Which term indicates the mark of an ECG tracing that represents the stimulation of electrical current from the pacemaker generator?
Pacing spike
Which pacemaker rhythm has a pacing spike before P waves?
Atrial pacemaker rhythm
Which pacemaker rhythm has a pacing spike before QRS complexes?
Ventricular pacemaker rhythm
Which of the following is not one of the components to be evaluated on the pacemaker tracing?
The QT interval
If the patient is experiencing hypertension, lightheadedness, black out, and bradycardia, what pacemaker complication may be occurring?
Malfunctioning
Which pacemaker complication shows a pacing Spike, but no waveform immediately following it?
Loss of capture
The pacemaker a complication in which the pacemaker perceives electrical current from sources other than the heart is:
Oversensing
What pacemaker complications occurs when the pacemaker does not sense the patient's own inherent rate?
Malsensing
What patient symptoms can occur with Malsensing "failure to sense?
With atrial pacing, ATRIAL fibrillation can occur, with ventricular pacing, ventricular tachycardia or ventricular fibrillation can occur
The steps in evaluating a pacemaker ECG tracing include:
What are the regularity and rate of the pace rhythm?
Is the ATRIAL capture present?
Is appropriate ventricular sensing occurring?
EXCEPT : what is the ratio of a paced beats to own beats in one minute?
What happens when one or both of the Ventricular pathways are not functioning properly due to damage or delay from cardiac disease, drugs, or other condition?
A bundle branch block occurs
What additional patient information is needed on the ECG tracing when a bundle branch block is discovered?
Patient's underlying rhythm
A bundle branch block must be considered when the QRS complex measured:
0.12 second or greater
If the dysrhythmia is one that originates from above the ventricles and you notice of wide QRS complex, which rhythm could this be?
Bundle branch block
How is a right bundle branch block RBBB distinguished from a left bundle branch block LBBB?
Lead V1 is referenced in the QRS is positively deflected, it is a RBBB; The QRS is negative, it is a LBBB
Bundle branch block rhythm often has similarities to a sinus complex, with the distinguishing criteria of:
QRS duration greater than 0.12 second
You observe a wide QRS complexes in lead 2. Which lead should you check to evaluate the location of the bundle branch block?
Lead V1
Atrioventricular pacing is similar to what characteristics of the heart?
Normal conduction pathway
What provides the extra blood supply needed for 10% to 30% of the normal cardiac output?
ATRIAL kick
What factor on a pacemaker tracing is similar to the measurement of the PR interval on a normal rhythm Tracing ?
Atrioventricular delay
The patient's own heart rhythm is known as:
Inherent rhythm
Appearance of the QRS complex after the pacing spike indicates what has occurred?
Ventricular capture
Complications of the pacemaker may include:
Slow firing than set, less effective sensing capabilities, lowell electrical current than determined
Which term indicates when the electrical current is sent from the pacemaker generator to the myocardium to cause depolarization of the myocardial tissue?
Chicken
Triggered
Electronic pacemakers function and are affective based upon the principle of that
The fastest pacemaker of the heart will control the heart rate.
When the pacemaker delivers ventricular pacing, the pacing spike will be followed by a wide QRS complex, which looks similar to:
Left bundle branch block
Pacemaker generators use what type of batteries to create the electrical Im impulses?
Lithium
What measurement on the ECG tracing represents how long it takes for the current to travel through the ventricular myocardial tissue?
QRS duration
Bundle branch block
Is a disorder in which one or both of The bundle branches fail to conduct impulses
With bundle branch block, patient will exhibit the normal effects of the basic underlying with them they are experiencing
Truep
Bundle branch blocks can be life-threatening
False
Every ATRIAL spike should have a P wave after it to indicate that do you electrical current is causing the cells to depolarize
True
The pacemakers electrical current can be dangerous to you or other people who encountered the patient. Use caution around the pacemaker site.
False
Pacemakers are sometimes temporary but are usually implanted under the skin to correct this w this year with Mears
True
A characteristic of a normal pace maker with them is a pacing Spike, with a P wave or wide QRS complex or both appearing on the tracing
True
The regularity of the pacemaker spikes should not be the same
False
Responsibility in caring for patients with pacemakers requires recognizing normal pace maker rhythms and possible complications
True
When the patient has a left bundle branch block, the left conduction pathway is blocked. The current travels down the left bundle branch to cause the left ventricle, septum, then the right ventricle to contract
False
When the patient has a right bundle branch block, the impulse will travel down the conduction pathway normally until after the bundle of His. Since the right side is blocked, the current must travel down the left bundle branch to activate the VENTRICLES.
True
CHAPTER 11
Exercise electrocardiography
A procedure that doesn't require entrance into a body cavity, tissue, or blood vessel is called:
Noninvasive
By what other names or names is electrocardiography known?
Exercise tolerance test
Treadmill stress test
Cardiac stress test
Why might a physician order an exercise electrocardiography for patient?
The patient has symptoms of cardiac problems that do not show up on a resting ECG
How long has exercise electrocardiography has been used?
More than 50 years
During an exercise stress test, what will the patient be asked to do?
Increase the level of exertion as the test progresses
What is obtained at the end of each exercise stage?
Blood pressure reading and a 12 lead ECG
In addition to monitoring the ECG and blood pressure, what else is assessed doing exercise electrocardiography?
Heart rate, oxygen level, physical appearance
What symptoms is the patient asked to report doing exercise electrocardiography?
Chest pain, dizziness, shortness pf breath
Your most important responsibility doing an exercise electrocardiography test this
Why for safety and be prepared for Mergen see
Exercise electrocardiography is used to evaluate
How the heart and blood vessels respond to physical activity
How well the patient's blood pressure is maintained during exercise
The functioning of the heart after a myocardial infarction
Which of the following is not a reason exercise electrocardiography is used?
To evaluate how the heart responds to electrical stimulation
Narrowing of the arteries surrounding the heart that causes a reduction in the blood flow to the heart is
Coronary vascular disease
An oppressive pain or pressure in the chest when the heart muscle does not receive enough oxygen due to partial or complete blockage of a coronary artery is
Angina
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