2017 RN HESI Critical Care Cardiac Exam.docx

When you cardiovert it resets your sa node it doesnt

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If adenosine does not work, you do cardioversion (shock the heart). When you cardiovert, it resets your SA node. It doesn’t matter what dysrhythmia we talk about, pt will have manifestations of decreased cardiac output. Whatever dysrhythmia you have, pt will have same manifestations. Atrial Flutter : atria is not beating, atria is fluttering (not contracting) . Single ectopic focus . SA node is initiating an electrical impulse but so is another part of your atrial heart tissue. Atria is getting 2 signals to contract which causes atria to flutter. Causes = heart disease, heart failure, valve disease. Waveforms between QRS are more distinguishable . Treat if pt is hemodynamically unstable.
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HESI EXAM RN Critical Care Exam 1 (3) Atrial Fibrillation : multiple ectopic foci . Not just SA node initiating electrical impulse, but so are multiple parts of the heart initiating electrical impulse. Atria is constantly getting signal to contract. Same causes as A-flutter. Most common dysrhythmia . Waveforms between QRS are more chaotic. Treat if pt is hemodynamically unstable. Both: blood sits in atria leading to clot. If you cardiovert, the clot could dislodge. You have to do echocardiogram first before you cardiovert. If they have clots in atria, we do not cardiovert them. Put pt on anticoagulants (Heparin in hospital & Coumadin for home). If you are giving pt coumadin, they probably have hx of a-fib. Treatment for both: rate control (if HR is too fast); Digoxin, betablockers, calcium channel blockers. Drug of choice is Cardizem (Diltiazem); comes as IV continuous med & can titrate to get to HR we want. If med doesn’t work, second treatment is cardioversion (shock heart); hoping that SA node is reset and takes over running of the heart. Surgery includes MAZE procedure or ablation; go in with cautery & burn parts of atrial tissue to hopefully stop ectopic response. AV block (Atrial ventricular Block) To identify an AV block, look at PR interval. Causes of ALL blocks: MI, meds, damage to conduction system, aging heart First degree AV block : delay; prolonged PR interval. SA node is sending signal but taking AV node longer to receive signal . It is working as it is supposed to, just taking longer. Pts usually asymptomatic. If it is new finding, assess pt. Make note of (document). No treatment (assess & document). Second degree AV block type 1 (aka Mobitz or Wenchebach): PR interval will progressively get longer & longer until you drop or lose a QRS complex. “Longer, longer, longer, drop, now you got a Wenchebach”. SA node initiates a signal and travels to AV node. SA node initiates another signal but takes longer for AV node to receive. Same thing happens again but takes longer. SA node fires & AV node doesn’t pick it up at all . Once it drops, it starts all over again. Typically asymptomatic. Treat them because HR is too slow: atropine. Epinephrine. Dopamine. Usually don’t need a pacemaker.
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