They sleep in the recliner because if the they lay down they feel like they’re drowning High Fowler’s position Oxygen, diuretics, morphine, and other prescribed drugs Limit and monitor activity Assess cardiopulmonary status
Cardiac conduction disorders Review chapter 17 for SA node, AV node, Bundle of HIS, and Perkinje Fibers How often does a healthy heart beat?
Etiology of Cardiac Conduction Disorders Congenital abnormalities Electrolyte disturbances Caffeine, illegal drug use, stress, medication side effects Valvular disorders, infarct, thyroid problems
Impulse Generation SA node generates impulses @ 60-100 times/min AV node generates impulses @ 40-60 times/min Purkinje Fibers @ 20-40 times/min Any disruption of the SA node leads to abnormal heart rhythm or arrhythmia/dysrhythmia
BOX 19-2 Evaluating ECG KNOW Find the QRS Is the rhythm regular or irregular? Calculate the rate by counting the QRS for 6 sec and multiply by 10 QRS should be 0.04 – 0.12 seconds (1-3 little boxes) Does every QRS look the same? Find the P wave directly in front of QRS Is there 1 P wave for every QRS? Measure P wave from start of P to start of QRS Should be 0.12 – 0.2 second (3-5 little boxes) Is the P wave length the same for every beat?
Signs and Symptoms: Cardiac Conduction Disorders Severity of the symptoms depends on if it is atrial or ventricular in nature, amount of CO, and if dysrhythmia is persistent Sinus rhythm (“normal”) Electrical impulse originates in sinus node Atrial rhythm Impulse originates in atrium Ventricular rhythm Impulse originates in ventricles
Signs and Symptoms: Cardiac Conduction Disorders Tachycardia HR >100 bpm Ventricles do not have adequate filling time Heart unable to pump effectively S/S – dizziness, palpitations, fatigue, chest pain, unconsciousness >150 is considered too fast Calcium channel blockers-inhibit transmission of the impulse at AV node Atrial fibrillation/flutter Atria quiver (up to 300 times/min) rather than contract Healthy heart receives “atrial kick” – which accounts for 20% of ventricular stroke volume Drops CO d/t decreased blood in the ventricles Clot formation – need to be started on anticoagulants! Atrial flutter will see multiple “spiked” P waves “saw-tooth pattern” Treatment diltiazem or digoxin, amiodarone, beta blocker, or cardioversion
Figure 29-6, C: Premature Ventricular Contractions
Signs and Symptoms: Cardiac Conduction Disorders Premature ventricular contractions (PVCs) 19-6C pg 436 Up to 7/min considered “normal” Ventricles contract before being filled with blood Wide QRS complex without a P wave Complete heart block (third degree heart block) 19-6B Uncoordinated contractions by the atria & ventricles d/t separate impulses Ventricular Tachycardia 19-6D Life Threatening! Ventricles contract 120-200 beats/min Usually pulseless but can be awake and alert Drug therapy: amiodarone or synchronized cardioversion
Figure 19-6B: Complete Heart Block
Figure 20-6, D: Ventricular Tachycardia You can shock ventricular tachycardia
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- Fall '19
- right ventricle, Heart block, Heart failure