They sleep in the recliner because if the they lay down they feel like theyre

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

Figure 19-4

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