Chapter 25 Nursing Care of Patients with Cardiac Arrhythmias

Answers CHAPTER 25 NURSING CARE OF PATIENTS WITH CARDIAC ARRHYTHMIAS COMPONENTS OF A CARDIAC CYCLE R AUDIO CASE STUDY Sandy and Identification and Care of Dysrhythmias P wave 1. (1) Regularity of rhythm, (2) heart rate, (3) P waves, (4) PR interval, (5) QRS interval, and (6) QT interval. 2. An arrhythmia, with a block. 3. PR interval is .12 to .20 seconds. QRS interval is equal to or less than 10 seconds. 4. Temporary transvenous pacemaker. P T Q S ST segment PR interval QRS complex VOCABULARY 1. (19) 2. (9) 3. (5) 4. (15) 5. (8) 6. (4) 7. (12) 8. (11) 9. (21) 10. (2) 11. (13) 12. (10) 13. (16) 14. (3) 15. (7) 16. (14) 17. (1) 18. (17) 19. (20) 20. (18) 21. (6) T wave HEART RATE 1. 100 2. 110 3. 80 CARDIAC CONDUCTION 1. (5) 2. (9) 3. (12) 4. (18) 5. (24) 6. (21) 7. (17) 8. (1) 9. (23) 10. (13) 11. (8) 12. (15) 13. (22) 1 2 Chapter 25 Answers 14. (20) 15. (14) 16. (3) 17. (19) 18. (16) 19. (4) 20. (7) 21. (10) 22. (11) 23. (6) 24. (2) ELECTROCARDIOGRAM INTERPRETATION A. 1. Rhythm: Regular 2. Heart rate: 38 beats per minute (bpm) 3. P waves: Rounded and upright in lead II, precede each QRS complex, alike 4. PR interval: 0.16 seconds 5. QRS interval: 0.10 seconds 6. QT interval: 0.40 seconds 7. Electrocardiogram (ECG) interpretation: Sinus bradycardia B. 1. Rhythm: Regular 2. Heart rate: 100 bpm 3. P waves: Smoothly rounded and upright in lead II, precede each QRS complex, alike 4. PR interval: 0.14 seconds 5. QRS interval: 0.06 seconds 6. QT interval: 0.34 seconds 7. ECG interpretation: Normal sinus rhythm CRITICAL THINKING: MRS. SAMUELS 1. Collect patient data (vital signs with apical rate), note symptoms, and place on heart monitor and oxygen per agency protocol. Remain with patient and provide reassurance. 2. Report the patient findings to the registered nurse or health care provider. Elevate head of bed for comfort, monitor vital signs, maintain oxygen per nasal cannula at 2 L/min per agency protocol, and continue to remain with patient to help alleviate anxiety. 3. Hypokalemia or ischemia causing irritability of the heart. 4. Light-headedness, feeling of heart skipping, chest pain, or fatigue. 5. ECG, oxygen, administration of potassium, electrolyte level monitoring; possible antiarrhythmic agent for symptoms. CRITICAL THINKING: MR. PEET 1. Initially, check responsiveness and the presence of a carotid pulse. Check breathing. 2. Open the airway. Call for assistance. Start cardiopulmonary resuscitation (CPR) until help arrives. 3. Once help arrives, report the patient’s status. Continue assisting as needed. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is correct. The complete heartbeat consists of contraction, or systole, and relaxation, or diastole, of the atria and ventricles. (1, 2) are incorrect. The circulation of the blood is a result of the action of the cardiac cycle. (4) is the mechanical portion of the cardiac cycle but it is not visible on ECG. Palpating peripheral pulses identifies it occurs. 2. (3) is correct. The heart receives blood through the superior and inferior vena cava. (1) delivers the blood back to the left side of the heart after oxygenation in the lungs. (2) receives the blood pumped from the left ventricle into the systemic circulation. (4) is a part of the heart’s own circulation. 3. (4) is correct. (1) controls the flow of blood from one heart chamber to another and into the pulmonary and systemic circulations. (2) is the sac covering the heart. (3) collects blood that is then pumped out of the heart into the circulation. 4. (1) is correct. (2, 3, 4) are incorrect. 5. (4) is correct. The T wave represents ventricular repolarization, or the resting state of the heart when the ventricles are filling with blood and preparing to receive the next impulse. (1) is incorrect. The P wave represents atrial depolarization. (2) is incorrect. The QRS represents ventricular depolarization. (3) is incorrect. The U wave is usually seen in patients with hypokalemia. 6. (3) is correct. 60 to 100 beats per minute is the inherent rate for the sinoatrial node. (1) is the inherent rate for the ventricles. (2) is the normal rate for the atrioventricular node. (4) is not a normal heart rate. 7. (3) is correct. Sinus rhythms identify the impulse as having originated in the sinoatrial node. (1) is incorrect. Escape beats are late beats occurring when a more rapid focus fails to initiate a beat. (2) is incorrect. A block, such as a bundle branch block, occurs when the normal conduction pathway of the heart is disturbed. (4) is incorrect. Ectopic rhythms are abnormal beats. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 8. (2) is correct. Examine patient and check attachment of monitoring equipment. Monitored rhythms can be deceptive. Always “treat the patient, not the monitor.” (1, 3, 4) may be appropriate actions after the patient is examined, if indicated. 9. (2, 5) are correct. Digoxin (Lanoxin) slows the heart rate and increases the force of contraction. (1) is incorrect. To decrease ectopic beats, an antiarrhythmic would be given. (3) is incorrect. To relieve chest pain, nitroglycerin would be given sublingually or intravenously. (4) is Chapter 25 incorrect. To raise blood pressure, a vasopressor such as dopamine would be given. 10. (1) is correct. Atrial fibrillation can cause interruptions in the movement of blood through the heart and the formation of a thrombus, with serious consequences. Anticoagulants such as warfarin will be used to prevent thrombus formation and remain an important component of patient care. (2) is incorrect. Swelling of feet, often an early sign of heart failure, could be a less serious result of atrial fibrillation. (3) is not contraindicated, although an exercise routine should be carefully constructed for a patient with a cardiac history. (4) is a psychosocial concern and not the highest priority for this patient. 11. (1, 3, 4, 5) are treatments used for atrial fibrillation. (2) is not an appropriate treatment as it treats angina. (6) is not a treatment for atrial fibrillation. It is used for cardiac arrest or allergic reactions. 12. (1) is correct. Three or more premature ventricular contractions in a row constitute ventricular tachycardia. (2) is incorrect. Bigeminy is a premature ventricular contraction every second beat. (3) Trigeminy is a premature ventricular contraction every three beats. (4) Multifocal premature ventricular contractions arise from different foci in the ventricle and therefore vary in appearance. 17. Premature ventricular contractions on the ECG strip. 18. Ventricular pacemaker spikes precede a paced QRS on the ECG strip. Answers 3 13. (4) is correct. In a hemodynamically stable patient, treatment with medication is the first choice. (1) is incorrect. Cardioversion would be tried only if other measures did not work. (2) is incorrect. Pacing is not an option for this. (3) is incorrect. Defibrillation is not appropriate treatment. 14. (1) is correct. (2) is incorrect. Rapid P waves appear as flutter waves on electrocardiogram. (3) is incorrect. Atrial rate is extremely rapid and chaotic on electrocardiogram. (4) is a pattern showing chaotic ventricular activity. 15. (2, 3, 5) are correct. Elevate the head of the bed and start oxygen by nasal cannula per agency policy to improve oxygenation because oxygen hunger is a common cause of heart irritability. Have the health care provider contacted as these actions are being done. (1) is incorrect. This cannot be done until HCP orders are given to do so. (4) is not an appropriate action with an anxious patient. 16. (4, 5) are correct. Third-degree atrioventricular block requires a permanent pacemaker, and symptomatic bradycardia may require it depending on the cause. (1, 2, 3, 6) do not require a permanent pacemaker. 4 Chapter 25 Answers 19. The two areas on the person where the nurse should attach the automatic external defibrillator pads. 20. The two areas where a permanent pacemaker could be placed.