Dysrhythmias

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Dysrhythmias

• Pacemakers

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Dysrhythmias

• EKG - electrical activity
• - depolarization repolarization
• - info on conductivity mechanical
• Normal Sinus Rhythm (NSR)
• - HR 60 - 100 bpm
• -regular

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Dysrhythmias

• P wave - impulse through atria
• - depolarization SA Node
• PR interval - initial stim. of atria stim.
  of ventricles
• - conduction through atria
• - (0.10 - 0.20)

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Dysrhythmias

• QRS - follows P wave
• - impulse through ventricles (ventricles
  repolarize)
• - (0.04 - 0.12)
• ST segment - return of ventricles to resting
  state
• T wave - repolarized ventricle
• RR interval - regulation of rhythm
• count R waves in 6 sec ? 10 HR

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Dysrhythmias

• Abnormal ? rate
• abnormal rhythm
• abnormal conduction time

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• Two activities of the heart
• Propagation of electrical activity
• Mechanical activity
• The ECG picks up the electrical impulses
  generated by the heart

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12 lead ECG

• 6 limb leads
• I, II, III, AVR, AVL, AVF
• Six precordial leads
• V1, V2, V3, V4, V5, V6

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Causes

• Drug effects
• Cell degeneration
• Hypertrophy
• Emotional
• Alcohol
• Tea/Coffee/Tobacco/Colas

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Dysrhythmias

• Fast Rates
• Tachycardia
• Flutter (250)
• Fibrillation (350)
• Slow Rates
• Bradycardia

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Assessment Findings (possible)

• Apical pulse lt60 or gt100
• Irregular rhythm
• Pulse deficit - radial apical differ
• Pulse that varies in intensity
• Chest pain, dizziness, syncope, SOB.

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Assessment Findings (possible)

• ? B/P, CHF, ? LOC, ? U.O.
• Slow heart rate that does not ? with activity
• Clinical cardiac arrest

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Dysrhythmias

• Ventricular Dysrhythmias
• PVC - pacemaker cells fire prematurely
• - lidocaine drip
• Ventricular Tachycardia
• - 3 or more PVC with rate gt 100
• - can lead quickly to V.F.
• - lidocaine or defibrillate

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Dysrhythmias

• Defibrillation - electrical current
• - 200 - 300 kJ
• - myocardium depolarizes
• Ventricular Fibrillation
• - lethal with loss BP, P, R, No C. O.
• - defib CPR
• Ventricular Asystole
• - no electrical or mechanical activity -
  epinephrine IV defib

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Pacemakers

• Electronic device
• Delivers controlled electrical impulse through
  electrodes
• Internal or external

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Indications

• 1. S.A. Node damage
• 2. Impulse from S.A. node atria inadequately
  trans. (3? heart block)
• 3. Tachycardias unresponsive to drugs

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Modes of Pacing

• 1. Fixed Rate - takes over completely
• 2. Demand - usually set at 72
• 3. Temporary - external

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Nursing Care

• Assess
• - C.O. - fatigue
• - weakness - chest pain
• - dizziness
• Rx of discomfort
• Wound Care
• no rising of arms ? 48 hrs
• EKG

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Complications

• Failure to sense impulse
• failure to fire
• perforation of ventricle or septum
• Diaphragm pacing ? hiccups

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Ongoing Care

• How long works lasts
• follow-up
• activity/rest protocol
• wear ID
• devices to avoid - mag fields, ?volt areas,
• microwaves, radiotransmitters
• how to take pulse

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Ongoing Care

• Report symptoms
• avoid blunt trauma
• avoid restrictive clothing
• avoid vigorous movement lifting 6 weeks
• someone learn CPR
• Normal ADLs 6 weeks