,1. Cardiac -Fundamental skill of critical care nurses or nurses
rhythm distur- em- ployed in patient care areas where ECG
monitoring occurs
bances/Dysrhyth- -Crucial for early nursing and medical intervention
mia -The ability to rapidly analyze a rhythm
interpretation disturbance as well as initiate appropriate
treatment improves patient safety and optimizes
successful outcomes
-The critical care nurse is often the healthcare
professional responsible for the continuous
monitoring of the patient's cardiac rhythm and
has the opportunity to provide early intervention
that can prevent an adverse clinical situation
*this responsibility requires not only a mastery of
interpret- ing dysrhythmias but also to critically
identity the unique monitoring needs of each
patient
-If seeing a different rhythm, first thing the nurse
should do is *assess the patient*
2. Cardiac *focus on lungs, labs, new meds, vs;
conduc- tion overloaded very easily if old
pathway
-Conduction system is in *Right Atrium*
*you have to have an electrical charge that is in a
specific pattern
-SA node: pacemaker of the heart
*if doesnt fire correctly, or if electrolytes are off,
it may not fire
-Arrhythmias show on monitor if conduction is
messed up
-P wave is where SA node works
-AV node is backup if SA isn't working
-Electrical charge: node-> bundle of His-> PF->
heart beat
-PR interval: when AV doesn't work and Q gets
extended when AV node finally kicks in
-If SA and AV are both struggling, then
complete heart block
,-SA node
sleepy-> AV
kicks in-> Q
interval longer-
> 1st degree
AV block
-Always ask
what have we
don't different
and *WHY* is
this happening
, 3. Inherent rates -These don't count for those with naturally low HR
-AV node is sinus brady; HR drops when SA starts
to get lazy and AV has to kick in
-Decreased perfusion= kidneys are first affected
-MAP: greater than or equal to 65
-
4. SA node 60-100 bpm
-In sinus rhythm
-The SA node reaches threshold at a rate of 60
to 100 times per minute.
-Because this is the fastest pacemaker in the
heart, the SA node is the dominant pacemaker of
the heart
5. AV node 40-60 bpm
-The AV node and His-Purkinje pacemakers are
latent pacemakers that reach threshold at a
slower rate but can take over if the SA node fails
or if sinus impulse conduction is blocked
-The AV node has an inherent rate of 40 to 60
beats per minute
6. Ventricles 15-40 bpm
(Purk- inje -The His-Purkinje system (ventricles) can fire at a
Fibers) rate of 20-40 beats per minute
-Purkinje fibers=ventricles
*ventricles are the powerhouse of the heart
*L ventricle is very important (it is the pump)
*PF go around the ventricles
*if we don't fix AV node, and it keeps slowing
down, it will start to affect ventricles, whole
conduction system is blocking out-> complete
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