Summary
Summary NUR 440 Exam 2 Study Guide
- Course
- NURSING 440
- Institution
- Denver School Of Nursing
This is a comprehensive and detailed study guide on Exam 2 for Nur 440. An Essential Study Resource just for YOU!!
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1. All dysrhythmias place the patient at risk for decreased cardiac output and decreasedperfusion.
2. Impacted by the parasympathetic and sympathetic
3. Risk of decreased cardiac output.
HEART BLOCKS
First Degree AV Block
• Lease concerning heart block.
• Normal PR interval is: 0.12-0.2
• Identifying factors:
• PR interval is >0.2 seconds
• There is no disruption to atrial or ventricular conduction
• Most people are asymptomatic. It is usually found on a pre-op EKG or before
giving certain medication EKG.
• There is still communication between the SA node and AV node or atria to
ventricles. Just a little bit slow.
POEM
Approx. 8 boxes @
0.04=0.32 (>0.2) The wife (the P wave) is waiting at home and the husband
(the QRS complex) comes home late every night but he
always comes home…at the same time every night.
• Treatment:
• Not too worried about these patients
• Just watch the patient…could be associated with age.
• Monitor them periodically to be sure it does not evolve into a worse heart
block
Second Degree AV Block Type I/Mobitz I/Wenckeback
• Identifying factors:
• Gradual lengthening of the PR interval until an atrial impulse is noncuonducted and
the QRS complex is blocked (missing).
• Can be a sign of a more serious conduction issue: can happen after ischemia, or
infarction.
• Treatment:
• If the are symptomatic:
• Atropine 0.5mg
• Dizziness, chest pain, etc.
, • We know atropine is given for bradycardia. In this block, there is a skipped
QRS (no ventricular squeeze) and can put them into bradycardia rhythm the
more beats they skip.
• Patient will likely need a pacemaker
• If they are asymptomatic:
• Just watch them closely
Dropped the
QRS complex
POEM
The wife (the P wave) is waiting at home and the husband (the QRS
complex) comes home later and later every night until one night he just
doesn’t come home at all.
Longer, longer, longer, drop, Wencke, Wencke, Wenckeback
Mobitz II/Second Degree AV Block Type II
• Identifying factors:
• Involves consistent PR interval for every conducted breat, but involves a P wave that
does not stimulate a QRS
• Worst of the three so far…ex. Wenckeback we could see the predictable lengthening
of the PR interval and know that the QRS would be dropped…with this one
everything is normal and then randomly the QRS doesn’t show up.
• Treatment:
• These patients have a poor prognosis. Pacemaker is needed.
Normal PR interval Dropped the QRS complex
POEM
The wife (the P wave) is waiting at home and the husband (the QRS
complex) sometimes the husband comes home, sometimes he doesn’t.
When he does come home, its at the same time and when he doesn’t, he
just randomly doesn’t show up. Requires counseling in the form of a
pacemaker.
, Third Degree AV Block/Complete Heart Block
• Identifying Factors
• NO impulses from the atria are conducted to the ventricles resulting in variable PR
intervals.
• Zero communication between the SA node and the AV node.
• The SA node is beating regularly but the AV node is also on its own schedule and not
listening to SA.
• The second degree/Mobitz II can convert into this.
• The worst prognosis of all.
• Most patients are symptomatic
• Treatment
• Pacemaker-usually transcutaneously first while we get them ready for the permanent
pacemaker.
POEM
The wife (the P wave) is no longer waiting at home. She and her husband
(the QRS complex) are now on separate schedules. They have no
relationship and they are no longer talking. Each spouse has regular,
individual schedules. Requires counseling in the form of pacing.
VENTRICULAR DYSRHYTHMIAS
Premature Ventricular Contraction (PVC)
• Identifying Factors:
• Premature occurrence of the QRS complex causing a distorted QRS complex
compared to normal conduction.
• Not initiated from SA node, it is initiated at AV node.
• Normally a benign finding-as long as they are infrequent.
• Caused by: stimulant use, electrolyte imbalances, hypoxia
• Assess for “runs” of PVC. Look for the patterns.
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