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Relias Dysrhythmia Test Questions Relias Dysrhythmia Test Questions .
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normal sinus rhythm heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute Sinus Arrhythmia Appearance is ALMOST NORMAL: Respiratory – Circulatory interaction Rate INCREASES with INSPIRATION (IN=IN) Sinus Bradycardia < normal sinus rhythm Sinus Tachycardia
100 (100-150) normal sinus rhythm
Premature Atrial Contraction (PAC) Heart Rate: Depends on underlying rhythm Regularity: Interrupts the regularity of underlying rhythm P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave PRI: measures between. 12 -. 20 seconds and can be prolonged; can be different from other complexes QRS: <. 12 seconds Sinus Arrest/Pause
Supraventricular Tachycardia (SVT) an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node First degree heart block atrioventricular (AV) block in which the atrial electrical impulses are delayed by a fraction of a second before being conducted to the ventricles 2nd degree heart block type 1 (Wenkebach) Progressively longer PR interval until the P wave is not followed by a QPR 2nd Degree Heart Block (Mobitz II) Rare, but more serious Sudden appearance of a nonconducted P-wave P-waves are nl, but some aren’t followed by a QRS complex PR & RR intervals are constant 3rd degree heart block
no obvious correlation between p and qrs, need pace maker premature ventricular contraction (PVC) a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker) Bigeminy PVC every other beat is a PVC PVC couplets PVC occurring in pairs, no adequate C.O. when this occurs monomorphic ventricular tachycardia presents with wide QRS complexes of a common shape. Torsades de pointes Rate: 120 – 200 usually P wave: Obscured by ventricular waves
Rhythm: Regular- benign rhythm that is sometimes seen during acute MI or early after reperfusion. – Rarely sustained, does not progress to vfib, rarely requires treatment asystole absence of contractions of the heart Failure to capture (pacemaker) failure to sense (pacemaker) Atrial paced rhythm spike before P wave Ventricular paced rhythm ventricular contractions which occur in cases of complete heart block.
Normal sinus rhythm Regular Rate: 60 - 100 P Wave: Present, upright PR Interval: 0. 12 - 0. 20 sec QRS: < 0. 12 sec Sinus Bradycardia Regular Rate: < 60 P Wave: Present, upright PR Interval: 0. 12 - 0. 20 sec QRS: < 0. 12 sec Sinus Tachycardia Regular Rate: 100 - 150 P Wave: Present, upright PR Interval: 0. 12 - 0. 20 sec QRS: < 0. 12 sec
Atrial Flutter Usually REGULAR can be irregular Atrial rate: 250 - 350 Ventricular rate: variable BUT < atrial rate P Wave: Flutter PR Interval: N/A QRS: < 0. 12 sec Supraventricular Tachycardia Regular Rate: 150 - 350 P wave: Hidden in QRS or T wave PR: unable to determine QRS: < 0. 12 sec Junctional Rhythm Regular Rate: 40 - 60 P Wave: ABSENT or INVERTED PR Interval: None or < 0. 12
QRS: < 0. 12 sec Accelerated Junctional Rhythm Regular Rate: 60 - 100 P Wave: NONE or INVERTED PR Interval: None or < 0. 12 QRS: < 0. 12 sec Junctional Tachycardia Regular Rate: > 100 P Wave: NONE or INVERTED PR Interval: None or < 0. 12 QRS: < 0. 12 sec Premature Ventricular Contraction IRREGULAR Rate: refer to underlying rhythm P Wave: NONE PR Interval: N/A
P wave: NONE PR Interval: N/A QRS: WIDE, > 0. 12 sec Accelerated Idoventricular Rhythm Regular Rate: 50 - 100 P wave: NONE PR Interval: N/A QRS: WIDE, > 0. 12 sec 1st Degree AV Block Regular Rate: 60 - 100 P Wave: Present, upright PR interval: > 0. 20 sec CONSISTENTLY LONG QRS: < 0. 12 secHusband stays late till 9 consistently 2nd Degree AV Block Type I Mobitz, Wenckebach IRREGULAR Rate: 60 - 100
P wave: Present, upright PR Interval: Progressively longer until drop (PR interval longer and longer until drop) QRS: < 0. 12 secHusband stays late till 9 , then 11 , then 1 , then doesn’t come home at all 2nd Degree AV Block Type II Irregular or regular Rate: < 60 P wave: Present, upright PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop QRS: < 0. 12 secHusband stays late till 9 consistently, then wife goes out and doesn’t come home 3rd Degree AV Block Atrials and ventricles don’t communicate Rate: regular atrial P wave: Present, upright No relationship between P waves and QRS PR Interval: VARIABLE QRS: variableP-P ad R-R consistent but NO correlationHusband and wife live separate lives and don’t communicate SA Node
Will be shorter than T wave
Shows firing of SA node QRS 0.06-0.10 sec SHOULD BE <0.12 sec Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular) Calculate Regular Rate 1500/ boxes R-R Calculate Irregular Rate of Rs in 6 sec strip X 10 Unifocal PVCs Only 1 shape PVC Bigeminy PVC occurs every OTHER beat Trigeminy PVC occurs every THIRD beat Couplet 2 PVCs together Triplet 3 PVCs together Multifocal Multiple shapes
Spike before P and before QR Failure to Capture Spikes with no QRS Failure to Sense Spikes happen regardless of QRS on their own How to determine the rhythm Regular or irregular? Rate? P before every QRS? QRS for every P? QRS wide or narrow? QT Interval 0.34-0. P Wave 0.06-0.12 sec PR Interval 0.12-0.20 sec SA Node Firing Rhythms Fires normally @ 60-100 -SR 60- -SB < -ST 100-
AV Node Firing, SA Node Failed Rhythms Fires normally @ 40-60 -Junctional rhythm 40- -Accelerated junctional rhythm 60- -Junctional tachycardia 100- Only Purkinje Fibers Firing Rhythms (Everything else has failed) Fires normally @ 20-50 -Idioventricular 20- -Accelerated idioventricular 50-
