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Ppt1

  1. 1. Chapter 27 Management of Patients With Dysrhythmias and Conduction Problems
  2. 2. Dysrhythmias • Disorders of the formation and/or conduction of electrical impulses in the heart • Cause disturbances of heart rate and/or heart rhythm • May be evidenced by changes in hemodynamics • Diagnosed by analyzing electrocardiogram
  3. 3. ECG Interpretation • P wave represents atrial depolarization • QRS complex represents ventricular depolarization • T wave represents ventricular repolarization • U wave may represent repolarization of Purkinje fibers. May also be seen in hypokalemia, hypertension, or heart disease
  4. 4. • PR interval normal range is 0.12-0.20 seconds • ST segment is identified as isoelectric, or above or below isoelectric line • QT interval normal range is 0.32-0.40 seconds • TP interval is isoelectric period • PP interval signifies atrial rhythm and rate • RR interval signifies ventricular rate and rhythm
  5. 5. Analyzing the ECG Rhythm Strip 1. Determine ventricular rate 2. Determine ventricular rhythm 3. Determine QRS duration 4. Determine whether QRS duration is consistent 5. Identify QRS shape
  6. 6. Analyzing the ECG Rhythm Strip (cont’d) 6. Identify P waves, is there a P in front of every QRS? 7. Identify P wave shape 8. Determine atrial rate 9. Determine atrial rhythm
  7. 7. Analyzing the ECG Rhythm Strip (cont’d) 10. Determine PR interval 11. Determine if PR intervals are consistent, irregular but with a pattern, or just irregular 12. Determine how many P waves for each QRS (P:QRS ratio)
  8. 8. Sinus Node Dysrhythmias •Sinus Bradycardia •Sinus Tachycardia •Sinus Arrhythmia
  9. 9. Atrial Dysrhythmias • Premature Atrial Complex • Atrial Flutter • Atrial Fibrillation
  10. 10. Junctional Dysrhythmias • Premature Junctional Complex • Junctional Rhythm • Atrioventricular Nodal Reentry Tachycardia –Supraventricular tachycardia
  11. 11. Ventricular Dysrhythmias • Premature Ventricular Complex • Ventricular Tachycardia • Ventricular Fibrillation • Idioventricular Rhythm • Ventricular Asystole
  12. 12. Conduction Abnormalities • First-Degree Atrioventricular Block • Second-Degree Atrioventricular Block, Type I • Second-Degree Atrioventricular Block, Type II • Third-Degree Atrioventricular Block
  13. 13. Nursing Interventions • Monitoring and managing the dysrhythmia • Minimizing anxiety • Teaching self-care
  14. 14. Pacemaker Therapy • Provides electrical stimuli to heart muscle • Used for slower-than-normal impulse formation, to control some tachycardias, or for advanced heart failure
  15. 15. Pacemaker Therapy (cont’d)• NASPE-BPEG code –First letter identifies chambers being paced –Second letter describes the chambers being sensed –Third letter describes type of response by pacemaker to what is sensed
  16. 16. Cardioversion and Defibrillation • Delivery of electrical current to depolarize a critical mass of myocardial cells • When cells repolarize the SA node, is usually able to recapture its role as pacemaker of heart • Cardioversion involves use of “timed” electrical current to terminate a tachydysrhythmia
  17. 17. Cardioversion and Defibrillation (cont’d)• Defibrillation is used in emergency situations as treatment for ventricular fibrillation and pulseless VT

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