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  • Chapter 27 Management of Patients With Dysrhythmias and Conduction Problems
  • 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
  • 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
    View slide
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    • 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
  • Analyzing the ECG Rhythm Strip
    • Determine ventricular rate
    • Determine ventricular rhythm
    • Determine QRS duration
    • Determine whether QRS duration is consistent
    • Identify QRS shape
  • Analyzing the ECG Rhythm Strip (cont’d)
    • Identify P waves, is there a P in front of every QRS?
    • Identify P wave shape
    • Determine atrial rate
    • Determine atrial rhythm
  • 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)
  • Sinus Node Dysrhythmias
    • Sinus Bradycardia
    • Sinus Tachycardia
    • Sinus Arrhythmia
  • Atrial Dysrhythmias
    • Premature Atrial Complex
    • Atrial Flutter
    • Atrial Fibrillation
  • Junctional Dysrhythmias
    • Premature Junctional Complex
    • Junctional Rhythm
    • Atrioventricular Nodal Reentry Tachycardia
      • Supraventricular tachycardia
  • Ventricular Dysrhythmias
    • Premature Ventricular Complex
    • Ventricular Tachycardia
    • Ventricular Fibrillation
    • Idioventricular Rhythm
    • Ventricular Asystole
  • Conduction Abnormalities
    • First-Degree Atrioventricular Block
    • Second-Degree Atrioventricular Block, Type I
    • Second-Degree Atrioventricular Block, Type II
    • Third-Degree Atrioventricular Block
  • Nursing Interventions
    • Monitoring and managing the dysrhythmia
    • Minimizing anxiety
    • Teaching self-care
  • Pacemaker Therapy
    • Provides electrical stimuli to heart muscle
    • Used for slower-than-normal impulse formation, to control some tachycardias, or for advanced heart failure
    • May be permanent or temporary
  • 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
  • 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
  • Cardioversion and Defibrillation (cont’d)
    • Defibrillation is used in emergency situations as treatment for ventricular fibrillation and pulseless VT