Basic Characteristics of Different RhythmsNursing Care of Patients’ with ArrhythmiasSinus Rhythms – initiated by the SA node: Characteristics include:EKG HANDOUT- EKG paper is made of small boxes; each small box = 0.04 seconds- Atrial Depolarization = P waves- Atrial Repolarization = hidden in the QRS complex- Ventricular Depolarization = QRS complex- Ventricular Repolarization = T Wave (remember R = Rest)- Normal Intervalso PR = 0.12-0.20 secondso QRS = less than 0.10 secondso QT – less than 0.40 seconds- Heart Rates & Rhythm (identify when analyzing EKG rhythms) o Atrial Rate = count P waves in 6-second strip & multiply X 10o Atrial Rhythm = measure P to P (irregular or regular)o Ventricular Rate = count QRS complexes in 6 second strip & multiply X 10o Ventricular Rhythm = R to R (irregular or regular)Basic Characteristics of Different RhythmsNursing Care of Patients’ with Arrhythmias 1) – Assessment, assessment, assessment – Know your patient.a. Vital signsb. Physical assessment (heart sounds, BS, skin color, etc.)c. Check all labsd. Always be PREPARED for emergencies2) – Be familiar with patient’s medications, OTC meds, herbs, or nutritional supplements.3) – Treat arrhythmia if patient’s are symptomatic (decrease b/p, lightheadedness, dizziness, fatigue, chest pain, or palpitations.4) - Know the correct drugs, dosages, and routine orders.5) – Identify nursing diagnosis, set goals, implement nursing interventions, and evaluate (nursing process).8/07 JE1Sinus Rhythms – initiated by the SA node: Characteristics include:1) Positive, upright P waves2) Smooth, rounded P waves – all P’s look the same3) QRS is narrow Normal Sinus Rhythm (NRS) Sinus Arrhythmia Sinus Bradycardia Atropine 0.5 mg IV for symptomatic bradycardia Be prepared for transcutaneous pacing Sinus Tachycardia (table 27.1) Beta blockers Calcium channel blockers  Catheter ablationAtrial Rhythms –initiated by the an atrial cell outside the SA node1) P waves look different than those generated by the SA node2) QRS is narrow Premature Atrial Complexes (PAC) Atrial Flutter Adenosine Cardizem Beta Blockers Amiodarone, digoxin, or clonidine, or mag. Possible elective cardioversion Atrial Fibrillation Same as above Warfarin is indicated is indicated if high risk for stroke or over 48 hours or chronic a-fib.Junctional Rhythms – initiated by a junctional cell1) Inverted P waves before QRS complex2) Missing P waves with narrow WRS complex3) Inverted P waves after QRS complex Premature Junctional Complexes (PJC) Junctional Escape Rhythm Accelerated Junctional Rhythm Junctional Tachycardia Adenosine Cardizem Beta Blockers8/07 JE2Ventricular Rhythms – initiated by ventricular cells1) Wide, bizarre QRS complexes2) T waves can also be bizarre Premature Ventricular Complexes (PVC) Ventricular Tachycardia (VT) Amiodarone for stable VT Procainamide Lidocaine Cardioversion Ventricular Fibrillation (VF) CPR Defibrillation – Stat Vasoactive meds (epinephrine, vasopressin or both) Possible induction of hypothermia Ventricular Asystole CPRAV Blocks –can be classified according to location of block.Treatment will depend on the degree of block and symptoms of patient. Be prepared for insertion of pacemaker. 1st Degree AV Block 2nd Degree AV Block Type I 2nd Degree AV Block Type II 2nd Degree AV Block 2:1 Block 3rd Degree AV Block (Complete Heart Block)Pacemacker Rhythms Pacemaker Identification Codeso 1st letter – identifies the chamber(s) paced. (A=Atrium, V=Ventricles, or D= both)o 2nd letter – identifies chamber(s) where patient-initiated is being sensed by the pacemaker.o 3rd letter – indicates how the pacemaker will respond when itsenses. (I=Inhibited, T=Triggered, D=Both, or O=None). Single-Chamber Pacemakerso Atrial pacemaker – stimulation of the atria produces a pacemaker spike on the EKG, followed by a P wave.o Ventricular pacemaker – produces a pacemaker spike on the EKG followed by a wide QRS complex.8/07 JE3 Dual-Chamber Pacemakerso Both the Atria and Ventricle are paced TCP (Transcutaneous Pacing)o Type of pacing used in an emergency situation Pacemaker Malfunction (Also see table 27.2 , page 848 of BrunnerTextbook)o Failure to Pace – See on the EKG by an absence of pacemaker spikeso Failure to Capture – Seen on the EKG by visible pacemaker spikes not followed by P waves (if atrial) or QRS (if ventricular).o Failure to Sense – Seen on the EKG by pacemaker spikes that follow too closely behind the QRS complexes.o Loss of Pacing – Total absences of pacing spikes.o Rhythmic diaphragmic or chest wall twitching or hiccuping Patient Teaching and Home care (See table 27.4, page 853) Review the nursing process8/07