![]() ![]() Identified Rhythm: Atrial Fibrillation (A-fib) 8. Causes: Atherosclerotic heart disease, atrial dilation, Caffeine, cocaine, alcohol, CHF, Digoxin toxicity, Hyperthyroidism, hypertension, Chronic lung disease, chronic renal and hepatic disease. Pt may become symptomatic with increased heart rate. Increased risk of thrombus leading to increased risk for stroke. The atria do not contribute to cardiac output. Clinical Significance: There is no organized atrial contraction and there is random and irregular ventricular response. Treat with cardioversion or antiarrhythmics especially if hemodynamically unstable. Rhythm: Irregular Rate- 90 Atrial: unable Ventricular: 90 P Wave: Not distinguishable PR Interval: Not measurable QRS Complex: 0 (<0) Nursing Action: Pt should be anticoagulated. Identified Rhythm: Ventricular Tachycardia (V-tach) 7. Causes: Acid-base abnormalities, electrolyte imbalances, hypertension, hypovolemia, hypoxia, Myocardial infarct, increased sympathetic tone. The faster the rhythm, the less the perfusion. Sustained V-tach results in low cardiac output and it may deteriorate into V-fib or asystole. This is associated with poor cardiac output and a medical emergency. Clinical Significance: V-tach is defined as 3 or more ventricular complexes in succession with ventricular ectopic focus overriding the underlying rhythm. If sustained and patient is symptomatic it is a shockable rhythm refer to ACLS guidelines. Nursing Action: Check if there is a pulse. Rhythm: Irregular Rate- 180 Atrial: Ventricular: 180 P Wave: Absent PR Interval: Absent QRS Complex: >0 seconds T waves have opposite polarity. Causes: Myocardial infarct, trauma, hypoxia, hyperkalemia or hypokalemia, hypothermia, acid-base imbalance, and drug overdose. Clinical Significance: In asystole there is no cardiac output, and no pulse is present. Provide an advanced airway as soon as possible. Rate- 0 BPM P Wave: Absent PR Interval: Absent QRS Complex: Absent Nursing Action: Initiate CPR and establish IV access and refer to ACLS guidelines for drug administration (Epinephrine every 3 to 5 minutes). Causes: Dig toxicity, heart disease, sometimes associates with Wolff Parkinson White syndrome, stress smoking, caffeine and over exertion. May deteriorate into atrial flutter or fibrillation, decreases cardiac output and coronary artery perfusion which could lead to angina, hypotension, CHF, ventricular tachycardia or ventricular defibrillation. Clinical Significance: Hallmarks of SVT are sudden and rapid regular rhythm. If unstable may require synchronized cardioversion or adenosine IV push. QRS Complex: 0 seconds Nursing Action: If stable try vagal maneuvers and/or drugs per ACLS. PR Interval: No possible to differentiate P from T. Rhythm: Regular (may be regular or irregular) Rate- 180 Atrial: 180 Ventricular: 180 P Wave: Cannot be seen buried in the preceding T wave which is not discernable either. Identified Rhythm: Premature Atrial Contraction (PAC) 3. Causes: Atrial stretch, caffeine, tobacco, alcohol, digoxin toxicity, electrolyte imbalance, hypertrophy, hypoxia. In a patient with chest pain the catecholamine release with pain and anxiety can trigger a PAC. PAC’s result from a single ectopic focus originating from within the atria. Clinical Significance: They may be of no consequence, but frequent PAC’s may indicate heart disease or CHF. PAC may go away with pain relief or sedation if that is the cause. PR Interval: Cannot be measured QRS Complex: 0 seconds Nursing Action: Determine underlying rhythm and find out the frequency of PAC. Will often distort T wave on which they occur. Rhythm: Irregular Rate- 90 Atrial: Ventricular: 90 P Wave: May differ in size and amplitude. Identified Rhythm: Normal Sinus Rhythm 2. Clinical Significance: Indicates that the electrical signal is generated through the SA node, traveling through the AV junctions and activating the ventricles. Rhythm: Regular Rate- 80 Atrial: 80 Ventricular: 80 P Wave: Upright and one for every QRS PR Interval: 0 (0.12-0 seconds) QRS Complex: 0 (0.040 seconds) Nursing Action: Monitor patient. Rhythm Identification Worksheet Answer Key 1. ![]()
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