Assignment 1: ______________________32 points
1
N476 | Care of the Person with Complex Needs
Assignment 1: Dysrhythmias
Name: Fatimot Onanusi
Instructions: Answer the following questions and fill in your responses. All rhythm
strips included on the assignment are 6-seconds.
1. When looking at telemetry paper, how many seconds are each individual small
box? (1pt)
Answer: 0.04seconds
2. ____________ describes when sodium and potassium slowly leave the cells
and return to a more negative intracellular environment and cellular relaxation is
achieved. (1 pt)
Answer: Repolarization
3. Explain the path of an impulse traveling through the cardiac conduction system,
beginning at the point where the electrical impulse is initiated. (5pt)
Answer:
When electrical impulse is initiated by the sinoatrial (SA) node in the right
atrium, it travels through the internodal connection to the atrioventricular
(AV) node located in the AV junction. The impulse is then conducted to the
bundle of his then to the left and right bundle branches. The bundle
branches divide into smaller branches called the Purkinje fibers and the
impulse travels through them to stimulate the ventricles.
Assignment 1: ______________________32 points
2
Use the following scenario for questions 4, 5, and 6.
Scenario: A 56-year-old patient has been extubated 4 hours after coronary artery
bypass graft surgery. Two hours later, the patient complains of their heart racing, and it
is determined that they are experiencing palpitations. The patients’ heart rate is 168,
blood pressure is 90/60, and respiratory rate is 26 and slightly labored. The ECG shows
the rhythm below which is a change from sinus rhythm noted at the last assessment.
4. Using the picture of a rhythm above, what rhythm is this? (1pt)
Answer: Atrial Fibrillation with rapid ventricular rate
5. List 2 potential major complications that can result from this rhythm. (2 pt)
Answer (Complication 1): Pulmonary embolism
Answer (Complication 2): Systemic embolism
6. List at minimum 2 orders the nurse should anticipate receiving, based on the
rhythm identified in question 4. (2 pt)
Answer (Order 1): order to administer anticoagulant
Answer (Order 2): order for calcium channel blocker
Assignment 1: ______________________32 points
3
7. The nurse is caring for a patient wearing a continuous telemetry monitor. At the
start of the shift the nurse analyzes the patient’s cardiac rhythm noting heart rate
52, regular rhythm, no visible P wave thus no PR interval, QRS 0.08. Based on
the information provided, what rhythm would the nurse document the patient is
experiencing? (1pt)
Answer: Junctional Escape Rhythm
The following scenario will be used for questions 8, 9 and 10.
Scenario: You are caring for a patient when their telemetry monitor alarm starts
sounding. As you enter the room your patient states “it feels like my heart is coming out
of my chest.” You look at the monitor and note the rhythm below.
8. Using the picture of a rhythm above, what rhythm is this? (1pt)
Answer: Supraventricular Tachycardia (SVT)
9. As you continue to assess your patient you note they are slow to respond, moans
while grabbing their chest, and has the following vital signs.
Pulse
200 weak
BP
78/40
Respirations
28 shallow, labored
Pulse Ox
91% on 4 L/NC
The patient has patent IV access.
Based on the patient findings, what would you expect the priority treatment will be
for management of this patient? (1pt)
Answer: 6mg of adenosine IV. Since symptomatic, go straight to cardioversion
10. Why do tachycardic dysrhythmias sometimes lead to heart failure? (3pt)
Answer: The fast heart rhythm causes a decrease in cardiac output
because of shorter filling time for the ventricles. The heart is unable to
pump as much blood as needed because of this leading to heart failure
Assignment 1: ______________________32 points
4
The following scenario will be used for questions 11 and 12.
Scenario: A 65-year-old client with a history of type 2 diabetes and chronic anxiety
present to the emergency department appearing dyspneic and reporting severe neck
and shoulder pain with audible crackles bilaterally. Vital signs are as follows.
Pulse
48
BP
86/54
Respirations
26
Pulse Ox
94%
Temp.
98.9
You place the patient on a cardiac monitor and see the following rhythm.
11. Using the picture of a rhythm above, what rhythm is this? (1pt)
Answer: Second degree heart block (Mobitz) type 2
12. List a minimum of 3 interventions the nurse should anticipate for this patient,
based on the rhythm identified in question 11. (3 pt)
Answer (Intervention 1): Monitoring for progression,
Answer (Intervention 2): Transcutaneous pacing
Answer (Intervention 3): if cause is not resolved, a permanent pacemaker
might be inserted
Assignment 1: ______________________32 points
5
The following scenario will be used for questions 13,14, and 15.
Scenario: A patient with a history of high-degree heart blocks, hypertension, and
coronary artery disease arrives in the emergency department complaining of being
dizzy, weak, nauseated, and short of breath. An IV is initiated, vital signs are obtained,
2L oxygen via nasal cannula and a 12-lead ECG is ordered. The patient denies chest
pain.
BP
82/60
Pulse
40
Respirations
24 labored, crackles in bases
Pulse Ox
95% 2 L NC
You place the patient on a cardiac monitor and see the following rhythm.
13. Using the picture of a rhythm above, what rhythm is this? (1pt)
Answer: Ventricular paced rhythm with failure to capture
14. List 3 potential causes for the rhythm identified in question 13. (3pt)
Answer (Cause 1): low set output
Answer (Cause 2): Displacement of pacing leads wire from myocardium.
Answer (Cause 3): Increased pacing threshold because of medication or
electrolyte imbalance
15. List 2 interventions the nurse should anticipate for this patient, based on the
rhythm identified in question 13.
Answer (Intervention 1): Turning patient to the left side
Assignment 1: ______________________32 points
6
Answer (Intervention 2): Adjusting the output if patient has a temporary
pacemaker
16. What are the 2 areas of the heart that the 12-lead ECG does not view? (2pt)
Answer (Area 1): Posterior wall of the left ventricle
Answer (Area 2): Right ventricle
17. What intervention can be completed to see the missing views of the heart? (1pt)
Answer: Using a 15-lead ECG will show the right ventricle and the posterior
wall of the left ventricle.
18. On an ECG waveform, what is the “J” (junctional) point defined as? (1 pt)
Answer: This is the point where the QRS complex ends and the ST segment
begins.