Cardiac Dysrhythmias - Medical-Surgical - Cardiovascular System | @LevelUpRN
Cardiac Dysrhythmias - Medical-Surgical - Cardiovascular System | @LevelUpRN
Sinus dysrhythmias (sinus tachycardia, sinus bradycardia, and sinus arrhythmia), including the causes and treatment of these dysrhythmias. Atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, and aystole. Finally, atrioventricular blocks, including: first degree AV block, second degree type 1 AV block, second degree type 2 AV block, and third degree AV block.
Our Medical-Surgical video tutorial series is taught by Cathy Parkes BSN, RN, CWCN, PHN and intended to help RN and PN nursing students study for their nursing school exams, including the ATI, HESI and NCLEX.
0:00 What to Expect with Dysrhythmias 0:44 Sinus Dysrhythmias 1:15 Treatment of Sinus Dysrhythmias 1:29 Sinus Bradycardia 2:06 Treatment of Sinus Bradycardia 2:25 Sinus Arrhythmia 2:49 Atrial Dysrhythmias 3:00 AFIB 3:23 Treatment of AFIB 3:52 Arterial Flutter 4:21 Ventricular Dysrhythmias 4:50 Treatment 5:33 Memory Trick 5:40 Asystole 5:59 Treatment 6:20 AV Blocks 6:55 Treatment 7:27 Type 2 AV Block 7:55 Type 3 AV Block 8:23 Quiz Time!
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Content
0.48 -> I am Cathy with Level Up RN. In this video,
I am going to cover cardiac dysrhythmias,
6.4 -> and at the end of the video, I'm going to give you
guys a little quiz to test your knowledge of some
11.28 -> of the key facts I'll be covering in this video.
So definitely stay tuned for that. If you have our
16.72 -> medical-surgical nursing flashcards, definitely
pull those out so you can follow along with me.
22.4 -> So in this video, I will not be covering
how to interpret EKGs. We actually have
28.08 -> a whole separate flashcard deck and video
playlist for that. So if you need help with
33.36 -> interpretation of EKGs, definitely head on over
there to get help. Here, we're just going to go
38.64 -> over some basic facts about dysrhythmias
and the treatment of those dysrhythmias.
44.56 -> First up, let's talk about sinus dysrhythmias,
which includes sinus tachycardia. With sinus
50.64 -> tachycardia, we have a regular cardiac rhythm,
but our heart rate is over 100 beats per minute.
57.44 -> Causes include physical activity, anxiety, fever,
pain, anemia. It can also be caused by your body,
67.92 -> compensating for decreased blood pressure or
decreased cardiac output. Treatment is focused
75.52 -> on treating the underlying cause. So, for example,
if your patient has sinus tachycardia due to
82.48 -> unresolved pain when we give them pain medication
that often allows that heart rate to come down.
89.36 -> Then we have sinus bradycardia. This is where
we have a regular cardiac rhythm, but our heart
95.44 -> rate is under 60 beats per minute. Causes include
excess vagal stimulation, cardiovascular disease,
103.68 -> hypoxia, as well as certain medications. It's also
important to note that with athletes, they often
111.28 -> have sinus bradycardia, and this is a normal and
expected finding in athletes. So I'm not saying
118.8 -> I'm an athlete, but I do work out a lot and my
resting heart rate is around 50 beats per minute.
126.16 -> In terms of treatment, if the patient is
symptomatic, if they have a shortness of breath
132.16 -> and fatigue associated with their bradycardia,
we can give them atropine as well as a pacemaker.
140.16 -> But for asymptomatic bradycardia,
treatment is often not required.
145.76 -> And finally, we have sinus arrhythmia. So this
is a normal variant from normal sinus rhythm.
152.56 -> This is where the heart rate increases slightly
155.6 -> with inspiration and decreases slightly
with expiration. It's common in children,
162.24 -> and it usually disappears with age, and
treatment is not necessary for sinus arrhythmia.
169.68 -> Next up, we have our atrial dysrhythmias, and
I won't go through all the information on the
174.72 -> card, but I do want to highlight atrial
fibrillation as well as atrial flutter.
180.16 -> So with atrial fibrillation or AFib, we have
a rapid and disorganized depolarization of
187.44 -> the atria, such that the atria will sit there and
quiver instead of fully squeezing. And as it sits
195.52 -> there and quivers, blood collects in there, and we
have increased risk for blood clot formation. So a
203.92 -> key intervention for a patient who has AFib is to
put them on an anticoagulant in order to prevent
211.2 -> that clot from occurring. Also, we can treat
this condition with cardioversion, which
216.96 -> we'll talk about more in my next video as well as
antiarrhythmics. So when you look at an EKG strip,
225.24 -> AFib will look like lots of little bumps between
the QRS complexes. All right, with atrial flutter,
233.28 -> we have an abnormal electrical circuit
that forms in the atria and causes
239.52 -> rapid depolarization of the atria. So
between 250 and 350 times per minute.
247.44 -> So when you look at an EKG strip and you see
these sawtooth waves, so these are F waves, that's
254.32 -> atrial flutter, and we would also treat this
with antiarrhythmics as well as cardioversion.
261.84 -> Next, let's talk about some key ventricular
dysrhythmias, including ventricular tachycardia
267.92 -> or V-tach. With V-tach, we have a rapid
ventricular rhythm. So over 100 beats per minute
275.2 -> on an EKG strip. You will not see any P waves.
You will see wide QRS complexes that occur
283.44 -> regularly. V-tach is typically caused by
ischemic heart disease. Treatment of V-tach
290.88 -> with a pulse includes cardioversion, as well
as antiarrhythmics and correction of any
297.68 -> electrolyte imbalances. If we have V-tach
without a pulse, we need to defibrillate.
305.6 -> V-tach can deteriorate into ventricular
fibrillation or V-fib. With V-fib we have
313.52 -> rapid, ineffective, quivering of
the ventricles. So on an EKG strip,
319.92 -> you're not going to see any P waves and
you're really not going to be able to see any
324.64 -> QRS complexes. It's just going to be all these
little bumps going across the screen. Treatment
330.96 -> of ventricular fibrillation is defibrillation. So
our little chicken hint here is to D-fib, V-fib.
340.24 -> And then finally, we have asystole, which is
where there is absence of any ventricular rhythm.
346.8 -> So on an EKG strip, this will look like a
line. So this is something you never want
352.56 -> to see in your patient, but you always want
to see on a test because it's really easy
357.36 -> to identify that dysrhythmia. So treatment of
asystole includes CPR. So despite what you may
366.16 -> have seen on some kind of medical TV show where
they attempt defibrillation on a patient with
373.04 -> asystole, you cannot do that in real life. So you
need to perform CPR on a patient who has asystole.
380.56 -> Finally, let's talk about some AV blocks or
atrial ventricular blocks, which are typically
386 -> caused by heart disease, by myocardial infarction.
They can also be caused by certain medications,
392.64 -> such as beta-blockers or the digoxin.
With a first-degree AV block, we have a
399.84 -> prolonged impulse conduction time between the
atria to the ventricles due to a delay in the AV
407.2 -> node. So on a EKG strip, you will see
a long PR interval that is consistent.
415.04 -> Treatment is typically not required for this type
of heart block. Then we have a second-degree type
421.12 -> one AB block, which is where we have a progressive
increase in the conduction time between the
428 -> atria and the ventricles until one impulse
fails to conduct at all. So on an EKG strip,
435.6 -> we will see a PR interval that will gradually
get bigger and bigger until a QRS complex drops.
442.72 -> Treatment is also not typically
needed for this type of block, either.
447.44 -> Then we have a second-degree type two AV block.
This is where we have a sudden failure of impulse
454.56 -> conduction between the atria and the ventricles
without a progressive increase in conduction time.
462.16 -> So on your EKG strip, you will see a consistent
PR interval. It'll either be consistently long or
470.16 -> consistently normal, but then suddenly you'll
just have a QRS complex that drops off.
475.68 -> This type of block typically requires a pacemaker.
And then finally, we have a third-degree AV block.
483.04 -> This is where we have complete failure
of any conduction between the atria
489.12 -> and ventricles. So when you look at an EKG strip,
you will see no association between the P waves
497.36 -> and the QRS complexes. Treatment of this
type of block does require a pacemaker.
503.84 -> Okay, time for a quiz. I have three
questions for you. First question,
508.88 -> what dysrhythmia is associated with an increased
risk for clots? The answer is atrial fibrillation.
519.44 -> And that's why anyone who has AFib is put on an
anticoagulant to help prevent that clot formation.
527.36 -> Question number two, what is the treatment
for ventricular tachycardia without a pulse?
536.72 -> The answer is defibrillation. Question number
three, what is the treatment for ventricular
543.84 -> fibrillation? The answer is defibrillation,
again. So we want to D-fib, V-fib. All right,
553.68 -> I hope this video has been helpful for you, and
I hope you enjoyed this quiz. If so, be sure to
559.44 -> leave me a comment. I would love to hear from
you, and I'll see you on another video soon.
565.68 -> I invite you to subscribe to our channel
and share a link with your classmates and
570 -> friends in nursing school. If you found value
in this video, be sure and hit the like button,
575.6 -> and leave a comment and let us know
what you found particularly helpful.
