sinus rhythms

Question 1

Where do sinus rhythms originate?

Answer 1

SA node

Question 2

What are the main types of sinus rhythms?

Answer 2

Normal Sinus Rhythm, Sinus Bradycardia, Sinus Tachycardia, Sinus Arrhythmia, Sinus Arrest/Pause

Question 3

Rate of Normal Sinus Rhythm?

Answer 3

60–100 BPM

Question 4

Rhythm of Normal Sinus Rhythm?

Answer 4

Regular

Question 5

Is there a P before every QRS in Normal Sinus Rhythm?

Answer 5

Yes

Question 6

Are P waves uniform in Normal Sinus Rhythm?

Answer 6

Yes

Question 7

PR interval in Normal Sinus Rhythm?

Answer 7

0.12–0.20 sec (3–5 boxes)

Question 8

QRS in Normal Sinus Rhythm?

Answer 8

Yes, 0.06–0.12 sec (1.5–3 boxes)

Question 9

Nursing action for Normal Sinus Rhythm?

Answer 9

Nothing to do, monitor per order

Question 10

Example of Normal Sinus Rhythm rate?

Answer 10

70 BPM (within range, all normal)

Question 11

Rate of Sinus Bradycardia?

Answer 11

< 60 BPM

Question 12

Rhythm of Sinus Bradycardia?

Answer 12

Regular

Question 13

Is there a P before every QRS in Sinus Bradycardia?

Answer 13

Yes

Question 14

PR interval in Sinus Bradycardia?

Answer 14

0.12–0.20 sec (3–5 boxes)

Question 15

QRS in Sinus Bradycardia?

Answer 15

Yes, 0.06–0.12 sec (1.5–3 boxes)

Question 16

Common heart-related causes of Sinus Bradycardia?

Answer 16

Sick sinus syndrome, heart attack, heart disease (CAD, CHF, valve problems), conduction system problems

Question 17

Other causes of Sinus Bradycardia?

Answer 17

Electrolyte imbalance (low K/Ca), medications (beta blockers), hypothyroidism, sleep, aging, ANS dysfunction

Question 18

Symptoms of Sinus Bradycardia?

Answer 18

Syncope, dizziness, chest pain, SOB, exercise intolerance, cool/clammy skin (may be asymptomatic if chronic)

Question 19

Risk of Sinus Bradycardia?

Answer 19

Reduced cardiac output

Question 20

Treatments for Sinus Bradycardia (if symptomatic)?

Answer 20

Atropine, pacing, monitor

Question 21

Nursing interventions for Sinus Bradycardia?

Answer 21

Assess symptoms, O2/SPO2, BP/HR, IV access, notify provider. <90 SBP = unstable

Question 22

Rate of Sinus Tachycardia?

Answer 22

101–160 BPM

Question 23

Rhythm of Sinus Tachycardia?

Answer 23

Regular

Question 24

Is there a P before every QRS in Sinus Tachycardia?

Answer 24

Yes

Question 25

PR interval in Sinus Tachycardia?

Answer 25

0.12–0.20 sec (3–5 boxes)

Question 26

QRS in Sinus Tachycardia?

Answer 26

Yes, 0.06–0.12 sec (1.5–3 boxes)

Question 27

Common heart-related causes of Sinus Tachycardia?

Answer 27

Arrhythmias (Afib, V tach, SVT), CAD, CHF, valve disease, heart attack

Question 28

Other causes of Sinus Tachycardia?

Answer 28

Electrolyte imbalances (K, Ca, Mg), stimulants (cocaine, meth, albuterol), stress/anxiety, fever, hyperthyroid, blood loss/anemia

Question 29

Symptoms of Sinus Tachycardia?

Answer 29

Syncope, dizziness, SOB, rapid pulse, palpitations, chest pain (may be asymptomatic)

Question 30

Risk of Sinus Tachycardia?

Answer 30

↓ Cardiac output, ↑ O2 demand, may cause MI/ischemia

Question 31

Nursing interventions for Sinus Tachycardia?

Answer 31

Assess stability, O2/SPO2, BP/HR, IV access, notify provider, treat cause (antipyretics, stop stimulants, stress reduction)

Question 32

Medications for Sinus Tachycardia (narrow QRS)?

Answer 32

Vagal maneuvers, beta blockers, calcium channel blockers, cardioversion

Question 33

Medications for Sinus Tachycardia (wide QRS)?

Answer 33

Procainamide, amiodarone, sotalol

Question 34

Example case: 150 BPM, regular, P for every QRS, PR normal

Answer 34

Sinus Tachycardia bordering SVT

Question 35

What is SVT?

Answer 35

Group of abnormal heart rhythms from atria or AV junction, HR >150 BPM

Question 36

Rhythm of SVT?

Answer 36

Regular

Question 37

P before every QRS in SVT?

Answer 37

Yes

Question 38

QRS for every P in SVT?

Answer 38

Yes

Question 39

Typical SVT HR?

Answer 39

>150 BPM (exam: not 150, 149 or 151)

Question 40

Symptoms of SVT?

Answer 40

Syncope, dizziness, chest pain, SOB, pounding pulse, throat tightness, fatigue, sweating, palpitations

Question 41

Causes of SVT?

Answer 41

Stimulants, hypoxia, hypokalemia, stress, atherosclerosis

Question 42

Risks of SVT?

Answer 42

Prolonged episodes → heart failure

Question 43

Treatment of stable/asymptomatic SVT?

Answer 43

Vagal maneuvers, adenosine (6 mg → 12 mg if needed), cardioversion if unsuccessful

Question 44

Treatment of unstable SVT?

Answer 44

Immediate cardioversion (sedation if possible)

Question 45

Nursing interventions for SVT?

Answer 45

Assess stability, O2/SPO2, BP/HR, IV access, prep for cardioversion, have MD, RT, code cart, EKG, O2, 2 large-bore IVs, BVM ready

Question 46

Rate of Sinus Arrest/Pause?

Answer 46

Variable

Question 47

Rhythm of Sinus Arrest/Pause?

Answer 47

Irregular

Question 48

P before every QRS in Sinus Arrest?

Answer 48

Yes, if QRS present

Question 49

PR interval in Sinus Arrest?

Answer 49

0.12–0.20 sec (3–5 boxes)

Question 50

QRS in Sinus Arrest?

Answer 50

Yes, if present, 0.06–0.12 sec

Question 51

Symptoms of Sinus Arrest?

Answer 51

Asymptomatic, syncope, dizziness, LOC, bradycardia

Question 52

Causes of Sinus Arrest?

Answer 52

Normal during sleep, myocarditis, cardiomyopathy, MI, digitalis toxicity, age, vagal stimulation

Question 53

Risks of Sinus Arrest?

Answer 53

Rare sudden cardiac death, syncope, falls, stroke, CHF, progression to atrial arrhythmias (aflutter, afib)

Question 54

Treatments for Sinus Arrest (if symptomatic)?

Answer 54

Atropine, pacemaker

Question 55

Nursing interventions for Sinus Arrest?

Answer 55

Assess stability, O2/SPO2, BP/HR, IV access, notify provider, correct causes (meds, electrolytes, pacemaker if age-related)

Question 56

Example case of Sinus Arrest?

Answer 56

HR 40, QRS regular when present, P for every QRS, but pauses in rhythm