Atrial fibrillation Describe the three methods for determining heart rate What i

Question

Atrial fibrillation Describe the three methods for determining heart rate What is the 8-step method for ECG rhythm analysis What is the Vaughn-William Classification of drugs: What would you see for a patient with sinus tachycardia? What would you teach the patient? What would you see for a patient with sinus bradycardia? What are the intervention What would you see when caring for a patient with Afib? How is it managed What is the CHAD scoring system? What would you see when managing a patient with PVC's? How is it managed What is ventricular tachycardia? What is ventricular fibrillation? How are they managed What's the difference between CPR and ACLS? What is an automated external defibrillation? What are your considerations for the older patient with dysrhythmias What is taught to patients with permanent pacemakers/ DOLL

Explanation / Answer

1. Atrial fibrillation (AF or A-fib) is an abnormal heart rhythm characterized by rapid and irregular beating of the atria. Often it starts as brief periods of abnormal beating which become longer and possibly constant over time. Often episodes have no symptoms.Occasionally there may be heart palpitations, fainting, lightheadedness, shortness of breath, or chest pain. The disease is associated with an increased risk of heart failure, dementia, and stroke. It is a type of supraventricular tachycardia.

2. Your heart rate can be taken at any spot on the body at which an artery is close to the surface and a pulse can be felt. The most common places to measure heart rate using the palpation method is at the wrist (radial artery) and the neck (carotid artery).

Manual Method

Monitor Method

A heart rate monitor or ECG/EEG can be used to get a more accurate heart rate measurement. There is now also a heart rate phone App that can measure heart rate too.

3. Analysing an ECG report in 8 steps includes;

Step 1

evaluate the P wave
-is it present
-round and upright in Lead II
-Precedes QRS complex
-one P wave for every QRS complex

Step 2

Evaluate atrial rhythm
-regular
-may have small variations caused by respirations
-measure P-P intervals: from each P wave to the next

Step 3

Determine the atrial rate

Step 4

PR interval
-count number of small squares between the beginning of P wave and the beginning of the QRS complex and multiply by 0.04 seconds

Step 5

evaluate the ventricular rhythm

Step 6

Determine the ventricular rate.

Step 7

calculate the duration of the QRS complex
-count number of small squares between the beginning and end of the QRS complex

Step 8

calculate the duration of the QT interval
-count number of squares from the beginning of the QRS complex to the end of the T wave
-multiply by 0.04 seconds
-normal range = 0.36-0.44 seconds

4. The Vaughan Williams classification was introduced in 1970 by Miles Vaughan Williams.

The five main classes in the Vaughan Williams classification of antiarrhythmic agents are:

With regards to management of atrial fibrillation, classes I and III are used in rhythm control as medical cardioversion agents, while classes II and IV are used as rate-control agents.

8.   CHADS2 and CHA2DS2-VASc Score for Stroke Risk Assessment in Atrial Fibrillation

Atrial fibrillation (AF) is a cardiac arrhythmia with the potential to cause thromboembolism. Studies suggest that AF increases the risk of stroke five-fold. Thus, it is important to determine which patients with AF may benefit from oral anticoagulant (OAC) and possibly aspirin therapy to reduce the risk of stroke.

Score CHADS2 Risk Criteria 1 point Congestive heart failure 1 point Hypertension 1 point Age 75 years 1 point Diabetes mellitus 2 points Stroke/transient ischemic attack

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