Medical Surgical EKG #11

Question

A nursing student understands that a client with which arrhythmia will be the most likely to need an immediate pacemaker?

Answers

  1. Ventricular fibrillation
    • Rationale:

      This answer is not correct because you treat ventricular fibrillation with defibrillation and CPR immediately. That is the top priority because ventricular fibrillation is a rapid disorganized ventricular rhythm that causes ineffective quivering of the ventricles. clients may become unresponsive, without a pulse, and may stop breathing.

  2. Atrial fibrillation
    • Rationale:

      This answer is not correct because atrial fibrillation consists of multi-foci impulses, which are disorganized, usually without discernable P waves, and may have a rapid atrial rate of 350 – 600 bpm. The quivering atria may place the client at risk for thrombus formation. Symptoms of weakness, dizziness, shortness of breath, palpitations, and chest pain may occur. Treatments include medications like anticoagulants, beta blockers, and calcium channel blockers.

  3. Third degree AV block
    • Rationale:

      This answer is correct because a third degree AV block or complete heart block is where there is no conduction through the AV node, which causes complete dissociation between the atria and ventricles. The ECG will reflect no relation between the P-waves and the QRS complexes. Third degree heart block generally has an extremely low heart rate. The client will experience weakness, dizziness, confusion, shortness of breath. A pacemaker will have to be placed to make this client perfuse the body properly and prevent a lethal heart arrhythmia.

  4. First degree AV block
    • Rationale:

      This answer is not correct because with a first degree AV block everything about the cardiac cycle is normal besides the PR interval. There is a delay in conduction to the SA node that is usually at the level of the AV node causing a longer PR interval. This is a constant value before each QRS complex. This can be caused by a number of things including; AMI, myocarditis, endocarditis, cardiomyopathy, hyperkalemia, or increased vagal tone. Clients are usually asymptomatic.

Overview

A pacemaker is often implanted to treat symptomatic bradycardia, which may occur from a number of different pathophysiological conditions. These include second-degree AV block type II, third-degree AV block, and sick sinus syndrome.

Explanation

Learning Outcomes

Third degree AV block or complete heart block is where there is no conduction through the AV node, which causes complete dissociation between the atria and ventricles. The ECG will reflect no relation between the P-waves and the QRS complexes. Third degree heart block generally has an extremely low heart rate, such as this one, that is 34 bpm. The client with a 34 heart rate will experience weakness, dizziness, confusion, shortness of breath. A pacemaker will have to be placed to make this client perfuse the body properly and prevent a lethal heart arrhythmia.

Test Taking Tip

As a nurse it is important to understand the need for any treatment or why a healthcare provider and/or other members of the healthcare team develops a plan of care for a client.

Video Rationale