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EKG Review 5: PAC, PJC, PVC etc.
| Course Number |
LWN305 |
| Objectives |
At the end of this course, you will define, know
the characteristics and nursing interventions of 1. PAC, 2.PJC, 3. PVC,
4.3BVT and VT, and 5. Bigeminy and Trigeminy |
| Credit Hours and Fee |
3.0 CE Credit Hours with a fee of $24.00 |
| Instructor/developer |
Rudolf Klimes, PhD (Indiana U), MPH
(Johns Hopkins U);
Adjunct Professor at Folsom Lake
College, Folsom CA
Robyn Nelson, RN, DNSc |
Welcome to an accredited continuing education
course in health for nurses, counselors and others.
Take
this course for free. Or study this web-site for an
approved (RN-CEP 11430, MFT- PCE 39) 3-hours Continuing Education Certificate (0.3
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to the bottom of this page.
PAC: Premature Atrial
Contraction
Definition:
A PAC is an ectopic premature beat, not originating from a SA node. The atria
are usually irritable in this situation. This irritability is what causes the
premature firing of the atrial complex. The ventricular complex is normal.
Possible causes are drug interaction, caffeine, fatigue, cardiac ischemia,
atrial enlargement, alcohol, anterior myocardial infarction, emotional stress
and tobacco. See
http://www.mei.com/resource/arrythm/show.cgi?121
EKG Characteristics.
Rate: Atrial and ventricular usually normal. Rhythm: Irregular. P Wave: Ectopic
P Wave. PR Interval: Usually normal, but could also be greater than 020 seconds.
QRS Complex: normal configuration. ST Segment: Normal configuration. T Wave:
Usually normal, but could have P Wave hidden in it, which distorts T
Waves.
Nursing Intervention:
No nursing intervention is needed unless it is a frequent arrhythmia, or it
is anew patient. Determine the underlying causes and treat.
PJC: Premature Junctional
Complexes
Definition:
PJC have an ectopic foci in the AV junctional tissue that paces the heart. The
result is a PJC. The P wave may be inverted in lead II as a result of the
abnormal conductive pathway. Possible causes are ischemia, hypoxemia, valvular
disease, stimulants (caffeine), alcohol, atrial enlargement, emotional stress,
digitis toxidity, and it may be a normal variant.
EKG Characteristics:
Usually 60-100 beats per minute. Rhythm: Irregular, due to PJC. P Wave: Can
occur before, during, or after QRS complex. The P wave also can be inverted in
lead II. PR Interval: Less than 0.12 seconds. QRS Complex: Normal in
configuration and duration. The QRS complex just occurs sooner due to the PJC.
ST Segment: Could be distorted if the P wave follows QTS complex.
Nursing Interventions:
No nursing intervention is needed unless the PJCs frequently occur, or if the
arrhythmia is new for the patient. Determine the cause and treat the underlying
etiology.
PVC: Premature Ventricular
Contractions
Definition:
A PVC is an ectopic foci originating in the ventricles. This depolarization is
premature. The two ventricles do not usually depolarize simultaneous. A widened
QRS complex may result. Three or more PVCs in a row or PVCs lasting more than 30
seconds are considered a run of ventricular tachycardia (VT). PVCs may occur in
an isolated complex, or in every other beat (bigeminy), or even in every third
beat (trigeneminy). PVC can be isolated incidents without symptoms, which is no
cause for alarm, or PVCs can be symptomatic. Possible causes are electolyte
imbalances, hypoxia, ischemia, acute myocardial infarction and medical
toxicity.
EKG Characteristics:
Rate: Normal for the intrinsic rhythm. Rhythm: Regular, except for the
PVC. P Wave: None. PR Interval: None. QRS Complex: Greater than 0.12
seconds.
Nursing Intervention:
Treatment is only indicated if PVC is symptomatic. Determine the cause of the
PVCs and treat the cause. Oxygen administration, standing protocol orders, and
notify the MD if this is a new event.
3BVT: e Beat Ventricular
Tachycardia
Definition:
3BVT is a rapid arrhythmia that originates from the ventricles. The appearance
is that of three successive wide, bizarre QRSa being greater than 0.12 second
per complex. VT can be caused from ischemia, infarction, cardiomyopathy,
congestive heart failure, hypokalemia, hypomagnesia, reperfusion or medical
toxicity.
EKG Characteristics:
Rate: The wide QRS complex are 100-250 beats per minute. Rhythm: the VT happens
in the intrinsic rhythm. QRS Complex: The VT must be greater than 0.12 seconds
in length.
Nursing Intervention:
Obtain vital signs, treat with prescribed medication per parameters of the hospital.
Continue to monitor the patient for further VT.
VT: Ventricular Tachycardia
Definition:
VT is a rapid deadly rhythm originating from the ventricles. The appearance is
that of rapid wide QRS complex. They are often wide and bizarre with a QRS of
0.12 seconds or greater. It is often found in patients with myocardial ischemia
or infarction, cardiomyopathy, congestive heart failure, hypokalemia,
hypomagnesemia, reperfusion following thromboytic therapy, or mediation toxocity.
EKG Characteristics:
Rate: 100-250 beats per minute. Rhythm: QRS complex and wide and bizarre. QRS
Complex: This is the determining factor for VT. It must be greater than 0.12
seconds.
Nursing Intervention:
The patient may have a pulse. If he or she does, administer the prescribed
medication. Start oxygen, obtain vital signs. If the patient is pulse-less, start
the code process with serial defibrillation and CPR per hospital protocol.
Definition:
Bigeminy is a type of premature ventricular contraction. This type of PVC occurs
when a PVC is followed by a normal QRS complex, then another PVC, in an
alternating pattern. Possible causes are electrolyte imbalances, (K+, Mg+),
hypoxia, ischemia, medication toxicity, and acute infarction.
EKG Characteristics:
Rate: Usually normal 60-100 beats per minute. Rhythm: Irregular, QRS Complex:
Normal complex followed by a wide QRS complex.
Nursing Intervention:
Treatment is indicated if arythmia is symptomatic. Interventions are oxygen
administration, initiating standing protocol orders. Notify the MD if this is a
new arrhythmia. Determine
underlying causes and treat.
Definition: Trigeminy is a
type of PVC pattern. The PVC follows very two normal QRS complexes. Possible
causes are electrolyte imbalances, hypoxia, ischemia, acute myocardial
infarction, and medication toxicity.
EKG Characteristics and
Nursing Interventions: Same as Bigeminy PVC.
Study this web-site for 3 hours for
an approved (RN-CEP 11430, MFT- PCE 39) 3-hours Continuing Education
Certificate (0.3 CEUs).
Click
here for the self-correcting test & online payment, and 2) receive your
certificate immediately online. All is online, nothing by post-mail.
Course developed by California State University of California Nursing
Students Kristi Cargill, Tommy Ferguson, Leslie Keear, Tracy Milne Leach and
Jennifer Moores. Instructors: Robyn Nelson, RN, DNSc and R.
E. Klimes, PhD, MPH.
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