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EKG Review 6:
JR, IVR, VFib etc
| Course Number |
LWN306 |
| Objectives |
At the end of this course, you will define, know
the characteristics and nursing interventions of 1. JR, 2. IVR, 3. VFib
4.Agonal, 5. Asystole. |
| 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 this 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
CEUs) and take the 12-question multiple-choice quiz that is linked
to the bottom of this page.
Definition:
JR is a rhythm that originates from AV junction. It is characterized by P waves
that are downward conducted and less than 0.10 seconds, or in or behind
the QRS complex. JR can be caused by inferior wall myocardial infarctions,
hypoxia, electrolyte disturbances, congestive heart failure, valvular disease
cardiomyopathy and medications.
EKG Characteristics.
Rate: 40-60 beats per minute. Rhythm: Regular. P Waves: Downward deflected, less
than 0.10 seconds, in the QRD, or behind it. QRS Complex: Normal for the
intrinsic rhythm.
Nursing Intervention:
Monitor vital signs, treat underlying cause. Possibly prepare to increase the
heart rate with prescribed medication or external pacing device should the patient become
symptomatic.
IVR: Idioventricular Rhythm
Definition:
IVR originates from the ventricles with a hear rate of 30-40 per minute.
Accelerated IVR (AIVR) has a hear rate of 40-60 beats per minute. IVR is
characterized by a wide QRS complex, regularity, and its rate determines if it
is AIVR or IVR. It may transient or continuous. It is cause by increased vagal
effect, and hear disease. Continuous IVR is generally a terminal event,
occurring just before the patient enters agonal, then asystole.
EKG Characteristics:
30-40 beats per minute for IVR, 40-60 for AIVR. Rhythm : Usually regular without
P waves. QRS Complex: Wide, being greater than 0.12 seconds.
Nursing Interventions:
Get vital signs, see if the blood pressure is tolerating the decreased cardiac
output. Notify the MD. Administer oxygen, medication per hospital protocol,
possibly initiate transcutaneous pacing,
and consider external pacing. Prepare for code situation.
Definition:
Agonal rhythm is characterized by wide bizzare QRS complexes at a slow rate of
10-20 beats per minute. This is considered a terminal rhythm and is usually the
last rhythm before asystole. This is a terminal rhythm which would require a
code situation.
EKG Characteristics:
Rate: 10-20 beats per minute. Rhythm: It can be regular or irregular. P Waves:
There are no P waves. QRS Complex: Wide and bizarre. It is greater than 0.12
seconds, but usually is much greater than 0.12 seconds. ST Segment: It becomes
elevated or depressed with increasing ischemia.
Nursing Intervention:
This is a terminal rhythm in which the patient is becoming very close to death.
This would be a code situation in which one would follow the hospital protocol
for code procedure.
VFib: Ventricular
Fibrillation
Definition:
In VFib many foci take over from the ventricles and produce a disorganized,
chaotic rhythm. The patient is considered pulse-less, with no blood pressure,
requiring immediate intervention. This is a deadly rhythm. The cause of VFib is
coronary artery disease, myocardial ischemia, myocardial infarction,
cardiomyopathy, cardic trauma, drug toxicity, hypoxia, and electrolyte
imbalance.
EKG Characteristics: Rate:
No apparent rate. Rhythm: Fibrillatory waves. P Waves and QRS Complex: none.
Nursing Intervention:
This is a code situation in which one would follow the hospital protocol. Qickly
check the vital signs, serial defibrillate, CPR, IV line access, intubate,
advanced cardiac life support protocol, and transport to Iintensive Care Unit.
Definition:
In Arystole, there is no QRS complex, no hear beat, no pulse. This rhythm is
associated with death. There is no cardic output, therefore no blood pressure.
This is a code situation.
EKG Characteristics: Rate:
Less than 5 beats per minute. Rhythm: It is a straight line with no complexes. P
Waves: None. QRS Complexes: There are less than 5 complexes per minute.
Generally asystole is a flat line.
Nursing Intervention:
Check the pulse and rapidly assess the patient. Start CPR, establish an IV line,
intubate and begin the code algorithm. Transport to the Intensive Care Unit.
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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