PROF. DR. M.J.

DINO

COURSE MAP
Critical Care Nursing is an elective course that allows nursing students to manage common healthcare problems
involved in critical care, trauma or emergency situations. The course focuses on the introduction to critical care
nursing, foundation of circulation, airway and breathing management, and management of client with critical
4.0 conditions. The nursing students are expected to develop an effective nursing care plan for critically-ill clients.

Unit Learning Outcome

Distinguish the etiology, characteristics, rhythm and conduction abnormalities seen on ECG strips and associated management

RHYTHMS ORIGINATING IN THE SINUS NODE

Arrhythmias are any cardiac rhythm that is not normal sinus
rhythm. It may result from altered impulse formation or
conduction. Arrhythmias are named by the place where they
originate and by their rate. The typologies of arrhythmias are as
follows: (a) rhythms originating in the sinus node, (b) rhythms
originating in the atria, (c) rhythms originating in the ventricle,
and (e) AV blocks.
Sinus Bradycardia - can be normal findings in athletes during
sleep; may be a response to vagal simulation and certain
medications (digitalis, beta-blockers, calcium channel blockers);
seen in patients with increased ICP, uremia, myxedema and
obstructive jaundice.

NORMAL SINUS RHYTHM

It is imperative for critical care nurses to recognize the normal

sinus rhythm to ascertain deviations and abnormalities.

NORMAL SINUS RHYTHM (NSR)

Sinus Tachycardia - a normal response to exercise and
emotion; and can be caused by some medications (e.g.
CHARACTERISTICS DESCRIPTION ephinephrine, dopamine, caffein)
Rate 60-100 bpm
Rhythm regular

P-wave precede QRS, consistent shape

PR Interval 0.12 to 0.20 second
QRS Complex 0.04 to 0.10 second Sinus Arrhythmia - occurs when sinus node discharges
irregularly, and is a normal phenomenon during respiration; may
Conduction normal flow be caused by digitalis toxicity.

Sinus Arrest - occurs when impulses from the sinus node are
not formed as expected (p-wave absent at some point); also
known as sinus pause; causes include vagal simulation and
drugs (digitalis, beta-blockers, calcium channel blockers)
 NELEC 2: PROF. DR. M.J. DINO

Summary of Rhythms Originating in Sinus Node RHYTHMS ORIGINATING IN THE VENTRICLES

RHYTHMS ORIGINATING IN SINUS NODE

[NOTE: ventricular arrhythmias are considered to be more
dangerous than other arrhythmias due to their potential to
SB ST SArrh SArst decrease cardiac output]

Rate below 60 above 100 OK uOK Ventricular Asystole - absence of any ventricular rhythm.
Rhythm OK OK irregular irregular
P-wave OK OK OK with fail
PR Interval OK OK OK with fail
QRS Complex OK OK OK with fail
Conduction OK OK OK with fail Ventricular Fibrillation - rapid, ineffective quivering of the
ventricles; no cardiac output or palpable pulse (fatal without
immediate treatment)
RHYTHMS ORIGINATING IN THE ATRIA

Atrial Flutter - caused by fixed re-entry circuit in the right atrium

on patients with health concerns (e.g. rheumatic heart disease,
atherosclerotic heart disease, heart failure, myocardial infraction)

Supraventricular Tachycardia - rapid rhythm of the heart that

begins in the upper chambers.

Atrial Fibrillation - an extremely rapid and disorganised pattern

of depolarisation; most commonly seen in adults post cardiac
surgery and with conditions such as rheumatic heart disease,
pulmonary disease , MI, and congenital heart disease.
Ventricular Tachycardia - rapid ventricular rhythm; commonly
caused by coronary artery diseases.

Summary of Rhythms Originating in the Atria

RHYTHMS ORIGINATING IN VENTRICLES

RHYTHMS ORIGINATING IN THE ATRIA
VF VA
AFlut AFib
Rate rapid none
Rate uOK varies
Rhythm irregular none
Rhythm OK irregular
P-wave none none
P-wave sawtooth not present
PR Interval none none
PR Interval uOK not present
QRS Complex none none
QRS Complex uOK uOK
Conduction abnormal none
Conduction uOK disorganized
 NELEC 2: PROF. DR. M.J. DINO

AV BLOCKS

First Degree AV Block - prolonged AV conduction to the

ventricles; due to coronary artery disease, rheumatic heart
disease and administration of some drugs (e.g. digitalis, beta-
blockers or calcium channel blockers).

Second Degree AV Block (Type 1) - occurs when one atrial

impulse at a time fails to be conducted to the ventricles (occurs
at AV node)

Second Degree AV Block (Type 2) - occurs when one atrial

impulse at a time fails to be conducted to the ventricles (occurs
below AV node)

Third Degree AV Block - complete failure of conduction of all

atrial impulses to the ventricles.

FIN