Junctional Rhythms

Question 1

What are the 2 primary causes of Junctional Rhythms?

Answer 1

1. SA node failure to generate impulse
2. Increased automaticity of junctional tissue
   If SA node fails, it is no longer primary pacemaker of the heart and AV node takes its place.

Question 2

What are the primary effect of a junctional rhythm?

Answer 2

Ineffective Depolarization of Atria & loss of atrial kick

This causes a decrease in cardiac output.

Question 3

Is there a P wave?

Answer 3

1. Absent = AV –> Bundle of HIS
2. Inverted = Retrograde (Backward conduction)
3. After QRS = Atrial depolarization occurred after ventricular depolarization.

Question 4

Is there a QRS?

Answer 4

Yes; may be normal = <.12

Question 5

Is there a PR interval?

Answer 5

If there is, it may be shorter than its normal <.20 seconds.

Question 6

Is the rate normal in a junctional rhythm?

Answer 6

Yes: 40 – 60 bpm

Question 7

Is the rhythm normal in a junctional rhythm?

Answer 7

Yes

Question 8

What are some causes of Junctional Rhythms?

Answer 8

1. Electrolyte Imbalance
2. Ischemia
3. Toxic Drug Levels: Digitalis

Question 9

What are some Treatments for Junctional Rhythms?

Answer 9

1. Atropine: If results in symptoms.
   a. Chest Pain
   b. SOB
   c. Decreased LOC

Question 10

What are the RN Interventions for a junctional rhythm?

Answer 10

1. ID appropriately (Distinguish between SB & HB)
2. Notify HCP if onset is sudden
3. Observe & monitor
4. Withhold heart medications r/t decreasing HR. (Digoxin)