Resources for Nursing Education Online

Basic Arrhythmia Interpretation

Course Description

This self-paced course taught via the Internet provides the health care provider with the basic skills utilized in interpretation of basic cardiac arrhythmias. It is a nine week course consisting of weekly lessons, reading assignments, quizzes with feedback, and access to the instructor via email. Students will be able to complete the course at their own pace, with a maximum time limit of 9 weeks from the start of the course, to take the final exam. The course should take approximately 28 hours total class time.

Computer/Systems Requirements

The course can be viewed with any web browser; recommended are Microsoft Internet Explorer, version 4.0 or higher, Mozilla Firefox, Google Chrome, or Mac Safari. In order to use a Web browser, you will need to have an Internet connection.

Textbook

Although you can choose to take the course entirely online,  a supplemental textbook for those that are entirely new to interpreting basic arrhythmias is strongly recommended.  It is not mandatory but extremely helpful for those that need lots of repetitive practice.

Recommended texts:

  • Walraven, G. (2010). Basic Arrhythmias (7th ed.). Upper Saddle River: Brady/Prentice Hall. ISBN-10: 0135002389 ISBN-13: 978-0135002384. This book is great. It's my personal favorite and I have used it for many years. You are going to love it. It includes lots of color graphics and some clear practice strips. Also notice that you get a great heart rate ruler/calculator in the front of the book and my favorite: flash cards in the back of the book (these are GREAT). A few words of warning: The Walraven book contains answers to all the practice sheets in the back of book. BE CAREFUL WITH THESE AND DO NOT RELY ON THEM TOO MUCH OR YOU WILL NOT LEARN THE MATERIAL. Also, I guarantee that you will not get THE EXACT ANSWERS THAT THE BOOK SAYS. I don't and you won't. It doesn't matter. As long as your measurements are not too far off, "don't sweat the small stuff!"

OR

  • Huff, J. (2005) ECG Workout-Exercises in Arrhythmia Interpretation (7th ed., Philadelphia: Lippincott Williams & Wilkins ISBN-13: 978-1469899817, ISBN-10:1469899817). The Huff text is also great. The advantage of this book is that it is cheaper than Walraven.

You can order either of these textbooks through Amazon.com

Click here to order the Walraven text

Click here to order the Huff text

If you have another Basic Arrhythmia textbook (and it's up to date) and you want to use it, it's probably OK....just correlate the lessons with the topics in the book you own.

Make sure you do lots of practice strips though (many of the books don't contain enough practice strips) Some students also find it helpful to purchase calipers (measuring device). These are inexpensive and can be purchased in any uniform store.

Proctor

You will be required to find someone to serve as a proctor for your final exam. This individual can be a local librarian, schoolteacher, hospital educator, clinical supervisor/nurse manager, clinical nurse specialist, or nurse practitioner. You will need to submit information about your proctor at least one week prior to the time you plan to take the final exam. When you complete your course work, you will be given detailed instructions for the process. Once you make arrangements with your proctor for a mutually agreeable location, date, and time, you will let us know. We will email the final exam and proctor contract to your proctor. After you complete the exam, the proctor will either return it to us by US mail, scan and email, or fax the exam back to us for grading.

Contact Hours

A Certificate of Completion will be issued by Resources for Nursing Education Online after successful completion of the Final Exam and Course Evaluation. This is equivalent to 28.0 Contact Hours of Continuing Nursing Education Credit.

Program Objective

The objective of this course is to familiarize the nurse with the key features of each arrhythmia along with the physiological consequences and signs and symptoms of each. In addition, management of each arrhythmia will be reviewed.

Student Learning Objectives

Upon completion of this course, the student will be able to:

  1. Identify the normal EKG complex.
  2. Name the key features of selected arrhythmias.
  3. Demonstrate a systematic approach in interpreting selected rhythm strips.
  4. Differentiate the pathophysiologic mechanism of selected arrhythmias.
  5. Outline the hemodynamic consequences and signs and symptoms of selected arrhythmias. Summarize the nursing and medical responsibilities of selected arrhythmias.

Lesson Objectives

Lesson 1

  1. Discuss the location, size and position of the heart in the thoracic cavity.
  2. Identify the heart chambers and valves.
  3. Trace the blood flow from the periphery through the heart and lungs and out to the periphery.
  4. Describe the coronary arteries.
  5. Explain three properties of cardiac cells.
  6. Label the parts of the conduction system.
  7. Distinguish between the electrical and the mechanical functions of the heart.
  8. Relate cardiac arrhythmia monitoring to pulse/perfusion assessment.

Lesson 2

  1. Explain how cardiac impulses are formed.
  2. Give the uses and limitations of cardiac arrhythmia monitoring.
  3. Describe the components of monitoring equipment used to detect cardiac electrical activity.
  4. Summarize the heart’s electrical conduction system.
  5. Explain the influence of the nervous system on the rate of cardiac impulse formation.

Lesson 3

  1. Relate the components of a single cardiac cycle to the electrophysiological events that created them.
  2. Given a single cardiac cycle, locate each of the following components:
    1. P wave
    2. PR segment
    3. PR interval
    4. Q wave
    5. R wave
    6. S wave
    7. QRS complex
    8. ST segment
    9. T wave
  3. Relate the use of a systematic analysis format to the eventual interpretation of an arrhythmia.
  4. Outline the five components of an organized approach to rhythm strip analysis.
  5. Describe the pertinent aspects of a systematic analysis of regularity, including R-R intervals, P-P intervals, patterns and ectopics.
  6. Describe the systematic analysis of rate.
  7. Describe the systematic analysis of P waves, including location, morphology and patterns.
  8. Describe the systematic analysis of PR intervals, including duration, changes and patterns.
  9. Describe the systematic analysis of QRS complexes, including duration, morphology and patterns.

Lesson 4

  1. Outline the physiological mechanisms common to the sinus rhythms.
  2. Describe the expected path of conduction for an impulse originating from a sinus pacemaker.
  3. Identify EKG features common to all arrhythmias in the sinus category.
  4. Outline the key identifying EKG features of a sinus rhythms/arrhythmias, including regularity, rate, P waves, PR intervals and QRS complexes.
  5. Summarize the clinical significance and/or hemodynamic consequences of sinus arrhythmias.
  6. Report the medical and nursing interventions appropriate for sinus arrhythmias.
  7. Recognize arrhythmias that originate in the sinus node, including: normal sinus rhythms, sinus bradycardia, sinus tachycardia and sinus arrhythmia.

Lesson 5

  1. Outline the physiological mechanisms common to the atrial rhythms. Describe the expected path of conduction for an impulse originating from a atrial pacemaker. Identify EKG features common to all arrhythmias in the atrial category. Outline the key identifying EKG features of atrial arrhythmias, including regularity, rate, P waves, PR intervals and QRS complexes.
  2. Summarize the clinical significance and/or hemodynamic consequences of atrial arrhythmias.
  3. Report the medical and nursing interventions appropriate for each atrial arrhythmia.
  4. Recognize arrhythmias that originate in the atria, including premature atrial contractions, atrial flutter, atrial fibrillation, atrial tachycardia and wandering pacemaker.

Lesson 6

  1. Outline the physiological mechanisms common to the junctional rhythms.
  2. Describe the expected path of conduction for an impulse originating from a junctional pacemaker.
  3. Identify EKG features common to all arrhythmias in the junctional category.
  4. Outline the key identifying EKG features of junctional arrhythmias, including regularity, rate, P waves, PR intervals and QRS complexes.
  5. Summarize the clinical significance and/or hemodynamic consequences of each junctional arrhythmia.
  6. Report the medical and nursing interventions appropriate for junctional arrhythmias.
  7. Recognize arrhythmias that originate in the junction including: premature junctional contractions, junctional escape rhythm, accelerated junctional rhythm, junctional tachycardia and supraventricular tachycardia.

Lesson 7

  1. Outline the physiologic mechanisms common to the heart blocks.
  2. Describe the expected path of conduction for each heart block.
  3. Identify EKG features common to each type of block.
  4. Outline the key identifying EKG features of each type of block, including regularity, rate, P waves, PR intervals and QRS complexes.
  5. Summarize the clinical significance and/or hemodynamic consequences of each heart block.
  6. Report the medical and nursing interventions appropriate for each heart block.
  7. Recognize each type of heart block, including: first degree, second degree - Type 1, second degree - Type II, and third degree/complete heart block.

Lesson 8
Click here for an excerpt

  1. Outline the physiological mechanisms common to the ventricular rhythms.
  2. Describe the expected path of conduction for an impulse originating from a ventricular pacemaker.Identify EKG features common to all arrhythmias in the junctional category.
  3. Outline the key identifying EKG features of ventricular arrhythmias, including regularity, rate, P waves, PR intervals and QRS complexes.
  4. Summarize the clinical significance and/or hemodynamic consequences of each ventricular arrhythmia.
  5. Report the medical and nursing interventions appropriate for each ventricular arrhythmia.
  6. Recognize arrhythmias that originate in the junction including: premature ventricular contractions, ventricular tachycardia, ventricular fibrillation, idioventricular rhythm and agonal rhythm.
  7. Outline the physiological mechanism of asystole.
  8. List six possible causes of asystole.
  9. Outline the key identifying EKG features of asystole.
  10. Summarize the clinical significance and/or hemodynamic consequences of asystole.
  11. Report the medical and nursing interventions appropriate for asystole.
  12. Recognize asystole.

Lesson 9

  1. Demonstrate the systematic analysis method in interpretation of various rhythm strips.