The nurse is analyzing a 6-second ECG rhythm strip with the following findings: P to QRS ratio is 1:1; four regular R waves were present; QRS width was 0.10 second; PR interval was 0.18 second. The nurse documents this rhythm as:
1. Atrioventricular (AV) block with 2:1 ratio
2. Sinus tachycardia noted with AV junctional rhythm
3. AV complete heart block noted
4. Sinus bradycardia
4
Rationale 1: An atrioventricular block of 2:1 ratio would mean that there are two atrial deflections (P waves) per one ventricular response (QRS), which is negated by the findings of a P to QRS ratio of 1:1.
Rationale 2: The rate is 40 beats per minute and does not meet the criteria for tachycardia, which is a rate greater than 100 beats per minute. In addition, a junctional rhythm would have an inverted P wave, or it may be hidden in the QRS, which would alter the PR interval.
Rationale 3: Complete heart block would have two separate rates for the atrial initiation of charge (P waves) at one rate and the ventricular initiation of a separate rate and cycle unrelated to the P waves. Therefore, no conduction is occurring between the atria and ventricles and both have set up their escape rhythms to try to compensate.
Rationale 4: Bradycardia is a heart rate below 60, which is validated by the 4 R waves in 3 slash marks = 4 times 10 or a rate of 40 per minute. The P to QRS ratio shows normal conduction between the atria and the ventricle. The QRS width and PR interval are both within normal limits. Therefore, the problem is just a slower than normal heart rate called bradycardia.
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