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TL Dysrhythmias
Nursing of the adult with Dysrhythmias
| Question | Answer |
|---|---|
| Define dysrhythmia. | disturbance in the heart rate or rhythm |
| What is and what is not responsible for dysrhythmias? | They are caused by disturbance in the electric conduction of the heart, not by abnormal heart structure. |
| Talk about the onset of symptoms of dysrhythmias. | The client with dysrhythmias may be asymptomatic until cardiac output is altered. |
| Name 5 common causes of dysrhythmias. | certain drugs, acid-base or electrolyte imbalance, marked thermal changes, disease and trauma, stress |
| Name 5 drugs that could cause dysrhythmias. | Digoxin, quinidine, caffeine, nicotine, alcohol |
| Name 3 electrolytes that if out of balance could result in dysrhythmias. | Potassium, calcium, and magnesium |
| What might the nurse find on assessment of the client with dysrhythmia? | Change in pulse rate or rhythm; irregular ECG; client complaint of palpitation, syncope, pain, dyspnea; Diaphoresis; hypotension; electrolyte imbalance |
| Give a couple applicable nursing diagnoses for the patient with dysrhythmia. | Ineffective tissue perfusion; activity intolerance |
| What is happening in the heart during Atrial Fibrillation? What would you see on an ECG? | Chaotic activity in the AV node, Irregular ventricular rhythm, no true P waves visible on ECG |
| Give three treatments for atrial fibrillation. | anticoagulant therapy (increased risk for CVA), cardioversion, antiarrhytmic drugs |
| What would a patient experience with atrial flutter? How would the ventricular rhythm be affected? What would it look like on an ECG? | fluttering in chest, ventricular rhythm stays regular, saw toothed waves between QRS spikes |
| How is atrial flutter treated? | cardioversion, antiarrhytmic drugs, radiofrequency catheter ablation |
| How does ventricular tachycardia look on an ECG? | Wide, bizarre QRS |
| What might a nurse find on assessment of a client with ventricular tachycardia? | Altered pulse and impaired cardiac output |
| How is ventricular tachycardia treated? | synchronized cardioversion, antiarrhythmic drugs |
| What kind of dysrhythmia results in no cardiac output/cardiac emergency? | ventricular fibrillation |
| How is ventricular fibrillation treated? | CPR, defibrillation ASAP, antiarrhythmic drugs |
| What does the nurse assess for the client with dysrhythmia? | Current medications, serum drug levels esp. digitalis, electrolyte levels esp. K+ and Mg++, Set up and monitor ECG – watch for premature ventricular contractions (PVCs), watch for medication side effects, monitor activity level and symptoms with activity |
| A holter monitor offers continuous observation of the client’s heart rate. In order to interpret the readings best what activities should we ask the client to record? | Medication- time/dose, Chest pain – type/duration, valsalva maneuver, sexual activity, exercise |
| Give some examples of times a person would employ the valsalva maneuver. | straining at stool, sneezing, coughing |
| When the client has been admitted for dysrrhythmia what emergency measures should the nurse be ready to employ? | cardioversion and defibrillation |
| Define cardioversion. | Cardioversion is the delivery of synchronized electrical shocks to the myocardium |
| What’s the difference between synchronous and asynchronous pacemakers? | synchronous = on demand- only when the client’s heart rate falls below a certain level; Asynchronous = always on – fires at a constant rate |
| What is the attitude the nurse wants to display for the patient admitted with dysrhythmia? | calm and reassuring |
| What does the nurse do for the client admitted with dysrhythmia other than assessment? | monitor activity and observe for symptoms with activity; ensure proper administration of medications and observe for side effects; be ready to employ emergency measures; be prepared for pacemaker insertion |
| When is a temporary pacemaker employed? | in emergency situations |
| Describe 2 ways in which a temporary pacemaker might be introduced. | a pacing wire is threaded into the right ventricle through the superior vena cava or an epicardial wire is put in place (through the client’s incision) during cardiac surgery |
| Where is the pulse generator usually implanted in a permanent internal pacemaker? | in the shoulder or abdomen |
| How are programmable pacemakers programmed? | by placing a magnetic device over the generator |
| What instructions does the nurse give the client with a pacemaker? | Report pulses below the set rate of the pacemaker; avoid leaning over an automobile with the engine running; stand 4-5 feet away from electromagnetic sources; Avoid MRI |
| Give a couple of examples of electromagnetic sources. | microwave oven; radar detectors |
| Why might it be important to watch for PVCs when our patient has been admitted for dysrhythmia? | PVCs tend to be precursors of ventricular tachycardia and ventricular fibrillation |
| Give several examples of ominous PVCs. | Occurring more often than once in 10 heartbeats; occurring in groups of 2 or 3; occurring near the T wave; taking on multiple configurations |
Created by:
Perseverandovercome
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