Dysrhythmias and Ventricular Tachycardia

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Questions and Answers

What vital sign indicates that the patient is tachycardic?

Blood pressure of 80/50 mmHg

Oxygen saturation of 88% on room air

Temperature of 37 C

Heart rate of 150 bpm (correct)

Which nursing action is most appropriate to address the patient's hypotension and high heart rate?

Encourage the patient to rest without intervention.

Administer fluids to increase blood volume.

Administer beta-blockers or calcium channel blockers as prescribed. (correct)

Place the patient in a supine position.

Which assessment finding is most critical for evaluating the risk of stroke or heart attack in this patient?

Heart rate of 150 bpm (correct)

Tachypneic respiratory rate of 28 breaths/min

Oxygen saturation of 88% on room air

Blood pressure of 80/50 mmHg

What goal should be included in the patient's plan of care regarding their physical activities?

The patient will experience no chest pain during light activities. Signup and view all the answers

What is the reason for monitoring the patient's blood pressure alongside heart rate?

Hypotension may indicate an inadequate response to cardiac output. Signup and view all the answers

What does the presence of wavy lines on the cardiac monitor, with a rate of 120 beats per minute and no P waves, most likely indicate?

Atrial fibrillation Signup and view all the answers

When assessing a client with atrial fibrillation, what auscultation finding would be expected?

A continuous and totally unpredictable irregularity Signup and view all the answers

What characteristic change in QRS complexes is expected for a patient with a bundle branch block?

Widening of QRS complexes to 0.12 second or greater Signup and view all the answers

In a client with complete heart block, which adaptation is most likely to be observed?

Syncope and slow ventricular rate Signup and view all the answers

In addition to administering an antidysrhythmic drug, which medication is appropriate for a client with atrial fibrillation?

Heparin Signup and view all the answers

For a client experiencing ventricular tachycardia, what is the first appropriate action to take?

Check the client for a pulse Signup and view all the answers

Which statement should a nurse include when educating clients at risk for bradydysrhythmias?

Stop smoking and avoid caffeine. Signup and view all the answers

What is indicated by a disorder of conduction of the electrical impulse within the heart?

Disturbance of the heart rate, rhythm, or both Signup and view all the answers

What range of heart rates defines ventricular tachycardia?

100 to 250 beats per minute Signup and view all the answers

Which of the following is NOT a cause of ventricular fibrillation?

Pneumonia Signup and view all the answers

What does an echocardiogram primarily provide information about?

The heart's structure and function Signup and view all the answers

Which diagnostic tool continuously records heart activity over an extended period while the patient is active?

Holter Monitor Signup and view all the answers

Which of these symptoms is associated with both ventricular tachycardia and ventricular fibrillation?

All of the above Signup and view all the answers

What is the main purpose of a tilt table test?

To evaluate heart response to changes in body position Signup and view all the answers

Which condition is NOT cited as a cause of ventricular tachycardia?

Atrial fibrillation Signup and view all the answers

Which medical management tool is primarily used to document the electrical impulses of the heart?

Electrocardiogram (EKG) Signup and view all the answers

What is the normal range for hemoglobin in women?

12.0–15.5 g/dL Signup and view all the answers

Which test would best indicate kidney function abnormalities?

Renal Function Tests Signup and view all the answers

What is the normal range for serum creatinine?

0.6–1.2 mg/dL Signup and view all the answers

Which of the following values indicates a normal Troponin I level?

0 - 0.04 ng/mL Signup and view all the answers

What is the significance of elevated B-type Natriuretic Peptide (BNP) levels?

Indicates heart failure Signup and view all the answers

Which of the following electrolyte values falls within the normal range for potassium?

3.5–5.0 mEq/L Signup and view all the answers

Which medication is administered to improve heart contractility?

Inotropes Signup and view all the answers

The normal range for calcium levels in the blood is?

8.5–10.2 mg/dL Signup and view all the answers

What is the primary function of sodium channel blockers in pharmacological management of arrhythmias?

Block sodium channels to reduce abnormal impulses Signup and view all the answers

Which of the following medications would be most effective in reducing the heart's workload?

Beta-blockers Signup and view all the answers

What is the main purpose of anticoagulants in patients with atrial fibrillation?

To prevent blood clots and reduce stroke risk Signup and view all the answers

Which procedure involves creating incisions in atrial tissue to treat atrial fibrillation?

Maze procedure Signup and view all the answers

Low levels of which electrolytes are known to trigger or worsen arrhythmias?

Potassium and magnesium Signup and view all the answers

What is the role of the pacemaker in patients with arrhythmias?

To send regular electrical impulses to regulate heart rhythm Signup and view all the answers

Which surgical procedure is specifically designed to improve blood flow to the heart by creating a bypass around narrowed arteries?

Coronary artery bypass grafting Signup and view all the answers

What does a complete blood count (CBC) primarily check for?

Anemia or infection Signup and view all the answers

Study Notes

Dysrhythmias

Dysrhythmias are disorders of impulse formation or conduction within the heart.
They can cause disturbance of the heart rate, the heart rhythm, or both.
Dysrhythmias are named according to the site of origin of the impulse and the mechanism of formation or conduction involved.
Dysrhythmias can be managed with beta-blockers such as metoprolol and calcium channel blockers such as verapamil.

Ventricular Tachycardia

Ventricular tachycardia is a type of ventricular arrhythmia where the ventricles beat very fast, usually at a rate of 100 to 250 beats per minute.
This is considered a medical emergency because cardiac output cannot be maintained due to decreased diastolic filling.
Some causes of ventricular tachycardia include:
- Myocardial infarction
- Aneurysm
- Coronary artery disease
- Rheumatic heart diseases
- Mitral valve prolapse
- Hypokalemia
- Hyperkalemia
- Pulmonary embolism
- Anxiety

Ventricular Fibrillation

Ventricular fibrillation is rapid, ineffective quivering of ventricles that may be rapidly fatal.
Some causes of ventricular fibrillation include:
- Myocardial ischemia
- Electrolyte imbalances
- Digoxin toxicity
- Hypothermia

Signs and Symptoms

Chest pain or tightness
Dizziness or lightheadedness
Fainting
Palpitations - a feeling of skipped heartbeats or fluttering
Pounding in the chest
Shortness of breath
Weakness or fatigue

Medical Management

Electrocardiogram (ECG or EKG): A diagnostic tool that records the electrical activity of the heart over a period of time using electrodes placed on the skin.
Holter Monitor: A portable device used to continuously record the heart’s electrical activity over 24 to 48 hours or longer.
Echocardiogram: A non-invasive imaging technique that uses ultrasound waves to create real-time images of the heart.
Tilt Table Test: A diagnostic procedure used to evaluate the cause of unexplained fainting and assess the response to changes in body position.
Stress Test (Exercise ECG): A diagnostic procedure that evaluates how the heart responds to physical stress or exercise.
Blood Tests: A medical diagnostic procedure that involves analyzing a sample of blood to provide information about a person's health.

Pharmacological Management

Sodium Channel Blockers (Class I): Medications that block sodium channels in the heart to slow down electrical conduction and reduce abnormal impulses.
Beta-Blockers (Class II): Medications that block the effects of adrenaline and reduce the heart’s workload, slowing the heart rate and decreasing the force of contraction.
Potassium Channel Blockers (Class III): Medications that prolong the repolarization phase of the heart’s electrical cycle by blocking potassium channels, which stabilizes the heart rhythm.
Calcium Channel Blockers (Class IV): Medications that slow down the conduction through the atrioventricular (AV) node.
Anticoagulants: Prevent blood clots and reduce stroke risk in patients with atrial fibrillation.
Electrolyte Supplements: Low levels of certain electrolytes, particularly potassium and magnesium, can trigger or worsen arrhythmias.

Surgical Management

Pacemaker Implantation: A procedure to put a small, battery-operated device called a pacemaker into the chest.
Maze Procedure: A surgical technique used primarily to treat atrial fibrillation.
Coronary Artery Bypass Grafting (CABG): This surgery improves blood flow to the heart by creating a bypass around narrowed coronary arteries.

Laboratories

Complete Blood Count (CBC): Check for anemia or signs of infection (elevated white blood cell count).
- Hemoglobin:
  - Men: 13.5–17.5 g/dL
  - Women: 12.0–15.5 g/dL
- Hematocrit:
  - Men: 38.8%–50.0%
  - Women: 34.9%–44.5%
- White Blood Cell Count (WBC): 4,500–11,000 cells/mcL
Thyroid function tests to check for hyperthyroidism
- TSH -.35 to.50
- TT4- 6-12 ug/d
- FTI- 4.6-10.9 mg/dl
- FT4- 0.7-1.53 ng/dL
- Resin T3 Uptake- 24-39 md/dl
- FT3- 260-480 pg/mL
Basic metabolic panel (BMP) to look for electrolyte abnormalities.
- Electrolytes: Monitor levels of sodium, potassium, calcium, and magnesium.
  - Sodium (Na): 135–145 mEq/L
  - Potassium (K): 3.5–5.0 mEq/L
  - Calcium (Ca): 8.5–10.2 mg/dL
  - Magnesium (Mg): 1.5–2.5 mEq/L
Renal Function Tests: serum creatinine and blood urea nitrogen (BUN) to assess kidney function.
- Serum Creatinine: 0.6–1.2 mg/dL
- Blood Urea Nitrogen (BUN): 7–20 mg/dL
Cardiac biomarkers:
- Troponin I and T: Elevated levels indicate myocardial injury or infarction.
  - normal Troponin I = 0 - 0.04 ng/mL.
  - normal Troponin T = 0 - 0.01 ng/mL
- Creatine Kinase-MB (CK-MB): Another marker for myocardial damage.
  - normal Creatine Kinase -MB (CK-MB)= 3 to 5% (percentage of total CK) or 5 to 25 IU/L.
B-type Natriuretic Peptide (BNP): Elevated levels suggest heart failure and can help assess the severity of heart dysfunction.
- normal BNP= (less than 100 pg/mL)

Nursing Management

Regularly evaluate the patient's blood pressure, pulse rate and rhythm , rate and depth of respirations and breath sounds to determine the dysrhythmias hemodynamic effect.
Ask the patient about episodes of lightheadedness, dizziness or fainting as part of the ongoing assessment.
Oxygen is applied with nasal prongs to supplement serum levels.
Administer medications as prescribed.
Vital signs:
- T - 37 C
- BP: 80/50 mmHg
- HR: 150 bpm (tachycardic with irregular rhythm)
- RR: 28 breaths/min (tachypneic)
- O2 Sat: 88% on room air

Diagnosis and Planning

Decreased Cardiac Output related to alterations in rate and rhythm of the heart.
After performing nursing interventions, the patient will manifest blood pressure and pulse rate within normal limits.
Patient will be able to tolerate activities without chest pain, dyspnea, or changes in the level of consciousness.

Nursing Interventions and Rationale

Assess for cardiovascular status: Cardiac arrhythmia places the patient at risk for stroke or heart attack. Assess for a history of coronary artery disease.
Monitor the patient’s blood pressure and pulse: With hypotension, tachycardia is a normal compensatory response to decreased cardiac output.
Place the patient in an upright position: This also allows the patient to breathe easier.
Administer beta-blocker or calcium-channel blocker as prescribed: Beta-blockers and calcium channel blockers offer quick heart rate control at rest and during activity.
Refer the patient to cardiac rehabilitation: Exercise, support, counseling, and diet education are all part of cardiac rehabilitation.

Evaluation

Patient blood pressure and pulse rate within normal limits.

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Description

Explore the critical aspects of dysrhythmias and specifically ventricular tachycardia in this quiz. Understand their definitions, causes, and management options. This quiz is essential for medical students and healthcare professionals seeking to deepen their knowledge of cardiac abnormalities.