40 Questions
What should patients taking beta blockers, digoxin, and other drugs be taught to do before taking the next dose?
to take their own radial pulse for 1 full minute and to notify their physicians before taking the next dose if the pulse is less than 60 beats/min
What are some signs of worsening dysrhythmia or toxic effects that patients should report to their healthcare provider?
Shortness of breath, Chest pain, Edema, Dizziness, Syncope, Blurred vision
What are some signs of therapeutic response to medication in patients with cardiac arrhythmia?
Decreased BP in hypertensive patients, Decreased edema, Decreased fatigue, Regular pulse rate, Pulse rate without major irregularities, Improved regularity of rhythm, Improved cardiac output
Why is it important for patients to monitor their radial pulse?
To detect any changes in heart rate that may indicate worsening dysrhythmia or toxic effects of medication
What is the primary goal of dysrhythmia prevention strategies?
To prevent worsening dysrhythmia or toxic effects of medication
What is the role of the nurse in cardiac arrhythmia management?
To educate patients on medication administration, monitor for therapeutic response, and detect signs of worsening dysrhythmia or toxic effects
What should patients be taught to report to their healthcare provider?
Worsening dysrhythmia or toxic effects of medication, including shortness of breath, chest pain, edema, dizziness, syncope, or blurred vision
Why is ECG monitoring important in cardiac arrhythmia management?
To detect changes in heart rhythm and monitor for therapeutic response to medication
What is the primary concern when a patient is receiving oral quinidine?
Prolonged QT interval
Why is it essential to check the IV lock before repeating a dose of diltiazem (Cardizem)?
To ensure the IV lock is functioning properly to prevent wasted doses
What should patients be instructed to do if they miss a dose of their medication?
Contact their physician for instructions
What precaution should be taken when administering IV infusions?
Use an IV pump
Why is it important to monitor ECG for patients receiving antidysrhythmics?
To detect potential dysrhythmia problems
What instruction should be given to patients regarding oral sustained-release preparations?
Not to crush or chew the medication
Why should solutions of lidocaine containing epinephrine not be given IV?
They are only for use as local anesthetics
What assessment finding is of most concern in a patient receiving oral quinidine?
Prolonged QT interval
What is a common adverse effect of all antidysrhythmic drugs, which can ironically worsen the condition they are intended to treat?
Dysrhythmias
What is the significant adverse effect of procainamide that results from the prolongation of the QT interval?
Torsades de pointes
What is the black box warning for quinidine, which can be life-threatening?
Torsades de pointes
What is the primary action of lidocaine on the heart, which makes it useful in treating cardiac arrhythmias?
Raises the ventricular fibrillation threshold
What is the first-line drug in the treatment of atrial fibrillation, which has a negative inotropic effect and depresses left ventricular function?
Flecainide
What is the common adverse effect of propafenone, which is similar to flecainide in its action?
Dizziness
What is the primary action of atenolol, which makes it a cardioselective beta blocker?
Blocks the beta1-adrenergic receptors located primarily in the heart
What is the potential interaction of grapefruit juice with certain antidysrhythmic drugs, which can increase their plasma concentrations?
Amiodarone, disopyramide, and quinidine
What is the main difference between cardioselective and noncardioselective beta blockers?
Cardioselective beta blockers only block beta1-adrenergic receptors in the heart, whereas noncardioselective beta blockers block both beta1 and beta2-adrenergic receptors in the heart and lungs.
What is the primary use of Esmolol (Brevibloc)?
Acute treatment of supraventricular tachydysrhythmias, hypertension, and post-MI tachydysrhythmias.
What is the mechanism of action of Amiodarone (Cordarone, Pacerone)?
It markedly prolongs the action potential duration and the effective refractory period in all cardiac tissues, blocking both alpha- and beta-adrenergic receptors of the sympathetic nervous system.
What is the indication for Ibutilide (Corvert)?
Atrial dysrhythmias.
What is the effect of Verapamil (Calan) on cardiac conduction time?
It inhibits calcium ion influx across the slow calcium channels, resulting in dramatic effects on the AV node.
What is the contraindication for Diltiazem (Cardizem, Others)?
Hypersensitivity, acute myocardial infarction, pulmonary congestion, Wolff-Parkinson-White syndrome, severe hypotension, cardiogenic shock, sick sinus syndrome, or second- or third-degree AV block.
What is the effect of Sotalol (Betapace) on conduction?
It has similar antidysrhythmic properties to Class III, while exerting beta blocker or Class II effects on conduction.
What is the most likely cause of asystole in a patient who has received an IV dose of adenosine?
The adenosine dose.
What is the primary purpose of administering adenosine to a patient with PSVT?
To convert PSVT to sinus rhythm
What should the nurse do after administering adenosine to a patient?
Continue to monitor the patient for therapeutic and adverse effects of the medication
Why is it important to measure serum potassium levels before initiating adenosine therapy?
To assess for potential contraindications or drug interactions
What should the nurse assess for during therapy with adenosine?
Cardiac rhythm, heart rate, BP, general well-being, skin color, temperature, and heart and lung sounds
What is the primary concern when a patient reports a wet sensation on their arm during IV administration of diltiazem?
Medication extravasation
Why is it important to instruct patients to report dosing schedules and adverse effects to their physician?
To ensure timely and effective management of their condition
What is the primary purpose of monitoring plasma drug levels during therapy?
To assess for potential toxic effects
What should the nurse do if a patient experiences asystole for a few seconds after receiving adenosine?
Continue to monitor the patient
Study Notes
Nursing Implications
- Ensure patients know to notify healthcare providers of worsening dysrhythmia or toxic effects, such as shortness of breath, chest pain, edema, dizziness, syncope, blurred vision, and gastrointestinal distress.
- Teach patients taking beta blockers, digoxin, and other drugs how to take their own radial pulse and notify physicians before taking the next dose if the pulse is less than 60 beats/min.
- Monitor for therapeutic response, including decreased BP in hypertensive patients, decreased edema, decreased fatigue, regular pulse rate, and improved cardiac output.
Antidysrhythmics
- Adenosine (Adenocard) slows conduction through the AV node, is used to convert PSVT to sinus rhythm, and has a very short half-life (less than 10 seconds).
- Procainamide (Pronestyl) is a Class Ia antidysrhythmic used for atrial and ventricular tachydysrhythmias, but has significant adverse effects, including ventricular dysrhythmias, blood disorders, and SLE-like syndrome.
- Quinidine (Quinidex) is a Class Ia antidysrhythmic with both direct and indirect effects on the heart, used for atrial and ventricular dysrhythmias, but has adverse effects, including cardiac asystole and ventricular ectopic beats.
- Lidocaine (Xylocaine) is a Class Ib antidysrhythmic that raises the ventricular fibrillation threshold, but has adverse effects, including twitching, convulsions, confusion, respiratory depression, hypotension, bradycardia, and dysrhythmias.
- Flecainide (Tambocor) is a Class Ic antidysrhythmic used for life-threatening ventricular dysrhythmias and atrial fibrillation, but has adverse effects, including dizziness, visual disturbances, and dyspnea.
- Propafenone (Rythmol) is a Class Ic antidysrhythmic with similar action to flecainide, used for life-threatening ventricular dysrhythmias and atrial fibrillation.
Beta Blockers
- Atenolol (Tenormin) is a cardioselective beta blocker used for antidysrhythmic effects, hypertension, and angina, but has contraindications, including severe bradycardia, second- or third-degree heart block, heart failure, cardiogenic shock, or known hypersensitivity.
- Esmolol (Brevibloc) is an ultrashort-acting beta blocker used for acute treatment of supraventricular tachydysrhythmias, hypertension, and post-MI tachydysrhythmias.
- Metoprolol (Lopressor) is a cardioselective beta blocker used for hypertension, angina, and post-MI treatment to reduce the risk of sudden cardiac death.
Amiodarone
- Amiodarone (Cordarone, Pacerone) is a Class III antidysrhythmic that prolongs the action potential duration and effective refractory period in all cardiac tissues, used for managing sustained ventricular tachycardia, ventricular fibrillation, and nonsustained ventricular tachycardia.
- Adverse effects of amiodarone include corneal microdeposits, photosensitivity, and pulmonary toxicity.
Other Antidysrhythmics
- Ibutilide (Corvert) is a Class III antidysrhythmic indicated for atrial dysrhythmias, dosed based on body weight, and can cause ventricular dysrhythmias.
- Sotalol (Betapace) is a Class III antidysrhythmic and beta blocker, used for life-threatening ventricular dysrhythmias.
- Diltiazem (Cardizem) is a Class IV antidysrhythmic used for temporary control of rapid ventricular response in patients with atrial fibrillation or flutter and PSVT.
- Verapamil (Calan) is a Class IV antidysrhythmic that inhibits calcium ion influx across the slow calcium channels in cardiac conduction time, used to prevent and convert recurrent PSVT and control ventricular response in atrial flutter or fibrillation.
This quiz covers the nursing implications for patients taking medication, including monitoring for toxic effects and worsening dysrhythmia, and recognizing symptoms such as shortness of breath, chest pain, and edema. It also covers patient education and teaching responsibilities.
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