Nursing Care of Patients with Dysrhythmias: Chapter 25 PDF

New Curriculum Nursing Care of Patients with Dysrhythmias Williams & Hopper (2023). Understanding Medical- Surgical Nursing 7th edition Chapter 25 02/12/2025 Nursing Care of Patients With Cardia...

New Curriculum Nursing Care of Patients with Dysrhythmias Williams & Hopper (2023). Understanding Medical- Surgical Nursing 7th edition Chapter 25 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 1 s Objectives Identify normal sinus rhythm on a cardiac monitor strip Identify selected dysrhythmias on a cardiac monitor strip Explain common signs and symptoms of dysrhythmias Explain the signs and symptoms associated with pulseless ventricular tachycardia, ventricular fibrillation, and asystole Describe the electrical interventions used to treat specific dysrhythmias Explain nursing care and teaching for the client with a cardiac pacemaker Apply the nursing process to clients with dysrhythmias 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 2 s Cardiac Conduction System Series of organized electrical impulses that stimulate cardiac contractions SA node: right atrium Intrinsic rate: 60-100 beats per minute Atrial bundle causes both atria to contract simultaneously AV node: base of right atrium Bundle of HIS Right and left bundle branches Perkinge fibers Ch 21, p 318, Ch 25, p 404 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 3 s Electrocardiogram Translates electrical impulses to a graph 12-lead most common 10 electrodes: 6 on chest (V1-V6), one on each arm and leg (RA, RL, LA, LL) Cardiac monitoring (telemetry): continuous rhythm display, usually only in one or two leads 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 4 s EKG paper 02/12/2025 Ch 25, p 404 Nursing Care of Patients With Cardiac Dysrhythmia 5 s Components of the Cardiac Cycle P wave T wave PR interval QT Interval From start of P wave to From start of Q to end of T start of QRS ST segment QRS complex From end of QRS to start of T (should begin and end on baseline) See Learning Tips page 405 02/12/2025 ChDysrhythmia Nursing Care of Patients With Cardiac 25, p 405 6 s Isoelectric line No electrical activity All wave forms should begin and end on baseline Positive deflection: impulses extend above baseline. Negative deflection: impulses drop below baseline. 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 7 s P wave, PR interval Click to add text P wave stimulates atrial contraction. PR Interval is time from start of P to start of QRS, normally 0.12- 0.20 seconds Nursing Care of Patients With Cardiac 02/12/2025 Dysrhythmias Ch 25, p 405 8 QRS Largest wave form. Usually upright. Stimulates ventricular contraction (systole). See alternate presentations (figure 25.4 p 405) 02/12/2025 Ch 25, p 405 Nursing Care of Patients With Cardiac Dysrhythmia 9 s T wave ST segment QT interval 02/12/2025 T wave: Ventricular repolarization (diastole, relaxation) ST segment should be at baseline Prolonged or shortened QT intervals can lead to cardiac arrhythmias Nursing Care of Patients With Cardiac Dysrhythmias 10 Ch 25, pp 405-406 ST segment ST elevation: Transmural myocardial infarction; ST depression: ischemia Ch 25, p 407 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 11 s  1. Regulari INTERPR ty 2. Rate ETING 3. P CARDIA Steps for Identifying Cardiac Dysrhythmias waves C 4. PR interval RHYTHM 5. QRS complex S 02/12/2025 Ch 25, p 407 Nursing Care of Patients With Cardiac Dysrhythmia 12 s Determining Regularity Measure distance between two consecutive R-waves, compare to distance between 2nd and 3rd R-waves. Considered equal if distance doesn’t vary by more than two small boxes. See Learning Tip ch 25, pp 405, 407) Ch 25, p 407 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 13 s Determining Rate Method 1: Count number of small boxes (0.04 seconds) between two consecutive R-waves and divide into 1500. Method 2: Count number of R-waves in a six-second interval (30 big boxes) and multiply by 10. Best for irregular rhythms. Ch 25, p 408 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 14 s Pause for Practice 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 15 s NORMAL SINUS RHYTHM Regular rhythm P wave before every QRS PR interval 0.12-0.20 seconds Narrow QRS Rate 60-100 Ch 25, p 409 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 16 s  Abnormalities on an electrocardiogram or rhythm strip that are not caused by cardiac conduction abnormalities Possible causes: patient movement, poor contact with skin, Artifact interference from electrical devices Makes interpretation of underlying rhythm difficult 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmias 17 DYSRHYTHMIAS Sinoatrial Atrial Ventricular 02/12/2025 Gerontologic Issues, ch 25, p 411 Nursing Care of Patients With Cardiac Dysrhythmia 18 s Common Signs and Symptoms None Palpitations Signs of Decreased Cardiac Output Dizziness Syncope Weakness Fatigue Dyspnea Diaphoresis, Pallor Confusion/Anxiety 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 19 s Pathophysiology Disturbances in conduction from SA node Sinus bradycardia: Delayed conduction through SA node, due to dysfunction or medications. May be normal in well conditioned athlete. Sinus tachycardia: Compensatory response to need for increased cardiac output or oxygen (exercise, fear, stress, fever, sepsis, dehydration, shock) Sinus arrhythmias are rarely dangerous. People with respiratory, renal or cardiac disease may require treatment. Ch 25, p 409 See Learning Tip ch 25, p 409 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 20 s SINUS BRADYCARDIA Age Well Conditioned Athletes Medications (Digoxin, Beta Blockers, Calcium Channel Blockers) Hypothyroidism Myocardial infarction Treatment: None if asymptomatic Medications (Epinephrine, Vasopressin, Atropine) Pacemaker Treat Symptoms; Treat Cause 02/12/2025 Ch 25, p 409 Nursing Care of Patients With Cardiac Dysrhythmia 21 s SINUS TACHYCARDIA Increased Metabolic Rate: Stress, Fear, Anxiety Fever Hyperthyroidism Volume Loss- Dehydration Hemorrhage, Shock Treat Symptoms Treat Cause Medications: (Adenosine, Digoxin, Beta Ch 25, p 412; Learning Tips Blockers) p 412 02/12/2025 Overdrive Pacing, Cardioversion (SVT) Nursing Care of Patients With Cardiac Dysrhythmia 22 s ATRIAL DYSRHYTHMIAS Atrial Fibrillation * 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 23 s Pathophysiology Review Increased irritability of cardiac cells Aberrant pathways formed Ectopic beats generated Hypoxia causes chaotic firing of cardiac cells 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 24 s Common Signs and Symptoms None Palpitations Signs of Decreased Cardiac Output Dizziness Syncope Weakness Fatigue Dyspnea Diaphoresis, Pallor Confusion/Anxiety 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 25 s ATRIAL FIBRILLATION Most Common Dysrhythmia in Elderly Smoking HTN, Heart Disease Pulmonary Embolism Treat Cause Medications: (Beta Blockers, Ch 25, p 412 Calcium Channel Blockers, Digoxin) Cardioversion 02/12/2025 Anticoagulants Nursing Care of Patients With Cardiac Dysrhythmia 26 s atrial fibrillation Irregularly irregular rhythm Narrow QRS complex, no identifiable P waves Risk for stroke Decreased cardiac output Palpitations Heart failure Ch 25, p 414 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 27 s 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 28 s Ventricular Dysrhythmias 01 02 03 Wide QRS Originate in More likely complexes ventricles to be fatal 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 29 s Signs and Symptoms None Signs of decreased cardiac output Ventricular fibrillation, pulseless ventricular tachycardia, asystole: Unresponsive Pulseless No BP No Respirations Fixed, Dilated Pupils Ch 25, p 417 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 30 s PREMATURE VENTRICULAR CONTRACTIONS Caffeine, Alcohol Anxiety Cardiomyopathy, MI Hypokalemia Treat Cause Medications: (Amiodorone, 02/12/2025 BetaBlockers) Ch 25, p 415 Nursing Care of Patients With Cardiac Dysrhythmia 31 s  Multi-focal PVCs 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 32 s VENTRICULAR TACHYCARDIA MI, Cardiac Irritability Hypokalemia Respiratory Acidosis Digoxin Toxicity Treat Cause Medications: (Amioderone, Magnesium) With a Pulse: Cardioversion Ch 25, p 418 Pulseless: CPR, DEFIBRILLATION 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 33 s VENTRICULAR FIBRILLATION Hyperkalemia Hypomagnesemia CAD MI ALWAYS PULSELESS! Medication: epinepherine CPR, DEFIBRILLATION 02/12/2025 Ch 25, p 418 Nursing Care of Patients With Cardiac Dysrhythmia 34 s ASYSTOLE V Fib Hyperkalemia CPR Epinepherine 02/12/2025 Ch 25, p 418 Nursing Care of Patients With Cardiac Dysrhythmia 35 s  Really? 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 36 s  Medications to Control Dysrhythmias (1) Anticoagulants (used to prevent stroke in atrial fibrillation): Warfarin Apixaban, Dabigatran, rivaroxaban Antidysrhythmics Adenosine Amiodarone 02/12/2025 Ch 25, table 25.2, p 410 Nursing Care of Patients With Cardiac Dysrhythmia 37 s Medications to Control Dysrhythmias – (2) Anticholinergics: Atropine Cardiac Glycosides: Digoxin Beta Blockers: Metoprolol, Atenolol Calcium Channel Blockers : Diltiazem Vasopressors: epinephrine, norepinephrine 02/12/2025 Ch 25, table 25.2, p 410 Nursing Care of Patients With Cardiac Dysrhythmia 38 s Nursing Diagnosis Decreased Cardiac Output Data collection: apical pulse, blood pressure, mental status, lung sounds, urine output Interventions: Administer antiarrhythmics as prescribed Monitor geriatric closely for adverse effects Ensure assistance with ADLs as needed; avoid overexertion Evaluation – stable vital signs, ability to complete ADLs without dyspnea, clear lung sounds, urine output at least 30 mL/hour, no change in mental status Ch 25, Nursing Care Plan for the Patient with Dysrhythmias, 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 39 p 421 s Electrical management Pacemakers Cardioversion Defibrillation Implanted Cardioverter Defibrillators 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 40 s Permanent Pacemakers Indications: persistent symptomatic bradycardia, 3rd degree heart block Paces atria and or ventricles Delivers electrical impulses directly to heart muscle Activity-responsive pacemakers deliver variable rates of impulses to allow for increased heart rate in response to need for increased cardiac output Ch 25, p 418 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 41 s Nursing Care of the Patient with a Pacemaker Monitor heart rate and rhythm Monitor for signs of decreased cardiac output May indicate pacemaker malfunction Notify provider immediately Monitor incision for signs of healing or infection Ch 25, p 419 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 42 s Patient Education Priorities Incision care, signs of infection Rationale- Infection can be prevented with proper aseptic technique, signs of infection can be reported Activity restrictions: Not raising arm on pacemaker side above head, driving, returning to work, lifting until approved by provider Rationale: Helps prevent complications related to pacer wire displacement while healing. Ch 25, pp 418-419 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 43 s Patient Education Priorities Devices Most grounded appliances safe to use, caution with metal detectors, MP3 player headphones, MRIs (contraindicated unless non-ferrous pacemaker) Rationale- Injury can be prevented without unduly limiting lifestyle Signs of decreased cardiac output, chest wall twitching or persistent hiccups Rationale: Alerts patient to possible pacemaker malfunction Ch 25, p 419 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 44 s Patient Education Priorities Carry cell phones on opposite side of pacer Carry pacemaker ID Keep scheduled appointments for pacemaker checks Rationale: Helps prevent complications related to pacer malfunction Ch 25, p 419 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 45 s Cardioversion Indications Symptomatic rapid dysrhythmias with a pulse Patient Preparation Consent, moderate sedation Monitoring Airway, SpO2, Vital signs, heart rhythm, skin for burns, respiratory problems 02/12/2025 Ch 25, p 420 Nursing Care of Patients With Cardiac Dysrhythmia 46 s  Defibrillation Indications Pulseless with a rhythm (not for asystole) Pulseless ventricular tachycardia Ventricular fibrillation Safety Concerns Shock to staff Patient burns Post Defibrillation Monitor rate, rhythm, vital signs Transfer to ICU 02/12/2025 Ch 25, p 420 Nursing Care of Patients With Cardiac Dysrhythmia 47 s Dysrhythmia Home Health Priorities Avoid Straining; Laxatives as Prescribed Pacemakers: Wear Loose Fitting Tops Medications Refill Prescriptions Before Major Holidays or Vacations Ch 25, p 422 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 48 s Patient Education Priorities Medications Beta Blockers, Digoxin, pacemakers: How to take a radial pulse Rationale- Symptomatic bradycardia can occur. Hold dose and notify HCP Medications Anticoagulants: Signs of abnormal bleeding, dietary restrictions, routine lab monitoring Rationale: Anticoagulants can cause bleeding. Warfarin requires consistent amounts of vitamin K, warfarin and heparin require routine lab monitoring to maintain therapeutic levels. 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 49 s Ch 25, p 422 Patient Education Priorities Medications Digoxin Digoxin: Check radial pulse; Hold if Below 60 and Notify HCP Report Signs of Dizziness, Chest Pain, Syncope (Decreased Cardiac Output) Report Muscle Weakness (Hypokalemia, Increases Risk of Digoxin Toxicity) Stay Hydrated (Dehydration Increases Risk of Digoxin Toxicity) Report Anorexia, Nausea, Visual Changes (Signs of Digoxin Toxicity) Ch 25, p 422 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 50 s Patient Education Priorities CPR, emergency phone numbers Rationale: patients with cardiac dysrhythmias are at risk for lethal dysrhythmias. Rapid initiation of CPR and emergency resources can save a life. Ch 25, p 422 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 51 s QUESTION S? 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 52 s Review Components of an EKG Recognizing normal sinus rhythm Dysrhythmias Sinus bradycardia Sinus tachycardia Atrial fibrillation PVCs Ventricular tachycardia Ventricular fibrillation 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 53 s Review Electrical management of dysrhythmias Permanent pacemakers Cardioversion Defibrillation Nursing process and patient education 02/12/2025 Nursing Care of Patients With Cardiac Dysrhythmia 54 s