CARING FOR CLIENTS WITH CARDIAC DYSRHYTHMIAS

MEDICAL SURGICAL NURSING

CARING FOR CLIENTS WITH
CARDIAC DYSRHYTHMIAS

NORMAL

CARDIAC RHYTHM – the pattern or pace of the heartbeat, regular
or irregular

USUAL RHYTHM/NORMAL called normal sinus rhythm – box 32-1, fig
32-1, fig 32-2 (A)

DYSRHYTHMIA – or arrhythmia is a conduction disorder that
causes a rate that is either too fast, too slow and is either regular or
irregular

Most common cause is CAD

ARRHYTHMIAS THAT ORIGINATE IN THE SA NODE

SINUS BRADYCARDIA – fig 32-2, B; regular, less
than 60; found in clients with heart disorders, ICP, hypothyroidism,
digitalis toxicity. Can also be found in healthy athletes & laborers- may be
treated with drugs, Atropine.

SINUS TACHYCARDIA – fig 32-2, C; regular,
100-150. Found in healthy hearts with strenous exercise, anxiety, fear,
pain, fever, hyperthyroidism, hemorrhage, shock or hypoxemia – no treatment
necessary

Supraventricular Tachycardia-SVT – rate more
than 150 Dangerous because it decreases the cardiac output. Can cause heart
failure, hypotension, syncope & reduced renal output. Drugs used to slow the
rate, digitalis, adrenergic blockers, & calcium channel blockers

ATRIAL FLUTTER – originates outside the SA node
– atrial rate is 200-400. Slower ventricular rate/response Characteristic
sawtooth pattern fig 32-4

ATRIAL FIBRILLATION

fig 32-5 – no identifiable P wave seen

Several areas in the right atrium initiate impulses;
disorganized, rapid atrial activity. Irregular ventricular rate, may cause
decreased cardiac output. Treated with digitalis, Corvert, Tambocor or
Rythmol or elective cardioversion

ARRHYTHMIAS ORIGINATING IN THE AV NODE

HEART BLOCK

disorders in the conduction pathway that
interferes with the conduction of impulses from the SA node to the AV node
to the ventricles.

First degree – impulse delayed, PR interval
prolonged

Second degree – impulse delayed

Third degree or
complete – fig 32-6
requires a pacemaker due to rate of 30-40 only. Cannot sustain life at a
rate that low

ARRHYTHMIAS ORIGINATING IN THE VENTRICLES

PREMATURE VENTRICULAR
CONTRACTIONS (PVC) occurs before the SA node initiates an impulse. No P
wave, wide and bizzare QRS Usually harmless, can be dangerous if are
precursors of lethal arrhythmias. Treatment for lethal PVCs is an IV bolus
of Lidocaine followed by a continuous infusion

Fig 32-7, fig 32-8

VENTRICULAR TACHYCARDIA

(VTACH) – impulse originates in the ventricle, very fast
150-250. Cardiac output decreased. May stop on it’s own or may go into
ventricular fibrillation

VENTRICULAR FIBRILLATION

The rhythm of the dying heart

usually preceded by PVCs and/or VTACH

fig 32-9

Assessment findings

No cardiac output. The ventricles are just quivering. Requires
immediate CPR with defibrillation

S/S – weakness, fatigue, anginal pain, fainting,
palpitations, fluttering feeling in the chest, hypotension. Skin pale, cool,
or diaphoretic or clammy if having pain

Assess the cardiac monitor & the pt, vs,
administer meds as ordered. May need to assist with cardioversion,
defibrillation or pacemaker insertion.

Medical & Surgical Management

Drug therapy table 32-1

Elective Electrical Cardioversion - table 32-1

Nonemergency procedure used to stop rapid, non-life threatening
atrial dysrhythmias

Defibrillation – table 32-1

Emergency procedure performed during resusitation

Automated Implanted Cardiac Defibrillator
(AICD)

An internal electrical device used for selected clients with
recurrent life-threatening tachydysthythmias

Consists of a generator with a battery & one lead placed in the
right ventricle

It senses the dysrhythm & delivers an electrical shock to
restore the heart to a life-sustaining cardiac rhythm

Clients must avoid devices with a magnetic field

PACEMAKERS

Used to treat slow abnormal heart rhythms; may
be temporary or permanent

demand or synchronous mode

fixed-rate or asynchronous mode

transcutaneous, usually temporary

transvenous, usually temporary

implanted, permanent

Radiofrequency Catheter Ablation- a heated
catheter tip is introduced transvenously into the heart & destroys the
tissue causing the dysrhythmia

Nursing Care – nursing process,

Client with a Dysrhythmia

Elective Electrical Cardioversion

Keep NPO

Consent form signed

Make sure an IV is established; give meds as
ordered to include sedatives

Make sure all equipment is in room

v/s after procedure

Defibrillation

Ensure that all equipment is in room

Perform CPR until ready to defibrillate

Pacemakers

Place on monitor & assess for the "spike" of the
pacer

Client & family teaching 32-1

General Nutritional Considerations

Clients with history of ETOH abuse are more at
risk for dangerous during withdrawal

General Pharmacologic Considerations

Administration of lidocaine can have serious adverse effects
including convulsions & cardiac arrest. Use very cautiously

Drug toxicity can occur even with normal doses of digitalis &
cardiac glycosides. Signs of toxicity are anorexia, n/v, visual disturbances
such as halos around dark objects, objects appearing green or yellow.
Withhold the drug & notify MD if heart rate is < 60beats/min

General Gerontologic Considerations

Older adults have an increased risk for dysrhythmias due to
cardiac degenerative changes

Sinus bradycardia and heart block are common dysrhythmias in
older adults