3.2 Care of Patient with Dysrhythmias Flashcards
Synergy
- Stability in a patient with dysrhythmias is not affected as long as their vitals remain normal
- If vitals being changing or getting worse, stability is becoming worse
Assessment
Physical
- Skin color, signs of fluid retention, HR, comparing apical with radial pulse, heart sounds, BP
- Health history
- Determine all medications being taken
- Interview how they are tolerating the rhythm
Psychosocial assessment (not highest priority)
Diagnosis
- ABC’s
- Make sure they have a proper airway (apneic)
Complications of Dysrhythmias
- BIGGEST IS CARDIAC ARREST
- Heart failure
- Thromboembolic events (stroke, pulmonary emboli)
Goals
- Maintain C/O
- Decrease occurrence of dysrhythmia
- Minimize anxiety
- Education on disease and treatment
- Promote home, community and follow up care
- Medication adherence
Interventions
- Maintain C/O via CPR and medications
- Monitor dysrhythmia symptoms (lightheaded, dizzy, faint), vitals, 12-lead ECG. Routinely assess the cardiac rhythm strips
- Minimize anxiety by remaining with patient and educate them on what is happening
EDUCATION
- Treatment Options
- Importance of monitoring therapeutic medication levels
- How to take pulse and BP
- Symptoms of dysrhythmia
- How to decrease re-occurrence of dysrhythmias
- Patients should have a plan of action in case of an emergency (medical alert button/bracelet)
- Family should be trained in CPR
Evaluation
- Evaluate vitals, symptoms, cardiac output
- Evaluate understanding of condition
- Evaluate anxiety
- These patients “cardiac cripples” may be afraid to preform activities due to chance of dysrhythmias coming back.
Treatment
- Medications
Adjunctive Modalities (when medications alone are not effective)
- Pacemaker
- Cardioversion
- Defibrillation
Transcutaneous Pacing (TCP)
- Temporary pacing/stabilizing during an emergency (until permanent option available)
- It sends electrical currents to patients heart to stimulate contraction
Common Uses
- Symptomatic Bradycardia (due to MI, SA node dysfunction, complete heart block)
How It’s Done
- Pads are placed on chest (anterolateral or anterior-posterior position. AP preferred)
CAUTION
- QRS on the ECG is not a way to tell if the heart is delivering sustainable BP
- Use a pulse-ox or arterial line waveform for confirmation of electrical activity
Considerations
- Advocate for your patient to be sedated because treatment is uncomfortable
Pacemaker
- Provide electrical stimuli to heart muscles to initiate action potentials
Permanent Pacemaker
- Stimulates atrial/ventricular contractions. Pulse generator is implanted under the skin in the upper chest
Temporary Pacemaker
- Used for emergency short-term control. Inserted with a catheter through the jugular vein into the heart. Pulse generator is connected to an external generator.
Transcutaneous Pacemaker
- Temporary emergency measures using conductive pads on the chest. They are attached to a portable monitor and low voltage currents are delivered through the skin. May require sedation because it is uncomfortable. (MUST VERIFY BP, PULSE, AND PULSE OX)
Pacemaker General Information
Pacemaker Capture - Capture means there is a visible pacemaker spike and the spike is followed by a QRS
Complications
- Infection
- Bleeding/Hematoma
- Skeletal muscle or phrenic nerve stimulation
- Cardiac Tamponade (fluid in the heart sack preventing it from pumping correctly)
- Pacemaker malfunction
Cardioversion/Defibrillation
- Basically a reset button where an electrical current is delivered to depolarize all myocardial cells. When they re-polarize usually the SA node can re-establish itself
- Used to treat tachydysrhythmias
Cardioversion
- Electric current is delivered synchronized with patients ECG. When you push the button, shock could be delayed to synch with patients ECG
Defibrillation
- Not synchronized with ECG. Shock delivered as soon as button is pushed
WARNING ABOUT ELECTRICAL PADS
- Make sure pads are not touching bedding/clothing
- Make sure patches are not placed near medical patches (could cause burns)
- Make sure pads are away from oxygen tubing
SAFETY
- Ensure good contact between skin, pads and paddles
- Use 20-25 pounds of pressure
- Paddles should not touch bedding/clothing/medication patches/oxygen flow
- Do not charge device until ready to shock
- Ensure everyone is clear (I’m Clear, You’re Clear, Everyone is Clear)
CARDIOVERTING - Turn synchronizer on
DEFIBRILLATING - Turn synchronizer off
Implantable Cardiac Defibrillators
- Used in combination with permanent pacemakers
- Monitors the heart and delivers automatic defibrillation if it senses tachydysrhythmias or fibrillation
- Patients need to keep a log of when their defibrillator discharges
EVALUATION OF PATIENTS WITH IMPLANTABLE CARDIAC DEFIBRILLATORS
- ECG
- Chest X-Ray to verify placement
