Cardiac - Cardiac Dysrhythmias Workbook.doc - Cardiac Dysrhythmias NURS 2106 Dysrhythmias(arrhythmias Most common complication post MI Disturbance of

Cardiac - Cardiac Dysrhythmias Workbook.doc - Cardiac...

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Cardiac Dysrhythmias NURS 2106 Dysrhythmias (arrhythmias): Most common complication post MI Disturbance of rate, rhythm or conduction of electrical impulses within the heart Prompt assessment of dysrhythmias and the patient’s response to the rhythm is critical Classifications of arrhythmias: Sites: o SA node (sinus rhythm) o Atrial (atrial rhythms) o AV node (nodal or junctional rhythm) o Ventricles (ventricular rhythms) Type: o Flutter o Fibrillation o Block Prognosis: Minor – no immediate concern Major – reduction of efficiency of the heart Lethal – requires immediate treatment or resuscitation, death producing Dysrhythmias symptoms: Some dysrhythmias no symptoms Some dysrhythmias life threatening (sudden collapse, death) Typical symptoms: o Dizziness o Weakness o Decreased exercise tolerance o Shortness of breath o Fainting o Palpitations or “heart has skipped a beat” Common causes of dysrhythmias: Cardiac causes o Accessory pathways, conduction defects o Cardiomyopathy, heart failure o Myocardial cell degeneration (ischemia, injury, infarction) o Valve disease Other conditions o Acid-base imbalances o Electrolyte disturbances o Caffeine, tobacco, alcohol o Drug effects (antidysrhythmia, stimulants, beta-blockers) o Emotional crisis, herbal supplements, connective tissue disorders o Hypoxia, shock
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o Metabolic conditions (thyroid dysfunction) o Near-drowning, poisoning Sinus Bradycardia Identifying EKG characteristics: Rate: < 60 beats a minute Rhythm: Regular P waves: Normal and precede each QRS PR interval: Normal range (0.12 – 0.20) QRS: Normal (< 0.12) Etiology: May be normal in physically conditioned adults and during sleep Increased vagal tone (Valsalva maneuver, endotracheal suctioning, vomiting, gagging) Medication effect (narcotics, cardiac glycoside, beta blockers, calcium channel blockers) Pathology (hypothermia, hypothyroidism, increased intracranial pressure, obstructive jaundice, MI--- inferior wall MI involves right coronary artery). Ischemia of sinus node slows rate. Clinical significance: May be asymptomatic. Symptoms are associated with decreased cardiac output: o Hypotension, dizziness, syncope o Pale, cool skin o Weakness o Confusion or disorientation o Shortness of breath o Angina o Decreased urinary output Treatment: Treat only is symptomatic Atropine IVP (0.5 – 1 mg) If due to medication discontinue or reduce dose Pacemaker may be required Nursing implications: Assess for signs and symptoms of decreased cardiac output 2
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Observe for premature ventricular contractions (PVCs) or other ectopic beats Assist with medical treatment: atropine if ordered, preparation for pacemaker insertion Sinus Tachycardia Identifying EKG characteristics: Rate: > 100 beats a minute (usually 101 – 200 bpm) Rhythm: Regular P waves: Present, normal in shape; may not be clearly identified if encroach on preceding T waves PR interval: Normal QRS: Normal Etiology:
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