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DYSRHYTHMIAS (INCLUDING DIGITALIS TOXICITY) A cardiac dysrhythmia is any disturbance in the normal rhythm of the electrical excitation of the heart. It can be the result of a primary cardiac disorder, a response to a systemic condition, the result of electrolyte imbalance or drug toxicity. Dysrhythmias vary in severity and in their effects on cardiac function, which are partially influenced by the site of origin (ventricular or supraventricular). CARE SETTING Generally, minor dysrhythmias are monitored and treated in the community setting; however, potential life-threatening situations (including heart rates above 150 beats/min) usually require a short inpatient stay. RELATED CONCERNS Angina Heart failure: chronic Myocardial infarction Psychosocial aspects of care Patient Assessment Database ACTIVITY/REST May report: Generalized weakness and exertional fatigue May exhibit: Changes in heart rate/BP with activity/exercise CIRCULATION May report: History of previous/acute MI (90%–95% experience dysrhythmias), cardiac surgery, cardiomyopathy, rheumatic/HF, valvular heart disease, long-standing hypertension, use of pacemaker Pulse: Fast, slow, or irregular; palpitations, skipped beats May exhibit: BP changes (hypertension or hypotension) during episodes of dysrhythmia Pulses may be irregular, e.g., skipped beats; pulsus alternans (regular strong beat/weak beat); bigeminal pulse (irregular strong beat/weak beat) Pulse deficit (difference between apical pulse and radial pulse) Heart sounds: irregular rhythm, extra sounds, dropped beats Skin color and moisture changes, e.g., pallor, cyanosis, diaphoresis (heart failure, shock) Edema dependent, generalized, JVD (in presence of heart failure) Urine output decreased if cardiac output is severely diminished EGO INTEGRITY May report: Feeling nervous (certain tachydysrhythmias), sense of impending doom Stressors related to current medical problems May exhibit: Anxiety, fear, withdrawal, anger, irritability, crying FOOD/FLUID May report: Loss of appetite, anorexia Food intolerance (with certain medications) Nausea/vomiting Changes in weight May exhibit: Weight gain or loss Edema Changes in skin moisture/turgor Respiratory crackles NEUROSENSORY May report: Dizzy spells, fainting, headaches
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May exhibit: Mental status/sensorium changes, e.g., disorientation, confusion, loss of memory; changes in usual speech pattern/consciousness, stupor, coma Behavioral changes, e.g., combativeness, lethargy, hallucinations Pupil changes (equality and reaction to light) Loss of deep tendon reflexes with life-threatening dysrhythmias (ventricular tachycardia, severe bradycardia) PAIN/DISCOMFORT May report: Chest pain, mild to severe, which may or may not be relieved by antianginal medication May exhibit: Distraction behaviors, e.g., restlessness RESPIRATION May report: Chronic lung disease History of or current tobacco use Shortness of breath Coughing (with/without sputum production) May exhibit: Changes in respiratory rate/depth during dysrhythmia episode Breath sounds: Adventitious sounds (crackles, rhonchi, wheezing) may be present,
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