caring for clients with dysrhythmias

7/29/2019 Caring for clients with dysrhythmias

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Caring for

Clients withDYSRHYTHMIAS


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CARDIAC RHYTHM

Pattern or pace of heart beat

Normal sinus rhythm (NSR)


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CHARACTERISTICS OF NSR

Heart rate is between 60 and 100 bpm

The SA node initiates the impulse

Impulse travels to the AV node in 0.12 to 0.2second (the PR interval)

Ventricles depolarize in 0.12 second or less

Each impulse occurs regularly


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DYSRHYTHMIA

Arrhhtmia

Conduction disorder that results in

abnormally slow or rapid heart rate

Does not proceed through the conduction

system in a usual manner

Most common cause of dysrhythmia isischemic heart disease


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PREDISPOSING FACTORS

Drug therapy

Electrolyte disturbances

Metabolic acidosis Hypothermia

Degenerative age related changes


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CARDIAC DYSRHYTHMIAS

DYSRHYTHMIAS ORIGINATING

IN THE SINOATRIAL NODE


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SINUS BRADYCARDIA

Proceeds normally through the conductionpathway but at a slower than usual rate

(


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Slow HR is insufficient to maintain CO

Atropine sulfate IV is given


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SINUS TACHYCARDIA Proceeds normally through the conduction pathway

but at a faster rate (100-150bpm)

Physiologic response to strenuous activity

Anxiety

Fear

Pain

Fever

Hyperthyroidism Hemorrhage

Shock

hypoxemia


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PREMATURE ATRIAL CONTRACTIONS

Early electrical impulse

Irregularity in underlying rhythm

Initiated somewhere in the atria other thanthe SA node

Consumption of caffeine

Use of nicotine or other sympathetic nervoussystem stimulants

Response to heart disease or hypothyroidism


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SUPRAVENTRICULAR TACHYCARDIA

Dysrhythmias in which the heart rate is

extremely high (>150 beats/minute)

Diastole is shortened

CO drops

Tachycardia, angina

Hypotension, syncope Reduced renal output

Digitalis, CCB, adrenergic blockers


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ATRIAL FLUTTER

Single atrial impulse outside the SA node

causes the atria to contract at an exceedingly

rapid rate (200 to 400 contractions/minute)

AV node conducts only some impulses resulting

in slower than atrial rate contractions

Saw tooth pattern


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ATRIAL FIBRILLATION

Several areas in right atrium initiates impulses

resulting in disorganized rapid activity

Atria quiver than contract

Ibutilide (corvert) {use to convert new onset

atrial fibrillation into sinus rhythm}

Flecainide (Tambocor) {use to treat andprevent atrial fibrillation}


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MANAGEMENT FOR FIBRILLATION

CHEMICAL CARDIOVERSION

Use of drugs to eliminate dysrhythmias

ELECTIVE CARDIOVERSION MAZE PROCEDURE

Creation of new conduction pathway

that eliminates rapid firing of ectopicpacemaker sites in the atria


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DYSRHYTHMIA ORIGINATING INTHE ATRIOVENTRICULAR NODE


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HEART BLOCK Disorder in the conduction pathway that

interfere with the transmission of impulses

from SA node through the AV node

May be first or second degree

Complete heart block = atrial impulse never

gets through

Ventricular rate is slow (30 to 40 bpm)

PACEMAKER insertion is the treatment for

heart block


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DYSRHYTHMIA ORIGINATING INTHE VENTRICLE


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PREMATURE VENTRICULAR

CONTRACTIONS

Ventricular contraction that occurs early and

independently in the cardiac cycle before SA

node initiates electrical impulses

Often cause flip-flop sensation in the chest

Sometimes describe as fluttering

Pallor, nervousness, sweating, faintness

Related to anxiety, stress, fatigue, alcohol

withdrawal or tobacco use


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VENTRICULAR TACHYCARDIA

Caused by single irritable focus in the

ventricle that initiates the heartbeat

Ventricles beat very fast (150-250bpm)

CO is decreased

May progress to ventricular fibrillation


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VENTRICULAR FIBRILLATION

Rhythm of a dying

heart

PVCs or VT may

precipitate it

Indication for CPR

and immediate

defibrillation


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PREDISPOSING FACTORS

Myocardial ischemia

Lack of oxygenated blood to heart muscles

CHF Inadequate ventilation

Shock

Anxiety Endocrine disorders

Valvular heart diseases


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ASSESSMENT

Weak and tired Anginal pain or faintness

Palpitations or fluttering

Low BP

Apical and radial pulse differ

Disoriented

Confuse

ELECTROPHYSIOLOGY STUDIES = origin

12 LEAD ECG = identification of dysrhythmias


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DRUG THERAPY

Oral and IV antidysrhythmics

Lidocaine hydrochloride (xylocaine)

Procainamide hydrochloride (pronestyl)Verapamil hydrochloride (calan)

Adenosin (Adenocard)

Athropine sulfateCalcium chloride


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ELECTIVE ELECTRICAL

CARDIOVERSION

Non-emergency procedure to stop rapid atrial

but necessarily life threatening dysrhytmia


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DEFIBRILLATION

Only treatment for

life treatening

ventricular

dysrhythmia

Used during

pulseless ventricular

fibrillation andasystole


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AUTOMATIC IMPLANTED

CARDIAC DEFIBRILLATOR


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PACEMAKERS

Provides electrical stimulus to the heartmuscle to treat an ineffective

bradydysrhythmia

2 divisions;

temporary

permanent

3 t f t


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3 types of temporary

pacemakers

TRANSTHORACIC

PACEMAKER

Inserted during

open heart

surgery



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pacemakers

TRANSVENOUS

PACEMAKERS

Temporary pulse

generating device

Subclavian

Jugular vein

Cephalic vein



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pacemakers

TRANCUTANEOUS

PACEMAKER

Emergency measure

for maintaining

adequate HR

Uses disposable, self

adhering leads


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PACEMAKER FUNCTION

1. DEMAND (SYCHRONOUS) MODE

Self activating when pulse falls below

certain level

2. FIXED RATE (ASYNCHRONOUS) MODE

Produce electrical stimulus at presetrate despite the clients natural rhythm


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RADIOFREQUENCY CATHETER

ABLATION


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END

caring for clients with dysrhythmias

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