Download - 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
3 types of temporary
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3 types of temporary
pacemakers
TRANSVENOUS
PACEMAKERS
Temporary pulse
generating device
Subclavian
Jugular vein
Cephalic vein
3 types of temporary
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3 types of temporary
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