management of patients with dysrhythmias and conduction problems hinkle ppt ch 26

7/18/2019 Management of Patients with Dysrhythmias and Conduction problems Hinkle PPT Ch 26

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Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 26

Management of Patients With

Dysrhythmias andConduction Problems


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Dysrhythmias

Disorders of formation or conduction (or both) ofelectrical impulses within heart

Can cause disturbances of

Rate

Rhythm

Both rate and rhythm

Potentially can alter blood flow and cause hemodynamicchanges

Diagnosed by analysis of electrographic waveform


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Normal Electrical Conduction

! node (sinus node)

!" node Conduction

Bundle of #is

Right and left bundle branches

Pur$in%e fibers

Depolari&ation ' stimulation ' systole

Repolari&ation ' relaation ' diastole


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Relationship of ECG Comple!"ead #ystem! and Electrical $mpulse


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%he Electrocardiogram &ECG'

lectrode placement

lectrode adhesion

*ypes of C+

C+ ,nterpretation

P wave

-R comple

* wave

. wave

PR interval

* segment

-* interval

*P interval

PP interval


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ECG Electrode Placement


7/40Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

ECG Graph and Commonly MeasuredComponents



(eart Rate Determination



Normal #inus Rhythm



#inus )radycardia



#inus %achycardia



#inus *rrhythmia



+uestion

*he nurse is preparing a male patient to have a /01leadC+ performed2 3hen prepping the s$in the nurse noticesthat the patient has abundant chest hair2 3hat is the most

appropriate nursing intervention to improve adhesion of theC+ leads4

!2.se alcohol swabs to cleans the s$in before applying theleads2

B2Clip the chest hair with the patient5s permission beforeapplying the leads2

C2!pply the leads to the arms and legs only2

D2Reschedule the C+2



*ns,er

B2 Clip the chest hair with the patient5s permission beforeapplying the leads2

Rationale6 !lcohol should not be used to prep the s$inbecause it increases the s$in5s electrical impedance7thereby hindering the detection of the cardiac electricalsignal2 Clipping the hair would provide access to thes$in to assist with adhesion2 *he C+ would not beperformed correctly if the leads were only placed on theetremities7 and there is no need to reschedule the C+at this time2



Nursing Process- Care of the Patient ,itha Dysrhythmia.*ssessment

Causes of dysrhythmia7 contributing factors

!ssess indicators of cardiac output and oygenation #ealth history6 include presence of coeisting conditions7

indications of previous occurrence

!ll medications (prescribed and 8*C)

Psychosocial assessment6 patient5s 9perception: ofdysrhythmia



Nursing Process- Care of the Patient ,itha Dysrhythmia.*ssessment &cont/d'

Physical assessment include

$in (pale and cool) igns of fluid retention (;"D7 lung auscultation)

igns of decreased C8 (altered



Nursing Process- Care of the Patient Witha Dysrhythmia.Diagnoses

Decrease cardiac output

!niety

Deficient $nowledge



Collaborati0e Problems and PotentialComplications

Cardiac arrest

#eart failure

*hromboembolic event7 especially with atrial fibrillation



Nursing Process- Care of the Patient Witha Dysrhythmia.Planning

+oals

radicating or decreasing occurrence of dysrhythmiato maintain cardiac output

=inimi&ing aniety

!c>uiring $nowledge about dysrhythmia and its

treatment



Nursing Process- Care of the Patient Witha Dysrhythmia.Nursing $nter0entions

=onitor and manage the dysrhythmia

=inimi&e aniety

Promote home1 and community1based cared

ducate the patient

Continuing care


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Nursing $nter0ention- Monitor andManage the Dysrhythmia

!ssess vital signs on an ongoing basis

!ssess for lightheadedness7 di&&iness7 fainting

,f hospitali&ed

8btain /01lead C+

Continuous monitoring

=onitor rhythm strips periodically

!ntiarrhythmic medications

9?1minute wal$ test:


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Nursing $nter0ention- Minimi1e *niety

tay with patient

=aintain safety and security

Discuss emotional response to dysrhythmia

#elp patient develop a system to identify factors thatcontribute to episodes of the dysrhythmia

=aimi&e the patient5s control


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Nursing $nter0ention- Promote (ome andCommunity)ased Cared

ducate the patient

*reatment options

*herapeutic medication levels

#ow to ta$e pulse before medication administration

#ow to recogni&e symptoms of the dysrhythmia

=easures to decrease recurrence

Plan of action in case of an emergency

CPR (family)


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Nursing $nter0ention- Continuing Care

Referral for home care

#emodynamically unstable with signs of decreasedC8

ignificant comorbidities

ocioeconomic issues


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Nursing Process- Care of the Patient Witha Dysrhythmia.E0aluation

=aintain cardiac output

table "7 no signs of dysrhythmia perience decreased aniety

Positive attitude7 confidence in ability to act if anemergency occurs

press understanding of dysrhythmia and treatment


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*d3uncti0e Modalities and Management

.sed when medications alone are ineffective againstdysrhythmia

Pacema$ers

Cardioversion

Defibrillation

@urse responsible for assessment of the patient5sunderstanding regarding the mechanical therapy


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Pacema4ers

lectronic device that provides electrical stimuli to heartmuscle

*ypes

Permanent

*emporary

@!P1BP+ code for pacema$er function


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$mplanted %rans0enous Pacema4er


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%ranscutaneous Pacema4er


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Complications of Pacema4er 5se

,nfection

Bleeding or hematoma formation

Dislocation of lead

$eletal muscle or phrenic nerve stimulation

Cardiac tamponade (pressure on the heart when fluid builds upbetween muscle and sac)

Pacema$er malfunction


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$mplantable Cardio0erter Defibrillator&$CD'

Device that detects and terminates life1threateningepisodes of tachycardia and fibrillation

@!P1BP+ code

!ntitachycardia pacing


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$CD &cont/d'


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Nursing Management &*fter PermanentElectronic De0ice $nsertion'

C+ assessment

CAR

@ursing assessment

C8 and hemodynamic stability

,ncision site

igns of ineffective coping


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Cardio0ersion and Defibrillation

*reat tachydysrhythmias by delivering electrical currentthat depolari&es critical mass of myocardial cells

3hen cells repolari&e7 sinus node usually able torecapture role as heart pacema$er

,n cardioversion7 current delivery synchroni&ed withpatient5s C+

,n defibrillation7 current delivery is unsynchroni&ed


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#afety Measures

nsure good contact between s$in7 pads7 and paddles

.se conductive medium7 0 to 0 pounds of pressure

Place paddles so they do not touch bedding or clothingand are not near medication patches or oygen flow

,f cardioverting7 turn synchroni&er on

,f defibrillating7 turn synchroni&er off


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#afety Measures &cont/d'

Do not charge device until ready to shoc$

Call 9clear: three times follow chec$s re>uired for clear

nsure no one is in contact with patient7 bed7 ore>uipment


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Paddle Placement for Defibrillation


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+uestion

3hat must a patient with an automatic ,CD do4

!2Continue to go through metal1detection devices at theairport

B2Call for assistance when blood pressure increases

C2Document events that trigger a shoc$ sensation

D2Be compliant with all of the above1listed interventions


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*ns,er

C2 Document events that trigger a shoc$ sensation

Rationale6 *he patient with an automatic ,CD mustdocument events that trigger a shoc$ sensation2 *hepatient must avoid magnetic fields such as metal1detection devices at the airport and should call foremergency assistance when feeling di&&y2


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$n0asi0e Methods to Diagnose and %reatRecurrent Dysrhythmias

lectrophysiologic studies

!blation

Cardiac conduction surgery

=a&e procedure (E=a&eE refers to the series ofincisions arranged in a ma&e1li$e pattern in the atria)

Catheter ablation therapy

management of patients with dysrhythmias and conduction problems hinkle ppt ch 26

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