Arrhythmia for nurses

8/12/2019 Arrhythmia for nurses

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HOSPITALS

LifeLongHealthCare

www.AtlasEra.com


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During The PresentationPLEASE:

Put cell-phones on silent/vibrate mode. Take emergency calls outside.

Maintain silence.

HOSPITALS


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CARDIAC DYSRHYTHMIAS

Mrs. Akhila Sailesh


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4

Learning Outcomes

Describe the normal electrical

conduction of the heart.

Discuss the characteristics of varioustypes of sinus node and ventricular

dysrhythmias.

Describe the nursing management of apatient with dysrhythmias.


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5

IntroductionFor the heart to perform efficiently as a pump, it

should have a regular rate and rhythm.

Without this, the heart is considered dys-rhythmic,

which could be a dangerous condition.

Dysrhythmias are disorders of the formation or

conduction (or both) of the electrical impulse withinthe heart that can cause disturbances of the heart

rate, rhythm, or both.


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REVIEW OF

CONDUCTION

Normal Sinus Rhythm in Lead II


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To make an accurate assessment of the hearts electrical activity,

the ECG needs to be evaluated from every lead. Here the different

areas of electrical activity are identified by color.


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ELECTRICAL

CONDUCTION

Sinoatrial node (SA)Intra-atrial fiber

Intranodal tracts

Atrioventricular (AV) NodeBundle of his (Common

bundle)

Bundle branches

Purkinje fibers


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PR INTERVAL

Time from the

beginning of atrial

depolarization to the

beginning of ventricular

depolarization

Measured from the

beginning of the P

wave to the beginningof the QRS complex

(0.12-0.20 sec)


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QRS INTERVALLength of time for

depolarization of the

ventricular muscle and

is measured from thebeginning of the QRS

complex to the end of

the s wave,

Should measurebetween 0.06-0.10 secs

in duration


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ST INTERVAL

Total length of timefor ventricular muscle

to be depolarized and

repolarized,measured from the

beginning of the QRS

complex to the end of

the T wave

Normal 0.32-0.42 sec


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PR interval

0.12-0.2 sec

QRS Complex

0.06-0.10 secST segment

0.12 secs

QT interval

0.34 -0.43 secs

P wave

0.040.12 secs

T wave

0.16 secs

Normal ECG

To Summarize


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INHERENT RATES

SA 60-100

AV JUNCTION 40-60

VENTRICULAR 20-40


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15

Dysrhythmias include

sinus node, atrial,

junctional, andventricular dysrhythmias

and their varioussubcategories.

Types of

Dysrhythmias


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SINUS

DYSRHYTHMIAOccurs if the P-P interval vary by

more than 0.16 sec

Less than 0.16 is considered normal

because of the fluctuation of the

sympathetic/ parasympathetic

stimulation

Associated with respiration in children

and elderly


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SINUS BRADYCARDIA

HR < 60/min arising from the SA nodeImpulses follow the normal pathway through

the conduction system

P & QRS complexes normal duration andpattern


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ETIOLOGYIncreased vagal stimulation

May be a normal variation in athletes and healthyyoung adults

Medical conditions: Anorexia nervosa

Atherosclerotic heart disease

Hypo-endocrine states Hypothermia

Increased intracranial pressure

Myocardial infarction

Medications: Anti-hypertensives Beta blockers

Calcium channel blockers

CNS depressants

Digoxin


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SINUS TACHYCARDIAHR of 100-160/ min

Normal response to sympathetic nervous

system stimulation

Any condition that produces an increase

in metabolic rate


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ETIOLOGY

DietcaffeineLife-stylesmoking / nicotine

Medical conditionsanemia,

hemorrhage, fever, hypotension,pain, shock

MedicationsCentral NervousSystem stimulants

Myocardial damage


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ATRIAL DYSRHYTHMIAS

Impulse arises outside the Sino Atrial node

P waves differ in configuration

Types Wandering atrial pacemaker

Premature atrial contractions

Paroxysmal atrial tachycardia

Atrial flutter Atrial fibrillation


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ETIOLOGY

Cardiac disease

Ischemia

Coronary artery disease

Congestive heart failure

Myocardial infarction

Increased vagal stimulation

Medications


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ATRIAL FLUTTER

Atrial ectopic pacer fires at a rate of 250-400/ min

Occurs in a variety of heart diseases- rheumatic, coronary,hypertensive, also cardiomyopathy, hypoxia, heart failure,

May be asymptomatic or have palpitations

Management- digitalis, beta blockers, calcium channel

blockers, may use cardioversion

ATRIAL FIBRILLATION


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ATRIAL FIBRILLATION

Several ectopic foci causing the atria to quiver rather

than contract

Rate >400

Ventricular rate depends on the number of impulses

conducted thru the av node

Management- Digoxin, Beta blockers, calcium channelblockers, counter-shock


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AV HEART BLOCKS

Abnormal delay in conduction of

impulse from the atrium to the ventricles

Usually asymptomatic


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ETIOLOGYCommon occurrence in normal hearts

Cardiac disease including: Arteriosclerotic heart disease,

myocarditis, organic heart disease,myocardial infarction

Medications: Beta blockers

Calcium channel blockers

Digitalis toxicity


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SECOND DEGREE

- TYPE IIEvery second third or fourth sinus impulse isblocked may have 2,3,4 Ps to each QRS

More serious- aggressive management to

prevent progression to complete heart blockTreatment: Pacer

Atropine

Dopamine for severe hypotension


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THIRD DEGREE HEART

BLOCKTotal disassociation of atria to ventricles. Ventricles arestimulated by a secondary or escape beat. The ventricular ratewill be 40-60 depending upon the location of the ventricularpacemaker

Both the sinus P wave and the escape rhythm will be obvious onthe electrocardiogram

Etiology Cardiac disease

Medicationsbeta blockers, calcium channel blockers, digitalistoxicity

Manifestations- fatigue, hypotension, syncope, heart failureTx.- Atropine, dopamine, pacer.


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THIRD DEGREE HEART

BLOCK


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JUNCTIONAL RHYTHMS

Rate 40- 60The dominant pacer of the heart fails ,

retrograde or backward stimulation of the

atria- producing a characteristic P wave - maybe a negative deflection before or after the

QRS complex or no P wave at all


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VENTRICULAR

DYSRHYTHMIASImpulse originates in the ventricles

Causes-

Drug toxicity

Hypoxia

Hypothermia

Electrolyte imbalances


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VENTRICULAR TACHYCARDIA

Three or more premature ventricular contractions in a

rowRate of ventricular discharge is 100-250/min

Etiology- increased myocardial irritability associatedwith coronary artery disease, myocardial infarction,electrolyte imbalance, cardiomyopathy


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ETIOLOGY

Same as ventricular tachycardia

Untreated ventricular tachycardia

Electrical shock


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ETIOLOGY

Hypoxia

Acidosis

Electrolyte imbalance

Drug overdose

Hypothermia


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NURSING PROCESS

DIAGNOSES:

Decreased cardiac output

Anxiety related to fear of the unknown

Deficient knowledge about the

dysrhythmia and treatment


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NURSING PROCESS

PLANNING AND GOALS

Eradicating or decreasing the incidence of

the dysrhythmiaAcquire knowledge about the dysrhythmia

and treatment


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NURSING PROCESS

INTERVENTIONS

Monitor :

Blood pressure, pulse rate and rhythm, rate and rhythm ofrespirations, breath sounds

Episodes of lightheadedness, dizziness, faintness

Rhythm strips

Medication administration

Assist in developing a plan to modify lifestyle

Minimize anxiety

Teach self care


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NURSING PROCESS

EVALUATION

EXPECTED OUCOMES

Maintains cardiac output Experiences reduced anxiety

Expresses understanding of the

dysrhythmia and its treatment.

N i I t ti


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Nursing Interventions:

Arrhythmias in summaryDocument any arrhythmias in a monitored patient.

Notify the doctor if a change in pulse pattern or rate

occurs in an unmonitored patient.

As ordered, obtain an ECG tracing in an unmonitoredpatient to confirm and identify the type of arrhythmia

present.

Be prepared to initiate cardiopulmonary resuscitation,

if indicated, when a life threatening arrhythmia

occurs.

N rsing Inter entions


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Administer medication as ordered, monitor for adverseeffect, and perform nursing interventions related to

monitoring vital signs, hemodynamic monitoring, and

appropriate laboratory work.

Nursing Interventions:

Arrhythmias.contd

Provide adequate oxygen and reduce heart workload while carefully

maintaining metabolic, neurologic, respiratory, and hemodynamicstatus.

Evaluate the monitored patients ECG regularly for arrhythmia.

Monitor for predisposing factors, such as fluid and electrolyte

imbalance, and signs of drug toxicity, especially with digoxin.

Teach the patient how to take his pulse and recognize an irregularrhythm and instruct him to report alterations from his baseline to the

doctor.

Emphasize the importance of keeping laboratory and physicians

appointments.


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Arrhythmia for nurses