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Dysrhythmias-Notes - for medical surgical nursing.
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Dysrhythmias-Notes - This are notes for medicalsurgical nursing in 3rd year
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VENTRICULAR DYSRHYTHMIAS
100 – 200 bpm, regular
3 or more PVC IN A ROW @ 100 bpm ±
Associated w/ CARD & MI
PREMATURE YENTRICULAR COMPLEZ May precede VFib
EMERGENCY
pt unresponsive and pulseless
PVC VTach VFib Asystole
FACTORS TO DETERMINE INITIAL TREATMENT
Identifying the rhythm as monomorphic or polymorphic
Existence if a prolonged QT interval before the initiation of VT
Any comorbidities
Ascertaining the heart
function MANAGEMENT
If stable: Continue assessment (ECG)
Monomorphic stable VT (no MI or severe HF)
o Procainamide
o Sotalol
IV amiodarone (medication of choice) - if impaired
impulse that starts in a ventricle and is conducted through cardiac function or MI
the ventricles before the next normal sinus impulse. Lidocaine - most commonly used for immediate, short-term
extra heartbeats that begin in one of the heart's two lower therapy
pumping chambers (ventricles). These extra beats disrupt Cardioversion (treatment of choice) - monophasic,
the regular heart rhythm, sometimes causing a fluttering symptomatic VT
sensation or a skipped chest beat.
Defibrillation (treatment of choice) - pulseless VT
CAUSES: Long-term management:
o <35% ejection fraction - implantable
cardiac ischemia/ infarction cardioverter defibrillator (ICD)
increased workload on the heart
digitalis toxicity
o B - brady/tachycardia
o A - anorexia
o N - nausea
o D - dysrhythmia/diarrhea
o A - abdominal pain
o G - green halo vision
hypoxia
acidosis – ABG result
electrolyte imbalances
o hypokalemia (³ potassium) N=3.5-5 mEq/L
TYPES OF PVC
Unifocal PVC
Bigeminy– every other complex is PVC
Trigeminy – every third complex is PVC
Quadrigeminy – every fourth complex is a PVC
Torsedes de Pointes
a polymorphic VT preceded by a prolonged QT interval
Requires immediate treatment
o Correct electrolyte imbalance
IV magnesium
IV isoproterenol (Isuprel)
Pacing (if with bradycardia)
MANAGEMENT
Usually not seriosus
If frequent: Amiodarone or Sotalol – antiarrhythmics
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