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Cardiac dysrhythmias workbook

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Cardiac dysrhythmias workbook

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  • December 8, 2023
  • 19
  • 2023/2024
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lOMoARcPSD|20734855
lOMoARcPSD|20734855




Cardiac Dysrhythmias Workbook

, lOMoARcPSD|20734855




Cardiac Dysrhythmias
NURS 2106

Dysrhythmias (arrhythmias):
 Most common complication post MI
 Disturbance of rate, rhythm or conduction of electrical impulses within the heart
 Prompt assessment of dysrhythmias and the patient’s response to the rhythm is critical

Classifications of arrhythmias:
 Sites:
o SA node (sinus rhythm)
o Atrial (atrial rhythms)
o AV node (nodal or junctional rhythm)
o Ventricles (ventricular rhythms)
 Type:
o Flutter
o Fibrillation
o Block

Prognosis:
 Minor – no immediate concern
 Major – reduction of efficiency of the heart
 Lethal – requires immediate treatment or resuscitation, death producing

Dysrhythmias symptoms:
 Some dysrhythmias  no symptoms
 Some dysrhythmias  life threatening (sudden collapse, death)
 Typical symptoms:
o Dizziness
o Weakness
o Decreased exercise tolerance
o Shortness of breath
o Fainting
o Palpitations or “heart has skipped a beat”

Common causes of dysrhythmias:
 Cardiac causes
o Accessory pathways, conduction defects
o Cardiomyopathy, heart failure
o Myocardial cell degeneration (ischemia, injury, infarction)
o Valve disease
 Other conditions
o Acid-base imbalances
o Electrolyte disturbances
o Caffeine, tobacco, alcohol
o Drug effects (antidysrhythmia, stimulants, beta-blockers)
o Emotional crisis, herbal supplements, connective tissue disorders
o Hypoxia, shock
o Metabolic conditions (thyroid dysfunction)

, lOMoARcPSD|20734855




2
o Near-drowning, poisoning
Sinus Bradycardia




Identifying EKG characteristics:
▪ Rate: < 60 beats a minute
▪ Rhythm: Regular
▪ P waves: Normal and precede each QRS
▪ PR interval: Normal range (0.12 – 0.20)
▪ QRS: Normal (< 0.12)

Etiology:
▪ May be normal in physically conditioned adults and during sleep
▪ Increased vagal tone (Valsalva maneuver, endotracheal suctioning, vomiting, gagging)
▪ Medication effect (narcotics, cardiac glycoside, beta blockers, calcium channel blockers)
▪ Pathology (hypothermia, hypothyroidism, increased intracranial pressure, obstructive jaundice,
MI--- inferior wall MI involves right coronary artery). Ischemia of sinus node slows rate.

Clinical significance:
▪ May be asymptomatic.
▪ Symptoms are associated with decreased cardiac output:
o Hypotension, dizziness, syncope
o Pale, cool skin
o Weakness
o Confusion or disorientation
o Shortness of breath
o Angina
o Decreased urinary output

Treatment:
▪ Treat only is symptomatic
▪ Atropine IVP (0.5 – 1 mg)
▪ If due to medication  discontinue or reduce dose
▪ Pacemaker may be required

Nursing implications:
▪ Assess for signs and symptoms of decreased cardiac output
▪ Observe for premature ventricular contractions (PVCs) or other ectopic beats

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