Cardiac dysrhythmia management & pacemakers
Cardiac dysrhythmias
Students to review slides 4-29 prior to class: this content will not be covered in NUR 4120
Normal sinus rhythm
• Answers to evaluation of rhythm will always be within normal limits
• Rate: 60-100bpm
Sinus node...
cardiac dysrhythmia management amp pacemakers cardiac dysrhythmias students to review slides 4 29 prior to class this content will not be covered in nur 4120 normal sinus rhythm • answers to
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Cardiac dysrhythmia management & pacemakers
Cardiac dysrhythmias
Students to review slides 4-29 prior to class: this content will not be covered in NUR 4120
Normal sinus rhythm
Answers to evaluation of rhythm will always be within normal limits
Rate: 60-100bpm
Sinus node dysrhythmias
Sinus bradycardia
HR < 60 bpm
Sinus node creates impulse at slower than normal rate
Characteristics of NSR but a slower rate
Etiology: sinus bradycardia
Sleep Medication
Athletic training CCB (decrease HR/BP), amiodarone,
Hypothyroidism beta-blockers
Vagal stimulation Increased intracranial pressure
Vomiting, suctioning, pain CAD/Acute MI
Hypoxemia Acute decompensated heart failure
Altered mental status
Sinus bradycardia: clinical manifestations and management
Clinical manifestations:
SOB altered LOC
Hypotension
EKG changes (ST segment changes PVC’s)
Management:
Resolve causative factors
Atropine 0.5 mg IV every 3-5 minutes
◊ Maximum dose of 3 mg
◊ Atropine won’t work on a patient with a heart transplant
Emergency transcutaneous pacing
Catecholamines
, Sinus tachycardia
HR: 100-120
Sinus node creates impulse at faster than normal rate
Does not start or stop suddenly
, Conduction defect in the atrium, filling time is affected, risk = coagulation
Creates atrial rate between 250-400 times/minute (ventricular rate 75-150)
Not all impulses conducted to ventricle: therapeutic block at AV node
2:1, 3:1, 4:1
Regular atrial activity
P wave = “saw tooth” appearance
HR > 100 bpm
“uncontrolled”
HR > 150 bpm
“rapid ventricular rate”
Etiology: atrial flutter**
COPD
Pulmonary HTN
Valvular disease
Thyrotoxicosis
Open heart surgery
Atrial flutter: clinical manifestations and management
Clinical manifestations:
Chest pain
Dyspnea
Hypotension
Management:
Electrical cardioversion for unstable patient
See treatment for atrial fibrillation
Medications to slow the ventricular response:
◊ Beta blockers
◊ Calcium channel blockers
◊ Digitalis (digoxin) decreases HR
◊ Diltiazem
Usually resolves on own but if it doesn’t resolve within 48 hours, look out for a blood
clot/coagulation
Atrial fibrillation (more disorganized than atrial flutter)
Rapid, disorganized and uncoordinated twitching of atrial muscle
Paroxysmal or chronic
Rapid ventricular response; loss of atrial kick (25-30% of cardiac output)
Atrial rate 300-600 BPM
Ventricular rate: 120-200 BPM
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