5 Pathophysiology:-Results from a disturbance in conductivity.-Heart rate and rhythm are altered, reducing cardiacoutput.Assessment finding:-Palpitations.-Chest pain.-Weakness, fatigue.
6 -Irregular heart rhythm. -Bradycardia or tachycardia.-Dizziness.-Hypotension.-Altered level of consciousness.-Pallor.-Nausea, vomiting.-Cold skin.
7 Possible diagnostic findings: * ECG: changes in heart rate, rhythm.* Blood chemistry: electrolyte imbalance.Nursing intervention:Monitor pulse for irregular pattern or abnormally rapidor slow rate.Observe for arrhythmias if the patient is receivingcontinuous cardiac monitoring.Assess cardiovascular, respiratory, and neurovascularstatus.Initiate cardiopulmonary resuscitation (CPR), ifindicated, until other advanced cardiac life supportmeasures are available and successful.Perform defibrillation early for ventricular tachycardiaand ventricular fibrillation.
8 Administer medications, oxygen, and I.V fluids, as needed.Prepare for procedures, such as cardioversion orpacemaker insertion, if indicated.Monitor for predisposing factors (such as fluid andelectrolyte imbalance) and signs of drug toxicity,especially digoxin.* Monitor and record vital signs.* Maintain prescribed diet.* Maintain bed rest, until patient is stable.* Provide support to the patient and family.
9 Characteristics of normal rhythm include: -Ventricular and atrial rates of 60 to 100 beats/minute.-Regular and uniform QRS complexes and Pwaves.-PR interval of 0.12 to 0.2 second.-QRS duration <0.12 second.
12 Causes-Fever, anxiety, pain, dehydration, may also left ventricular failure, hyperthyroidism, anemia, hypovolemia, pulmonary embolism, and anterior wall MI.-May also occur with atropine, epinephrine, alcohol,caffeine, and nicotine use.
13 Treatment-Correction of underlying cause.-Beta and calcium blockers.
15 -Increased intracranial pressure, increased vagal Causes:-Normal, in well-conditioned heart, as in an athlete.-Increased intracranial pressure, increased vagaltone due to straining during defecation, vomiting,intubation, mechanical ventilation, sick sinussyndrome, hypothyroidism, inferior wall MI.-Morphine use.
16 Treatment:-Correction of underlying cause.-Administration of atropine.-Temporary or permanent pacemaker.-Dopamine or epinephrine infusion.
18 Causes:-Heart failure (HF), tricuspid or mitral valvedisease, pulmonary embolism, inferior wall MI andcarditis.-Digoxin toxicity.
19 Treatment:-If patient is unstable with a ventricular rate>150 b/m, immediate cardioversion.If patient is stable, drug therapy may include calcium blockers, or antiarrhythmics.-Anticoagulation therapy (heparin).
22 Treatment:-If patient is unstable with a ventricular rate>150 b/m, immediate cardioversion.- If patient is stable, drug therapy may include calcium and beta blockers, or antiarrhythmics.-Anticoagulation therapy (heparin).
28 Treatment:Initiate cardiopulmonary resuscitation and administration of epinephrine.
29 Correction of underlying cause TreatmentCausesArrhythmia And FeatureCorrection of underlying causePossibly atropine if severe bradycardia develops and the patient is symptomaticCautious use of digoxin and beta –adrenergic blockersMay be seen in a healthy personInferior wall MI, or Ischemia, hypothyroidism, hypokalemia , hyperkalemia.Digoxin toxicityFirst – degree AV blockAtrial and ventricular rhythms regularPR interval > secondQSR complex normal
30 Treatment of underlying cause Atropine for symptomaticBradycardiaDiscontinuation of digoxin .Inferior wall MI ,cardiac surgery acute rheumatic fever ,and vagal stimulationDigoxin toxicitySecond- degree AV blockAtrial rhythm regularVentricular rhythm irregularAtrial rate exceeds ventricular ratePR interval progressively longer
31 Atropine , dopamine , or epinephrine for symptomatic bradycardia Temporary or permanent pacemakerInferior or anterior wall MI , congenital abnormality , rheumatic fever ,hypoxia , postoperative complication of mitral valve replacementDigoxin toxicityThird – degree AVblockAtrial rhythm regularVentricular rate slow and rhythm regularNo relation between P waves and QRS complexNo stable PR intervalQRS interval normal or widePR interval variesP wave may be covered in QRS complexes or T waveQSR complex normal