1. Elsevier items and derived items © 2006 by Elsevier Inc. Chapter 37 Interventions for Clients with Dysrhythmias

2. Elsevier items and derived items © 2006 by Elsevier Inc. Review of Cardiac Electrophysiology Automaticity Excitability Conductivity Contractility Action potential Automaticity Excitability Conductivity Contractility Action potential

3. Elsevier items and derived items © 2006 by Elsevier Inc. Cardiac Conduction System Sinoatrial node –Electrical impulses at 60 to 100 beats/min Atrioventricular junctional area Bundle branch system Sinoatrial node –Electrical impulses at 60 to 100 beats/min Atrioventricular junctional area Bundle branch system

4. Elsevier items and derived items © 2006 by Elsevier Inc. Electrocardiography Electrocardiogram (ECG) Lead systems Limb leads Chest leads Continuous electrocardiographic monitoring Telemetry Electrocardiogram (ECG) Lead systems Limb leads Chest leads Continuous electrocardiographic monitoring Telemetry

5. Elsevier items and derived items © 2006 by Elsevier Inc. Electrocardiographic Complexes, Segments, and Intervals P wave PR segment PR interval QRS complex QRS duration ST segment T wave U wave QT interval P wave PR segment PR interval QRS complex QRS duration ST segment T wave U wave QT interval

6. Elsevier items and derived items © 2006 by Elsevier Inc. Electrocardiographic Rhythm Analysis Determine the heart rate. Determine the heart rhythm. Analyze the P waves. Measure the PR interval. Measure the QRS duration. Determine the heart rate. Determine the heart rhythm. Analyze the P waves. Measure the PR interval. Measure the QRS duration.

7. Elsevier items and derived items © 2006 by Elsevier Inc. Normal Rhythms Normal sinus rhythm Sinus arrhythmia Normal sinus rhythm Sinus arrhythmia

8. Elsevier items and derived items © 2006 by Elsevier Inc. Dysrhythmias Tachydysrhythmias Bradydysrhythmias Premature complexes Repetitive rhythms Escape complexes and rhythms Tachydysrhythmias Bradydysrhythmias Premature complexes Repetitive rhythms Escape complexes and rhythms

9. Elsevier items and derived items © 2006 by Elsevier Inc. Dysrhythmias Classification Sinus dysrhythmias Sinus tachycardia When the rate of SA node discharge exceeds 100 beats/min Clinical manifestations Interventions Classification Sinus dysrhythmias Sinus tachycardia When the rate of SA node discharge exceeds 100 beats/min Clinical manifestations Interventions

10. Elsevier items and derived items © 2006 by Elsevier Inc. Sinus Bradycardia Rate of sinus node discharge < 60 beats/min Clinical manifestations Interventions Rate of sinus node discharge < 60 beats/min Clinical manifestations Interventions

11. Elsevier items and derived items © 2006 by Elsevier Inc. Premature Atrial Complexes Ectopic focus of atrial tissue fires an impulse before the next sinus impulse is due. Clinical manifestations Interventions Ectopic focus of atrial tissue fires an impulse before the next sinus impulse is due. Clinical manifestations Interventions

12. Elsevier items and derived items © 2006 by Elsevier Inc. Supraventricular Tachycardia Rapid stimulation of atrial tissue occurs at a rate of 100 to 280 beat/min with a mean of 170 beats/min in adults. Paroxysmal supraventricular tachycardia rhythm is intermittent and terminated suddenly with or without intervention. Clinical manifestations Interventions Rapid stimulation of atrial tissue occurs at a rate of 100 to 280 beat/min with a mean of 170 beats/min in adults. Paroxysmal supraventricular tachycardia rhythm is intermittent and terminated suddenly with or without intervention. Clinical manifestations Interventions

13. Elsevier items and derived items © 2006 by Elsevier Inc. Atrial Flutter Rapid atrial depolarization occurring at a rate of 250 to 350 times per minute Clinical manifestations Interventions Rapid atrial depolarization occurring at a rate of 250 to 350 times per minute Clinical manifestations Interventions

14. Elsevier items and derived items © 2006 by Elsevier Inc. Atrial Fibrillation Multiple, rapid impulses from many atrial foci at a rate of 350 to 600 times per minute Clinical manifestations Interventions Multiple, rapid impulses from many atrial foci at a rate of 350 to 600 times per minute Clinical manifestations Interventions

15. Elsevier items and derived items © 2006 by Elsevier Inc. Premature Ventricular Complexes A result of increased irritability of ventricular cells: early ventricular complexes followed by a pause Clinical manifestations Interventions A result of increased irritability of ventricular cells: early ventricular complexes followed by a pause Clinical manifestations Interventions

16. Elsevier items and derived items © 2006 by Elsevier Inc. Ventricular Tachycardia Also called V tach: repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min Clinical manifestations Interventions Also called V tach: repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min Clinical manifestations Interventions

17. Elsevier items and derived items © 2006 by Elsevier Inc. Ventricular Fibrillation Also called V fib: a result of electrical chaos in the ventricles Clinical manifestations Interventions Also called V fib: a result of electrical chaos in the ventricles Clinical manifestations Interventions

18. Elsevier items and derived items © 2006 by Elsevier Inc. Ventricular Asystole Also called ventricular standstill: complete absence of any ventricular rhythm Clinical manifestations Interventions Also called ventricular standstill: complete absence of any ventricular rhythm Clinical manifestations Interventions

19. Elsevier items and derived items © 2006 by Elsevier Inc. Decreased Cardiac Output and Ineffective Tissue Perfusion Interventions include: –Cardiac care –Nonsurgical management –Drug therapy Vaughn-Williams classification Other antidysrhythmic drugs Emergency cardiac drugs Interventions include: –Cardiac care –Nonsurgical management –Drug therapy Vaughn-Williams classification Other antidysrhythmic drugs Emergency cardiac drugs

20. Elsevier items and derived items © 2006 by Elsevier Inc. Nonsurgical Management Vagal maneuvers Carotid sinus massage Valsalva maneuvers Vagal maneuvers Carotid sinus massage Valsalva maneuvers

21. Elsevier items and derived items © 2006 by Elsevier Inc. Temporary Pacing Modes of pacing –Synchronous pacing –Asynchronous pacing Noninvasive temporary pacing –Procedure –Complications Modes of pacing –Synchronous pacing –Asynchronous pacing Noninvasive temporary pacing –Procedure –Complications

22. Elsevier items and derived items © 2006 by Elsevier Inc. Invasive Temporary Pacing Procedure Complications Prevention of microshock Procedure Complications Prevention of microshock

23. Elsevier items and derived items © 2006 by Elsevier Inc. Treatments Cardiopulmonary resuscitation Advanced cardiac life support Cardioversion: synchronized countershock that may be used for emergent hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias resistant to medical therapies Cardiopulmonary resuscitation Advanced cardiac life support Cardioversion: synchronized countershock that may be used for emergent hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias resistant to medical therapies

24. Elsevier items and derived items © 2006 by Elsevier Inc. Defibrillation Asynchronous countershock depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit and allow the sinus node to regain control of the heart. Maintain a patent airway. Administer oxygen. (Continued) Asynchronous countershock depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit and allow the sinus node to regain control of the heart. Maintain a patent airway. Administer oxygen. (Continued)

25. Elsevier items and derived items © 2006 by Elsevier Inc. Defibrillation (Continued) Assess vital signs and level of consciousness. Administer antidysrhythmic drugs. Monitor for dysrhythmias. Assess for burns, emotional support, documentation. Assess vital signs and level of consciousness. Administer antidysrhythmic drugs. Monitor for dysrhythmias. Assess for burns, emotional support, documentation.

26. Elsevier items and derived items © 2006 by Elsevier Inc. Other Therapies Automatic external defibrillation Radiofrequency catheter ablation Surgical procedures: –Permanent pacemaker –Coronary artery bypass grafting –Aneurysmectomy –Insertion of implantable cardioverter/defribillator –Open-chest cardiac massage Automatic external defibrillation Radiofrequency catheter ablation Surgical procedures: –Permanent pacemaker –Coronary artery bypass grafting –Aneurysmectomy –Insertion of implantable cardioverter/defribillator –Open-chest cardiac massage