Chapter 27 Management of Patients With Dysrhythmias and Conduction Problems

1. Chapter 27Management of Patients With Dysrhythmias and Conduction Problems

2. Dysrhythmias (See Chart 27-1) • Dysrhythmias: disorders of the formation or conduction (or both) of the electrical impulses in the heart • These disorders can cause disturbances of: • Rate • Rhythm • Both rate and rhythm • Potentially can alter blood flow & cause hemodynamic changes • Diagnosed by analysis of ECG waveform

3. Relationship of ECG Complex, Lead System, and Electrical Impulse

4. ECG Electrode Placement

5. ECG Graph and Commonly Measured Components

6. Heart Rate Determination

7. Normal Sinus Rhythm

8. Sinus Bradycardia

9. Sinus Tachycardia

10. Sinus Arrhythmia

11. Premature Atrial Complexes

12. Atrial Flutter

13. Atrial Fibrillation

14. Multifocal PVCs-Quadrigeminy

15. Ventricular Tachycardia

16. Ventricular Fibrillation

17. Asystole

18. First-Degree AV Block

19. Second-Degree AV Block, Type 1

20. Second-Degree AV Block, Type 2

21. Third-Degree AV Block

22. Nursing Process: The Care of the Patient with a Dysrhythmia: Assessment • Assess indicators of cardiac output and oxygenation, especially changes in level of consciousness. • Physical assessment includes: • Rate and rhythm of apical and peripheral pulses • Assess heart sounds • Blood pressure and pulse pressure • Signs of fluid retention • Health history: include presence of coexisting conditions and indications of previous occurrence • Medications

23. Nursing Process: The Care of the Patient with a Dysrhythmia: Diagnosis • Decreased cardiac output • Anxiety • Deficient knowledge

24. Collaborative Problems/Potential Complications • Cardiac arrest • Heart failure • Thromboembolic event, especially with atrial fibrillation

25. Nursing Process: The Care of the Patient with a Dysrhythmia: Planning • Goals may include eradicating or decreasing the occurrence of the dysrhythmia to maintain cardiac output, minimizing anxiety, and acquiring knowledge about the dysrhythmia and its treatment.

26. Decreased Cardiac Output • Monitoring • ECG monitoring • Assessment of signs and symptoms • Administration of medications and assessment of medication effects • Adjunct therapy: cardioversion, defibrillation, pacemakers

27. Other Interventions • Anxiety • Use a calm, reassuring manner. • Measures to maximize patient control to make episodes less threatening • Communication and teaching • Teaching self-care • Include family in teaching

28. Pacemakers • An electronic device that provides electrical stimuli to the heart muscle • Types: • Permanent • Temporary • NASPE-BPEG code for pacemaker function

29. Implanted Transvenous Pacemaker

30. Transcutaneous Pacemaker

31. ECG On-Demand Pacing

32. Complications of Pacemaker Use • Infection • Bleeding or hematoma formation • Dislocation of the lead • Skeletal muscle or phrenic nerve stimulation • Cardiac tamponade • Pacemaker malfunctionSee Table 27-2

33. Nursing Process: The Care of the Patient with an Implanted Cardiac Device: Assessment • Device function; ECG • Cardiac output and hemodynamic stability • Incision site • Coping • Patient and family knowledge

34. Nursing Process: The Care of the Patient with an Implanted Cardiac Device: Diagnosis • Risk for infection • Risk for ineffective coping • Knowledge deficiency

35. Nursing Process: The Care of the Patient with an Implanted Cardiac Device- Planning • Goals include absence of infection, adherence to self-care program, effective coping, and maintenance of device function.

36. Interventions • Risk for ineffective coping • Support of patient and family coping • Setting of realistic goals • Allow patient to talk, share feeling and experiences • Support groups or referral • Stress reduction techniques • Knowledge deficiency • Patient and family teachingSee Chart 27-3

37. Cardioversion and Defibrillation • Treat tachydysrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial ceils. When cells repolarize, the sinus node is usually able to recapture its role as heart pacemaker. • In cardioversion, the current delivery is synchronized with the patient’s ECG. • In defibrillation, the current delivery is unsynchronized.

38. Safety Measures • Ensure good contact between skin and pads or paddles. Use a conductive medium and 20-25 pounds of pressure. • Place paddles so that they do not touch bedding or clothing and are not near medication patches or oxygen flow. • If cardioverting, turn the synchronizer on. • If defibrillating, turn the synchronizer off. • Do not charge the device until ready to shock. • Call “clear” three times; follow checks required for clear and ensure that no one is in contact with the patient, bed, or equipment.

39. Paddle Placement for Defibrillation

40. Implantable Cardioverter Defibrillator (ICD) • A device that detects and terminates life-threatening episodes of tachycardia or fibrillation • NASPE-BPEG code • Antitachycardia pacing

41. ICD

42. Invasive Methods to Diagnose and Treat Recurrent Dysrhythmias • Electrophysiologic studies • Cardiac conduction surgery • Maze procedure • Catheter ablation therapy