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

Elsevier items and derived items © 2006 by Elsevier Inc.

Chapter 37

Interventions for Clients with Dysrhythmias

Interventions for Clients with Dysrhythmias


Review of Cardiac Electrophysiology

• Automaticity

• Excitability

• Conductivity

• Contractility

• Action potential

• Automaticity

• Excitability

• Conductivity

• Contractility

• Action potential


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


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


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


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.


Normal Rhythms

• Normal sinus rhythm

• Sinus arrhythmia

• Normal sinus rhythm

• Sinus arrhythmia


Dysrhythmias

• Tachydysrhythmias

• Bradydysrhythmias

• Premature complexes

• Repetitive rhythms

• Escape complexes and rhythms

• Tachydysrhythmias

• Bradydysrhythmias

• Premature complexes

• Repetitive rhythms

• Escape complexes and rhythms


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


• Interventions


Sinus Bradycardia

• Rate of sinus node discharge < 60 beats/min


• Interventions

• Rate of sinus node discharge < 60 beats/min


• Interventions


Premature Atrial Complexes

• Ectopic focus of atrial tissue fires an impulse before the next sinus impulse is due.


• Interventions

• Ectopic focus of atrial tissue fires an impulse before the next sinus impulse is due.


• Interventions


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.


• 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.


• Interventions


Atrial Flutter

• Rapid atrial depolarization occurring at a rate of 250 to 350 times per minute


• Interventions

• Rapid atrial depolarization occurring at a rate of 250 to 350 times per minute


• Interventions


Atrial Fibrillation

• Multiple, rapid impulses from many atrial foci at a rate of 350 to 600 times per minute


• Interventions

• Multiple, rapid impulses from many atrial foci at a rate of 350 to 600 times per minute


• Interventions


Premature Ventricular Complexes

• A result of increased irritability of ventricular cells: early ventricular complexes followed by a pause


• Interventions

• A result of increased irritability of ventricular cells: early ventricular complexes followed by a pause


• Interventions


Ventricular Tachycardia

• Also called V tach: repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min


• Interventions

• Also called V tach: repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min


• Interventions


Ventricular Fibrillation

• Also called V fib: a result of electrical chaos in the ventricles


• Interventions

• Also called V fib: a result of electrical chaos in the ventricles


• Interventions


Ventricular Asystole

• Also called ventricular standstill: complete absence of any ventricular rhythm


• Interventions

• Also called ventricular standstill: complete absence of any ventricular rhythm


• Interventions


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


Nonsurgical Management

• Vagal maneuvers

• Carotid sinus massage

• Valsalva maneuvers

• Vagal maneuvers

• Carotid sinus massage

• Valsalva maneuvers


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


Invasive Temporary Pacing

• Procedure

• Complications

• Prevention of microshock

• Procedure

• Complications

• Prevention of microshock


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


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)


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.


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

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