N211: Health Differences Across the Lifespan I Dysrhythmias are a disturbance in the heart rate or heart rhythm. An abnormal electrical conduction or automaticity changes the heart rate and rhythm. The most common arrhythmias include atrial fibrillation, asystole, ventricular fibrillation, and ventricular tachycardia. Client is often asymptomatic until cardiac output is altered. Common causes of dysrhythmias are drugs (digoxin, quinidine, caffeine, nicotine and alcohol); acid base and electrolyte imbalances (potassium, calcium and magnesium); marked thermal changes; disease and trauma and stress. Nursing Assessment Change in pulse rate and rhythm; tachycardia (>100 bpm), bradycardia (<60 bpm), irregular rhythm, pulselessness. Client may complain of palpitations, syncope, pain, dyspnea, diaphoresis, hypotension and electrolyte imbalance. Determine medications client is currently taking. Determine serum drug levels, especially digitalis. Determine serum electrolyte levels, especially K+ and Mg++. Obtain EKG reading and monitor continuously. Approach client in a calm and reassuring manner. Be prepared for emergency procedures such as cardioversion or defibrillation. Temporary Pacemaker: used temporarily in emergency situations. A pacing wire is threaded into the right ventricle via the superior vena cava, or an epicardial wire is put in place (through the client’s chest incision) during cardiac surgery. Permanent Pacemaker: internal pacemaker with pulse generator implanted in the abdomen or shoulder. It may be single or dual chambered. Programmable pacemakers can be reprogrammed by placing a magnetic device over the generator. Teach the client to report pulse rate lower than the set rate of the pacemaker; avoid leaning over an automobile with the engine running; stand 4 to 5 feet away from electromagnetic sources, such as operating microwave ovens and radar detectors; and to avoid MRI testing. Synchronous or demand pacemakers fire only when the client’s heart rate falls below a rate set on the generator. Asynchronous or fixed pacemakers fire at a constant rate. It is important to recognize and treat premature ventricular contractions (PVCs). A PVC is a contraction originating in an ectopic focus in the ventricles. It is a premature occurrence of a QRS complex that is wide and distorted in shape. Nursing Diagnosis • Altered circulation, peripheral related to decreased cardiac output • Anxiety related to lack of knowledge and fear of the unknown Atrial Fibrillation is chaotic activity in the AV node, no true P waves and an irregular ventricular rhythm. Management is with anticoagulant therapy due to the risk of stroke, antidysrhythmic drugs and cardioversion to treat atrial dysrhythmias.
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