Dysrhythmias - Nursing Lecture

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Dysrhythmias - Nursing Lecture - Presentation Transcript

  1. http://nursinglectures.blogspot.com
    • Disorders of the formation or conduction
    • (or both) of the electrical impulse within the heart
    • Cause disturbance in heart rate, heart rhythm, or both
    • Diagnosed by analyzing the electrocardiographic waveform
    • named according to the site of origin of the impulse and the mechanism of formation or conduction involved
    • Sites of Origin:
    • Sinus (SA) node
    • Atria
    • Atrioventricular (AV) node or junction
    • Ventricles
    • Normal Sinus Rhythm
    • Bradycardia
    • Tachycardia
    • Dysrhythmia
    • Flutter
    • Fibrillation
    • Premature complexes
    • Blocks
    • Occurs when the electrical impulse starts at a regular rate and rhythm in the sinus node and travels through the normal conduction pathway
    • Ventricular and atrial rate : 60-100 in adults
    • Ventricular and atrial rhythm : regular
    • QRS shape and duration : usually normal, but may be regularly abnormal
    • P wave : Normal and consistent shape; always in front of the QRS
    • PR interval : Consistent interval between 0.12 and 0.20 seconds
    • P: QRS ratio : 1:1
  2.  
      • Impulse is created by the sinus node
      • P to QRS ratio is 1:1
      • Treatment is directed at the cause and done symptomatically
      • TYPES:
      • Sinus Bradycardia
      • Sinus Tachycardia
      • Sinus Arrhythmia
      • Occurs when the sinus node creates an impulse at a slower than normal rate
      • Ventricular and atrial rates below 60
      • Causes:
        • lower metabolic needs (sleep, athletic training hypothermia, hypothyroidism)
        • Vagal stimulation (vomiting, suctioning, severe pain, extreme emotions)
        • CAUSES:
        • Medications (calcium channel blockers, amiodarone, beta blockers)
        • Increased intracranial pressure
        • Myocardial infarction
        • TREATMENT for Symptomatic clients
          • Atropin Sulfate
          • O2 Administration
          • Insertion of pacemaker
  3.  
    • Ventricular and atrial rates above 100
    • Causes:
        • acute blood loss
        • anemia
        • shock
        • hyperbulimia
        • congestive heart failure
        • pain
        • hypermetabolic states
        • fever, exercise, anxiety
        • sympathomimetic medications
      • Beta-blockers and Calcium channel blockers may be given
  4.  
    • irregular rhythm
    • Rate increased with inspiration and decreases with expiration
    • No hemodynamic changes, treatment is not necessary
  5.  
    • TYPES:
    • Premature Atrial Complex
    • Atrial Flutter
    • Atrial Fibrillation
  6.  
    • Single ECG complex that starts in the atrium before the next normal impulse from the sinus node
    • P : QRS ration is 1:1
    • Causes:
        • caffeine, alcohol, nicotine
        • stretched atrial myocardial (as in hypervolemia)
        • hypermetabolic states
        • Atrial ischemias, injury or infarction
    • < 6/mm: no treatment
    • > 6/mm: Signal of worsening condition, treatment directed at the cause
  7.  
    • atrial rate between 250 to 400
          • P : QRS ratio is 2-4 : 1
          • Associated with:
        • valvular heart disease
        • coronary artery disease
        • hypertension
        • cardiomyopathy
        • hyperthyroidism
        • Pulmonary disease
        • Acute moderate to heavy ingestion of alcohol
        • Aftermath of open heart surgery
        • S/Sx: chest pain, SOB, low BP
        • Treatment: Diltiazem, Beta-blockers, Digitalis > to slow the conduction to the AV node
        • CARDIOVERSION
        • elective procedure; activation of synchronous electric impulse/ current
            • countershock
            • a method of restoring the normal rhythm of the heart of patients with increased heart rate due to arrhythmia
            • a controlled direct-current shock, synchronized with the R wave of the ECG
  8.  
    • atrial rate 350-600
    • Disorganized impulses from the atria
    • Atria may quiver resulting in thrombi formation and emboli formation
    • P wave is absent
    • S/Sx: palpitation, fatigue, malaise, pulse deficit
    • Treatment: Quinidine, amiodarone, Digoxin, Verapanil > to achieve conversion to sinus rhythm
    • TYPES:
    • 1. Premature Ventricular Contractions
    • 2. Ventricular Tachycardia
    • 3. Ventricular Fibrillation
    • 4. Idioventricular Rhythm
    • 5. Ventricular Asystole
  9.  
      • Impulse starts at the ventricle and conducted before the next normal sinus impulse
      • Cause:
            • in healthy people, use of caffeine, nicotine, or smoke
            • cardiac ischemia or infarction
            • increased workload on the heart
            • Digitalis toxicity
            • Hypoxia, acidosis
            • Electrolyte imbalance
    • In the absence of disease, PVCs are not serious
    • In the client with MI PVCs may indicate more aggressive therapy
    • Client may report that the heart “skip a beat”
    • Treatment: Lidocaine
  10.  
    • 3 or more PVCs in a row exceeding 100/mm
    • Causes: similar to PVCs
    • Stable client with sustained VT – O2 and antidysrhthmic drugs
    • Unstable client: O2 and antidysrhymic drugs, cardioversion, cough and CPR
    • Pulse less VT: defibrillation and CPR
  11.  
    • rapid but disorganized ventricular rhythm
    • No atrial activity
    • Absence of audible heartbeat, palpable pulse and respiration
    • Causes: electrical shock, Brugada syndrome
    • Treatment: Defibrillation
    • Rapidly fatal if not terminated within 3-5 minutes
    • Occurs when the impulse starts in the conduction system below the AV node
    • Commonly causes the patient to lose consciousness and other signs and symptoms of reduced cardiac output
    • Treatment: IV Atropine as ordered
    • bed rest
  12.  
    • Commonly called flat line without treatment, VA is fatal
    • Treatment: CPR
    • Causes:
            • medications
            • myocardial ischemia or infarction
            • valvular disorders
            • myocarditis
    • TYPES OF HEART BLOCKS
    • First Degree AV Block
    • Second Degree AV Block
    • c. Third Degree AV Block/ Complete Heart Block
            • Rarely cause hemodynamic change
            • Conduction of impulse in the SA node is delayed
            • PR interval is more than 0.02 seconds
    • - Type 1 : atrial impulse takes longer time for conduction than the one before it, until one impulse is fully blocked
    • - Type 2 : only some of the atrial impulse is conducted
  13.  
  14.  
    • No atrial impulse is conducted to the ventricles
    • Two impulses stimulate the heart
  15.  
    • S/Sx: SOB, chest pain, lightheadedness
    • Treatment directed at increasing the HR to maintain normal cardiac output
    • No treatment indicated for stable, asymptomatic patient
    • Treatment options: Atropine SO4, pacemaker
    • a. VAGAL MANEUVERS
    • Vagal stimulation to terminate supraventricular tachydysrhythmias
            • Carotid Sinus Massage
            • Valsalva Maneuver
    • CARDIOVERSION
    • Synchronized countershock to convert an undesirable rhythm to stable rhythm
    • c. DEFIBRILLATION
    • Asynchronous countershocks used to terminate pulseless VT or VF
    • 3 rapid consecutive shocks: 200 joules, 300 joules and 360 joules
    • d. AUTOMATIC EXTERNAL DEFIBRILLATOR (AED)
    • e. IMPLANTED CARDIOVERTER DEFIBRILLATOR
    • ANTIANTIRRHYTHMIC
    • Class I : Na + channel blocker
        • Quinidine, Procanamide, Disopyridamole
        • Lidocaine
        • Flocainaide, Propafenone
        • Class II : Beta-blockers- propanolol, metoprolol, aenolol, esmolol
        • Class III : K+ channel blockers- Amiodarone
        • Class IV : Calcium channel blockers: Verapamil, Diltiazem
    • G. PACEMAKERS
    • Implanted on the anterior chest and connected to the heart
    • devices that provide electrical stimulation to the heart to maintain the heart rate when the client’s pacemaker fails
    • Settings:
        • Synchronous or demand pacemaker
        • Asynchronous or fixed rate (preset)
        • Overdrive pacing (to increase cardiac output)
          • Types:
            • Temporary Pacemakers
            • Permanent Pacemakers
    Management of Dysrhythmias
    • 1. MONITORING AND MANAGING THE DYSRHYTHMIA
      • To determine hemodynamic effect
    • Evaluate:
            • pulse rate and rhythm
            • respiratory rate and depth
            • breath sounds
    • Ask for episodes of lightheadedness, dizziness, or faintness
    • Obtain 12L ECG
    • Administer antidysrhythmic drugs as prescribed
    • Assess contributing factors to dysrhythmia
    • Administer O2 inhalation as prescribed
    • 2. MINIMIZE ANXIETY
    • Maintain a calm and reassuring attitude to foster trusting relationship
    • Promote self confidence in living with dysrhythmia
    • 3. PROMOTING HOME AND COMMUNITY BASED CARE
    • Teach patient self care
    • FREE NURSING LECTURES
    • Medical Surgical
    • Obstetric Nursing
    • Psychiatric Nursing
    • Operating Room Nursing
    • And many more…
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