Chapt27

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Chapt27

  1. 1. Chapter 27 Management of Patients With Dysrhythmias and Conduction Problems
  2. 2. Dysrhythmias <ul><li>Disorders of the formation and/or conduction of electrical impulses in the heart </li></ul><ul><li>Cause disturbances of heart rate and/or heart rhythm </li></ul><ul><li>May be evidenced by changes in hemodynamics </li></ul><ul><li>Diagnosed by analyzing electrocardiogram </li></ul>
  3. 3. DEPOLARIZATION <ul><li>Depolarization is a rapid change in the permeability of the cell membrane. When sensory input or any other kind of stimulating current is received by the neuron, the membrane permeability is changed, allowing a sudden influx of sodium ions into the cell. The high concentration of sodium, or action potential, changes the overall charge within the cell from negative to positive. The local change in ion concentration triggers similar reactions along the membrane, propagating the nerve impulse. </li></ul>
  4. 4. <ul><li>polarization of muscle fiber: the restoration of the normal electrical polarity of a nerve or muscle cell membrane following reversal of its polarity depolarization during passage of a nerve impulse or muscle. </li></ul>REPOLARIZATION
  5. 5. ECG Interpretation <ul><li>P wave represents atrial depolarization </li></ul><ul><li>QRS complex represents ventricular depolarization </li></ul><ul><li>T wave represents ventricular repolarization </li></ul><ul><li>U wave may represent repolarization of Purkinje fibers. May also be seen in hypokalemia, hypertension, or heart disease </li></ul>
  6. 7. <ul><li>PR interval normal range is 0.12-0.20 seconds </li></ul><ul><li>ST segment is identified as isoelectric, or above or below isoelectric line </li></ul><ul><li>QT interval normal range is 0.32-0.40 seconds </li></ul><ul><li>TP interval is isoelectric period </li></ul><ul><li>PP interval signifies atrial rhythm and rate </li></ul><ul><li>RR interval signifies ventricular rate and rhythm </li></ul>
  7. 9. <ul><li>Depolarization is a rapid change in the permeability of the cell membrane. When sensory input or any other kind of stimulating current is received by the neuron, the membrane permeability is changed, allowing a sudden influx of sodium ions into the cell. The high concentration of sodium, or action potential, changes the overall charge within the cell from negative to positive. The local change in ion concentration triggers similar reactions along the membrane, propagating the nerve impulse. </li></ul>
  8. 10. Analyzing the ECG Rhythm Strip <ul><li>Determine ventricular rate </li></ul><ul><li>Determine ventricular rhythm </li></ul><ul><li>Determine QRS duration </li></ul><ul><li>Determine whether QRS duration is consistent </li></ul><ul><li>Identify QRS shape </li></ul>
  9. 11. Analyzing the ECG Rhythm Strip (cont’d) <ul><li>Identify P waves, is there a P in front of every QRS? </li></ul><ul><li>Identify P wave shape </li></ul><ul><li>Determine atrial rate </li></ul><ul><li>Determine atrial rhythm </li></ul>
  10. 12. Analyzing the ECG Rhythm Strip (cont’d) <ul><li>10. Determine PR interval </li></ul><ul><li>11. Determine if PR intervals are consistent, irregular but with a pattern, or just irregular </li></ul><ul><li>12. Determine how many P waves for each QRS (P:QRS ratio) </li></ul>
  11. 14. Sinus Node Dysrhythmias <ul><li>Sinus Bradycardia </li></ul><ul><li>Sinus Tachycardia </li></ul><ul><li>Sinus Arrhythmia </li></ul>
  12. 16. Atrial Dysrhythmias <ul><li>Premature Atrial Complex </li></ul><ul><li>Atrial Flutter </li></ul><ul><li>Atrial Fibrillation </li></ul>
  13. 18. Junctional Dysrhythmias <ul><li>Premature Junctional Complex </li></ul><ul><li>Junctional Rhythm </li></ul><ul><li>Atrioventricular Nodal Reentry Tachycardia </li></ul><ul><ul><li>Supraventricular tachycardia </li></ul></ul>
  14. 19. Ventricular Dysrhythmias <ul><li>Premature Ventricular Complex </li></ul><ul><li>Ventricular Tachycardia </li></ul><ul><li>Ventricular Fibrillation </li></ul><ul><li>Idioventricular Rhythm </li></ul><ul><li>Ventricular Asystole </li></ul>
  15. 22. Conduction Abnormalities <ul><li>First-Degree Atrioventricular Block </li></ul><ul><li>Second-Degree Atrioventricular Block, Type I </li></ul><ul><li>Second-Degree Atrioventricular Block, Type II </li></ul><ul><li>Third-Degree Atrioventricular Block </li></ul>
  16. 23. Nursing Interventions <ul><li>Monitoring and managing the dysrhythmia </li></ul><ul><li>Minimizing anxiety </li></ul><ul><li>Teaching self-care </li></ul>
  17. 24. Specific Nursing Managements <ul><li>Provide continuous ECG monitoring. </li></ul><ul><li>Maintain heart rate alarms at appropriate limits. </li></ul><ul><li>Administer anti-arrhythmic medications as ordered. </li></ul><ul><li>Administer defibrillation or CPR as appropriate for life threatening arrhythmias. </li></ul><ul><li>Monitor electrolyte levels and replace as necessary. </li></ul>
  18. 25. <ul><li>Maintain at least one patent IV site. </li></ul><ul><li>Monitor serum levels of anti arrhythmic medications. </li></ul><ul><li>Provide information to the patient regarding disease process, procedures and medications. </li></ul><ul><li>Teach patient regarding symptoms of arrhythmias. </li></ul><ul><li>Teach patient how to take own pulse </li></ul><ul><li>Teach patient to avoid proarrhythmic substances. </li></ul>
  19. 26. Pacemaker Therapy <ul><li>Provides electrical stimuli to heart muscle </li></ul><ul><li>Used for slower-than-normal impulse formation, to control some tachycardias, or for advanced heart failure </li></ul><ul><li>May be permanent or temporary </li></ul>
  20. 27. Pacemaker Therapy (cont’d) <ul><li>NASPE-BPEG code </li></ul><ul><ul><li>First letter identifies chambers being paced </li></ul></ul><ul><ul><li>Second letter describes the chambers being sensed </li></ul></ul><ul><ul><li>Third letter describes type of response by pacemaker to what is sensed </li></ul></ul>
  21. 29. Cardioversion and Defibrillation <ul><li>Delivery of electrical current to depolarize a critical mass of myocardial cells </li></ul><ul><li>When cells repolarize the SA node, is usually able to recapture its role as pacemaker of heart </li></ul><ul><li>Cardioversion involves use of “timed” electrical current to terminate a tachydysrhythmia </li></ul>
  22. 30. Cardioversion and Defibrillation (cont’d) <ul><li>Defibrillation is used in emergency situations as treatment for ventricular fibrillation and pulseless VT </li></ul>

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