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Chapter 27 Management of Patients With Dysrhythmias and Conduction Problems. 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 - PowerPoint PPT Presentation
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Copyright © 2008 Lippincott Williams & Wilkins.
Chapter 27Management of Patients With
Dysrhythmias and Conduction Problems
Chapter 27Management of Patients With
Dysrhythmias and Conduction Problems
Copyright © 2008 Lippincott Williams & Wilkins.
Dysrhythmias (See Chart 27-1)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
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Relationship of ECG Complex, Lead System, and Electrical ImpulseRelationship of ECG Complex, Lead System, and Electrical Impulse
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ECG Electrode PlacementECG Electrode Placement
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ECG Graph and Commonly Measured ComponentsECG Graph and Commonly Measured Components
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Heart Rate DeterminationHeart Rate Determination
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Normal Sinus Rhythm Normal Sinus Rhythm
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Sinus BradycardiaSinus Bradycardia
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Sinus TachycardiaSinus Tachycardia
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Sinus ArrhythmiaSinus Arrhythmia
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Premature Atrial ComplexesPremature Atrial Complexes
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Atrial FlutterAtrial Flutter
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Atrial FibrillationAtrial Fibrillation
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Multifocal PVCs-QuadrigeminyMultifocal PVCs-Quadrigeminy
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Ventricular TachycardiaVentricular Tachycardia
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Ventricular FibrillationVentricular Fibrillation
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AsystoleAsystole
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First-Degree AV BlockFirst-Degree AV Block
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Second-Degree AV Block, Type 1Second-Degree AV Block, Type 1
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Second-Degree AV Block, Type 2Second-Degree AV Block, Type 2
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Third-Degree AV BlockThird-Degree AV Block
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Nursing Process: The Care of the Patient with a Dysrhythmia: AssessmentNursing 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
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Nursing Process: The Care of the Patient with a Dysrhythmia: DiagnosisNursing Process: The Care of the Patient with a Dysrhythmia: Diagnosis
• Decreased cardiac output
• Anxiety
• Deficient knowledge
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Collaborative Problems/Potential ComplicationsCollaborative Problems/Potential Complications
• Cardiac arrest
• Heart failure
• Thromboembolic event, especially with atrial fibrillation
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Nursing Process: The Care of the Patient with a Dysrhythmia: PlanningNursing 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.
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Decreased Cardiac OutputDecreased Cardiac Output
• Monitoring
– ECG monitoring
– Assessment of signs and symptoms
• Administration of medications and assessment of medication effects
• Adjunct therapy: cardioversion, defibrillation, pacemakers
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Other InterventionsOther 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
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PacemakersPacemakers
• An electronic device that provides electrical stimuli to the heart muscle
• Types:
– Permanent
– Temporary
• NASPE-BPEG code for pacemaker function
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Implanted Transvenous PacemakerImplanted Transvenous Pacemaker
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Transcutaneous PacemakerTranscutaneous Pacemaker
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ECG On-Demand PacingECG On-Demand Pacing
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Complications of Pacemaker UseComplications 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
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Nursing Process: The Care of the Patient with an Implanted Cardiac Device: Assessment
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
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Nursing Process: The Care of the Patient with an Implanted Cardiac Device: Diagnosis
Nursing Process: The Care of the Patient with an Implanted Cardiac Device: Diagnosis• Risk for infection
• Risk for ineffective coping
• Knowledge deficiency
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Nursing Process: The Care of the Patient with an Implanted Cardiac Device- Planning
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.
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InterventionsInterventions
• 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
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Cardioversion and DefibrillationCardioversion 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.
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Safety Measures 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.
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Paddle Placement for DefibrillationPaddle Placement for Defibrillation
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Implantable Cardioverter Defibrillator (ICD)Implantable Cardioverter Defibrillator (ICD)
• A device that detects and terminates life-threatening episodes of tachycardia or fibrillation
• NASPE-BPEG code
• Antitachycardia pacing
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ICDICD
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Invasive Methods to Diagnose and Treat Recurrent DysrhythmiasInvasive Methods to Diagnose and Treat Recurrent Dysrhythmias
• Electrophysiologic studies
• Cardiac conduction surgery
– Maze procedure
– Catheter ablation therapy