CH 36 Care of patients with Dysrrhythmias

In teaching clients at risk for bradydysrhythmias, what information does the nurse include?

"Use a stool softener." Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps to prevent this.

The nurse is determining whether the client's rhythm strip demonstrates proper firing of the sinoatrial (SA) node. Which waveform indicates proper function of the SA node?

A P wave precedes every QRS complex A P wave is generated by the SA node and represents atrial depolarization.

The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug?

Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore monitoring of heart rate and rhythm is needed. Electrolyte depletion, specifically potassium and magnesium, may predispose to further dysrhythmia.

A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan?

Anticoagulation Because of the risk for thromboembolism, anticoagulation is necessary.

The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate?

Bearing down for a bowel movement Possible inferior wall myocardial infarction (MI) Diltiazem (Cardizem) administered an hour ago The Valsalva maneuver stimulates the vagus nerve, causing bradycardia. Inferior wall MI is a cause of bradycardia and heart blocks. Calcium channel blockers such as diltiazem may cause bradycardia.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first?

Check the client for a pulse The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first?

Check the client for a pulse. The nurse needs to assess the pulse and client stability before proceeding with further interventions; pulseless ventricular tachycardia is treated with defibrillation.

The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0.24 second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record. What action should the nurse take?

Continue to monitor The client is displaying sinus rhythm with first-degree atrioventicular heart block; this is usually asymptomatic and does not require treatment.

A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next?

Defibrillate at 200 J. Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols.

The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the new graduate when the graduate offers to perform which intervention?

Defibrillation Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over: in asystole, there is no rhythm to interrupt; therefore this intervention is not used.

The nurse teaches a client with new-onset atrial fibrillation that risk factors for this dysrhythmia may include which?

Excessive alcohol use Advancing age High blood pressure Excessive alcohol use may cause atrial fibrillation. Atrial fibrillation occurs more frequently in older people. Hypertension is a risk factor in the development of atrial fibrillation.

The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication?

Heart Rate The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand.

The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer?

Heparin Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).

The nurse receives in report that the client with a pacemaker has experienced loss of capture. Which situation is consistent with this?

Pacemaker spikes are noted, but no P wave or QRS complex follows. Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode.

The nurse is caring for a client with heart rate of 143. For which manifestations should the nurse observe?

Palpitations Chest discomfort Hypotension Tachycardia, heart rate greater than100 beats/min, produces palpitations, that is, the ability to feel the heart beating in the chest. Chest discomfort may occur because decreased time for diastole results in lower perfusion through the coronary arteries to the myocardium. Hypotension results from decreased time for ventricular filling, secondary to shortened diastole and therefore reduced cardiac output and blood pressure.

What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin?

Report nosebleeds to your provider immediately

The nurse recognizes that which intervention provides safety during cardioversion?

Setting the defibrillator to the synchronized mode Setting the defibrillator to the synchronized mode ensures discharging the shock during the vulnerable period on the T wave, which may cause ventricular fibrillation.

The client's rhythm strip shows a heart rate of 76 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.24 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip?

Sinus rhythm with first-degree atrioventricular (AV) block These are the characteristics of sinus rhythm with first-degree AV block.

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student?

The client is instructed to breathe deeply through the mouth. Normal breathing is required or artifact will be observed, perhaps leading to inaccurate interpretation of the ECG.

Which information would cause the nurse to withhold digoxin in the client with atrial fibrillation and heart failure?

The digoxin level is 2.8 mg/dL The therapeutic range for digoxin is 0.8 to 2.0 ng/mL; hold the medication because this client has digoxin toxicity.

How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia?

The monitor shows sinus rhythm. Sinus rhythm presents with heart rates from 60 to 100 beats/min; by definition, the bradydysrhythmia has resolved.