Chapter 27: Dysrhythmia

Question 1

Amiodarone hydrochloride (Why)

Answer 1

used for various types of life-threatening tachydysrhythmias, both ventricular and atrial dysrhythmias.

The oral form is given to treat recurrent ventricular tachycardia or ventricular fibrillation and to maintain an NSR after conversion of atrial fibrillation and atrial flutter.

The IV form is given mainly for acute suppression of refractory, hemodynamically destabilizing ventricular tachycardia and ventricular fibrillation

Question 2

Amiodarone hydrochloride (What)

Answer 2

vasodilating effects and decreases systemic vascular resistance, it prolongs conduction in all cardiac tissues and decreases heart rate, and it decreases contractility of the left ventricle.

The major effect is slowing conduction through the AV node and prolonging the effective refractory period

Question 3

Amiodarone hydrochloride (Important Assessments)

Answer 3

If the nurse notes any change in heart rate greater than 100 beats/minute or less than 60 beats/minute or any change in the regularity of the rhythm, increased vigilance in assessing cardiac status is warranted

Question 4

Supraventricular tachycardia meds (Quinidine) : What

Answer 4

reduces automaticity and slows conduction throughout the cardiac system through direct and indirect anticholinergic effects on cardiac tissue, reducing myocardial contractility.

In addition, it prolongs the refractory period of the myocardial cells

Question 5

Propranolol / Esmolol

Answer 5

competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus

causes a decrease in the influence of the sympathetic nervous system on these tissues and a decrease
in the excitability of the heart, cardiac workload, and oxygen consumption

Question 6

Diltiazem

Answer 6

Calcium channel blockers obstruct the movement of calcium into conductive and contractile myocardial cells by inhibiting the influx of calcium through its channels, causing slower conduction through the SA and AV nodes

Question 7

Adenosine

Answer 7

depresses conduction at the AV node and is used to restore NSR in patients with paroxysmal supraventricular tachycardia; (it is ineffective in other dysrhythmias)

Question 8

Verapamil (uses)

Answer 8

effective only in supraventricular tachycardias

Routes: PO, IV push, IV infusion

Question 9

Verapamil (contraindications)

Answer 9

in digoxin toxicity because it may worsen heart block.

Use of IV verapamil with IV propranolol should not take place; it may result in potentially fatal bradycardia and hypotension

Question 10

Verapamil (Assessment)

Answer 10

monitor the cardiac rate and rhythm for a return to the patient’s normal baseline.

Monitor carefully for changes in blood pressure and cardiac rhythm as well as output.

Assess for dizziness and light-headedness

Question 11

Adenosine administration (which and why)

Answer 11

For an optimal effect, adenosine will be administered as a rapid bolus injection, preferably through a central venous line

The drug has a very short duration of action (serum half-life of less than 10 seconds) and a high degree of effectiveness

Question 12

Lidocaine in ventricular tachycardia

Answer 12

AHA guidelines do not recommend the routine use of lidocaine after the return of spontaneous circulation

experts believe that it may be reasonable to continue lidocaine infusion in the immediate period after ventricular fibrillation