Dysrhythmias

Question 1

nursing priorities if too fast

Answer 1

• VT, ST, SVT, AFIB, AFLUTTER
• want to s l o w it down
• vagal maneuvers (only if pt. is awake, talking, and stable)
• antidysrhythmic drugs (amiodarone, adenosine, beta blockers)
• shock
  
  • synchronized cardioversion (VT w/ a pulse, SVT, AFIB, AFLUTTER)
  • defibrillate (VFIB, VT w/o a pulse)

Question 2

nursing priorities if too slow

Answer 2

• SB, symptomatic AVBs, junctional
• want to SPEED it up
• atropine
• pacing

Question 3

nursing priorities for all dysrhythmias

Answer 3

• always assess first
• cardiac output
  
  • are the atria and ventricles filling appropriately
  • is the rate: fast enough? too fast?
• signs of low CO
  
  • fatigue, confusion, agitation/change in LOC, SOB,
    crackles, high CVP, oliguria, decreased peripheral
    pulses, mottling, cool extremities
• diagnosing
  
  • what is the rhythm? why did it happen?
  • 12 lead EKG
  • Labs (especially K and Mg)
  • health hx (MI, CHF, toxicity)
  • oxygenation
  • drugs
  • is it new? has it happened before?

Question 4

nursing priorities for unstable patients with NO pulse

Answer 4

• ALWAYS CPR AND EPI
• VFIB and VTACH w/o a pulse = DEFIB, can give amiodarone
• asystole and PEA = can’t defib, just give EPI
• DEFIB = DEAD
  
  • Delivers a large impulse whenever the shock
    button is pushed- only for patients w/o a pulse and
    with disorganized electricity (only VF and pulseless
    VT)

Question 5

nursing priorities for unstable patients WITH a pulse

Answer 5

FAST:
- VTACH with a pulse, AFIB, AFLUTTER, SVT
- vagal maneuvers (NO IF PT IS HYPOTENSIVE)
- adenosine, amiodarone
- synchronized cardioversion

SLOW:
- symptomatic bradycardias
- atropine
- pacing
- pediatrics: HR<60 –> CPR

ACT IMMEDIATELY WITHIN YOUR SCOPE OF PRACTICE THEN CALL THE PHYSICIAN

Synchronized cardioversionis a LOW ENERGY SHOCK that uses a sensor to deliver electricity that is synchronizedwith the peak of the QRS complex (the highest point of the R-wave). When the “sync” option is engaged on a defibrillator and the shock button pushed, there will be a delay in the shock.
Synchronization avoids the delivery of a LOW ENERGY shock during cardiac repolarization (t-wave). If the shock occurs on the t-wave (during repolarization), there is a high likelihood that the shock can precipitate VF (Ventricular Fibrillation).
Cardiovert at 50 biphasic and 200 monophasic. Defib – biphasic: 120-200, monophasic 360

Epi 1 mg Q3-5 mindiluted in 10 mL of NS given as IV bolus over 5-20 minutes
Magnesium 1-2 g IV/IO for torsades
Aminodarone for VT/VF: 300 mg bolus then 150 mg sec dose
Adenosine 6 mg rapid IVP followed by 20 ml flush and elevate the arm – if not convert in 1-2 minutes then second dose of 12 mg
Adenosine increases AV block and will terminate 90% of reentry arrhythmias in 2 minutes.
Can cause bronchiospasm in asthma and COPD patients