WEEK 5 PRT 2- dysarrythmia

Question 1

The primary “pacemaker” of the heart is the

Answer 1

sinoatrial node (sinus node or SA node)

Question 2

PACEMAKER

Answer 2

It generates electrical impulses at a rate of 60-100bpm

When normal function of the electrical conduction through the heart is impaired, arrhythmias occur.

Question 3

Dysrhythmias –

Answer 3

abnormal heart conduction and contraction- too fast, too slow or irregular

Question 4

BRADYCARDIA

Answer 4

Most common reason for PM insertion-also used for anti-tachycardia pacing and overdrive pacing
Heart beat is too slow (lower than 60 bpm)
Due to a block or delay in the electrical conduction of the heart
Clinical findings may include:
Lightheadedness
dizziness
syncope

Question 5

Diagnostic Tests

Answer 5

ECG (EKG)
Holter Monitor
Echocardiogram
Electrophysiology studies
Stress test

Question 6

Medical Treatments for Arrhythmia

Answer 6

Lifestyle changes/modifications (dietary)
Medical devices/implantation (pacemaker/defibrillators)
Catheter ablation therapy (atrial flutter/Atrial Fib)
Medications to control dysrhythmias (tachycardias)
Cardioversion

Question 7

Artificial Pacemakers

Answer 7

Small battery operated device
Monitors and records the heart’s electrical activity and supplies an electrical stimulation if the client’s own sinus node fails.
One or two leads that connect the generator to the heart
Impulses transmitted by leads implanted in the wall of the heart
The generator is implanted beneath the skin in the upper chest and batteries should last 5-15 years (6-7 average)

Question 8

Pacemakers

Answer 8

Two types: “Demand” or “Rate-Responsive” pacing
Pacemakers can be temporary or permanent
Indications:
-primarily bradycardia or heart block
-occassionally over-drive pacing caused by SA node dysfunction (eg: MI, aging, SSS etc)
-Cardiac Resynchronization Therapy (CRT) to treat HF

Question 9

Nursing considerations for clients with permanent pacemakers

Answer 9

Cardiovascular assessment pre- and post-implant
Pacemaker site skin care-avoid infection
Client’s physiological/psychological responses
Health teaching:
drug therapy
pulse checks
pacemaker details-carry PM information card
**Teach clients to report heart rate lower than pacemaker settings

Question 10

Considerations for clients with permanent pacemakers

Answer 10

Wear medic alert
Carry wallet card
Cellular phones at least 6 inches away from the side of the generator
Avoid/limit contact with electrical transmitters and magnets (eg: MRIs, airport security usually okay)
Notify HCPs that you have a PM
Monitor for return of symptoms (chest pain, diaphoresis, dizziness)

Question 11

Atrial Fibrillation

Answer 11

Most common dysrhythmia
Caused by disorganized electrical conduction in addition to an irregular ventricular response.
Rapid irregular pulse rate-atrial rate 350-600 bpm, ventricular response rate 50-190 bpm or higher

Question 12

AF: Causes

Answer 12

Left sided heart failure
Pericarditis
Valvular heart disease
Myocardial ischemia

Question 13

AF Symptoms

Answer 13

Irregular, rapid heart rate
Shortness of breath 
May be hypoxic and report chest pain
Palpitations
Fatigue

Question 14

Key Risk

Answer 14

Loss of atrial contraction-also decreases Cardiac Output (CO)
Leads to decreased emptying of blood from atrial
Pooling of blood
Increased risk of blood clots
Dislodged blood clots may travel to brain
Embolic stroke!

Question 15

Nursing diagnosis

Answer 15

Decreased cardiac output
Ineffective tissue perfusion
Impaired gas exchange
Activity intolerance
Knowledge deficit

Question 16

Planning and implementation

Answer 16

-Maintain normal vital signs
-Improved activity tolerance
-Maintain cognitive status
-Understand condition and treatment
-Understand medication regime and lab tests
-Community care if warranted
Nurses role:
-Assess for complications and response to treatment
-Cardiac monitoring- pulses (radial and apical) as well as pulse deficits

Question 17

Interventions

Answer 17

Assess and intervene for S/S of complications
Evaluate chest pain (if present)
Assess peripheral circulation
Monitor cardiovascular status (including ECG)
Document cardiac arrhythmias
Administer anti-arrhythmics and/or anti-coagulants as ordered
Monitor client response to treatment
Monitor lab and diagnostic results
Health teach client and family

Question 18

Treatment

Answer 18

Anticoagulation 
-Heparin
-Coumadin
-ASA
Anti-dysrhythmia medications
-Amiodarone
-Diltiazem
-Verapamil
Cardioversion
Surgery- ablation
Atrial overdrive pacing