Download Bradycardia: Portfolio Pages

SYMPTOMATIC BRADYCARDIA
The Activities on these Portfolio Pages correspond with the learning objectives
of the Guided Learning unit published in Nursing Times 104: 38 (23 September
2008) and 104; 39 (30 September 2008). The full reference list for this unit
follows Activity 4.
Before starting to work through these Activities, save this document onto your
computer, then print the completed work for your professional portfolio.
Alternatively, simply print the pages if you prefer to work on paper, using extra
sheets as necessary.
Recording your continuing professional education
To make your work count as part of your five days’ CPD for each registration
period, make a note in the box below of the date and the total number of hours
you spent on reading the unit and any other relevant material, and working
through the Activities.
Hours:
Date:
ACTIVITY 1
Learning objective: Be able to discuss
the conduction system of the heart.
Activity: Put together a factsheet or
PowerPoint presentation for nursing
students in your clinical area on the
conduction of the heart and intrinsic heart
rates
RESPONSE
Begin your response here.
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SYMPTOMATIC BRADYCARDIA
ACTIVITY 2
Fig 2.
Learning objective: Know how to
differentiate between various types of
heart block.
Fig 3.
Activity: Using the stepwise approach,
identify the following three rhythm strips
(see Figs 1, 2 and 3). For future practice
it may be beneficial for practitioners to
collect a portfolio of rhythm strips for
reference and education purposes.
RESPONSE
Fig 1.
Begin your response here.
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SYMPTOMATIC BRADYCARDIA
ACTIVITY 3
Learning objective: Be able to discuss
the pharmacological management
options for treating bradycardia
Activity: Ben Jones* is found to be in
second degree heart block, type II. On
assessment the findings are as follows:
Airway – Patent with no added sounds;
Breathing – RR 25, SpO2 89% on 40%
oxygen therapy, bilateral coarse crackles;
Circulation – BP 110/70, P35, capillary
refill time 2-3 seconds, apyrexial;
Disability – alert, GCS 14/15 (slight
confusion which is new), blood Glucose
6.0;
Exposure – No oedema, skin
cool/clammy, no pain, no previous
surgery, no IV cannula or drips in place.
What adverse signs are present and what
action should be taken?
RESPONSE
Begin your response here.
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SYMPTOMATIC BRADYCARDIA
ACTIVITY 4
Learning objective: Know the
indications for transcutaneous pacing and
how to initiate it.
Activity: a) Mr Jones has symptomatic
bradycardia/heart block. What are the
pharmacological options to treat this?
requires transcutaneous pacing. You
have a junior nurse assisting you; make
notes on how you would start
transcutaneous pacing for Mr Jones.
* The patient’s name has been changed.
RESPONSE
Begin your response here.
b) Despite maximum pharmacological
intervention Mr Jones is deteriorating and
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SYMPTOMATIC BRADYCARDIA
FULL REFERENCE LIST
Author, Altamura, G., Toscano, S. (2007)
Emergency cardiac pacing for severe
bradycardia. Pacing and Clinical
Electrophysiology; 13: 12, 2038-2043.
British Medical Association and Royal
Pharmaceutical Society of Great Britain
(2007) British National Formulary. London:
BMJ Group/RPS Publishing.
Hayes, D.D. (2004) Bradycardia: Slow
heart rate? Think fast. Nursing.
http://findarticles.com/p/articles/mi_qa3689/
is_200401/ai_n9345915
Rang, H.P., Dale, M.M. (2007)
Pharmacology. Edinburgh: Churchill
Livingstone.
Resuscitation Council UK (2006, revised
2008) Advanced Life Support. London:
RCUK.
Schulz-Stübner, S. (2005) The use of
small-dose theopyhylline for the
management of bradycardia in patients with
spinal cord injury. Anaesthesia and
Analgesia; 101: 1808-1811.
Sinnatamby, C.S. (2006) Last’s Anatomy.
Edinburgh: Churchill Livingstone.
Jevon, P. (2007) Cardiac monitoring part 3:
external pacing. Nursing Times; 103: 3, 2627.
Smith, G. (2003) ALERT. Acute Life
Threatening Events Recognition and
Treatment. Learning Media Development
University of Portsmouth.
Love, J.N. et al (1998) A potential role for
glucagon in the treatment of drug induced
symptomatic bradycardia. Chest; 114: 1,
323-326.
Watson, D. (2006) The impact of accurate
assessment on patient care. Nursing
Times; 102: 6, 34-37.
Mangrum, J.M. (2000) The evaluation and
management of bradycardia. New England
Journal of Medicine; 342: 10, 703-709.
Nursing Times Portfolio Pages: Symptomatic Bradycardia
Woodrow, P. (2003) Intensive Care
Nursing: A Framework for Practice.
London: Routledge.
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ADDITIONAL MATERIAL???
Table 1. ABCDE assessment
ABCDE
Airway
Breathing
Circulation
Disability
Exposure
Looking for:
 Trachea central
 Airway obstruction
 Added sounds
 Ability to speak
 Respiratory rate
 SpO2
 Cyanosis
 Auscultation
 Percussion
 Palpation
 Accessory muscles
 Posture
 Peak flow
 Blood pressure
 Urine output
 Pulse (rate/rhythm/quality)
 ECG
 Capillary refill time
 Neck veins
 Temperature
 GCS
 AVPU
 Blood glucose
 Pupil response
 Limb movements
 Full look at patient
 Old scars
 Rash
 Bruising
 Swelling
 General appearance
 Drains/drips/monitoring etc
Author, References here
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