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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. Nursing Times Portfolio Pages: Symptomatic Bradycardia 11 1 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. Nursing Times Portfolio Pages: Symptomatic Bradycardia 22 2 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. Nursing Times Portfolio Pages: Symptomatic Bradycardia 3 3 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 Nursing Times Portfolio Pages: Symptomatic Bradycardia 4 4 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. 5 5 SYMPTOMATIC BRADYCARDIA 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 Nursing Times Portfolio Pages: Symptomatic Bradycardia 6 6