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Chapter 37 Interventions for Clients with Dysrhythmias Elsevier items and derived items © 2006 by Elsevier Inc. Review of Cardiac Electrophysiology • Automaticity • Excitability • Conductivity • Contractility • Action potential Elsevier items and derived items © 2006 by Elsevier Inc. Cardiac Conduction System • Sinoatrial node – Electrical impulses at 60 to 100 beats/min • Atrioventricular junctional area • Bundle branch system Elsevier items and derived items © 2006 by Elsevier Inc. Electrocardiography • Electrocardiogram (ECG) • Lead systems • Limb leads • Chest leads • Continuous electrocardiographic monitoring • Telemetry Elsevier items and derived items © 2006 by Elsevier Inc. Electrocardiographic Complexes, Segments, and Intervals • P wave • PR segment • PR interval • QRS complex • QRS duration • ST segment • T wave • U wave • QT interval Elsevier items and derived items © 2006 by Elsevier Inc. Electrocardiographic Rhythm Analysis • Determine the heart rate. • Determine the heart rhythm. • Analyze the P waves. • Measure the PR interval. • Measure the QRS duration. Elsevier items and derived items © 2006 by Elsevier Inc. Normal Rhythms • Normal sinus rhythm • Sinus arrhythmia Elsevier items and derived items © 2006 by Elsevier Inc. Dysrhythmias • Tachydysrhythmias • Bradydysrhythmias • Premature complexes • Repetitive rhythms • Escape complexes and rhythms Elsevier items and derived items © 2006 by Elsevier Inc. Dysrhythmias • Classification • Sinus dysrhythmias • Sinus tachycardia • When the rate of SA node discharge exceeds 100 beats/min • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Sinus Bradycardia • Rate of sinus node discharge < 60 beats/min • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Premature Atrial Complexes • Ectopic focus of atrial tissue fires an impulse before the next sinus impulse is due. • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Supraventricular Tachycardia • Rapid stimulation of atrial tissue occurs at a rate of 100 to 280 beat/min with a mean of 170 beats/min in adults. • Paroxysmal supraventricular tachycardia rhythm is intermittent and terminated suddenly with or without intervention. • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Atrial Flutter • Rapid atrial depolarization occurring at a rate of 250 to 350 times per minute • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Atrial Fibrillation • Multiple, rapid impulses from many atrial foci at a rate of 350 to 600 times per minute • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Premature Ventricular Complexes • A result of increased irritability of ventricular cells: early ventricular complexes followed by a pause • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Ventricular Tachycardia • Also called V tach: repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Ventricular Fibrillation • Also called V fib: a result of electrical chaos in the ventricles • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Ventricular Asystole • Also called ventricular standstill: complete absence of any ventricular rhythm • Clinical manifestations • Interventions Elsevier items and derived items © 2006 by Elsevier Inc. Decreased Cardiac Output and Ineffective Tissue Perfusion • Interventions include: – Cardiac care – Nonsurgical management – Drug therapy • Vaughn-Williams classification • Other antidysrhythmic drugs • Emergency cardiac drugs Elsevier items and derived items © 2006 by Elsevier Inc. Nonsurgical Management • Vagal maneuvers • Carotid sinus massage • Valsalva maneuvers Elsevier items and derived items © 2006 by Elsevier Inc. Temporary Pacing • Modes of pacing – Synchronous pacing – Asynchronous pacing • Noninvasive temporary pacing – Procedure – Complications Elsevier items and derived items © 2006 by Elsevier Inc. Invasive Temporary Pacing • Procedure • Complications • Prevention of microshock Elsevier items and derived items © 2006 by Elsevier Inc. Treatments • Cardiopulmonary resuscitation • Advanced cardiac life support • Cardioversion: synchronized countershock that may be used for emergent hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias resistant to medical therapies Elsevier items and derived items © 2006 by Elsevier Inc. Defibrillation • Asynchronous countershock depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit and allow the sinus node to regain control of the heart. • Maintain a patent airway. • Administer oxygen. (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. Defibrillation (Continued) • Assess vital signs and level of consciousness. • Administer antidysrhythmic drugs. • Monitor for dysrhythmias . • Assess for burns, emotional support, documentation. Elsevier items and derived items © 2006 by Elsevier Inc. Other Therapies • Automatic external defibrillation • Radiofrequency catheter ablation • Surgical procedures: – Permanent pacemaker – Coronary artery bypass grafting – Aneurysmectomy – Insertion of implantable cardioverter/defribillator – Open-chest cardiac massage Elsevier items and derived items © 2006 by Elsevier Inc.