NURSING PROCESS: THE PATIENT WITH A DYSRHYTHMIA
Major
areas of assessment include possible causes of the dys-rhythmia and the
dysrhythmia’s effect on the heart’s ability to pump an adequate blood volume.
When cardiac output is re-duced, the amount of oxygen reaching the tissues and
vital organs is diminished. This diminished oxygenation produces the signs and
symptoms associated with dysrhythmias. If these signs and symptoms are severe
or if they occur frequently, the patient may experience significant distress
and disruption of daily life.
A
health history is obtained to identify any previous occur-rences of decreased
cardiac output, such as syncope (fainting), lightheadedness, dizziness,
fatigue, chest discomfort, and palpi-tations. Coexisting conditions that could
be a possible cause of the dysrhythmia (eg, heart disease, chronic obstructive
pulmo-nary disease) may also be identified. All medications, prescribed and
over-the-counter (including herbs and nutritional supple-ments), are reviewed.
Some medications (eg, digoxin) can cause dysrhythmias. A thorough psychosocial
assessment is performed to identify the possible effects of the dysrhythmia and
to deter-mine whether anxiety is a significant contributing factor.
The
nurse conducts a physical assessment to confirm the data obtained from the
history and to observe for signs of diminished cardiac output during the
dysrhythmic event, especially changes in level of consciousness. The nurse
directs attention to the skin, which may be pale and cool. Signs of fluid
retention, such as neck vein distention and crackles and wheezes auscultated in
the lungs, may be detected. The rate and rhythm of apical and peripheral pulses
are also assessed, and any pulse deficit is noted. The nurse auscultates for
extra heart sounds (especially S3 and S4)
and for heart murmurs, measures blood pressure, and determines pulse pressures.
A declining pulse pressure indicates reduced cardiac output. Just one
assessment may not disclose significant changes in cardiac output; therefore,
the nurse compares multiple assess-ment findings over time, especially those
that occur with and without the dysrhythmia.
Based on assessment data, major nursing diagnoses of the patient may include:
·
Decreased cardiac output
·
Anxiety related to fear of the
unknown
·
Deficient knowledge about the
dysrhythmia and its treat-ment
In
addition to cardiac arrest, a potential complication that may develop over time
is heart failure. Another potential complica-tion, especially with atrial
fibrillation, is a thromboembolic event. If the dysrhythmia necessitates
treatment with medication, the beneficial and detrimental effects must be
assessed.
The
major goals for the patient may include eradicating or de-creasing the
incidence of the dysrhythmia (by decreasing contrib-utory factors) to maintain
cardiac output, minimizing anxiety, and acquiring knowledge about the
dysrhythmia and its treatment.
The
nurse regularly evaluates blood pressure, pulse rate and rhythm, rate and depth
of respirations, and breath sounds to de-termine the dysrhythmia’s hemodynamic
effect. The nurse also asks patients about episodes of lightheadedness,
dizziness, or faint-ing as part of the ongoing assessment. If a patient with a
dys-rhythmia is hospitalized, the nurse may obtain a 12-lead ECG, continuously
monitor the patient, and analyze rhythm strips to track the dysrhythmia.
Control
of the incidence or the effect of the dysrhythmia, or both, is often achieved
by the use of antiarrhythmic medications. The nurse assesses and observes for
the beneficial and adverse ef-fects of each of the medications. The nurse also
manages med-ication administration carefully so that a constant serum blood
level of the medication is maintained at all times.
In
addition to medication, the nurse assesses for factors that contribute to the
dysrhythmia (eg, caffeine, stress, nonadherence to the medication regimen) and
assists the patient in developing a plan to make lifestyle changes that
eliminate or reduce these factors.
When
the patient experiences episodes of dysrhythmia, the nurse maintains a calm and
reassuring attitude. This demeanor fosters a trusting relationship with the
patient and assists in reducing anxiety (reducing the sympathetic response).
Successes are em-phasized with the patient to promote a sense of confidence in
liv-ing with a dysrhythmia. For example, if a patient is experiencing episodes
of dysrhythmia and a medication is administered that begins to reduce the
incidence of the dysrhythmia, the nurse com-municates that information to the
patient. The nursing goal is to maximize the patient’s control and to make the
unknown less threatening.
When
teaching patients about dysrhythmias, the nurse presents the information in
terms that are understandable and in a man-ner that is not frightening or
threatening. The nurse explains the importance of maintaining therapeutic serum
levels of antiarrhythmic medications so that the patient understands why
medications should be taken regularly each day. In addition, the relationship
between a dysrhythmia and cardiac output is explained so that the patient
understands the rationale for the medical reg-imen. If the patient has a
potentially lethal dysrhythmia, it is also important to establish with the
patient and family a plan of ac-tion to take in case of an emergency. This
allows the patient and family to feel in control and prepared for possible
events.
A
referral for home care usually is not necessary for the patient with a
dysrhythmia unless the patient is hemodynamically un-stable and has significant
symptoms of decreased cardiac output. Home care is also warranted if the
patient has significant comor-bidities, socioeconomic issues, or limited
self-management skills that could potentiate the risk for nonadherence to the
therapeu-tic regimen.
Expected
patient outcomes may include:
1)
Maintains cardiac output
a)
Demonstrates heart rate, blood
pressure, respiratory rate, and level of consciousness within normal ranges
b)
Demonstrates no or decreased
episodes of dysrhythmia
2)
Experiences reduced anxiety
a)
Expresses a positive attitude about
living with the dys-rhythmia
b)
Expresses confidence in ability to
take appropriate actions in an emergency
3)
Expresses understanding of the
dysrhythmia and its treat-ment
a)
Explains the dysrhythmia and its
effects
b)
Describes the medication regimen and
its rationale
c)
Explains the need for therapeutic
serum level of the medication
d)
Describes a plan to eradicate or
limit factors that con-tribute to the occurrence of the dysrhythmia
e)
States actions to take in the event
of an emergency
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.