Question

11. For each arrhythmia, draw a heart beat characterizing the arrhythmia, determine significance to cardiac output, common pharmacological and nonpharmacological treatment modalities, and the nursing implications. Drawing Cardiac Output Pharmacological Nonpharmacological Nursing Implications Atrial fibrillation Atrial flutter premature atrial contraction Ventricular fibrillation Ventricular flutter Ventricular tachycardia Torsades de pointes

Answer 1

Atrial fibrillation: refers to irregular heartbeat that results from irregular heart beat. The clinical manifestation includes heart palpitations, shortness of breath and weakness.

The common pharmacological management includes treating underlying blood clots using anti coagulants like warfarin. To treat the tachycardia beta blockers like atenolol,propranolol,metoprolol,bisoprolol used to keep heart rate under control. Calcium channel blockers like Diltiazem,verapamil are used to reduce the myocardial contraction. Sodium channel blockers and potassium channel blockers used to slow down the electrical impulses of the heart.

Non pharmacological treatment includes radifrequency ablation,maze procedure to treat focal activity. Nursing implications : The prime goal of nursing intervention is to maintain tissue perfusion and adequate cardiac output. Hemodynamic monitoring helps to monitor vital measurements. Oxygen therapy is initiated if patient has any chest discomfort as it is suggestive of myocardial ischemia.In case of digoxin infusion monitor for digoxin toxicity and also serum digoxin levels.

Atrial flutter is an abnormal heart rhythm originates in the atrium of the heart. The drug regimen includes anti arrhythmic drugs amiodarone. Digoxin is administered to decrease the firing of electrical impulses in the heart. Calcium channel blockers like Diltiazem,verapamil are used to reduce the myocardial contraction.Beta blockers like atenolol,propranolol,metoprolol,bisoprolol used to keep heart rate under control. Non pharmacological treatment includes electrical cardioversion and catheter ablation. Nursing intervention focuses on preventing the stroke occurrence and to follow NICE guidelines in administering anti coagulants.

Pre mature atrial contraction results when depolarization occurs earlier before the sinu atrial node triggers the heart beat. Initial goal of management is to treat arrhythmias. Anti arrhythmic drugs to control the electrical impulses of the heart. AV nodal blocking drugs like beta blockers,calcium channel blockers and digoxin to reduce the hearts electrical activity. Anticoagulants to decrease the incidence of blood clot. Pacemaker implantation to regulate the heart beat. Implantable cardioverter defibrillator to treat cardiac arrest. Ablation procedure to treat arrhythmias. Nursing interventions focussed on identification of the route cause of the problem.

Ventricular fibrillation refers to rapid heart beat and needs an emergency medical attention. Emergency management with cardiopulmonary resuscitation to keep the heart pump incase of sudden cardiac arrest. Defibrillation to stop abnormal heart rhythm. Anti arrhythmic drugs to control the electrical impulses of the heart. AV nodal blocking drugs like beta blockers,calcium channel blockers and digoxin to reduce the hearts electrical activity. Implantable cardioverter defibrillator to monitor heart rhythm and to deliver shocks incase of abnormal heart rhythm. Coronary angioplasty and stent placement to treat underlying coronary artery disease. CABG to remove occlusion in coronary artery and thud re perfusing the coronary blood flow.

Ventricular flutter a form of ventricular tachycardia occurs as a result of disturbance in organized electrical activity of the heart. The heart rate ranges from 200-350 beats minute. Anti arrhythmic drugs to control the electrical impulses of the heart. AV nodal blocking drugs like beta blockers,calcium channel blockers and digoxin to reduce the hearts electrical activity. Implantable cardioverter defibrillator to monitor heart rhythm and to deliver shocks incase of abnormal heart rhythm.