De La Salle Health Sciences Institute Dasmarias, Cavite College of Nursing and School of Midwifery Level IV

NURSING CASE ANALYSIS:

Ventricular Tachycardia
Submitted By: Salinas, Danica Alyssa H. Group 2 BSN 4-4

Submitted to: Ms. Darryl M. Tejada RN, MAN

August 29, 2012

I.

Personal Data Clients Name or Initial: A.R.M Gender: Male Age: 10 years old Birthdate: August 8, 2002 Birthplace: Gen. Trias, Cavite Marital Status: Single Nationality: Filipino Religion: Roman Catholic Address: Gen. Trias, Cavite Educational Attainment: Elementary student at present Occupation: Student Usual Source of Medical Care: Hospital and OTC

II.

Assessment Patient was apparently well until 1 day PTC, patient experienced

palpitations for abot 2-3 minutes but still he continued with his activities of daily living and did not take any medications. Few hours PTC, patient had his class in Physical Education and experienced difficulty of breathing. Patient was then rushed by his mother to DLSUMCER for consultation. After 3 hours of giving emergency treatment to the patient, he was then admitted to the Pediatric Intensive Care Unit for close monitoring and further treatment. PR = 240 bpm BP = 70 palpatory (+) Distended jugular vein Cold clammy skin Difficulty of breathing Use of accessory muscles during inspiration

III. Procedure/ Date

Laboratory Normal Values Actual Findings Nursing Responsibilitie s Monitor the condition of the patient Monitor vital signs

Indications

Urinalysis (Urine Test)

Urinalysis to help doctors diagnose urinary tract diseases, like infections. Abnormal test results in such cases commonly include blood and increased white cells in the urine A urinalysis consists of a number of physical, chemical and microscopic tests of a urine sample as part of a checkup to help diagnose a urinary tract or metabolic disease

PH Specific Gravity

5-7 1.0021.030

6 1.005

Color Transparency Albumin Sugar Protein

Yellow Clear Negative Negative Negative Negative

Straw Hazy Negative Negative Negative Negative

Glucose Negative Negative

Ketone

Bilirubin Blood Nitrite Leukocyte

Negative Negative Negative Negative

Negative Negative Negative Negative

-Complete Blood Count -Electrolyte levels - Particularly potassium, bicarbonate, calcium, and magnesium -Serum Ammonia Clotting and Prothombin Time

IV.

Emergency Nursing Interventions

Assess and stabilize airway, breathing, and circulation. Administer oxygen via nasal cannula @ 1-2 lpm Start intravenous (IV) fluids when indicated and ordered by physician. Place a cardiorespiratory monitor. Monitor heart status by hooking on ECG with 10 leads. Place a pulse oximeter to monitor oxygen saturation. Monitor Vital Signs of patient every 15 minutes. Administer Ice cold compress on head part. This will stimulate the vagus nerve, which can slow conduction of electrical impulses that control the heart rate.

Encouraged patient to perform deep breathing exercises.

V.

Medical Management Amiodarone Hydrochloride (Cordarone) -Drug classification: Antiarrhythmic, Adrenergic Blocker -Indication: Ventricular Arrhythmia, atrial fibrillation and paroxysmal supraventricular tachycardia, treatment of symptomatic atrial flutter -Adverse effects: CNS: Malaise, fatigue, dizziness, tremors, ataxia, paresthesias, lack of coordination CV: Cardiac arrhythmias, CHF, cardiac arrest, hypotension

EENT: Corneal microdeposits (photophobia, dry eyes, halos, blurred vision); ophthalmic abnormalities including permanent blindness

Endocrine: Hypothyroidism or hyperthyroidism GI: Nausea, vomiting, anorexia, constipation, abnormal LFTs, hepatotoxicity

Respiratory: Pulmonary toxicitypneumonitis, infiltrates (shortness of breath, cough, rales, wheezes)

-Contraindications Contraindicated with hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation. Use cautiously with thyroid dysfunction, pregnancy.

-Nursing Considerations: Monitor BP carefully during infusion and slow the infusion if significant hypotension occurs; bradycardia should be treated by slowing the infusion or discontinuing if necessary. Monitor heart rate and rhythm and BP until drug response has stabilized. Sustained monitoring is essential because drug has an unusually long half-life. Check pulse daily once stabilized, or as prescribed. Report a pulse <60. Take oral drug consistently with respect to meals. Do not breast feed while taking this drug without consulting physician Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of drug therapy.

VI.

Pathophysiology

The heart is innervated primarily by the vagus nerve and the sympathetic ganglion. Pain sensation travels through afferent fibers associated with the sympathetic ganglia. In most patients, the sensation of a normal heartbeat is not felt. Some children may complain of palpitations or rushing or pounding in the ears. Supraventricular Tachycardia usually occurs without other symptoms. However, it may be associated with a number of medical conditions, such as the following:

Hardening of the arteries (atherosclerosis) Heart failure Thyroid disease Chronic lung disease Pneumonia Pulmonary emboli, or blood clots migrating into the lung arteries from elsewhere in the body Pericarditis Drinking too much caffeine in coffee, tea, or soft drinks Emotional stress

PSVT may also occur as a side effect of medications such as digitalis, asthma medications, or cold remedies. In some cases, the cause of PSVT is unknown. PSVT is the most common arrhythmia in infants, children, and pregnant females.

SCHEDULE OF ACTIVITIES August 23, 2012

Rounds in assigned area Checking of IV levels and regulation Vital signs of patients Triage of incoming new patients Vital signs of incoming patients Perform 10 leads ECG Draining of urine bag of patients with IFC Changing of linens Administration of Anti- Rabies vaccine Suction patients with ET if needed Discontinuation of IV Assist staff nurses in transferring patients to their respective room of choice in the ward.