Anda di halaman 1dari 4

Amanda Morgan Sim Lab Week Three 02-08-13 1. What are the effects of fast heart rhythms?

Effects of fast heart rhythms include: Tachycardia (heart rate +100 bpm), palpitations, feeling tired, dizzy, lightheaded and suffering from fainting spells, chest pain or pressure, extreme fatigue or weakness, vision changes or trouble breathing. 2. Discuss the characteristics of the following cardiac rhythms: Sinus Bradycardia - heart rhythm that originates from the sinus node and has a rate of under 60 beats per minute. The decreased heart rate can cause a decreased cardiac output resulting in symptoms such as lightheadedness, dizziness, hypotension, vertigo, and syncope. Sinus Tachycardia - heart rhythm with elevated rate of impulses originating from the sinoatrial node, defined as a rate greater than 100 bpm in an average adult. If the heart rate is too high, cardiac output may decrease due to the markedly reduced ventricular filling time. Rapid rates, though they may be compensating for ischemia elsewhere, increase myocardial oxygen demand and reduce coronary blood flow, thus precipitating an ischemic heart or valvular disease. Atrial Fibrillation with Rapid Ventricular Response - the normal regular electrical impulses generated by the sinoatrial node are overwhelmed by disorganized electrical impulses usually originating in the roots of the pulmonary veins, leading to irregular conduction of impulses to the ventricles which generate the heartbeat. AF may occur in episodes lasting from minutes to days, or be permanent. (Most common cardiac arrhythmia.) Supraventricular Tachycardia - rapid heart rhythm originating at or above the atrioventricular node. Symptoms can arise suddenly and may resolve without treatment. Episodes can last from a few minutes to as long as one or two days, sometimes persisting until treated. The rapid heart rate reduces the opportunity for the "pump" to fill between beats decreasing cardiac output and consequently blood pressure. The following symptoms are typical with a rate of 150270 or more beats per minute: Pounding heart, shortness of breath, chest pain, rapid breathing, dizziness, loss of consciousness (in serious cases). 3. Discuss possible causes for each of these rhythms. Sinus Bradycardia - may be caused by one of the following: Increased vagal tone, Sleep, Hypothermia, Hypothyroidism, Intrinsic disease of the SA node (E.g. sick sinus syndrome). An effect of drugs, such as the use of digitalis, beta-blockers, quinidine, Adenosine, Calcium channel blocker, Seizure. It could also be a normal finding in a healthy, well-conditioned person.

Amanda Morgan Sim Lab Week Three 02-08-13 It may be secondary to infections like Diphtheria, acute rheumatic fever, viral myocarditis. It is physiologic in trained athletes. Increased intracranial pressure, Rhodotoxin poisoning. Sinus Tachycardia - usually a response to normal physiological situations, such as exercise and an increased sympathetic tone with increased catecholamine releasestress, fright, flight, anger. Other causes include: Pain, Fever, Anxiety Dehydration, Malignant hyperthermia, Hypovolemia with hypotension and shock, Anemia, Heart failure, Hyperthyroidism, Mercury poisoning, Kawasaki disease, Pheochromocytoma, Sepsis, Pulmonary embolism, Acute coronary ischemia and myocardial infarction, Chronic pulmonary disease, Hypoxia, Intake of stimulants such as caffeine, nicotine, cocaine, or amphetamines, Hyperdynamic circulation, Electric shock, Drug withdrawal Atrial Fibrillation with Rapid Ventricular Response - linked to several cardiac causes, but may occur in otherwise normal hearts. Known associations include: Hypertension, Primary heart diseases including coronary artery disease, mitral stenosis (e.g. due to rheumatic heart disease or mitral valve prolapse), mitral regurgitation, hypertrophic cardiomyopathy(HCM), pericarditis, congenital heart disease, previous heart surgery, Lung diseases (such as pneumonia, lung cancer, pulmonary embolism, sarcoidosis), Excessive alcohol consumption ("binge drinking" or "holiday heart syndrome"). Even otherwise healthy middleaged women who consumed more than 2 drinks daily were 60% more likely to develop AF. Hyperthyroidism, Carbon monoxide poisoning, Dualchamber pacemakers in the presence of normal atrioventricular conduction, A family history of AF may increase the risk of AF, Various genetic mutations may be responsible, Friedreich's ataxia, Rheumatoid arthritis Supraventricular Tachycardia - Stress, exercise, and emotion can all result in a normal or physiological increase in heart rate, but can also, more rarely, precipitate SVT.

4. Discuss nursing interventions for each of these rhythms. All dysrhythmias: Risk for decreased cardiac output. - Auscultate the heart for bradycardia, tachycardia, and irregular rhythm. - Assess for signs of reduced cardiac output: rapid, slow, or weak peripheral pulses; hypotension; dizziness; syncope; SOB; chest pain; fatigue; and restlessness. - Determine acuteness or chronicity of dysrhythmia. - Review hx and assess for causative factors. - If pt on ECG, determine type of dysrhythmia. - Carefully monitor pts response to activity.

Amanda Morgan Sim Lab Week Three 02-08-13 Monitor side effects of medication therapy.

5. Identify medications that could be used to treat each of these rhythms and discuss how they work to change the rhythm. Sinus Bradycardia - atropine- antiarrhythmics; Inhibits the action of acetylcholine at postganglionic sites located in: Smooth muscle, Secretory glands, CNS (antimuscarinic activity); Increases heartrate. hyoscyamine (levosin) antispasmodics; Inhibits the action of acetylcholine at postganglionic sites located in: Smooth muscle, Secretory glands , CNS (antimuscarinic activity). Increases heart rate. Sinus Tachycardia/Supraventricular Tachycardia - BETA BLOCKERS: example: esmolol - antiarrhythmics; Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, or uterine)-receptor sites. Decreased heart rate. Decreased AV conduction. - CALCIUM CHANNEL BLOCKERS: example: flecainide antiarrhythmics; Slows conduction in cardiac tissue by altering transport of ions across cell membranes. Suppression of arrhythmias. Atrial Fibrillation - digoxin: antiarrhythmics, inotropics; Increases the force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect). 6. Which electrolytes affect the cardiac rhythm and how? Potassium plays a vital role in normal electrical transmission across nerves and muscles, including the muscles in the heart. Minor disruption of electrical transmission in the heart begins at low levels of hyperkalemia and can progress to complete cardiac arrest in severe hyperkalemia. Magnesium plays an important catalytic role in certain reactions in the body relating to energy production and cell division and, along with calcium, is essential for normal muscle contraction. Hypermagnesemia causes decreased muscular reflexes at mild elevations, which progresses to low blood pressure, decreased breathing, paralysis and coma as magnesium levels in the blood rise. 7. How does fluid loss or excess affect the cardiac rate and rhythm? Fluid loss effects cardiac stability and increases cardiovascular strain. Severe dehydration can trigger irregular heart rhythms, especially in people with an underlying heart condition. A sustained rapid and irregular heart rate drops blood pressure and can raise the potential of cardiovascular collapse. In response to low blood pressure, which is further aggravated by a fast heart rate, vasoconstriction occurs.

Amanda Morgan Sim Lab Week Three 02-08-13 Fluid overload- chief cause is heart failure; the heart's contractions become weaker and less able to pump out the blood that enters the heart, blood backs up in the veins, causing fluid buildup in the body's tissues. The kidneys' ability to eliminate excess sodium and water is also affected by heart failure, further increasing the body's fluid congestion cause edema. Fluid buildup can also cause increasing fatigue.