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38 Cardiovascular system

ASSESSMENT FINDINGSAtrial fibrillation Commonly asymptomatic Palpitations Complaints of feeling faint Irregular pulse with no pattern to the irregularity

Asystole Unresponsive Apnea Cyanosis No palpable blood pressure Pulselessness

Ventricular fibrillation Unresponsive Apnea No palpable blood pressure Pulselessness

Ventricular tachycardia Chest pain Diaphoresis Hypotension Weak or absent pulse Dizziness Possible loss of consciousness

DIAGNOSTIC TEST RESULTSAtrial fibrillation ECG shows irregular atrial rhythm, atrial rate possibly greater than 400 beats/minute, irregular ventricular rhythm, QRS complexes of uniform configuration and duration, indiscern ible PR interval, and no P waves (fibrillation waves).

Asystole ECG shows no atrial or ventricular rate or rhythm and no discernible P waves, QRS complexes, or T waves.

Ventricular fibrillation ECG shows rapid and chaotic ventricular rhythm, wide and irregular or absent QRS complexes, and no visible P waves.

Ventricular tachycardia ECG shows ventricular rate of 140 to 220 beats/minute, wide and bizarre QRS complexes, and no discernible P waves. VT may start or stop suddenly.

Teaching topics Explanation of the disorder and treatment options Medications and possible adverse effects Taking sublingual nitroglycerin for acute attacks and prophylactically to prevent anginal episodes Reducing risk factors through diet, exercise, weight loss, cholesterol reduction, smoking cessation, and stress reduction Avoiding activities or situations that cause angina, such as exertion, heavy meals, emo-tional upsets, and exposure to cold Seeking medical attention if pain lasts longer than 20 minutes Differentiating between symptoms of angina and symptoms of MI Contacting the American Heart Association

Arrhythmias

In cardiac arrhythmias, abnormal electrical conduction or automaticity changes heart rate and rhythm. Arrhythmias vary in severity, from mild and asymptomatic ones that require no treatment (such as sinus arrhythmia, in which heart rate increases and decreases with respirations) to catastrophic ventricular fibrillation (VF), which necessitates immediate resuscitation.

Arrhythmias are generally classi-fied according to their origin (atrial or ventricular). Their effect on cardiac output and blood pressure, partially influenced by the site of origin, determines their clinical significance. The most common arrhythmias include atrial fibrillation, asystole, VF, and ventricular tachycardia (VT).

CAUSES Congenital Degeneration of conductive tissue Drug toxicity Heart disease MI Myocardial ischemia

What a shock! A change in electrical conduction breaks

my rhythm.

313419NCLEX-RN_Chap03.indd 38313419NCLEX-RN_Chap03.indd 38 4/8/2010 7:01:41 PM4/8/2010 7:01:41 PM

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