Nursing Diagnosis and Intervention : Heart Rhythm Disorders: Arrhythmia
Definition
Heart rhythm disorder or arrhythmia is a common complication of myocardial infarction. Arrhythmias or dysrhythmias is the change in frequency and heart rhythm caused by abnormal electrolyte conduction or automatic (Doenges, 1999).
Arrhythmias arising from changes in the cells of the myocardium electrophysiology. The electrophysiological changes manifest as changes in action potential shape that is recording the electrical activity of the cell chart (Price, 1994). Heart rhythm disorders are not just limited to the irregularity of the heart rate but also including rate and conduction disturbances (Hanafi, 1996).
Etiology
The etiology of cardiac arrhythmias in outline can be caused by:
Clinical Manifestations
Changes in blood pressure (hypertension or hypotension); pulse may be irregular; pulse deficit; irregular heart rhythm sound, extra sound, rate decreases; pale skin, cyanosis, sweating; edema; Urine output decreases as weight decreases cardiac output.
Syncope, dizziness, throbbing, headache, disorientation, confusion, lethargy, changes in the pupil. Mild to severe chest pain, may be lost or not with antianginal drugs, anxiety, shortness of breath, cough, change of velocity / depth of respiration; additional breath sounds (crackles, wheezing) may exist indicate respiratory complications such as left heart failure (pulmonary edema) or pulmonary thromboembolic phenomena; hemoptysis, fever; redness of the skin (drug reactions); inflammation, erythema, edema (siperfisial thrombosis); loss of muscle tone / strength.
Diagnosis and Tests
Nursing Diagnosis and Intervention
Risk for decreased cardiac output related to electrical conduction disturbances, decreased myocardial contractility.
Expected outcomes:
Intervention:
Definition
Heart rhythm disorder or arrhythmia is a common complication of myocardial infarction. Arrhythmias or dysrhythmias is the change in frequency and heart rhythm caused by abnormal electrolyte conduction or automatic (Doenges, 1999).
Arrhythmias arising from changes in the cells of the myocardium electrophysiology. The electrophysiological changes manifest as changes in action potential shape that is recording the electrical activity of the cell chart (Price, 1994). Heart rhythm disorders are not just limited to the irregularity of the heart rate but also including rate and conduction disturbances (Hanafi, 1996).
Etiology
The etiology of cardiac arrhythmias in outline can be caused by:
- Inflammation of the heart, such as rheumatic fever, myocardial inflammation (myocarditis due to infection).
- Impaired coronary circulation (coronary atherosclerosis or coronary artery spasm), for example; myocardial ischemia, myocardial infarction.
- Because drugs (intoxication), among others, by; digitalis, quinidine and anti-arrhythmia drugs other.
- Electrolyte balance disorders (hyperkalemia, hypokalemia).
- Disorders of the autonomic nervous system settings that affect the work and heart rhythm.
- Psychoneurotic disruption and central nervous system.
- Metabolic disorders (acidosis, alkalosis).
- Endocrine disorders (hyperthyroidism, hypothyroidism).
- Arrhythmia due to cardiomyopathy or heart tumors.
- Arrhythmia due to degeneration (fibrosis cardiac conduction system).
Clinical Manifestations
Changes in blood pressure (hypertension or hypotension); pulse may be irregular; pulse deficit; irregular heart rhythm sound, extra sound, rate decreases; pale skin, cyanosis, sweating; edema; Urine output decreases as weight decreases cardiac output.
Syncope, dizziness, throbbing, headache, disorientation, confusion, lethargy, changes in the pupil. Mild to severe chest pain, may be lost or not with antianginal drugs, anxiety, shortness of breath, cough, change of velocity / depth of respiration; additional breath sounds (crackles, wheezing) may exist indicate respiratory complications such as left heart failure (pulmonary edema) or pulmonary thromboembolic phenomena; hemoptysis, fever; redness of the skin (drug reactions); inflammation, erythema, edema (siperfisial thrombosis); loss of muscle tone / strength.
Diagnosis and Tests
- ECG: shows the pattern of ischemic injury and conduction disturbances. Stating the type / source dysrhythmia and the effects of electrolyte imbalance and heart medications.
- Holter monitor: Overview of ECG (24 hours) may be required to determine where dysrhythmia caused by specific symptoms when the patient is active (at home / work). Also can be used to evaluate the pacemaker function / effect of anti dysrhythmias.
- Chest x-ray: Can show an enlarged cardiac silhouette in connection with ventricular dysfunction or valve.
- Myocardial imaging scan: can indicate areas of ischemic / myocardial damage that could affect or disrupt the normal conduction wall motion and ability to pump.
- Exercise stress test: can be done to demonstrate that exercise causes dysrhythmias.
- Electrolytes: An increase or decrease in potassium, calcium and magnesium can cause dysrhythmias.
- Examination of drugs: can declare cardiac drug toxicity, the presence of drugs or suspected instances of drug interactions; digitalis, quinidine.
- Examination of the thyroid: an increase or decrease in serum thyroid levels can cause increase dysrhythmias.
- Sedimentation rate: Elevation can demonstrate an acute inflammatory process instance; endocarditis as a precipitating factor dysrhythmias.
- GDA / pulse oximetry: Hypoxemia can cause / exacerbate dysrhythmias.
Nursing Diagnosis and Intervention
Risk for decreased cardiac output related to electrical conduction disturbances, decreased myocardial contractility.
Expected outcomes:
- Maintain / improve cardiac output adequately evidenced by blood pressure / pulse in the normal range, adequate urine output, same palpable pulse, normal mental status.
- Showed a decrease in the frequency / no presence of dysrhythmias.
- Participate in activities that decrease myocardial work.
Intervention:
- Feel the pulse (radial, femoral, dorsalis pedis) record the frequency, regularity, amplitude and symmetrical.
- Auscultation of heart sounds, record the frequency, rhythm. Note the extra heart rate, decreased pulse.
- Monitor vital signs and examine the adequacy of cardiac output / reperfusion.
- Determine the type of dysrhythmia and note rhythm: tachycardia; bradycardia; atrial dysrhythmias; ventricular dysrhythmias; heart block.
- Provide quiet environment. Assess the reasons for limiting the activity during the acute phase.
- Demonstrate / encourage the use of stress management behaviors such as deep breathing relaxation, guided imagery.
- Investigate reports of pain, note the location, duration, intensity and factor relievers / ballast. Note the non-verbal instructions pain examples wrinkle face, crying, changes in blood pressure.
- Prepare / do CPR as indicated.
- Monitor laboratory tests, sample electrolyte.
- Provide supplemental oxygen as indicated.
- Give the drug as indicated: potassium, anti dysrhythmias.
- Prepare for elective cardioversion help.
- Help installing / maintaining the pacemaker function.
- Enter / maintain input IV.
- Prepare for invasive diagnostic procedures.
- Prepare for the installation of automatic cardioverter or defibrillator
