Case Study V

James, 16 year male, is admitted to your unit for complaints of palpitations and dizziness. On admission he had no symptoms complaints, but right after your shift starts he calls and tells you his palpitations are starting again. He is very anxious.

Physical Assessment

Neuro: AAOx3, perrla, exhibits restlessness and complains of anxiety.
Pulmonary: Lungs clear to auscultation in all lobes. Respiratory rate rapid.
GI: BS active x 4 quadrants, abdomen soft and non tender.
GU: Voiding clear yellow urine in adequate amounts.
CV: Heart sounds rapid S1S2, good capillary refill, peripheral pulses 2+, complains of palpitations.

Vital signs: Pulse 160, BP 100/64, Resp. rate 22, temp 98.7 F

History: James is a normally healthy teenager. He is active in track sports and does not smoke or consume alcohol. He states that the palpitations and dizziness started about a month ago and he experiences episodes once or twice per week.

Diagnostic studies: Na+ 140, K+ 3.4, BUN and creat normal, Cardiac markers all normal.

EKG rhythm strip:

(IMPORTANT! See instructions below*)

1. What rhythm is this?
Ventricular tachycardia
 PSVT
 Normal sinus rhythm
 Atrial fibrilation
2. Which of the following medications would be appropriate for this dysrhythmia?
Atropine
 Lidocaine
 Adenosine
 Vasopressin
3. This dysrhythmia is more common in teenagers and young adults.
True
 False
4. Nursing care for James would include?
Frequent CV assessment
 Psychological support
 Education for James and his family
 All of the above

5. An interventional technique to eliminate this dysrhythmia is:

Ablation
 Cardiac stenting
 Thrombolysis
 Coronary artery bypass grafts

The basic dysrhythmia course that is recommended as background for this Cardiac Case Studies course is the RnCeus.com course:

EKG Strip Indentification and Evaluation

*IMPORTANT!

Please write down and save your answers to the above questions. The questions will be repeated on the "Exam and Evaluation", but the scenarios and strips will not be repeated.

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