•Alteration in cardiac output (decreased): In the case of dysrhythmias, decreased cardiac output is due to changes in heart rate, rhythm and conduction. This ultimately effects the mechanical function of the heart.
Nursing Interventions:
- Assess the patient for the underlying cause and contributing factors.
- Assess the patient for signs and symptoms of impending failure. This includes physical assessment, review of lab values, patient history and invasive hemodynamic parameters if available.
- Correct the underlying cause. This may include reduction of pain and anxiety, fluid restriction, fluid replacement, restricting activities that precipitate dysrhythmias. (e.g.valsalva) or placing the patient on oxygen.
- Maintain patency of all IV and other invasive lines.
- Provide psychosocial support for patient and family members.
- Promote adequate rest.
- Maintain appropriate nutritional and fluid balances.
- Patient teaching: includes acute activities such as reporting chest pain or dyspnea and wellness teaching such as stop smoking, stress reduction, weight reduction, heart healthy diet, drug regimen, and relaxation. Other patient teaching activities include teaching the patient home blood pressure, pulse and weight monitoring.
•Alteration in tissue perfusion (cardiopulmonary): Decreased tissue perfusion that is associated with dysrhythmias is probably due to decreased cardiac output
Nursing Interventions:
- Assess the patient for causative factors. In the case of dysrhythmias, this would entail identifying the dysrhythmia and determining if it was causing a decrease in tissue perfusion.
- Assess the patient for alteration in mentation, vital signs, postural blood pressure and signs of pulmonary emboli.
- Assess baseline labs: ABGs, electrolytes, BUN/creatinine, cardiac profile.
- Document and report chest pain, noting precipitating factors.
- Encourage restful atmosphere.
- Teach patient to decrease cardiac workload.
- Administer cardiac medications.
- Teach patient to self administer medications.
- Discuss necessary lifestyle changes such as stop smoking, diet, weight loss, appropriate exercises, and stress reduction.
Apply the knowledge that you now have after taking this basic course by taking an intermediate level course "Cardiac Case Studies: Apply Your Knowledge". You can refer back to this course for basic information as you take the case study course.
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