Nursing Interventions for Patients with Dysrhythmias

Cardiac dysrhythmias associated with altered myocardial automaticity, conductivity or contractility can effect cardiac output. Reduced cardiac output increases the risk of ineffective tissue perfusion.

Assess for signs of ineffective tissue perfusion by system:

• Renal
  • oliguria or anuria
• Gastrointestinal
  • nausea
  • hypoactive or absent bowel sounds
• Peripheral
  • edema
  • altered skin color, temperature, sensation or integrity
  • weak or absent pulse
• Cerebral
  • dizziness
  • altered mental status (anxiety, confusion, syncope)
  • altered pupillary response
  • speech abnormalities
• Cardiopulmonary
  • hypotension
  • abnormal respiratory rate
  • capillary refill >3 seconds
  • chest pain
  • dyspnea, crackles & wheezes
  • jugular vein distention

Nursing Intervention for Ineffective Tissue Perfusion

• Assess for and report signs/symptoms of cardiac dysrhythmias (e.g. irregular apical pulse, adult pulse rate below 60 or above 100 beats/minute, apical-radial pulse deficit, syncope, palpitations).
• Reduce cardiac workload
  • Position patient to minimizes discomfort and facilitate respiration.
  • Minimize anxiety with calm reassurance and education.
  • Communicate rationale for monitoring and treatments.
  • Discuss the benefits calm with the patient and family.
• Initiate EKG monitor and pulse oximetry per policy.
• IV access, O₂, medication and 12 lead-EKG as ordered, monitor vital signs.
  • Positive inotropic agents (e.g. dobutamine, dopamine) to increase myocardial contractility
  • Vasodilators (e.g. nitroglycerin) to decrease cardiac workload
  • ACE inhibitors (e.g. captopril, ramipril) to decrease cardiac workload
  • Diuretics for elevated capillary wedge pressure
  • Morphine sulfate to reduce pain, preload and anxiety.
• Anticipate the need to initiate cardiopulmonary resuscitation.
• Assess for contributing factors: pain, fluid and electrolyte imbalance, drug toxicity (especially digoxin), medication non-adherence.
  
• Provide psychosocial support for patient and family members.
  • If the dysrhythmia is a life-threatening type, encourage the family unit to calmly formulate a plan of action.
  • Reassure the patient will receive the best care in keeping with his written directives or medical power of attorney.
  • Communicate the availability and value of social services as needed.
• Patient teaching:
  • Importance of reporting chest pain, dyspnea, loss of consciousness, confusion, etc.
  • Educate and prepare patient for planned treatments such as:
    • Echo-cardiogram
    • Cardioversion
    • Pacemaker insertion
    • Catheter ablation
    • Central Venous Catheter insertion
• Wellness teaching includes: smoking cessation, stress reduction, weight reduction, heart healthy diet, drug regimen, relaxation as well as home blood pressure, pulse and weight monitoring.
  

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