NR 341 Case Study Exercise: Dysrhythmia Interpretation 1

11 July 2024

NR 341 Complex Adult Health Nursing

CHAMBERLAIN COLLEGE OF NURSING NR 341 Complex Adult Health Nursing

CASE STUDY EXERCISE: Dysrhythmia Interpretation 1

1) Interpret basic dysrhythmias and identify: location, effect on conduction, assessment findings, causes, treatment, complications

Dysrhythmia Interpretation

Dysrhythmias, also known as arrhythmias, are abnormalities in the heart’s rhythm. These can occur in various locations within the heart, affecting the conduction system and consequently the cardiac output. Proper interpretation of these rhythms is crucial for determining appropriate treatment and management.

Location and Effect on Conduction

Dysrhythmias can originate from different parts of the heart including the atria, ventricles, and the atrioventricular (AV) node. The location impacts the conduction system by either accelerating or decelerating the heart rate, leading to different clinical manifestations and potential complications.

Assessment Findings and Causes

  • Location: Dysrhythmias can occur in the atria (e.g., atrial fibrillation), ventricles (e.g., ventricular tachycardia), or AV node (e.g., AV block).
  • Effect on Conduction: Dysrhythmias may cause the heart to beat too fast (tachycardia) or too slow (bradycardia), disrupting the normal conduction pathway.
  • Assessment Findings: Symptoms can vary based on the type of dysrhythmia and its severity. Common findings include shortness of breath (SOB), chest pain, dizziness, syncope, fatigue, and hypotension.
  • Causes: These may include electrolyte imbalances, myocardial infarction, drug toxicity, hypoxia, and structural heart changes.

Treatment and Complications

  • Treatment: Depending on the type of dysrhythmia, treatments may include medications (e.g., beta-blockers, calcium channel blockers), electrical cardioversion, or implantable devices like pacemakers.
  • Complications: If untreated, dysrhythmias can lead to serious complications such as stroke, heart failure, or sudden cardiac arrest.

2) Recognition and Treatment of Dysrhythmias

Rhythm Strip #1: Bradycardia

1. What is the dysrhythmia?Sinus Bradycardia

2. Are the atrial and ventricular rates equal? What is the rate? How did you measure to find out?Yes, the rates are equal since each P-wave is followed by a QRS complex, indicating a rate of 40 BPM. The rate is determined by counting the number of P-waves followed by QRS complexes in each 3-second segment and multiplying by 10.

3. How is conduction affected?Causes the heart to beat less than 60 BPM.

4. What are the possible causes?This type of strip may be seen in athletes and could be their normal, functioning heart rate (HR). Other causes include:

  • Beta-blockers
  • Calcium channel blockers
  • Myocardial infarction (MI)
  • Vasovagal responses
  • Drug use
  • Hypothermia

5. What assessment findings will the patient exhibit?The patient could be asymptomatic if they are an athlete with a naturally low HR. Symptomatic patients may exhibit:

  • Shortness of breath (SOB)
  • Pulmonary congestion
  • Chest pain or discomfort
  • Hypotension
  • Rapid, slow, or weak pulses
  • Syncope
  • Dizziness
  • Loss of consciousness (LOC)
  • Fatigue
  • Restlessness

6. How do we treat this patient?

  • Initial Treatment: Administer Atropine to increase the heart rate.
  • Long-term Treatment: If the heart rate remains below 60 BPM and the patient is symptomatic, a pacemaker may be recommended to regulate the heart rate to a more normal range of 60-100 BPM. Treatment is implemented only if the patient exhibits symptoms related to bradycardia.

Rhythm Strip #2: Junctional Rhythm

1. What is the dysrhythmia?Junctional Rhythm

2. What is normally seen or not seen in the rhythm strip?Identifiers of a junctional rhythm strip are an absent, retrograde (upside down), or hidden P-wave.

3. How is conduction affected?This is a dysrhythmia of the AV node.

Rhythm Strip #3: Premature Ventricular Contractions (PVCs)

1. What is the dysrhythmia?Premature Ventricular Contractions (PVCs)

2. What is normally seen or not seen in the rhythm strip?No signaling P-wave, a compensatory pause, wide and bizarre beats, irregular rhythm.

3. How is conduction affected?QRS complex is wide and prolonged (greater than 0.12 seconds).

4. What is the rate? Does it have a pattern?Rate is 90 BPM. The pattern is bigeminy, occurring every other beat.

5. What assessment findings would you observe in a patient with this rhythm?Palpitations

6. What are some of the causes?

  • Ischemic heart disease
  • Acid-base imbalance
  • Hypoxemia
  • Hypokalemia
  • Hypomagnesemia
  • Increased catecholamine levels

7. How can we treat a patient with this rhythm?

  • Initial Treatment: Administer anti-dysrhythmic agents.
  • Long-term Treatment: Address the underlying cause.

Rhythm Strip #4: Third-Degree Block (Complete Heart Block)

1. What is the dysrhythmia?Third-Degree Block (Complete Heart Block)

2. What is normally seen or not seen in the rhythm strip?P-wave is not absent or hidden but does not always stimulate a QRS complex; a QRS complex is not always stimulated by a P-wave.

3. How is conduction affected?Dysrhythmias from the AV junction due to atria and ventricles beating independently from each other.

References

  1. Thaler, M. S. (2018). The Only EKG Book You’ll Ever Need. Wolters Kluwer.
  2. Zimetbaum, P. J., & Josephson, M. E. (2016). Evaluation of patients with palpitations. The New England Journal of Medicine, 334(1), 161-172. doi:10.1056/NEJM199601183340307
  3. American Heart Association. (2021). Bradycardia (Slow Heart Rate). Retrieved from American Heart Association
  4. Mayo Clinic. (2021). Bradycardia. Retrieved from Mayo Clinic