Please enable JavaScript.

Coggle requires JavaScript to display documents.

Dysrhythmias (Dysrhythmias (Atrial Fibrillation Associated with atrial…

- - - - Alternative treatments
        
        Cardioversion: electrical treatment when drugs are not effective. PCP prescribes anticoagulation therapy for about 6 weeks to prevent thrombolytic event. TEE may be ordered to assess for the presence of atrial clots.
        
        Percutaneous radiofrequency catheter ablation: creates scar tissue that blocks impulses and disconnects the pathway of the abnormal rhythm.
        
        Bi- ventricular pacing:
        
        surgical maze procedure: open-chest surgical technique often performed with coronary artery bypass grafting (CABG); surgeon places a maze of sutures in strategic places in the atrial myocardium. pulmonary artery, and poss. the superior vena cava to prevent electrical circuits from developing
  - - - Priority is to defribillate immediately with an AED. If the VP does not end after one defribrillator shock, the nurse and resuscitation team resume high-quality CPR and provide airway management. Oxygen, and drug therapy such as vasopressin, epinephrine, amiodarone, lidocaine, and magnesium sulfate, alternating with defibrillation.
- - - - Synchronous pacing (demand): sensitivity is set to pt's own beats; When the heart rate is above the set rate, the pacemaker does not fire, When it is less, the pacemaker provides electrical impulses.
        
        Asynchronous: fixed-rate pacing
      - Noninvasive temporary pacing:
        application of two large external electrodes that are attached to an external pulse generator; used as an emergency measure, prophilactically when performing procedures, or transporting pts with bradycardia.
        
        Nursing responsibilies
        
        Prep the equipment, and wash skin with soap and water
        
        apply electrodes according to package instructions
        
        Turn pacer on, set rate as ordered, establish stimulation threshold
        
        Set current milliamperes output 2 mA above the dose at which consistent capture is observed
        
        Palpate right radial or carotid pulse, and assess BP ( use right arm not left b/c they may not be accurate
        
        Observe for discomfort from muscle stimulation, skin irritation, and diaphoresis from the electrodes
        
        give analgesics or sedatives as ordered
      - Invasive temporary pacemaker
        
        Nursing responsibilities
        
        Monitor for complications
        -infection or hematoma
        -ectopic complexes (PVC)
        -Loss of capture, noted by the presence of a pacing stimulus but no QRS complex)
        -Undersensing or pacemaker competition, noted when pacing occurs at a fixed rate in the presence of an adequate rhythm.
        -Oversensing, noted when the pacemaker fails to fire in the presence of inadequate rhythm.
        -Electromagnetic interference
        -Stimulation of the chest wall