Management of Patients With Dysrhythmias and Conduction Problems

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1. Janis White, 21 years of age, is a female patient who received a permanent atrioventricular pacemaker for the diagnosis of sick sinus rhythm, a disorder that leads to periods of tachycardia and periods of extreme bradycardia or sinus arrest. The nurse received the end-of-shift report and arrives at Ms. White’s room where she assesses the patient’s incision dressing on the upper left chest and it is dry. The patient’s left arm is edematous and ecchymotic and twice the size of the other arm. The patient states that her left arm feels numb and tingling. The distal pulses are present and at baseline. None of the findings were noted in the end-of-shift report. (Learning Objective 6)

a.What nursing management should the nurse provide immediately?

b.Explain the general care of the patient after receiving an implanted pacemaker.

2. The nurse on the telemetry unit responds to the cardiac monitor alarm on a patient recovering from a myocardial infarction. Upon entering the room, the nurse notes that the rhythm on the monitor appears to be ventricular tachycardia. (Learning Objective 7)

a.What action should the nurse take first?

b.The nurse notes the patient has no pulse, and tells someone to get the code cart and another to call the hospital’s code team. Upon arrival of the code cart, the nurse prepares the defibrillator for use. At what energy level does the nurse set the biphasic defibrillator for the first shock?

c.After defibrillation, the nurse assesses the patient, finds him pulseless, and initiates cardiopulmonary resuscitation. The code team has arrived, and epinephrine is administered. What is the rationale for this medication in this emergency situation?

d.What is the difference between monophasic and biphasic defibrillators?

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