nursing process for P.T with a dysrhythmia

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Nursing process for P.T with a dysrhythmia
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* Assessment

Major areas of assessment include possible causes of the dysrhythmia and the dysrhythmia’s effect on the heart’s ability to pump an adequate blood volume. When cardiac output is reduced, the amount of oxygen reaching the tissues and vital organs is diminished. This diminished oxygenation produces the signs and symptoms associated with dysrhythmias. If these signs and symptoms are severe or if they occur frequently, the patient may experience significant distress and disruption of daily life.



A health history is obtained to identify any previous occurrences of decreased cardiac output, such as syncope (fainting), lightheadedness, dizziness, fatigue, chest discomfort, and palpitations. Coexisting conditions that could be a possible cause of the dysrhythmia (eg, heart disease, chronic obstructive pulmonary disease) may also be identified. All medications, prescribed and over-the-counter (including herbs and nutritional supplements), are reviewed. Some medications (eg, digoxin) can cause dysrhythmias. A thorough psychosocial assessment is performed to identify the possible effects of the dysrhythmia and to determine whether anxiety is a significant contributing factor.



The nurse conducts a physical assessment to confirm the data obtained from the history and to observe for signs of diminished cardiac output during the dysrhythmic event, especially changes in level of consciousness. The nurse directs attention to the skin, which may be pale and cool.


Signs of fluid retention, such as neck vein distention and crackles and wheezes auscultated in the lungs, may be detected. The rate and rhythm of apical and peripheral pulses are also assessed, and any pulse deficit is noted.




The nurse auscultates for extra heart sounds (especially S3 and S4) and for heart murmurs, measures blood pressure, and determines pulse pressures.


A declining pulse pressure indicates reduced cardiac output. Just one assessment may not disclose significant changes in cardiac output; therefore, the nurse compares multiple assessment findings over time, especially those that occur with and without the dysrhythmia.


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* Diagnosis

NURSING DIAGNOSES

Based on assessment data, major nursing diagnoses of the patient may include:

• Decreased cardiac output
• Anxiety related to fear of the unknown
• Deficient knowledge about the dysrhythmia and its treatment


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* Planning and Goals:

The major goals for the patient may include eradicating or decreasing the incidence of the dysrhythmia (by decreasing contributory factors) to maintain cardiac output, minimizing anxiety, and acquiring knowledge about the dysrhythmia and its treatment.


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* Nursing Interventions

MONITORING AND MANAGING THE DYSRHYTHMIA

The nurse regularly evaluates blood pressure, pulse rate and rhythm, rate and depth of respirations, and breath sounds to determine the dysrhythmia’s hemodynamic effect.

The nurse also asks patients about episodes of lightheadedness, dizziness, or fainting as part of the ongoing assessment. If a patient with a dysrhythmia is hospitalized, the nurse may obtain a 12-lead ECG, continuously monitor the patient, and analyze rhythm strips to track the dysrhythmia.
Control of the incidence or the effect of the dysrhythmia, or
both, is often achieved by the use of antiarrhythmic medications.

The nurse assesses and observes for the beneficial and adverse effects of each of the medications.

The nurse also manages medication administration carefully so that a constant serum blood level of the medication is maintained at all times.

In addition to medication, the nurse assesses for factors that contribute to the dysrhythmia (eg, caffeine, stress, nonadherence to the medication regimen) and assists the patient in developing a plan to make lifestyle changes that eliminate or reduce these factors.


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* PROMOTING HOME AND COMMUNITY-BASED CARE:

Teaching Patients Self-Care


When teaching patients about dysrhythmias, the nurse presents the information in terms that are understandable and in a manner that is not frightening or threatening.
The nurse explains the importance of maintaining therapeutic serum levels of antiarrhythmic medications so that the patient understands why medications should be taken regularly each day.

In addition, the relationship between a dysrhythmia and cardiac output is explained so that the patient understands the rationale for the medical regimen.

If the patient has a potentially lethal dysrhythmia, it is also
important to establish with the patient and family a plan of action to take in case of an emergency. This allows the patient and family to feel in control and prepared for possible events.

A referral for home care usually is not necessary for the patient with a dysrhythmia unless the patient is hemodynamically unstable and has significant symptoms of decreased cardiac output.

Home care is also warranted if the patient has significant comorbidities, socioeconomic issues, or limited self-management skills that could potentiate the risk for nonadherence to the therapeutic regimen.


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* Evaluation

EXPECTED PATIENT OUTCOMES

Expected patient outcomes may include:
1. Maintains cardiac output:
a. Demonstrates heart rate, blood pressure, respiratory rate, and level of consciousness within normal ranges.

b. Demonstrates no or decreased episodes of dysrhythmia

2. Experiences reduced anxiety:
a. Expresses a positive attitude about living with the dysrhythmia.

b. Expresses confidence in ability to take appropriate actions in an emergency.

3. Expresses understanding of the dysrhythmia and its treatment:
a. Explains the dysrhythmia and its effects.

b. Describes the medication regimen and its rationale.

c. Explains the need for therapeutic serum level of the medication.

d. Describes a plan to eradicate or limit factors that contribute to the occurrence of the dysrhythmia.

e. States actions to take in the event of an emergency.








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