Generally, minor dysrhythmias are monitored and treated in the community setting; however, potential life-threatening situations (including heart rates above 150 beats/min) usually require a short inpatient stay.
- Heart failure: chronic
- Myocardial infarction
- Psychosocial aspects of care
- Patient Assessment Database
Generalized weakness and exertional fatigue
Changes in heart rate/BP with activity/exercise
- History of previous/acute MI (90%–95% experience dysrhythmias), cardiac surgery, cardiomyopathy, rheumatic/HF, valvular heart disease, long-standing hypertension, use of pacemaker
- Pulse: Fast, slow, or irregular; palpitations, skipped beats
- BP changes (hypertension or hypotension) during episodes of dysrhythmia
- Pulses may be irregular, e.g., skipped beats; pulsus alternans (regular strong beat/weak beat); bigeminal pulse (irregular strong beat/weak beat)
- Pulse deficit (difference between apical pulse and radial pulse)
- Heart sounds: irregular rhythm, extra sounds, dropped beats
- Skin color and moisture changes, e.g., pallor, cyanosis, diaphoresis (heart failure, shock)
- Edema dependent, generalized, JVD (in presence of heart failure)
- Urine output decreased if cardiac output is severely diminished
- Feeling nervous (certain tachydysrhythmias), sense of impending doom
- Stressors related to current medical problems
Anxiety, fear, withdrawal, anger, irritability, crying
- Loss of appetite, anorexia
- Food intolerance (with certain medications)
- Changes in weight
- Weight gain or loss
- Changes in skin moisture/turgor
- Respiratory crackles
- May report:
- Dizzy spells, fainting, headaches
- Mental status/sensorium changes, e.g., disorientation, confusion, loss of memory; changes in usual speech pattern/consciousness, stupor, coma
- Behavioral changes, e.g., combativeness, lethargy, hallucinations
- Pupil changes (equality and reaction to light)
- Loss of deep tendon reflexes with life-threatening dysrhythmias (ventricular tachycardia, severe bradycardia)
Chest pain, mild to severe, which may or may not be relieved by antianginal medication
Distraction behaviors, e.g., restlessness
- Chronic lung disease
- History of or current tobacco use
- Shortness of breath
- Coughing (with/without sputum production)
- Changes in respiratory rate/depth during dysrhythmia episode
- Breath sounds: Adventitious sounds (crackles, rhonchi, wheezing) may be present, indicating respiratory complications, such as left-sided heart failure (pulmonary edema) or pulmonary thromboembolic phenomena Hemoptysis
- Skin: Rashes (medication reaction)
- Loss of muscle tone/strength
- Familial risk factors, e.g., heart disease, stroke
- Use/misuse of prescribed medications, such as heart medications (e.g., digitalis), anticoagulants (e.g., warfarin [Coumadin]), benzodiazepines (e.g., diazepam [Valium]), tricyclic antidepressants (e.g., amitriptyline [Elavil]), or antipsychotic agents (e.g., fluphenazine [Prolixin], chlorpromazine [Thorazine]), or OTC medications (e.g., cough syrup and analgesics containing ASA)
- Stimulant abuse, including caffeine/nicotine
- Lack of understanding about disease process/therapeutic regimen
- Evidence of failure to improve, e.g., recurrent/intractable dysrhythmias that are lifethreatening
- Discharge plan
- DRG projected mean length of inpatient stay: 3.9 days
- Alteration of medication use/therapy
- Refer to section at end of plan for postdischarge considerations.
- ECG: Reveals type/source of dysrhythmia and effects of electrolyte imbalances and cardiac medications. Demonstrates patterns of ischemic injury and conduction aberrance. Note: Exercise ECG can reveal dysrhythmias occurring only when patient is not at rest (can be diagnostic for cardiac cause of syncope).
- Extended or event monitoring (e.g., Holter monitor): Extended ECG tracing (24 hr to weeks) may be desired to determine which dysrhythmias may be causing specific symptoms when patient is active (home/work) or at rest.
- May also be used to evaluate pacemaker function, antidysrhythmia drug effect, or effectiveness of cardiac rehabilitation.
- Signal-averaged ECG (SAE): May be used to screen high-risk patients (especially post-MI or unexplained syncope) for ventricular dysrhythmias, presence of delayed conduction, and late potentials (as occurs with sustained ventricular tachycardia).
- Chest x-ray: May show enlarged cardiac shadow due to ventricular or valvular dysfunction.
- Myocardial imaging scans: May demonstrate ischemic/damaged myocardial areas that could impede normal conduction or impair wall motion and pumping capabilities.
- Electrophysiological (EP) studies: Provides cardiac mapping of entire conduction system to evaluate normal and abnormal pathways of electrical conduction. Used to diagnose dysrhythmias and evaluate effectiveness of medication or pacemaker therapies.
- Electrolytes: Elevated or decreased levels of potassium, calcium, and magnesium can cause dysrhythmias.
- Drug screen: May reveal toxicity of cardiac drugs, presence of street drugs, or suggest interaction of drugs, e.g., digitalis and quinidine.
- Thyroid studies: Elevated or depressed serum thyroid levels can cause/aggravate dysrhythmias.
- ESR: Elevation may indicate acute/active inflammatory process, e.g., endocarditis, as a precipitating factor for dysrhythmias.
- ABGs/pulse oximetry: Hypoxemia can cause/exacerbate dysrhythmias.
- Prevent/treat life-threatening dysrhythmias.
- Support patient/SO in dealing with anxiety/fear of potentially life-threatening situation.
- Assist in identification of cause/precipitating factors.
- Review information regarding condition/prognosis/treatment regimen.
- Free of life-threatening dysrhythmias and complications of impaired cardiac output/tissue perfusion.
- Anxiety reduced/managed.
- Disease process, therapy needs, and prevention of complications understood.
- Plan in place to meet needs after discharge.