Before trying to figure out how to help your dysrhythmic patient, take a step back and make sure that you’ve understood the following:
If you’ve already been through those topics, then great let’s have a look at how we can care for patients with dysrhythmias.
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When it comes to patients with dysrhythmias, you’re more likely to meet them in a walk-in clinic or A&E setting. However, you might still get in-patients who call for your assistance because they fell “their heart is racing”, the feel a “tight chest” or they feel dizzy.
Always start off your nursing care by properly introducing yourself and your role, this will help towards building a good relationship with your patient. From there, you can go ahead and start assessing the patient.
Nursing Patients with Dysrhythmias: Assessment
Begin by taking a detailed health history of your patient to identify any previous occurrences of decreased cardiac output. These episodes might have previously presented themselves as
Syncope or fainting
Lightheadedness
Dizziness
Fatigue
Chest discomfort
Palpitations
Look out for any possible causes such as previously diagnosed heart disease or COPD, regular medication, herbs or supplements. If the patient is already on anti-arrhythmic medication assess the treatment adherence, side effects, adverse reactions and potential contraindications.
Ps. Keep in mind that certain medications such as Digoxin, might cause an Arrythmia.
While you’re questioning the patient, look out for signs of anxiety, stress or psychosocial issues that might be contributing to the dysrhythmia. Once you’re done, you should conduct a thorough physical assessment. This will help you to confirm the data you’ve just collected from the patient, as well as identify any signs of diminished cardiac output.
To start your physical assessment, ask your patient to lay down onto the bed, chest facing up, hands by the side and legs uncrossed. If your patient can not tolerate laying flat, you can opt to raise the back of the bed or use an armchair to facilitate an upright position. Next, record the vital signs including:
Respiration
Oxygen Saturation
Blood Pressure
Apical and Peripheral Pulses
Level of Consciousness
If your patient has reduced cardiac output, you’d expect to notice a weak pulse and a decrease in pulse pressure.
After documenting all of the values, assess the patient’s skin and identify any signs of pale, cool and clammy areas. Look out for signs of fluid retention such as neck vein distention, crackles in the chest and wheezing when auscultating the lungs. You should also auscultate to check for heart murmurs and extra heart sounds particularly S3 and S4. Lastly, check if the doctor has ordered any additional blood tests or if your patient requires an ECG test. Once you’ve completed the assessment you can move on to figure out your nursing diagnosis.
Keep in mind that one assessment might not reveal all the problems, so regular nursing assessments are necessary.
Nursing Patients with Dysrhythmias: Diagnosis
Every patient is different, and the nursing diagnosis must be altered to each individual. However, most patients with dysrhythmias will have the following:
Decreased cardiac output
Anxiety related to fear of the unknown
Deficient knowledge about the dysrhythmia and it’s treatment
Along with the nursing diagnosis, some patient might have additional complications including:
Cardiac arrest
Heart failure
Thromboembolic event
Nursing Patients with Dysrhythmias: Planning and Goals
You focus as a nurse should be to treat your patient holistically by taking all aspects of care into consideration. Your goals should include:
Decreasing the frequency and possibility eliminating the recurrence of a dysrhythmia episode to maintain a sufficient cardiac output.
Carrying out any diagnostic tests, and regular nursing assessments
Administering the prescribed treatment
Reducing anxiety
Educating the patient about dysrhythmia and it’s treatment
Developing a discharge plan that allows the patient to self-manage the condition.
Nursing Patients with Dysrhythmias: Nursing Interventions
1. Monitoring and Managing the Dysrhythmia
Similar to the initial assessment upon arrival, the vital signs, breath sounds and ECG are to be checked regularly to determine the dysrhythmia’s haemodynamic effect. When analysing the ECG strips, you should check for any changes that might increase the risk of having another dysthymic episode. These changes might include, widening of QRS, prolongation of the QT interval or an increased heart rate.
Ask your patient about any episodes of lightheadedness, dizziness or fainting, both when resting and when walking short distances. Note any factors that might contribute to the dysrhythmia such as decreased oxygen saturation, electrolyte and acid-base imbalance, a high caffeine intake or non-adherence to medications.
Ensure that you administer the correct anti-arrhythmic medication that has been prescribed by the medical team.
2. Minimizing Anxiety
In many cases, people experience anxiety because they feel like they have no control over the situation. Hence, as a nurse you should focus on maintaining a calm and reassuring environment.
If your patient is experiencing an episode of dysrhythmia, you should accompany them into a calm area and using a calm tone of voice, reassure them that they are safe under your care. Guide your patient to the nearest chair or bed, and instruct them to focus taking in slow and deep breaths.
Along with fostering a trusting therapeutic relationship, you’ll be reducing the patient’s sympathetic response to the incident and in turn reducing anxiety. Ask your patients to verbalise their feelings and fears, and encourage them to voice their concerns. Empathise with your patient, and try to see things from their perspective to better understand their emotions. Then you can help them to identify their trigger points, anger or sadness that might be worsening their episode. Make sure to explain what you’re doing while you’re administering treatment and continuously emphasize that the situation is getting better.
Once the dysrhythmia episode is over, help your patient to create a system to prevent future recurrences and teach them how to identify the alleviating factors. You can even suggest using a diary to record the instances when a dysrhythmia episode occurs, and the use of relaxing sounds, music or imagery to avoid any future episodes.
Nursing Patients with Dysrhythmias: Educating the Patient
Before you can educate a patient, you need to understand what level of knowledge they have and what approach works best for them. While some might be fine with simply discussing the topic, others might need to use resources such as videos or leaflets. Moreover, including a family member or friend in the discussion will make it feel less formal.
Start off by giving an explanation of dysrhythmias, why they occur and what is happening to their body when they experience an episode. Make sure to use easy words that don’t sound frightening or threatening, and take note of their facial expressions while you’re talking. If you notice that they are uncomfortable or confused, take a break and go over the topic again.
Explain in detail the treatment options, the importance of adhering to anti-arrhythmic medications and any expected side effects or scheduled follow-ups. You should also explain the risks if the dysrhythmia is left untreated, including the possibility to progress to more life-threatening conditions.
Nursing Patients with Dysrhythmias: Evaluation & Discharge
Before discharging your patient, ensure that the following are in order:
Patient’s vital signs are within normal range (This indicates that they are maintaining the cardiac output)
The frequency of dysrhythmia episodes have decreased
Anxiety and stress levels are under control
Understands their diagnosis, it’s implications and the necessary treatment regimen
Contact information for emergency situations, or routine follow-ups given
Bam! Now you know how to care for patients with dysrhythmias, next up: Pacemaker Therapy
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