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Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)

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Outline

Atrial Dysrhythmias

Definition/Etiology:

PCCN Focus: Identification, Cause & Treatment
Definition
- Rhythm whose impulse is generated by the Atrial, instead of the Sinus Node
- Analogy – Stone in Pond
  - If you drop a stone into one corner of a pond a neat ripple moves across the pond. In the same way, during a normal rhythm, electricity spreads smoothly from the pacemaker across the atria to the ventricles. If you drop stones randomly all over a pond you get choppy, messy waves moving in all
    directions.
Types & Etiology/Cause
- Hypoxia
- Electrolyte Disturbances
- Medications
- Injury to Myocardium
- Injury to Electrical System
- CAD/ACS

Pathophysiology:

Cardiac Conduction Pathway
- SA node (sinoatrial node)
- INTERNODAL PATHWAYS (Atria Contract)
- AV node (Delay)
- His-Purkinje Network (Ventricles COntract)
- The SA node fires another impulse and the cycle begins again.
  - Stones don’t Skip Smoothly = Makes waves
Atrial Dysrhythmia = Conducted by Internodal Pathways
- Starts in Atria

Noticing: Assessment & Recognizing Cues:

Decreased Cardiac Output
Subjective
- Chest Pain
- Weak/Fatigued/Dizzy
- SOB/dyspnea
- “Cold & Clammy”
Objective
- Vitals
  - Change in Hemodynamics
    - ↓BP, ↑HR, ↓pulses
- Heart Sounds
  - Possible Irregular S1S2 (Afib)
  - S3 = Heart Failure
- Lung Sounds
  - WET
- Other Signs/Symptoms
  - ↓Mentation
  - ↓ Urine Output

Interpreting: Analyzing & Planning:

Labs
- ABGs – Hypoxemia
- Electrolytes – Decreased KCL/MAG
- Troponin – Infarcts
- BUN/Creatinine – Renal Function
Diagnostics – Atrial TachyCardias
- ECG: Identify (Narrow QRS = above Ventricles)
  - Afib = Irregular R – R with fibrillation waves
  - Aflutter = Regular R – R with sawtooth flutter waves
  - SVT = Tachycardia (↑140) + Narrow QRS

Responding: Patient Interventions & Taking Action:

ABCs First
- Airway, O2, Heart monitor and IV
Stable vs Unstable
- Stable
  - Control Rate = Ventricular Filling
    - BB, ACE/ARBs, CCB, Digoxin, Antiarrhythmics
  - Convert Rhythm – Sedation/Cardioversion Depolarizes all cells. Resets environment so SN takes over again
    - Provider selects Joules
    - Stable = Sedation
    - Unstable = No Sedation
  - AFIB/AFLUTTER =Provide Anticoagulation
    - Avoid Embolic Stroke
- Unstable
  - Cardioversion FIRST
  - Meds come second

Reflecting: Evaluating Patient Outcomes:

Patient Stable?
- Control Rate
- Convert Rhythm
- Monitor for signs of ↑ Cardiac Output
  - Chest Pain resolved
  - Vital Stable
  - Good Mentation
  - Heart/Lung Sounds Normal

Linchpins (Key Points):

Notice
- Assessing signs of ↓ Cardiac Output
Interpret
- ECG -AFIB, AFLUTTER, SVT
Respond
- Treating underlying cause
- Pharm & Convert Rhythm
Reflect
- Symptom free. Remain in Stable Rhythm

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Transcript

References

AACN, & Hartjes, T. (2022). AACN Core Curriculum for Progressive and Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
Hafeez, Y., Rodriguez, B. S. Q., Ahmed, I., Grossman, S. A., & Haddad, L. M. (2021). Paroxysmal Supraventricular Tachycardia (Nursing). In StatPearls [Internet]. StatPearls Publishing.
Knippa, S., Rauen, C. A., Boyd, T. A., & Rader, C. (2018). Batter Up. Critical Care Nurse, 38(4), 68-72.

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Progressive Care Certified Nurse (PCCN)

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