Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
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.
- 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
- 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
- Change in Hemodynamics
- Heart Sounds
- Possible Irregular S1S2 (Afib)
- S3 = Heart Failure
- Lung Sounds
- WET
- Other Signs/Symptoms
- ↓Mentation
- ↓ Urine Output
- Vitals
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
- ECG: Identify (Narrow QRS = above Ventricles)
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
- Control Rate = Ventricular Filling
- Unstable
- Cardioversion FIRST
- Meds come second
- Stable
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
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.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
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- Shock
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- Disorders of the Thyroid & Parathyroid Glands
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- Prioritization
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