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Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)

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Outline

Ventricular Dysrhythmias

Definition/Etiology:

PCCN Focus: Identification, Cause & Treatment
Definition
- Rhythm whose impulse is generated by the Ventricles, instead of the Sinus Node
- Analogy – Stone in Pond
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.
Ventricular Dysrhythmia
- Ventricles
  - A good analogy for this is the movement of water in a 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.

Noticing: Assessment & Recognizing Cues:

Decreased Cardiac Output
Subjective
- Unresponsive
Objective
- Vitals
  - N/A
- Heart Sounds
  - NONE – Not Beating
- Lung Sounds
  - NONE – Not Breathing

Interpreting: Analyzing & Planning:

Labs – Drawn quickly when calling RR/CB
- ABGs – Hypoxemia
- Electrolytes – Decreased KCL/MAG
- Troponin – Infarcts
- BUN/Creatinine – Renal Function
Diagnostics
- ECG: (Most are wide and irregular)
  - VTach – Pulse vs No Pulse
    - Three or Wide & Irreg beats same shape
  - Torsades
    - Appears like Vtach except QRS twists around baseline
  - Vfib
    - Fibrillation waves with NO QRS
  - Asystole
    - Flatline

Responding: Patient Interventions & Taking Action:

Rapid Response vs Code Blue
ABCs First
- Airway, O2, Heart Monitor and IV
Pathways
- Vtach + Pulse = Atrial Dysrhythmia Algorithm
  - Rate Control + Cardioversion (Sync Button)
- Vtach – Pulse/Vfib/Torsades
  - Assess ABCs
  - CPR
  - Defibrillation
    - 120-200J biphasic
    - 360J monophasic
  - Epinephrine
  - Defib → Amiodarone
- Asystole
  - CPR + Meds Only
  - NO Defibrillation
    - alt-ctl-del for the heart. If there is no power, that won’t work.

Reflecting: Evaluating Patient Outcomes:

ECG Interpretation =Identify underlying cause!
Algorhythm
Monitor for signs of ↑ Cardiac Output
- Rhythm stabilized
- Vitals Stable
- Good Mentation
- Heart/Lung Sounds Normal

Linchpins (Key Points):

Notice
- Assessing signs of ↓ Cardiac Output
Interpret
- ECG
Respond
- Treating underlying cause
- NO pulse = Immediate CRP
- Follow Pathways
Reflect
- Return 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).
Gopinathannair, R., Cornwell, W. K., Dukes, J. W., Ellis, C. R., Hickey, K. T., Joglar, J. A., … & American Heart Association Electrocardiography and Arrhythmias Committee; Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing. (2019). Device therapy and arrhythmia management in left ventricular assist device recipients: a scientific statement from the American Heart Association. Circulation, 139(20), e967-e989.

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Progressive Care Certified Nurse (PCCN)

Course Lessons

Cardiovascular

Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)

Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)

Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)

Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)

Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)

Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)

Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)

Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)

AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)

Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)

Minimally-Invasive Cardiac Surgery (Non-Sternal Approach) for Progressive Care Certified Nurse (PCCN)

Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)

Vascular Disease for Progressive Care Certified Nurse (PCCN)

Pulmonary

Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)

Asthma (Severe) for Progressive Care Certified Nurse (PCCN)

COPD Exacerbation for Progressive Care Certified Nurse (PCCN)

Minimally-Invasive Thoracic Surgery (VATS) for Progressive Care Certified Nurse (PCCN)

Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)

Pleural Space Complications (Pneumothorax, Hemothorax, Pleural Effusion, Empyema, Chylothorax) for Progressive Care Certified Nurse (PCCN)

Pulmonary Embolism for Progressive Care Certified Nurse (PCCN)

Pulmonary Hypertension for Progressive Care Certified Nurse (PCCN)

Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)

Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)

Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)

Thoracic Surgery (Lobectomy, Pneumonectomy) for Progressive Care Certified Nurse (PCCN)

Endocrine/Hematology/Neurology/Gastrointestinal/Renal

Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)

Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)

Hyperglycemia for Progressive Care Certified Nurse (PCCN)

Hypoglycemia for Progressive Care Certified Nurse (PCCN)

Anemia for Progressive Care Certified Nurse (PCCN)

Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)

Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)

Seizure Disorder for Progressive Care Certified Nurse (PCCN)

Stroke for Progressive Care Certified Nurse (PCCN)

Functional GI Disorders (Obstruction, Ileus, Diabetic Gastroparesis, Gastroesophageal Reflux, Irritable Bowel Syndrome) for Progressive Care Certified Nurse (PCCN)

GI Bleed (Upper, Lower) for Progressive Care Certified Nurse (PCCN)

GI Infections (C. difficile) for Progressive Care Certified Nurse (PCCN)

GI Surgeries (Resections, Esophagogastrectomy, Bariatric) for Progressive Care Certified Nurse (PCCN)

Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)

Ischemic Bowel for Progressive Care Certified Nurse (PCCN)

Malnutrition (Failure to Thrive, Malabsorption Disorders) for Progressive Care Certified Nurse (PCCN)

Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)

Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)

Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)

End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)

Musculoskeletal/Multisystem/Psychosocial

Functional Issues (Immobility, Falls, Gait Disorders) for Progressive Care Certified Nurse (PCCN)

End of Life for Progressive Care Certified Nurse (PCCN)

Healthcare-Acquired Infections: Catheter-Associated Bloodstream Infections (CAUTI) for Progressive Care Certified Nurse (PCCN)

Healthcare-Acquired Infections: Central-Line-Associated Infections (CLABSI) for Progressive Care Certified Nurse (PCCN)

Healthcare-Acquired Infections: Surgical Site Infections (SSI) for Progressive Care Certified Nurse (PCCN)

Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)

Infectious Diseases: Multidrug-Resistant Organisms (MRSA, VRE, CRE, ESBL) for Progressive Care Certified Nurse (PCCN)

Pain (Acute, Chronic) for Progressive Care Certified Nurse (PCCN)

Palliative Care for Progressive Care Certified Nurse (PCCN)

Pressure Injuries (Ulcers) for Progressive Care Certified Nurse (PCCN)

Rhabdomyolysis for Progressive Care Certified Nurse (PCCN)

Sepsis for Progressive Care Certified Nurse (PCCN)

Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)

Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)

Wounds (Infectious, Surgical, Trauma) for Progressive Care Certified Nurse (PCCN)

Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)

Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)

Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)

Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)

Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)

Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)

Professional Caring and Ethical Practice

Advocacy & Moral Judgement for Progressive Care Certified Nurse (PCCN)

Caring Practices for Progressive Care Certified Nurse (PCCN)

Response to Diversity for Progressive Care Certified Nurse (PCCN)

Facilitation of Learning for Progressive Care Certified Nurse (PCCN)

Collaboration for Progressive Care Certified Nurse (PCCN)

Systems Thinking for Progressive Care Certified Nurse (PCCN)

Clinical Inquiry for Progressive Care Certified Nurse (PCCN)