Evaluation or Assessment of Cardiac Arrhythmia Patient in ICU:
1. Assess for and report signs/symptoms of cardiac arrhythmias (e.g. irregular apical pulse, adult pulse rate below 60 or above 100 beats/ minute, apical- radial, pulse deficit, syncope, and palpitations).
2. Reduce cardiac workload:
- Position patient to minimizes discomfort and facilitate respiration.
- Minimize anxiety with calm reassurance and education.
- Communicate rationale for monitoring and treatments.
- Discuss the benefits calm with the patient and family.
3. Initiate EKG monitor and pulse oximetry per policy.
4. IV access, 02, medication and 12 lead-EKG as ordered monitor vital signs:
- Positive inotropic agents (e.g. dobutamine, dopamine) to increase myocardial contractility,
- Vasodilators (e.g. nitroglycerin) to decrease cardiac workload,
- ACE inhibitors (e.g. captopril, ramipril) to decrease cardiac workload,
- Diuretics for elevated capillary wedge pressure,
- Morphine sulfate to reduce pain, preload and anxiety.
5. Anticipate the need to initiate cardiopulmonary resuscitation.
6. Assess for contributing factors: pain, fluid and electrolyte imbalance, drug toxicity (especially digoxin), medication non-adherence.
7. Provide psychosocial support for patient and family members:
- If the dysrhythmia is a life-threatening type, encourage the family unit to calmly formulate a plan of action.
- Reassure the patient will receive the best care in keeping with his written directives or medical power of attorney.
- Communicate the availability and value of social services as needed.
8. Patient teaching:
- Importance of reporting chest pain, dyspnea, loss of consciousness, confusion, etc.
- Educate and prepare patient for planned treatments such as: Echo-cardiogram, Cardioversion, Pacemaker insertion, Catheter ablation, and Central Venous Catheter insertion.
What are the Investigations Required for Cardiac Arrhythmia?
The following tests may be ordered:
- Blood and urine tests: These will check the patient’s blood count and liver, thyroid, and kidney function. They may also check for electrolytes and other chemicals.
- ECG (electrocardiogram): This device records the electrical activity and rhythm of the patient’s heart.
- Holter monitor: A wearable device that records the heart for one or two days. A button can be pressed which symptoms arrive this allows the doctor to see what heart rhythms were present at that moment.
- Echocardiogram: An ultrasound scan that checks the pumping action of the patient’s heart
- Chest X-ray: The images help the doctor check the state of the patient’s heart and lungs.
- Tilt-table test: If the patient experience fainting spells, dizziness, or lightheadedness, and neither the ECG nor the Holter revealed any arrhythmias, a tilt-table test may be performed.
- Electro physiologic testing (or EP studies): An invasive, relatively painless, non- Surgical test that can help determine the type of arrhythmia, why it is happening, and how it might respond to treatment.
- Heart Catheterization: This procedure provides information on how well the heart is working. A thin, hollow tube called a catheter is inserted into a large blood vessel, usually in the groin. It is a relatively safe procedure.
Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “[email protected]”