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Careplan

Dysrhythmia - Adult

Nov.18.2020

Dysrhythmia (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing an abnormal cardiac rhythm which may be either sinus or ectopic in origin and either regular or irregular.

Key Information

  • Dysrhythmia may be the result of a disturbance in impulse formation, conduction or both.
  • There is an increased risk for abnormal rhythm during the first few days following initiation of a new antidysrhythmic medication.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Normalized Cardiac Rhythm

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Dysrhythmia

Signs/Symptoms/Presentation

  • activity intolerance
  • anxiety
  • chest pain
  • crackles in lungs
  • dizziness
  • dyspnea on exertion
  • fatigue
  • heart sounds abnormal
  • level of consciousness altered
  • pallor
  • palpitations
  • pulse amplitude labile
  • pulse rate irregular
  • pulse strength decreased or absent
  • restlessness
  • seizure activity
  • shortness of breath
  • skin cool
  • syncope
  • urinary output decreased
  • weakness

Vital Signs

  • heart rate increased or decreased
  • respiratory rate increased or decreased
  • blood pressure increased or decreased
  • SpO2 (peripheral oxygen saturation) decreased

Laboratory Values

  • PaO2 (partial pressure of arterial oxygen) decreased
  • serum calcium abnormal
  • serum drug level elevated
  • serum magnesium abnormal
  • serum potassium abnormal

Diagnostic Results

  • ECG (electrocardiogram) abnormal
  • electrophysiology study abnormal
  • exercise stress test abnormal

Hemodynamic Values

  • cardiac index decreased
  • cardiac output decreased
  • stroke volume decreased

Problem Intervention

Monitor and Manage Cardiac Rhythm Effect

  • Monitor electrocardiogram closely for rate and rhythm changes; evaluate response to treatment.
  • Recognize elevated risk for VTE (venous thromboembolism); implement prophylaxis.
  • Anticipate administration of pharmacologic therapy to prevent or manage dysrhythmia, such as an antidysrhythmic agent, electrolyte replacement or binding agent.
  • If hypotensive, lower head of bed to enhance cerebral blood flow.
  • Provide oxygen therapy judiciously to avoid hyperoxemia; adjust to achieve oxygenation goal.
  • Promote comfort to prevent dysrhythmia triggered by increased sympathetic tone; consider pharmacologic and nonpharmacologic strategies (e.g., calm environment, rest, stress-reduction).
  • Anticipate need for additional therapy, such as cardioversion or cardiac rhythm management device, to improve perfusion and hemodynamic stability.
  • Initiate emergency protocol if life-threatening rhythm disturbance occurs.
  • Acknowledge fear and anxiety; encourage questions; provide support and information.

Associated Documentation

  • Dysrhythmia Management
  • Stabilization Measures
  • VTE Prevention/Management

Education

CPG-Specific Education Topics

Overview

  • description

  • signs/symptoms

Self Management

  • activity

  • CPR education

  • fluid/food intake

  • inform healthcare team

  • provider follow-up

  • pulse monitoring

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

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Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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