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

References

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Additional Information: Dysrhythmia-Adult Table. PDF. Download[]
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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.