Diseases » Arrhythmias

Pulse rhythm abnormality

Pulse rhythm abnormality: Excerpt from Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series

An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient, who complains of feeling palpitations. This important finding reflects an underlying cardiac arrhythmia, which may range from benign to life-threatening. Arrhythmias are commonly associated with cardiovascular, renal, respiratory, metabolic, and neurologic disorders as well as the effects of drugs, diagnostic tests, and treatments. (See Abnormal pulse rhythm: A clue to cardiac arrhythmias, pages 242 to 245.)

Act Now: If the patient has an abnormal pulse rhythm, quickly assess for signs of reduced cardiac output, such as a decreased level of consciousness (LOC), hypotension, or dizziness. Promptly obtain an electrocardiogram (ECG) and possibly a chest X-ray, and begin cardiac monitoring. Insert an I.V. line for administration of emergency cardiac drugs, and give oxygen by nasal cannula or mask. Closely monitor the patient’s vital signs, pulse quality, and cardiac rhythm because accompanying bradycardia or tachycardia may result in poor tolerance of the abnormal rhythm and cause further deterioration of cardiac output. Keep emergency intubation, cardioversion, and suction equipment handy.

Assessment

History

If the patient’s condition permits, ask if he’s experiencing pain. If so, ask about its onset and location. Does the pain radiate? Ask about a history of heart disease and treatments for arrhythmias. Obtain a drug history and check compliance. Also, ask about caffeine or alcohol intake. Digoxin toxicity, cessation of an antiarrhythmic, and the use of a sympathomimetic (such as epinephrine), quinidine, caffeine, cocaine, methamphetamine, or alcohol may cause arrhythmias.

Physical examination

Check the patient’s apical and peripheral arterial pulses. An apical rate exceeding a peripheral arterial rate indicates a pulse deficit, which may also cause associated signs and symptoms of low cardiac output. Evaluate heart sounds: A long pause between S₁ (lub) and S₂ (dub) may indicate a conduction defect. A faint or absent S₁ and an easily audible S₂ may indicate atrial fibrillation or flutter. You may hear the two heart sounds close together on certain beats — possibly indicating premature atrial contractions — or other variations in heart rate or rhythm. Take the patient’s apical and radial pulses while you listen for heart sounds. With some arrhythmias, such as premature ventricular contractions, you may hear the beat with your stethoscope but not feel it over the radial artery. This indicates an ineffective contraction that failed to produce a peripheral pulse. Next, count the apical pulse for 60 seconds, noting the frequency of skipped peripheral beats. Report your findings to the physician.

Pediatric pointers

Arrhythmias also produce pulse rhythm abnormalities in children.

Medical causes

Arrhythmias

An abnormal pulse rhythm may be the only sign of a cardiac arrhythmia. The patient may complain of palpitations, a fluttering heartbeat, or weak and skipped beats. Pulses may be weak and rapid or slow. Depending on the specific arrhythmia, dull chest pain or discomfort and hypotension may occur. Associated findings, if any, reflect decreased cardiac output. Neurologic findings, for example, include confusion, dizziness, light-headedness, a decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.

Nursing considerations

Be prepared to administer sedation if the patient requires cardioversion therapy. Check his vital signs frequently to detect bradycardia, tachycardia, hypertension or hypotension, tachypnea, and dyspnea. Also, monitor intake, output, and daily weight.

Collect blood samples for serum electrolyte, cardiac enzyme, and drug level studies. Prepare the patient for a chest X-ray and a 12-lead ECG. If possible, obtain a previous ECG with which to compare current findings. Prepare the patient for 24-hour Holter monitoring.

Assist the patient with ambulation, as necessary. To prevent falls and injury, raise the side rails of his bed and don’t leave him unattended while he’s sitting or walking.

If indicated, prepare the patient for transfer to a cardiac or intensive care unit.

Patient teaching

Instruct the patient to keep a diary of activities and symptoms that develop to correlate with the incidence of arrhythmias. Educate him about the importance of avoiding tobacco and caffeine, both of which increase arrhythmia. Provide information on smoking cessation programs. Discuss strategies to improve medication compliance.

Teach the patient how to take his pulse rate and advise him to notify his physician if he detects an abnormality. Explain the signs and symptoms he should report to his physician immediately as well as those necessitating immediate emergency care.

Pictures

Book Source Details

• Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

More About Arrhythmias

• Back to disease: Arrhythmias: Introduction
• Next Book Extract About Arrhythmias: Tachycardia (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

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More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

 » Next page: Tachycardia (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

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• Tachycardia (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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