The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Bradycardia may include:
Research quality ratings and patient incidents/safety measures
for hospitals and medical facilities in specialties related to Bradycardia:
Stabilize the patient with attention to ABCs
- If bradycardia is symptomatic or life threatening, consider using:
–Epinephrine: 0.01 mg/kg (maximum: 10 mL/dose) every 3–5 minutes IV, IO; or 0.1 mg/kg (0.1 mL; 1:1,000)/kg/dose ET
–Atropine 0.01–0.03 mg/kg/dose every 5 minutes prn via IV, endotracheal, or interosseous
-
Keep the patient in a monitored setting when appropriate (heart monitor to follow the bradycardia)
-
Treat the underlying cause when possible: Stop causative medications; treat sepsis, hypothermia, increased intracranial pressure, and electrolyte abnormalities emergently; intensive therapy for eating disorders; synthroid for hypothyroidism
-
Cardiac surgery for CHD may not resolve arrhythmias
-
Cardiac pacing (transcutaneous or implanted may be needed)
'>>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Pulse rhythm abnormality:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
Quickly look 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, defibrillation, and suction equipment handy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pulsus paradoxus:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
Pulsus paradoxus may signal cardiac tamponade — a life-threatening complication of pericardial effusion that occurs when sufficient blood or fluid accumulates to compress the heart. When you detect pulsus paradoxus, quickly take the patient’s other vital signs. Check for additional signs and symptoms of cardiac tamponade, such as dyspnea, tachypnea, diaphoresis, jugular vein distention, tachycardia, narrowed pulse pressure, and hypotension. Emergency pericardiocentesis to aspirate blood or fluid from the pericardial sac may be necessary. Then evaluate the effectiveness of pericardiocentesis by measuring the degree of pulsus paradoxus; it should decrease after aspiration.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Murmurs:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Instruct the patient to contact his physician before undergoing invasive procedures or dental work because prophylactic antibiotics may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pulse rhythm abnormality:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Quickly look for signs of reduced cardiac output, such as 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 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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pulsus paradoxus:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
A pulsus paradoxus may signal cardiac tamponade—a life-threatening complication of pericardial effusion that occurs when sufficient blood or fluid accumulates to compress the heart. When you detect pulsus paradoxus, quickly check the patient’s other vital signs. Check for additional signs and symptoms of cardiac tamponade, such as dyspnea, tachypnea, diaphoresis, jugular vein distention, tachycardia, narrowed pulse pressure, and hypotension. Emergency pericardiocentesis to aspirate blood or fluid from the pericardial sac may be necessary. Then evaluate the effectiveness of pericardiocentesis by measuring the degree of pulsus paradoxus; it should decrease after aspiration.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Murmurs:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Prepare the patient for diagnostic tests, such as electrocardiography, echocardiography, and angiography. Administer an antibiotic and an anticoagulant as appropriate. Because any cardiac abnormality is frightening to the patient, provide emotional support.
Patient teaching
Instruct the patient to contact his physician before undergoing invasive procedures or dental work because prophylactic antibiotics may be necessary. Explain the signs and symptoms the patient should report.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Pulse rhythm abnormality:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bradycardia:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Continue to monitor the patient’s vital signs frequently. Stay especially alert for changes in his cardiac rhythm, respiratory rate, and LOC.
Prepare the patient for laboratory tests, which can include complete blood count; cardiac enzyme, serum electrolyte, blood glucose, blood urea nitrogen, arterial blood gas, and blood drug levels; thyroid function tests; and a 12-lead electrocardiogram. If appropriate, prepare the patient for 24-hour Holter monitoring.
Patient teaching
Explain all tests and procedures to the patient and his family. Explain the need for cardiac monitoring and common alarms that may be heard. Teach the patient and his family how to take a radial pulse.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Pulsus paradoxus [Paradoxical pulse]:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Prepare the patient for an echocardiogram to visualize cardiac motion and help determine the causative disorder. If a pulmonary embolus is suspected, prepare the patient for a ventilation/perfusion scan. A helical CT scan of the chest or pulmonary arteriogram may also be indicated. Also, monitor his vital signs and frequently check the degree of paradox. An increase in the degree of paradox may indicate recurring or worsening cardiac tamponade or impending respiratory arrest in severe COPD. Vigorous respiratory treatment, such as chest physiotherapy, may avert the need for endotracheal intubation.
Patient teaching
Provide information about the disorder and symptoms to immediately report to the physician. Teach the patient techniques to conserve energy and decrease oxygen demands on the body. Provide information on diagnostic tests and treatment for pulsus paradoxus, including probable oxygen therapy.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Pulse, absent or weak:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient how to check his pulse. Advise him to call his health care provider if he has difficulty palpating or is unable to palpate a pulse. Explain the importance of following a low-sodium diet and maintaining fluid restrictions, if necessary. Discuss signs and symptoms of fluid overload to report to the health care provider. Teach the patient to avoid activities that reduce circulation, such as prolonged sitting and crossing the legs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Murmurs:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Although not usually a sign of an emergency, murmurs — especially newly developed ones — may signal a serious complication in patients with bacterial endocarditis or a recent acute MI. When caring for a patient with known or suspected bacterial endocarditis, carefully auscultate for any new murmurs. Their development along with crackles, distended jugular veins, orthopnea, and dyspnea may signal heart failure.
Regular auscultation is also important in a patient who has experienced an acute MI. A loud decrescendo holosystolic murmur at the apex that radiates to the axilla and left sternal border or throughout the chest is significant, particularly in association with a widely split S2 and an atrial gallop (S4). This murmur, when accompanied by signs of acute pulmonary edema, usually indicates the development of acute mitral insufficiency due to rupture of the chordae tendineae — a medical emergency.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse rhythm abnormality:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Quickly look for signs of reduced cardiac output, such as 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 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.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulsus paradoxus:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
A pulsus paradoxus may signal cardiac tamponade — a life-threatening complication of pericardial effusion that occurs when sufficient blood or fluid accumulates to compress the heart. When you detect pulsus paradoxus, quickly take the patient’s other vital signs. Check for additional signs and symptoms of cardiac tamponade, such as dyspnea, tachypnea, diaphoresis, jugular vein distention, tachycardia, narrowed pulse pressure, and hypotension. Emergency pericardiocentesis to aspirate blood or fluid from the pericardial sac may be necessary. Then evaluate the effectiveness of pericardiocentesis by measuring the degree of pulsus paradoxus; it should decrease after aspiration.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bradycardia:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Discuss signs and symptoms to report, such as light-headedness or syncope. Teach the patient to take his pulse and make sure he knows parameters for calling the physician and seeking emergency care. If the patient had a pacemaker inserted, provide instructions for its use.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse, absent or weak:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs to detect untoward changes in his condition.
▪ Monitor weight, intake and output, and central venous pressure.
▪ Monitor pulses and limb appearances.
Patient teaching
▪ Explain the signs and symptoms that require medical attention.
▪ Discuss activities to avoid that reduce circulation.
▪ Explain the underlying disorder and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Murmurs:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, such as electrocardiography, echocardiography, and angiography.
▪ Administer an antibiotic and an anticoagulant as appropriate.
▪ Because a cardiac abnormality is frightening to the patient, provide emotional support.
▪ Monitor the patient's heart rhythm and vital signs.
Patient teaching
▪ Explain the use of prophylactic antibiotics.
▪ Explain signs and symptoms that require prompt medical attention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pulse rhythm abnormality:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor cardiac rhythm and obtain a 12-lead ECG.
▪ Prepare the patient for cardioversion, if indicated .
▪ Check vital signs frequently to detect hypertension or hypotension, tachypnea, and dyspnea. Also, monitor intake, output, daily weight, and pulse oximetry.
▪ Collect blood samples for serum electrolyte, cardiac markers, complete blood count, and drug level studies. Prepare the patient for a chest X-ray.
▪ Obtain a previous ECG with which to compare current findings.
Patient teaching
▪ Explain the importance of keeping a diary of activities and any symptoms that develop to correlate with the incidence of arrhythmias.
▪ Instruct the patient to avoid tobacco and caffeine.
▪ Teach the patient how to take his pulse.
▪ Reinforce signs and symptoms that require prompt medical attention.
▪ Explain the underlying disorder and treatment plan.
▪ Teach the patient about prescribed medications, including dosage, administration, and possible adverse effects.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pulsus paradoxus:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for an echocardiogram to visualize cardiac motion and to help determine the causative disorder.
▪ Monitor vital signs and frequently check the degree of paradox because an increase in the degree of paradox may indicate recurring or worsening cardiac tamponade or impending respiratory arrest in severe COPD.
▪ Provide respiratory treatments, such as chest physiotherapy, to avert the need for endotracheal intubation.
Patient teaching
▪ Teach the patient about the underlying disorder and its treatments.
▪ Explain self-care techniques to the patient with COPD, such as pursed-lip, diaphragmatic breathing; coughing and deep-breathing exercises; and proper use of home oxygen equipment.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Bradycardia:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs, cardiac rhythm, and level of consciousness frequently.
▪ Prepare the patient for laboratory tests, such as complete blood count; cardiac markers, serum electrolyte, blood glucose, blood urea nitrogen, arterial blood gas, and blood drug levels; and thyroid function tests.
▪ Prepare the patient for a 12-lead electrocardiogram and possibly 24-hour Holter monitoring.
Patient teaching
▪ Inform the patient about signs and symptoms he should report.
▪ Teach him to take his pulse as well as the parameters for calling the practitioner or seeking emergency care.
▪ Provide instructions for care of a permanent pacemaker, if appropriate.
▪ Teach the patient about the cause of his bradycardia and the treatment plan after a diagnosis is established.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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» Next page: Alternative Treatments for Bradycardia
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