Pulse rhythm abnormality

Pulse rhythm abnormality: Excerpt from Nursing: Interpreting Signs and Symptoms

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 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 506 to 509.)

Action stat!

If you detect an abnormal pulse rhythm, 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. catheter for administration of emergency cardiac drugs and fluids, 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 deterioration of cardiac output. Keep emergency intubation, cardioversion, defibrillation, and suction equipment handy.

History and physical examination

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

Next, 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. Place the patient on a cardiac monitor and obtain an ECG to evaluate the cardiac rhythm. Report your findings to the practitioner.

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, decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.

Nursing considerations

▪ 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.

Book Source Details

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

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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