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Dysrhythmias and Lesser Vascular Disorders
- Dysrhythmias
- Definition: disturbance in heart rateor rhythm
- Types of dysrhythmia
- supraventricular: sinus, atrial, and junctional
- sinus tachycardia
- sinus bradycardia
- sinus arrhythmia
- premature atrial complexes
- atrial tachycardia
- atrial flutter
- atrial fibrillation
- premature junctional complex
- junctional tachycardia
- sinus tachycardia
- ventricular
- premature ventricular contraction
- ventricular tachycardia
- ventricular fibrillation
- asystole
- atrioventricular block:
- first degree A-V block (no treatment)
- second degree A-V block (no treatment)
- third degree A-V block
- premature ventricular contraction
- Nursing interventions
- supraventricular dysrhythmias
- asymptomatic - no nursing interventions indicated
- symptomatic
- administer medications as ordered
- provide emotional support
- teach client
- medications and side effects
- to wear dysrhythmia identification jewelry
- medications and side effects
- administer medications as ordered
- asymptomatic - no nursing interventions indicated
- ventricular dysrhythmias
- administer medications as ordered
- monitor
- monitor hemodynamic indicators as ordered
- administer oxygen as ordered
- provide a restful environment
- prepare the client for cardioversion
- initiate cardiopulmonary resuscitationas indicated
- provide emotional support
- teach client
- medications and side effects
- importance of dysrhythmia identification jewelry
- medications and side effects
- administer medications as ordered
- atrio-ventricular (AV) conduction disturbances
- asymptomatic: no nursing interventions indicated
- symptomatic
- administer medications as ordered
- prepare client for pacemaker insertion
- care of the client undergoing surgery
- provide emotional support
- provide a restful environment
- administer medications as ordered
- asymptomatic: no nursing interventions indicated
- supraventricular dysrhythmias
- supraventricular: sinus, atrial, and junctional
- Definition: disturbance in heart rateor rhythm
- Dysrhythmias
- Aneurysms
- Definition, four types, two locations
- dilation of an artery due to a weakness in the arterial wall
- four types of aneurysms
- saccular: outpouching of one wall in a circumscribed area
- fusiform: involves complete circumference of artery
- dissecting: accumulation of blood separating the layers of the arterial wall
- pseudoaneurysm: tear of the full thickness of the arterial wall, leading to a collection of blood contained in the connective tissue
- two locations: abdominal aorta and thoracic aorta
- location one: abdominal aortic aneurysm
- findings of abdominal aortic aneurysm
- usually asymptomatic
- vague abdominal or back pain
- tenderness on palpation
- hypotension
- diminished pulses in lower extremities
- commonest site: just below renal arteries and above iliac arteries
- treatment - surgical repair
- nursing interventions
- care of the client undergoing surgery
- after surgery, watch for back pain, a sign of retroperitoneal hemorrhage
- monitor perfusion
- provide comfort measures
- provide emotional support
- teach client - to avoid prolonged sitting and lifting of heavy objects
- location two: thoracic aortic aneurysm
- findings of thoracic aortic aneurysm
- may be asymptomatic
- vague chest pain
- dyspnea
- distended neck veins
- management - surgical repair
- nursing interventions
- care of the client undergoing surgery
- care of the client undergoing cardiac surgery
- Etiology - atherosclerosis
- Arterial occlusive disease
- Definition: insufficient blood supply in the arteries; usually in legs.
may be acute or chronic. - Acute arterial occlusive disease
- etiology
- embolism, thrombosis, and trauma(illustration 1
- femoral arterymost often affected
- findings
- pain in affected limb
- cyanosisin affected limb
- paresthesiain affected limb
- if untreated, gangrene
- management
- pharmacology
- surgical treatment
- embolectomy
- bypassof affected artery (illustration
- amputation of limb
- percutaneous transluminal coronary angioplasty
- Chronic arterial occlusive disease
- etiology
- arteriosclerosis obliterans, aneurysms, hypercoagulabilitystates, tobacco use
- slow, progressive arteriosclerotic changes give collateral circulationa chance to form
- collateral circulationcannot give tissues enough oxygen; result is hypoperfusion
- hypoperfusion leads to ischemia
- usually affects legs
- findings
- intermittent claudicationindicates mild to moderate obstruction
- pain at rest indicates severe obstruction
- affected limb will show
- edema
- paresthesia
- weak or absent pulses
- skin: waxy, hairless, cool, pale, cyanotic
- in men, impotence
- management
- pharmacologic
- anticoagulants
- vasodilators
- antiplateletdrugs - to prevent platelet aggregation
- pentoxifylline (Trental): increases blood flow by thinning blood
- surgical treatment
- endarterectomy
- femoral-popliteal bypass (illustration
- sympathectomy
- amputation of affected limb for gangrene
- laser coronary angioplasty(LTA)
- peripheral angioplasty
- Both acute and chronic arterial occlusive disease
