Assessment of the Dysrhythmic Patient

 

Assessment Focus Areas:

  1. Etiology
  • diminished oxygenation produces signs and symptoms associated with dysrhythmias
  1. Effect on cardiac output

 

  • Impaired cardiac output reduces gas exchange to vital tissues and organs.

 

Patient History:

Identifies previous occurrences of decreased cardiac output such as

  1. syncope
  2. light-headedness
  3. dizziness
  4. fatigue
  5. chest discomfort
  6. palpitations

 

Co-existing conditions may also cause dysrhythmias:

  1. heart disease
  2. chronic obstructive pulmonary disease

 

Medications may cause dysrhythmias:

  1. digoxin

anxiety may be a contributing factor to dysrhythmias

Assessment of dysrhythmic event – be attentive to changes such as loss of consciousness

Skin:assessment

  • pale and cool

Fluid retention assessment

  • neck vein distention
  • crackles and wheezes upon lung auscultation

 

Pulse assessment

  1. rate
  2. rhythm
  • apical and peripheral pulses
  • pulses deficits are noted
  • heart sound auscultation – note presence of S3 or S4
  • declining pulse pressure is indicative of reduced cardiac output
  • for this reason multiple assessment findings are compared over time

 Day et al. 2010. Textbook of Canadian Medical-Surgical Nursing. 2nd ed. Lippincott, Williams and Wilkins. Philadelphia.

 

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