Treatment of Atrial Dysrhythmias (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now look at these pictures that we have here.

    00:03 Why have we chosen to put that big up by the patient's brain? That's to help you remember when you're studying and you're preparing for your exams.

    00:12 And for your practice, I want you to look at that graphic.

    00:15 And remember somebody with atrial fib or an atrial dysrhythmia, we want to minimize their risk of thrombo embolic stroke, lots of big old word that just means blood clot, right? And because that blood clot breaks off and causes an embolism to travel into the brain.

    00:32 We want to do everything we can to minimize the risk of them developing that type of clot.

    00:37 Now, when it comes to cardiac dysfunction, we want to get them back into normal sinus rhythm.

    00:43 Now there's multiple ways that we can accomplish both of these goals.

    00:47 So let's talk about getting them back into normal sinus rhythm.

    00:52 We can use medications or procedures.

    00:55 So medications that we're looking at treating the patient, we want to first prevent those clots, right? So there's a listing of drugs there that could be used warfarin, apixaban, rivaroxaban, you go all those medications.

    01:09 They're going to prevent the patient from making clots as easily as a patient who is not taking those medications.

    01:16 We can try medication that controls a ventricular rate like beta blockers or calcium channel blockers or digoxin that will help get a more organized heart rhythm.

    01:26 So first group of meds prevents clots.

    01:29 Second group is going to control the ventricular rate.

    01:32 Now, atrial fib, atrium might continue to fibrillate in atrial fib, but we can at least make it a little more organized.

    01:40 Now if we want to just go straight back to returning sinus rhythm, we can use amiodarone or flecainide.

    01:47 We'll cover those medications in more detail in our pharmacology course.

    01:52 Here we're just going to give you an overview of the medications that we would use.

    01:56 Now procedures.

    01:58 Oh, these are really interesting to assist in.

    02:00 We can do electrical cardioversion.

    02:03 Thank goodness, now we can just put patches on someone and step away from the patient and push the button.

    02:10 We used to have to take the paddles and put them right on the chest wall.

    02:13 And that was a lot riskier for us as a healthcare provider.

    02:17 Now for using electro cardioversion, this is a procedure that usually involves anesthesia so that we can sedate the patient watch them very closely, they're not going to go down to surgery, oftentimes, we can just use this in a room.

    02:29 But a lot of places will have an anesthesiologist there.

    02:32 In addition to a cardiologist, as we perform the electro conversion, this is not something nurses would ever do on their own.

    02:41 Now, we can ablate it.

    02:42 So we can zap it, we can cauterize the areas of the heart that are having the most difficulty.

    02:48 We can also put a little plug called an LAA occlusion.

    02:53 We'll stop blood from pooling in there, and it'll reduce the risk of clots.

    02:59 So again, our goals for PAC, they're going to be very similar.

    03:02 The goals for PAC and for all the atrial dysrhythmias, we're gonna want to encourage lifestyle changes.

    03:08 So anything that lowers cardiovascular disease risk.

    03:12 We're going to encourage them to exercise, to make healthier food choices, and be careful when you're talking to patients about this area of their personal business.

    03:21 Please don't be judgmental.

    03:23 So instead of giving them this image that they're going to have to go to a gym every day and kill themselves, encourage them to become more active.

    03:31 Okay, that's going to be the next step in becoming more active and whatever that means for them, you can help them identify it.

    03:39 Make healthier choices.

    03:41 Don't tell them don't ever eat this, and don't ever eat that and stop eating this, and tell them, "Hey, let's make some healthier choices." That will help nudge your patient into making a change that they can actually sustain instead of making them feel like a failure because they can't make instantaneous radical lifestyle changes.

    03:59 Now you want to manage their triggers.

    04:01 Now, triggers for these atrial dysrhythmias could be stress, smoking, caffeine, any of those things.

    04:09 Each patient may have a little bit different type of trigger, but help them keep a journal or some entries to know what are their known triggers.

    04:17 We can teach them the average ones.

    04:19 But also if my patient is not a smoker, then smoking is not going to be an issue for them.

    04:24 So take the time to talk to them and have listened to what they say and what is currently part of their lifestyle.

    04:33 Ask them about sleep apnea.

    04:34 Now if the patient sleeps alone, they may not know that they have sleep apnea.

    04:39 But if they sleep where someone can hear them, ask them if they've ever been told that they snore loudly or they stop breathing and then they pick up breathing again, those are periods of apnea.

    04:52 So ask them if they're aware of sleep apnea because we definitely want to treat that.

    04:56 Sleep apnea can impact cardiac function no matter what what the dysrhythmia is.

    05:02 And lastly, hypertension, right? We don't want anyone to experience hypertension because it's hard on the whole rest of the body, particularly your kidneys, in chronic hypertension that's untreated.

    05:16 Now what we're going to do to manage the heart rate, we're going to see what needs to be done for this individual patient to manage their heart rate and the overall workload.

    05:26 Because we want to restore a normal sinus rhythm, if at all possible.

    05:32 So we talked about cardioversion with conscious sedation, we talked about ablation and we talked about medications.

    05:38 So why are we talking about this again? Because spaced repetition is the way you help remember things in your brain.

    05:46 So for cardiac dysrhythmias, we talked about catheter ablation, cardioversion and medications.

    05:54 Now, wait a minute, why didn't I go left to right? That's another study strategy I want you to use, I want you to mix things up.

    06:02 And when you see a list of things, sometimes start in the middle and go up, and then all the way back down and around again.

    06:08 The more you can think about your brain, looking at a topic from multiple angles, the better mastery you're going to have of that concept.

    06:18 Now, we introduced you to cardioversion.

    06:19 Look at what we have here.

    06:21 You see the patient.

    06:22 They have the pads on them, they've got an IV line in case we need to use emergency medications, and we'll also put some type of sedation in there.

    06:31 Now you have a practitioner next to the patient is monitored.

    06:36 That's really important.

    06:37 You look at the machine down there, you see atrial fib on the strip.

    06:43 And now you see, that's where the cardiovascular shock was delivered, we put the arrow right there.

    06:49 And magically the first time this patient turns into sinus rhythm.

    06:54 Now, I wish it was this simple.

    06:57 Sometimes it is.

    06:58 But oftentimes there needs to be more than one shock, we need to look at other things.

    07:04 But this is the way we'd like it all to go.

    07:07 Now notice the title of this slide.

    07:10 Cardioversion with conscious sedation, that means the patient is kind of their arousable.

    07:16 They might be able to talk to you but they're not really aware and they will not remember this procedure.

    07:23 That's what we want for the patient.

    07:25 So this is actually what it would look like in a room if you're assisting with cardioversion with conscious sedation.

    07:33 That's why the anesthesiologist needs to be in the room so they can monitor conscious sedation and respiratory.

    07:41 Now, how do we do catheter ablation? Well, the ablation line is going to go in ablate or numb or deadened that tissue, that's gonna be as problematic with electrical conductance.

    07:53 So a catheter is going to be moved in through the veins and the heart the physician is going to guide that.

    08:00 Now you are going to be in the cath lab, right? They've got some really high tech ways to monitor the patient and the heart and for the physician to visualize that catheter moving through the heart so they can get right to the spot that they think is the problem that's causing the atrial dysrhythmia.

    08:20 Remember that LAA occlusion? Super cool, isn't it? So that's like a filter plug that stops blood from being able to pull in the left atrium appendage.

    08:32 So why are we doing this? Remember, that's the most likely spot for a patient to develop clots.

    08:39 So if we put an LAA occlusion in there, we're going to prevent blood from pooling in there.

    08:45 So we've lowered the risk of clots turning into strokes or other tissue perfusion problems.

    08:52 Atrial dysrhythmias, like atrial fibrillation can become a chronic medical condition.

    08:57 Remember, this will significantly increase a patient's risk for thrombo embolic stroke.

    09:03 So our treatment goals are to minimize the risk of developing a thromboembolic stroke through appropriate medications and procedures.

    09:11 Now, premature atrial contractions may or may not require treatment.

    09:16 Patients with PACs may have increased risk of cardiovascular events, including things like stroke, MIs or the progression to atrial fibrillation.

    09:25 Atrial flutter can be one of two things, remember those P words? Paroxysmal or in some cases persistent.

    09:33 So treatment goals, we want to minimize the risk of a thrombo embolic stroke so we can use medications and procedures to control the patient's heart rate and rhythm.

    09:44 Thank you for watching our video series.

    About the Lecture

    The lecture Treatment of Atrial Dysrhythmias (Nursing) by Rhonda Lawes, PhD, RN is from the course Analysis of Abnormal ECG Strips (Nursing).

    Included Quiz Questions

    1. Warfarin
    2. Apixaban
    3. Rivaroxaban
    4. Amiodarone
    5. Cardizem
    1. Amiodarone
    2. Cardizem
    3. Flecainide
    4. Warfarin
    5. Digoxin
    1. Increased physical activity
    2. Healthy diet
    3. Quitting smoking
    4. Increased daily caffeine intake
    5. Managing stress
    1. Electrical cardioversion
    2. Catheter ablation
    3. LAA occlusion
    4. Defibrillation
    5. Pacemaker
    1. May need treatment
    2. May not need treatment
    3. Increased risk of stroke
    4. Increased risk of myocardial infarction
    5. Requires surgery

    Author of lecture Treatment of Atrial Dysrhythmias (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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