Ingestion of cold fluids: related to onset of arrhythmias?

Although the results of this study provide too limited a database for establishing definitive guidelines for practice, they underscore the need for critical care nurses to focus observations on patients' responses to iced fluid restriction. It is important to determine whether and to what extent limiting ingestion of iced fluids induces patient stress, a factor that alone can create physiologic conditions conductive to the occurrence of arrhythmias. Further, in view of the importance of maintaining fluid balance in cardiac patients, it would also be of interest to learn whether iced fluid restriction significantly alters fluid intake. Observations that derive from clinical practice, such as those described above, can stimulate and guide future research designed to evaluate more extensively the efficacy of this coronary precaution.

Hospital-based transtelephonic arrhythmia surveillance

Significant numbers of persons who have cardiac arrhythmias are living in the community following diagnosis and/or hospitalization of their potentially life-threatening condition. Living with these adjustments in life-style offers challenges to these patients and families. These authors describe an arrhythmia surveillance developed to link the patient with outpatient cardiac monitoring, diagnostic information, and patient education.

Antitachycardia pacing with cardioverter-defibrillator backup for malignant ventricular dysrhythmias

This article provides a summary of the history of antitachydysrhythmic devices and their current application in patients with ventricular dysrhythmias. Future trends are also discussed, followed by a case study illustrating the nursing care required for a patient with a combination antitachycardia pacemaker and automatic implantable cardioverter-defibrillator for slow ventricular tachycardia. The basic principles provided can be incorporated into the teaching plans of patients with antidysrhythmic devices for malignant ventricular dysrhythmias.

A practical approach to teaching the automatic implantable cardioverter-defibrillator patient

An implantable defibrillator is a surgically implanted device capable of continuously monitoring the patient's heart rhythm and automatically delivering a cardioverting or defibrillating shock to the heart. This article describes one approach to teaching the implanted defibrillator patient. Preoperative, postoperative, and discharge teaching goals and content are discussed. A case study illustrates the need for contact with the emergency medical system.

Cryoablation for refractory ventricular dysrhythmias

Several of the surgical ablative techniques currently used to treat patients with medically refractory ventricular dysrhythmias are performed in combination with cryosurgery. By inducing hypothermic injury, cryosurgery destroys the muscle responsible for the ventricular ectopy without disrupting the structural integrity of the heart. The use of this procedure in treating these patients, however, without adjunctive surgical techniques is uncommon. This case study describes the successful use of cryosurgery without concomitant surgical ablative techniques.

Nursing care for patients with implantable defibrillators

Patients with implantable defibrillators are a new patient population that presents challenging issues and concerns. The size of this population will increase as the device's availability increases and design improvements are made that widen its applicability. These protocols have evolved during our first year with these patients and will doubtless change as we accrue experience in assisting patients to assume the role of being their own most important healthcare manager.

Second generation antidysrhythmic agents

Several new antidysrhythmic agents have been or are about to be approved for the prevention and/or treatment of life-threatening or symptomatic ventricular arrhythmias. Prior to use in clinical practice, however, their relative risk/benefit ratio must be assessed. Whereas relief of bothersome symptoms of ventricular dysrhythmias may improve the patient's return to a more active role in society, one must be aware, at the same time, that these antidysrhythmics have adverse effects of their own that may significantly limit their effectiveness. None of these new antidysrhythmic agents has been shown to prevent suddent cardiac death in controlled trials. At the present time, studies are being conducted to assess the efficacy of these agents in preventing sudden cardiac death. The new antidysrhythmic agents are highly effective in treating a wide variety of ventricular, and in some cases, supraventricular dysrhythmias. These agents are orally effective and, because of their unique pharmacokinetic profile, can often be prescribed less often per day than first generation antidysrhythmics. Side effects, for the most part, are predictable and involve the gastrointestinal and central nervous systems. In most cases, such side effects are reversible with dosage reduction. Upon treating a patient for a potentially lethal dysrhythmia, a Class IC agent such as encainide, flecainide, or propafenone, may be considered as the first-line therapy. Class IB agents, although less effective when used alone, show augmented antidysrhythmic efficacy with a reduction in side effects when administered concomitantly with a Class IA agent, such as quinidine or procainamide.(ABSTRACT TRUNCATED AT 250 WORDS)

Developing an arrhythmia course for obstetric nurses

The need has increased for high-risk obstetric nurses to interpret cardiac rhythms, owing to the potential cardiovascular side-effects of tocolytic therapy in premature labor. The cardiovascular critical care nurse, educator, and clinical specialist are important to obstetric nurses as consultants for arrhythmia interpretation. These authors describe how to plan, develop, and implement an arrhythmia course for staff nurses working in obstetric units.

Cardiac rhythm responses. 1. An important phenomenon for nursing practice, science, and research

The human responses to actual or potential health problems that are of interest to nursing encompass physiologic, psychologic, and sociocultural responses. Measurement of cardiac rhythm responses provides a unique opportunity to look at the complex interplay of physiologic, emotional, and environmental factors at a particular time. A model depicting the relationships between cardiac rhythm responses and the central nursing domain concepts of individual, environment, health, transitions, and nursing therapeutics is presented. Measurement of cardiac rhythm responses provides an objective, quantifiable, noninvasive, inexpensive, readily accessible, reliable, and valid tool for measuring human responses. Study of the phenomenon holds promise for nursing practice, science, and research fostering links among the three. Study of cardiac rhythm responses will have direct applicability to practice with the potential for narrowing the research-practice gap. Moreover, study of the phenomenon will contribute to nursing knowledge and foster advancement of nursing science by the development of theory.

Monitoring and treating life-threatening ventricular dysrhythmias

Dealing with cardiac emergencies resulting from the development of life-threatening dysrhythmias always presents some degree of stress to the practitioner, regardless of the amount of experience and exposure to cardiac arrests. Dealing effectively with these emergencies is threefold. First is prevention of the event. The astute practitioner utilizes knowledge of precipitating factors, data collection, assessment, and intervention to prevent a patient's condition from advancing to an emergency situation. Second, one must be prepared to deal with the emergency, by having a plan of action and knowing what to expect. Finally, one must deal with the emergency as effectively as possible, and then evaluate what has occurred, how the emergency was handled, and what actions would have improved the experience.

Monitoring the patient with supraventricular dysrhythmias

Supraventricular dysrhythmias are abnormalities in the rhythm of the heart caused by ectopic impulses originating from the SA node, atria, and AV junction. Certain electrocardiographic characteristics facilitate identification of these dysrhythmias. Supraventricular dysrhythmias are not as dangerous as ventricular dysrhythmias, but they may affect the patient's cardiovascular function significantly. The effects of supraventricular dysrhythmias on the patient are physiologic--those relating to changes in cardiac output and cardiac workload--and psychological--those relating to the patient's perception of the sensations associated with the dysrhythmia. The nurse plays an important role in the care of patients with supraventricular dysrhythmias. Nursing functions include prompt identification and appropriate management consistent with the medical and nursing plans, alleviation of anxiety, and patient education.