Page 191 - Critical Care Nursing Demystified

176 CRITICAL CARE NURSING DeMYSTIFIED

missing the main points. With analyzing a cardiac rhythm, we suggest the same
thing. What you will be measuring falls into three categories:
1. Rate
2. Rhythm
3. Conduction

The rate can tell you whether the rhythm is fast, normal, or slow and where
the pacemaker is. For instance, if the pacemaker is the SA node, the rate is usu-
ally between 60 and 100. But if the heart rate is 30, it may be coming from the
ventricles. The rhythm can be regular, irregular, or regularly irregular. The con-
duction tells you about how long it took for this rhythm to go down through
the normal conductive tissues. It involves using the norms we talked about
before: the PRI, QRS, and QT intervals. Rhythm analysis involves looking at
what we find using rate, rhythm, and conduction findings.
Using the eight-part organized detective work format can help you to be thor-
ough and not miss any of the clues the heart is giving you. The eight-part format is

1. Count the atrial rate. (RATE)
2. Count the ventricular rate. (RATE)
3. Determine the atrial rhythm. (RHYTHM) Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
4. Determine the ventricular rhythm. (RHYTHM)
5. Measure the PRI. (CONDUCTION)

6. Measure the QRS duration. (CONDUCTION)
7. Measure the QTI. (CONDUCTION)
8. Analyze what the patient’s dysrhythmias is and continue to monitor OR
take action
Wow! Again, this is a lot for the novice critical care nurse, but you will get lots
and lots of practice with this from other nurses, your preceptor/mentor, or class
work. But let us back up and do this slowly, so you see the way it is done.

NURSING ALERT
Rhythm interpretation is only another tool of assessment. No matter what, always
look at the patient to see what he or she is telling you. What assessment data do you
see, feel, hear, and touch? Always go by the patient’s symptoms, not necessarily the
ECG rhythm strip. Patient assessment FIRST, rhythm strip analysis AFTER assessment!

Step One: Rate—Counting the Atrial Rate

To do this, take the number of “P” waves in a 6-second strip and multiply this
by ten (see Figure 4–5). Why? There are ten 6-second periods in a minute. You