Page 196 - Critical Care Nursing Demystified

Chapter 4 CARE OF THE PATIENT WITH CRITICAL CARDIAC RHY THM DISTURBANCE NEEDS 181

Step Eight: Analysis

The last step is taking all of the previous seven steps and putting them together to
determine what the rhythm is and whether you need to do something about it!

Recounting a True Story

It was a very busy evening in the telemetry unit with six admissions in the 26-bed
unit. All of the patients were finally settled in and all the admission assessments
were completed, as well as preliminary treatments. We had just settled in to write
up our nurses’ notes when the alarm bells went off on bed number 10, a 35-year-
old male who had been admitted with unstable chest pain for 23-hour observa-
tion. The monitor tech said the rhythm looked like ventricular tachycardia.
Running to check the patient, another very pregnant young nurse ran to get the
defibrillator and was having trouble bending down to unplug it from the wall
socket. When I went into the room, the man was vigorously brushing his teeth in
the bathroom. His biggest scare was when the very flustered and red-in-the-face
pregnant nurse ran into the room with the defibrillator. “What is that for?” he
shouted, beginning to get nervous.
We settled him in a chair and told him what was happening and apologized for 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.
scaring the “living daylights out of him.” The young, very nervous pregnant nurse
learned that night that you always assess your patient first. Every time the alarms
go off now, we look at each other and are reminded of this story.

Types of Basic Rhythms

Sinus Rhythms
A common theme about the rhythms in this group is that they all come from
the SA node pacemaker. There are three types of sinus rhythms. You probably
already know some information about them as you have been calling pulses by
some of these terms since nursing school. They include sinus bradycardia, sinus
tachycardia, and normal sinus rhythm. Let us start with the simplest first: nor-
mal sinus rhythm (NSR) or sinus rhythm.

Normal Sinus Rhythm (NSR)
In NSR, all the characteristics we used to forge a format are normal.