Page 218 - Critical Care Nursing Demystified

Chapter 4 CARE OF THE PATIENT WITH CRITICAL CARDIAC RHY THM DISTURBANCE NEEDS 203

CASE STUDY

June Carrier is a 68-year-old widow who has been struggling with recurrent bouts
of heart failure (HF) and has been hospitalized at least three times this year for
exacerbation of this chronic medical problem. At the local grocery store, Ms. Car-

rier is waiting in line when she passes out. EMS is notified and when they arrive,
Ms. Carrier is groggy but answering questions. She does not know where she is or
what time it is, but knows who she is. The cardiac monitor shows atrial tachycardia
with a rate of 180 without ectopy. After oxygen and an IV, Ms. Carrier reverts back
to a sinus tachycardia, where she remains until she reaches the ECU.
You admit her to the ICU for close monitoring. Suddenly she states, I “can not
catch my breath.” The monitor shows that she is back in an atrial tachycardia at 190.
Thus far, none of the medications given are working to convert Ms. Carrier to a
sinus rhythm. Since she is symptomatic, has increasing crackles that are ascending
to midscapula, and her SaO is dropping despite increasing her to a 100% nonre-
2
breather, the physician tells you to set up for an emergency cardioversion.
After giving Ms. Carrier sedation and three shocks of increasing amplitude start-
ing at 50 W/s, Ms. Carrier converts permanently to an NSR. Ms. Carrier’s short stay in
the hospital is uneventful, but she has a medication adjustment and has a home
health nurse on consult to help with medications and diet. 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.

QUESTIONS

1. What characteristics would confirm the presence of atrial tachycardia on the
monitor?
2. What characteristics would confirm the presence of sinus tachycardia?

3. What would you anticipate as usual treatment for ST tachycardia in the ECU?
4. What laboratory values would be important to anticipate seeing?
5. What nursing care will you perform to be ready for the emergency cardioversion?