Page 221 - Critical Care Nursing Demystified

206 CRITICAL CARE NURSING DeMYSTIFIED

ANSWERS

CASE STUDY

1. An atrial and ventricular rate of 180; sometimes P waves may not be seen, so this can
be confused with junctional tachycardia. Junctional tachycardia does not have this fast
a rate, though. Atrial and ventricular rhythms should be regular. If P waves are seen, the
PRI would be shorter than normal. The QRS should be of normal duration and the QTI
might be short.
2. Sinus tachycardia is confirmed by an atrial and ventricular rate above 100 but below 160.
Both atrial and ventricular rates should be regular. All intervals should be normal but
sometimes they can shorten, especially the QT.
3. Ms. Carrier’s medications should be reviewed to see what she is taking and when she
took them last. IV beta-blockers, calcium channel blockers, and digoxin can be adminis-
tered to control her ST.
4. It is important to check her digoxin level and her potassium, before administrating
digoxin to her. Also be sure that baseline chemistries are drawn and note the sodium,
potassium, calcium, and magnesium levels. Replace these if needed.
5. An emergency cardioversion is very much like a regular one but items must be set
up quickly. First, make sure you have a patent IV line and working suction equip-
ment. A functioning BVM is needed, and she is already on oxygen. Next, request se- 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.
dation if none has been ordered. Delegate checking the defibrillator but make sure
before it is used that there is a dot above every “R” wave, so the machine avoids the
T wave. After the procedure follow the ABCs, keeping an open airway and monitor-
ing her breathing. Montior VS every 15 minutes or according to protocol for the first
hour. Check the chest area for burns and provide care if they occur. Keep close cardiac
monitoring, remembering to document rhythm strips before/after and any time she
has a rhythm change. Teach her all of the above and reassure her that the procedure
went well.

CORRECT ANSWERS AND RATIONALES

1. A, C, D, and F are associated with fluid buildup in the body from a lack of pumping
(cardiac) action. Patients have oliguria due to poor kidney perfusion, dilated pupils due
to sympathetic activation, and do not usually have muffled heart sounds, which is as-
sociated with cardiac tamponade.
2. B. A junctional rhythm is known by a rate of between 60 and 40. Junctional rhythms
are started in the AV junction, so they are not caused by atrial depolarization, hence
no “P” waves. Everything else about them is normal. Atrial fibrillation is very fast and
the P waves can not be counted. A ventricular rhythm is known by a ventricular rate of
around 30.
3. A. Electrodes dry out rather quickly, so replace them periodically, especially if the
patient is febrile. They are placed anteriorly over intercostal spaces with all surfaces