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Extra info for Practice Makes Perfect - English K1
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Tell patient and family about the serious nature of this arrhythmia and required treatment. • If patient needs permanent pacemaker, explain how it works, how to recognize problems, when to contact physician, and how pacemaker function will be monitored.
A burst, or salvo, of three or more PVCs in a row is considered a run of VT. Multiform PVCs Multiform PVCs look different from one another (see shaded areas on strip above) and arise either from different sites or from the same site via abnormal conduction. Multiform PVCs may indicate severe heart disease or digoxin toxicity. qxd 5/13/09 12:17 PM Page 53 53 Patterns of potentially dangerous PVCs (continued) Bigeminy and trigeminy PVCs that occur every other beat (bigeminy) or every third beat (trigeminy) can result in VT or VF.
Watch for evidence of decreased CO and hemodynamic instability. • Monitor serum digoxin and electrolyte levels. qxd 5/13/09 12:16 PM Page 49 49 Junctional tachycardia (continued) What causes it How it’s treated • Digoxin toxicity (most common) • Electrolyte imbalances • Heart failure • Hypokalemia (may aggravate condition) • Inferior-wall MI • Inferior-wall myocardial ischemia • Inflammation of AV junction after heart surgery • Posterior-wall MI • Posterior-wall myocardial ischemia • Valvular heart disease What to look for • Pulse rate above 100 beats/ minute with regular rhythm • Effects of decreased CO (loss of atrial kick) and hemodynamic instability (hypotension) because of rapid HR What to do • Monitor heart rhythm.