Tuesday, May 1, 2012

Nursing Care Plan for Cardiac Arrhythmias

Nursing Care Plan for Cardiac ArrhythmiasHeart rhythm disorder or arrhythmia is a frequent complication in myocardial infarction. Arrhythmias or dysrhythmias is the change in frequency and heart rhythm caused by abnormal conduction of the electrolyte or automatic (Doenges, 1999).

Arrhythmias arise from changes in myocardial cell electrophysiology. Electrophysiological changes are manifest as changes in the form of an action potential is a graph recording the electrical activity of cells (Price, 1994). Heart rhythm disorders are not just limited to heart rate irregularities, but also including the rate and conduction disturbances (Hanafi, 1996).


Etiology

Etiology of cardiac arrhythmias in the outline can be caused by:
  1. Inflammation of the heart, such as rheumatic fever, myocardial inflammation (myocarditis due to infection)
  2. Interruption of coronary circulation (coronary atherosclerosis or coronary artery spasm), such as myocardial ischemia, myocardial infarction.
  3. Because the drug (intoxication), among others, by digitalis, quinidin and anti-arrhythmia drugs other.
  4. Electrolyte imbalance (hyperkalemia, hypokalemia)
  5. Disorders of the autonomic nervous system settings that affect the work and the rhythm of the heart.
  6. Psychoneurotic disorders and central nervous system.
  7. Metabolic disorders (acidosis, alkalosis)
  8. Endocrine disorders (hyperthyroidism, hypothyroidism)
  9. Arrhythmia due to cardiomyopathy or heart tumor
  10. Heart rhythm disturbances due to degeneration disease (fibrosis of the cardiac conduction system)

Clinical Manifestations
  1. Changes in BP (hypertension or hypotension); pulse may be irregular; pulse deficit; sounds irregular heart rhythm, extra sounds, beats down; pale skin, cyanosis, sweating; edema; decreased urine output when cardiac output decreased weight.
  2. Syncope, dizziness, throbbing, headache, disorientation, confusion, lethargy, pupillary changes.
  3. Mild to severe chest pain, may be lost or not with anti-angina drugs, anxiety
  4. Shortness of breath, cough, change in velocity / depth of breathing; additional breath sounds (crackles, wheezing) may have showed respiratory complications such as left heart failure (pulmonary edema) or pulmonary tromboembolitik phenomenon; hemoptysis.
  5. Fever; skin redness (drug reactions); inflammation, erythema, edema (siperfisial thrombosis); loss of muscle tone / strength

Physical Assessment
  1. Activities: general fatigue
  2. Circulation: changes in BP (hypertension or hypotension); pulse may be irregular; pulse deficit; sound of irregular heart rhythm, extra sounds, beats down; skin color and moisture changes such as pallor, cyanosis, sweating; edema; decreased urine output when cardiac output decreased weight.
  3. Ego Integrity : feeling nervous, feeling threatened, anxious, frightened, refused, angry, anxious, crying.
  4. Food / fluid: loss of appetite, anorexia, food intolerance, nausea, vomiting, weight peryubahan, changes in skin moisture
  5. Neuro-sensory: dizziness, throbbing, headache, disorientation, confusion, lethargy, pupillary changes.
  6. Pain / discomfort: mild to severe chest pain, may be lost or not with anti-angina drugs, anxiety
  7. Respiratory: chronic lung disease, shortness of breath, cough, change in velocity / depth of breathing; additional breath sounds (krekels, crackles, wheezing) may have showed respiratory complications such as left heart failure (pulmonary edema) or pulmonary tromboembolitik phenomenon; hemoptysis.
  8. Security: fever; skin redness (drug reactions); inflammation, erythema, edema (siperfisial thrombosis); loss of muscle tone / strength.

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