Nursing Care Plan for Cardiac Arrhythmias

Heart 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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Assessment of Cardiovascular

Doing a good assessment, it is necessary to the understanding, practice and skills, recognize the signs and symptoms displayed by patients. This process is carried out through the interaction of client care, observation, and measurement.

The purpose of conducting the assessment:

1. Assessing cardiovascular function.
2. Know the early presence of real or potential problems.
3. Identifying the cause of disturbance.
4. Plan how to overcome existing problems and avoid the problems that will occur.

Assessment techniques:
Assessment can be done at least once, but can be done several times on a regular basis, eg every hour in critically ill patients. Assessment techniques include:

1. Assessment
2. Physical examination
3. Diagnostic tests / investigations

Interview:
1. The main complaint
Ask about the most important problems perceived by the client, so it needs help. Complaints that should be considered include shortness of breath, chest pain radiating to the arms, fatigue, cough, or bloody mucus, fainting, palpitations, and other according to the pathology of the disease.

2. History of present illness
Ask about the course of the disease, since the complaint until the client asks for help. For example:

• ask since when the complaint is felt,
• how many times the complaint occurred,
• how the nature of the complaint,
• when and what the cause of the complaint,
• circumstances which aggravate and mitigate the complaint,
• how to attempt to resolve complaints before asking for help,
• the success of action.

3. History of previous illness
Ask about the disease that never experienced before:

• ask whether the client had been treated previously
• with any disease,
• have you ever experienced severe pain

4. Additional history adapted to the pathology of the disease

• family history
• employment history
• history of geography
• history of allergy
• social habits
• smoking habits

Physical examination of the cardiovascular system

• In topographic heart is in the front cavity of the mediastinum
• The chest which is occupied by the projection of the heart as illustrated above is called the precordium

General considerations:

• Clothes for the patient should be prepared in an open state.
• The courtroom must be quiet to show adequate auscultation.
• Fixed always maintain patient privacy
• Prioritize and watch for signs of distress.

Inspection of the Heart
Signs were observed:
(1) form of the precordium
(2) at the apex of the heart rate
(3) The pulse of the chest
(4) venous pulse

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