Nursing care of patient with arrhythmia in various scenario at non critical and critical ward

Prema

ICN Nursing Incharge, Kauvery Heartcity, Trichy, Tamil Nadu

Nursing Care of Patient with Arrhythmia:

Nursing care for patients with arrhythmia varies significantly depending on whether the patient is in Non-Critical Areas – e.g.: General Ward OPD, Critical Areas – e.g.: CCU and Emergency Dept., The approach is based on the severity of the arrhythmia, the patient’s hemodynamic stability and the risk of complication.

Non-Critical Scenarios (Stable Arrhythmia Patients):

Assessment & Monitoring

  • Monitor vital signs (HR, BP, RR, SpO₂) regularly.
  • Assess for palpitations, dizziness, fatigue, chest discomfort, or syncope.
  • Monitor ECG for rhythm abnormalities (e.g., atrial fibrillation, tachy arrhythmia, brady arrhythmia). Identify potential triggers like caffeine, stress, dehydration, or electrolyte imbalances.

Nursing Intervention

  • Administer medications as prescribed:
  • Amiodarone Betablockers (e.g., metoprolol) for tachyarrhythmia’s.
  • Anticoagulants for atrial fibrillation to prevent clots.
  • Digoxin or calcium channel blockers for rate control.

1). Critical Scenarios (Unstable Arrhythmia Patients)

  • Rapid Assessment & Monitoring
  • Assess ABCs (Airway, Breathing, Circulation) immediately.
  • Monitor vital signs & oxygen saturation closely.
  • Obtain a 12-lead ECG to identify the arrhythmia.
  • Assess for shock symptoms (hypotension, confusion, cold/clammy skin, cyanosis).

2). Emergency Nursing Interventions:

  • Brady arrhythmia (HR < 50 bpm, symptomatic or 3degree AV Block / Complete Heart Block)
  • Administer Atropine 0.6 mg IV push (repeat every 3–5 min if needed, max 3 mg).
  • If unresponsive, prepare for transcutaneous pacing.(Temporary Pace maker)
  • Monitor BP and symptoms closely.

3). Supraventricular Tachycardia (SVT):

  • Vagal maneuvers (Valsalva, carotid massage) if stable.
  • Administer Adenosine 6 mg IV push, followed by 12 mg if needed.
  • Prepare for synchronize cardioversion if patient is unstable.

4). Ventricular Tachycardia (VT) with Pulse

  • Amiodarone 150 mg IV over 10 minutes.
  • Prepare for synchronized cardioversion if patient is unstable.

5) Pulseless Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF):

  • Initiate CPR immediately.
  • Epinephrine 1 mg IV every 3–5 min Follow ACLS protocal .
  • Defibrillation (200J biphasic or 360J monophasic).
  • Consider Amiodarone 300 mg IV push, followed by 150 mg if needed.

Patient Education

  • Teach proper medication adherence.
  • Inform about the importance of regular follow-ups.
  • Instruct on when to seek medical help (e.g., worsening symptoms).
  • Encourage the patient to avoid triggers (like caffeine, stress, smoking & alcohol)

  • Educate on Lifestyle modification (Diet, Exercise, Stress Management)
  • Maintain an environment that reduces stress to avoid triggering episodes.
  • Teach the patient how to recognize early sign of arrhythmia.

 

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