Cardiac arrhythmias, also known as cardiac dysrhythmias, are abnormal electrical conduction or automatic changes in heart rate and rhythm. Arrhythmias vary in severity, from those that are mild, asymptomatic, and require no treatment to catastrophic ventricular fibrillation, which necessitates immediate resuscitation. It can be the result of a primary cardiac disorder, a response to a systemic condition, the result of electrolyte imbalance, or drug toxicity.
Dysrhythmias vary in severity and in their effects on cardiac function, which are partially influenced by the site of origin (ventricular or supraventricular).
Nursing Care Plans
Nursing care planning for patients with cardiac arrhythmia due to digitalis toxicity includes prompt assessment of the patient’s condition, prompt treatment of symptoms, and investigation of the cause.
Listed below are three (3) nursing care plans for cardiac arrhythmias nursing care plans and nursing diagnosis:
- Risk for Decreased Cardiac Output
- Risk for Poisoning
- Deficient Knowledge
- Other Possible Nursing Diagnosis
- Prevent/treat life-threatening dysrhythmias.
- Support patient/SO in dealing with anxiety/fear of the potentially life-threatening situations.
- Assist in the identification of cause/precipitating factors.
- Review information regarding condition/prognosis/treatment regimen.
- Free of life-threatening dysrhythmias and complications of impaired cardiac output/tissue perfusion.
- Anxiety reduced/managed.
- Disease process, therapy needs, and prevention of complications understood.
- Plan in place to meet needs after discharge.
Risk for Decreased Cardiac Output
Irregular heart rhythm can impair the heart’s ability to effectively pump blood, resulting in decreased oxygen and nutrient delivery to essential organs and decreased blood flow to the body. Effective management and treatment of cardiac dysrhythmias are essential for lowering the risk of decreased cardiac output and sustaining good cardiovascular health.
- Risk for Decreased Cardiac Output
Risk factors may include
- Altered electrical conduction
- Reduced myocardial contractility
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred, and nursing interventions are directed at prevention.
- The client will maintain/achieve an adequate cardiac output as evidenced by BP/pulse within normal range, adequate urinary output, palpable pulses of equal quality, and usual level of mentation.
- The client will display reduced frequency/absence of dysrhythmia(s).
- The client will participate in activities that reduce myocardial workload.
Nursing Assessement and Rationales
1. Palpate pulses (radial, carotid, femoral, dorsalis pedis), noting rate, regularity, amplitude (full or thready), and symmetry. Document the presence of pulsus alternans, bigeminal pulse, or pulse deficit.
Differences in pulse equality, rate, and regularity are indicative of the effect on the systemic or peripheral circulation of altered cardiac output.
2. Auscultate heart sounds, noting rate, rhythm, presence of extra heartbeats, and dropped beats.
Specific dysrhythmias are more clearly detected audibly than by palpation. Hearing extra heartbeats or dropped beats helps identify dysrhythmias in the unmonitored patient.
3. Monitor vital signs. Assess the adequacy of cardiac output and tissue perfusion, noting significant variations in BP/pulse rate equality, respirations, changes in skin color, temperature, level of consciousness, sensorium, and urine output during episodes of dysrhythmias.
Although not all dysrhythmias are life-threatening, immediate treatment may be required to terminate dysrhythmia in the presence of alterations in cardiac output and tissue perfusion.
4. Determine the type of dysrhythmia and document it with a rhythm strip (if cardiac/telemetry monitoring is available):
4.1. Sinus tachycardia
Useful in determining the need for/type of intervention required. Tachycardia can occur in response to stress, pain, fever, infection, coronary artery blockage, valvular dysfunction, hypovolemia, hypoxia, or as a result of decreased vagal tone or of increased sympathetic nervous system activity associated with the release of catecholamines. Although it generally does not require treatment, persistent tachycardia may worsen underlying pathology in patients with ischemic heart disease because of shortened diastolic filling time and increased oxygen demands. These patients may require medications.
4.2. Sinus bradycardia
Bradycardia is common in patients with acute MI (especially anterior and inferior) and is the result of excessive parasympathetic activity, blocks in conduction to the SA or AV nodes, or loss of automaticity of the heart muscle. Patients with severe heart disease may not be able to compensate for a slow rate by increasing stroke volume. Therefore, decreased cardiac output, HF, and potentially lethal ventricular dysrhythmias may occur.
4.3. Atrial dysrhythmias:
- 4.3.1. Premature Atrial Contractions (PACs)
PACs can occur as a response to ischemia and are normally harmless but can precede or precipitate atrial fibrillation.
- 4.3.2. Atrial flutter
Acute and chronic atrial flutter and/or fibrillation (the most common dysrhythmia) can occur with coronary artery or valvular disease and may or may not be pathological.
- 4.3.3. Atrial supraventricular tachycardias (PAT, MAT, SVT)
Rapid atrial flutter/fibrillation reduces cardiac output as a result of the incomplete ventricular filling (shortened cardiac cycle) and increased oxygen demand.
4.4. Ventricular Dysrythmias
- 4.4.1. Premature ventricular contractions or ventricular premature beats (PVCs/VPBs), ventricular tachycardia (VT), ventricular flutter or fibrillation (VF)
PVCs or VPBs reflect cardiac irritability and are commonly associated with MI, digitalis toxicity, coronary vasospasm, and misplaced temporary pacemaker leads. Frequent, multiple, or multifocal PVCs result in diminished cardiac output and may lead to potentially lethal dysrhythmias, e.g., VT or sudden death/cardiac arrest from ventricular flutter/fibrillation. Intractable ventricular dysrhythmias unresponsive to medication may reflect ventricular aneurysm. Polymorphic VT (torsades de pointes) is recognized by the inconsistent shape of QRS complexes and is often drug-related, e.g., procainamide (Pronestyl), quinidine (Quinaglute), disopyramide (Norpace), and sotalol (Betapace). Reflect altered transmission of impulses through normal conduction channels (slowed, altered) and may be the result of MI, coronary artery disease with reduced blood supply to sinoatrial (SA) or atrioventricular (AV) nodes, drug toxicity, and sometimes cardiac surgery.
- 4.4.2. Heart blocks
Progressing heart block is associated with slowed ventricular rates, decreased cardiac output, and potentially lethal ventricular arrhythmias or cardiac standstill.
5. Monitor laboratory studies:
- 5.1. Electrolytes
An imbalance of electrolytes, such as potassium, magnesium, and calcium, adversely affects cardiac rhythm and contractility. Electrolyte imbalances can cause changes in the electrical conduction system of the heart, leading to abnormal heart rhythms.
- 5.2. Drug levels
Reveal therapeutic or toxic levels of prescription medications or street drugs that may affect or contribute to the presence of dysrhythmias.
Nursing Interventions and Rationales
Cardiac arrhythmias are disturbances in the normal heart rhythm. Nursing interventions for managing these conditions involve monitoring and managing symptoms, administering medications and treatments, and providing patient education. The aim is to control the arrhythmia, prevent complications, and improve the patient’s quality of life. Effective nursing care also involves working closely with the healthcare team to develop an individualized care plan and ensure proper communication and coordination of care.
1. Provide a quiet and calm environment. Review reasons for the limitation of activities during the acute phase.
Reduces stimulation and release of stress-related catecholamines, which can cause or aggravate dysrhythmias and vasoconstriction, increasing myocardial workload.
2. Demonstrate and encourage the use of stress management behaviors: relaxation techniques, guided imagery, and slow/deep breathing.
Promotes patient participation in exerting some sense of control in a stressful situation.
3. Investigate reports of chest pain, documenting location, duration, intensity (0–10 scale), and relieving or aggravating factors. Note nonverbal pain cues: facial grimacing, crying, changes in BP/heart rate.
Reasons for chest pain are variable and depend on the underlying cause. However, chest pain may indicate ischemia due to altered electrical conduction, decreased myocardial perfusion, or increased oxygen need.
4. Be prepared to initiate cardiopulmonary resuscitation (CPR) as indicated.
The development of life-threatening dysrhythmias requires prompt intervention to prevent ischemic damage/death.
5. Administer supplemental oxygen as indicated.
Increases the amount of oxygen available for myocardial uptake, which decreases irritability caused by hypoxia.
6. Administer medications for cardiac arrhythmias as indicated:
- 6.1. Potassium
Dysrhythmias are generally treated symptomatically. Correction of hypokalemia may be sufficient to terminate some ventricular dysrhythmias. Potassium imbalance is the number one cause of atrial fibrillation.
- 6.2. Antidysrhythmics. Antidysrhythmics are medications used to regulate heart rhythm and treat various types of arrhythmias. These include:
- 6.2.1. Class I drugs.
Class I drugs depress depolarization and alter repolarization, stabilizing the cell. These drugs are divided into groups a, b, and c, based on their unique effects. These drugs increase action potential, duration, and effective refractory period and decrease membrane responsiveness, prolonging both QRS complex and QT interval. Useful for the treatment of atrial and ventricular premature beats, and repetitive arrhythmias (atrial tachycardias and atrial flutter or fibrillation). Myocardial depressant effects may be potentiated when class Ia drugs are used in conjunction with medications possessing similar properties.
- Class Ia drugs: disopyramide (Norpace), procainamide (Pronestyl, Procan SR), quinidine (Quinaglute, Cardioquin)
These drugs shorten the duration of the refractory period (QT interval), and their action depends on the tissue affected and the level of extracellular potassium.
- Class Ib: lidocaine (Xylocaine), phenytoin (Dilantin), tocainide (Tonocard), mexiletine (Mexitil); moricizine (Ethmozine)
Drugs of choice for ventricular dysrhythmias are also effective for automatic and reentrant arrhythmias and digitalis-induced dysrhythmias. These drugs may aggravate myocardial depression.
- Class Ic: flecainide (Tambocor), propafenone (Rythmol), encainide (Enkaid)
These drugs slow conduction by depressing SA node automaticity and decreasing conduction velocity through the atria, ventricles, and Purkinje fibers. The result is a prolongation of the PR interval and a lengthening of the QRS complex. They suppress and prevent all types of ventricular dysrhythmias. Flecainide increases the risk of drug-induced dysrhythmias post-MI. Propafenone can worsen or cause new dysrhythmias, a tendency called the “proarrhythmic effect.” Encainide is available only for patients who demonstrated good results before the drug was removed from the market.
- Class Ia drugs: disopyramide (Norpace), procainamide (Pronestyl, Procan SR), quinidine (Quinaglute, Cardioquin)
- 6.2.2. Class II drugs: atenolol (Tenormin), propranolol (Inderal), nadolol (Corgard), acebutolol (Sectral), esmolol (Brevibloc), sotalol (Betapace); bisoprolol (Zebeta)
Beta-adrenergic blockers have antiadrenergic properties and decrease automaticity. Therefore, they are useful in the treatment of dysrhythmias caused by SA and AV node dysfunction (SVTs, atrial flutter, or fibrillation). These drugs may exacerbate bradycardia and cause myocardial depression, especially when combined with drugs that have similar properties.
- 6.2.3. Class III drugs: bretylium tosylate (Bretylol), amiodarone (Cordarone), sotalol (Betapace), ibutilide (Corvert)
These drugs prolong the refractory period and action potential duration, consequently prolonging the QT interval. They are used to terminate ventricular fibrillation and other life-threatening ventricular dysrhythmias or sustained ventricular tachyarrhythmias, especially when lidocaine and procainamide are not effective. Sotalol is a nonselective beta-blocker with characteristics of both class II and class III.
- 6.2.4. Class IV drugs: verapamil (Calan), nifedipine (Procardia), diltiazem (Cardizem)
Calcium antagonists (also called calcium channel blockers) slow conduction time through the AV node (prolonging PR interval) to decrease ventricular response in SVTs, and atrial flutter/fibrillation. Calan and Cardizem may be used for bedside conversion of acute atrial fibrillation.
- 6.2.5. Class V drugs: atropine sulfate, isoproterenol (Isuprel)
Miscellaneous drugs are useful in treating bradycardia by increasing SA and AV conduction and enhancing automaticity.
- 6.2.1. Class I drugs.
- 6.3. Cardiac glycosides: digoxin (Lanoxin)
Cardiac glycosides may be used alone or in combination with other antiarrhythmic drugs to reduce ventricular rate in the presence of uncontrolled or poorly tolerated atrial tachycardias or flutter and fibrillation. First-line treatment for paroxysmal supraventricular tachycardia (PVST).
- 6.4. Adenosine (Adenocard)
Slows conduction and interrupts reentry pathways in the AV node. Note: Contraindicated in patients with second or third-degree heart block or those with sick sinus syndrome who do not have a functioning pacemaker.
7. Prepare and assist with elective cardioversion.
May be used in atrial fibrillation or certain unstable dysrhythmias to restore normal heart rate and relieve symptoms of heart failure.
8. Assist with insertion and maintenance of pacemaker function.
Temporary pacing may be necessary to accelerate impulse formation or override tachydysrhythmias and ectopic activity, to maintain cardiovascular function until spontaneous pacing is restored or permanent pacing is initiated.
9. Insert and maintain IV access.
Patent access line may be required for the administration of emergency drugs.
10. Prepare for invasive diagnostic procedures and surgery as indicated.
A differential diagnosis of the underlying cause may be required to formulate an appropriate treatment plan. Resection of ventricular aneurysm may be required to correct intractable ventricular dysrhythmias unresponsive to medical therapy. Surgery: CABG, may be indicated to enhance circulation to the myocardium and conduction system.
11. Prepare for implantation of a cardioverter or defibrillator (ICD) when indicated.
This device may be surgically implanted in those patients with recurrent, life-threatening ventricular dysrhythmias unresponsive to tailored drug therapy. The latest generation of devices can provide multilevel (“tiered”) therapy, that is, anti-tachycardia and anti-bradycardia pacing, cardioversion, or defibrillation, depending on how each device is programmed.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for cardiovascular system disorders:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 18 Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 6 Care Plans
3 thoughts on “3 Cardiac Arrhythmias Nursing Care Plans”
Love love this site. Trying to navigate my way around other than just doing NCLEX questions with rationale.still Trying to search fir a topics to do questions on specific areas. Eg. cardiac hematology and so forth. Hoping to master it!
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