A 60-year-old male patient is admitted with chest pain to the telemetry unit where you work. While having a bowel movement on the bedside commode, the patient becomes short of breath and diaphoretic. The ECG waveform shows bradycardia.
What other assessment findings should you anticipate?
Why does this patient probably have bradycardia?
Does this dysrhythmia need treatment?
Why or why not?
What intervention would you implement first?
What is the drug treatment and dosage of choice for symptomatic bradycardia?
How does this drug increase heart rate?
This assignment is to be completed using APA format. Please use complete sentences to answer the questions. Ensure that you are using correct grammar. In additions, support your answers by using your textbooks, scholarly journals, and credible Internet sources. All citations must be in APA format. The body of your submission must be at least 350 words.
Upon encountering the 60-year-old male patient with chest pain in the telemetry unit who experiences shortness of breath and diaphoresis while having a bowel movement on the bedside commode, and exhibits bradycardia on the ECG waveform, several assessment findings should be anticipated, and specific considerations need to be addressed.
- Anticipated Assessment Findings:
- Diminished or absent peripheral pulses.
- Hypotension, manifested as low blood pressure readings.
- Altered level of consciousness, such as confusion, dizziness, or syncope (fainting).
- Cold, clammy skin due to reduced cardiac output.
- Possibly associated symptoms like nausea, lightheadedness, or chest discomfort.
- Probable Causes of Bradycardia: The patient likely has bradycardia due to one of the following reasons:
- Sinus Bradycardia: A slow heart rate originating from the sinoatrial (SA) node.
- Heart Block: This could be second-degree or complete heart block, where electrical signals are delayed or blocked as they move through the heart’s conduction system.
- Sick Sinus Syndrome: A condition where the SA node doesn’t generate impulses properly, causing alternating bradycardia and tachycardia.
- Medication-Induced: Some medications, like beta-blockers or calcium channel blockers, can slow the heart rate.
- Need for Treatment: Symptomatic bradycardia, especially when associated with chest pain, shortness of breath, and diaphoresis, necessitates treatment because it can lead to inadequate cardiac output, reduced tissue perfusion, and even cardiac arrest. In such cases, intervention is critical to prevent life-threatening complications.
- Initial Intervention: The first intervention should be to ensure the patient’s airway, breathing, and circulation (ABCs) are stable. This includes administering supplemental oxygen to alleviate hypoxia and connecting the patient to a cardiac monitor for continuous ECG monitoring. Given the symptoms, it is also essential to establish intravenous access to prepare for potential treatment.
- Drug Treatment and Dosage for Symptomatic Bradycardia: The drug of choice for symptomatic bradycardia is often Atropine. The typical initial adult dosage is 0.5 mg IV, repeated every 3-5 minutes, with a maximum total dosage of 3 mg. Atropine works by blocking the action of the vagus nerve, which helps increase heart rate.
In summary, when a patient presents with chest pain, shortness of breath, diaphoresis, and bradycardia, it is crucial to consider various assessment findings, diagnose the probable cause, and recognize the need for intervention. Symptomatic bradycardia can lead to life-threatening consequences, making rapid and appropriate treatment, such as Atropine administration, essential in stabilizing the patient’s condition. Always remember that any intervention should be performed under medical supervision, and specific dosages may vary based on the patient’s condition and response.