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M&K Publishing - Fiona Foxall

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121 pages

English

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This workbook is a no-fuss, practical guide containing all the information you need to get to grips with cardiac monitoring. It will help you recognise common cardiac arrhythmias and guide you in what actions to take when they occur. Presented in a clear and simple format, this workbook builds on your understanding. If you work your way through this book and carry out the exercises, you will soon become more confident and competent about haemodynamic monitoring and manipulation as well as understanding all the information that initially seems so complicated. Here s to easy learning.

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Médecine

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Publié par	M&K Publishing
Date de parution	22 février 2010
Nombre de lectures	0
EAN13	9781907830532
Langue	English

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Cardiac Arrhythmia Recognition
An easy learning guide
Easy Learning Guides from M K
The array of complex functions carried out by senior clinical staff can be quite bewildering to more junior staff. Some of them would like to wave a magic wand that makes them instantly knowledgeable and confident. These Easy Learning Guides are not a magic wand, but they are probably the next best thing! They were written by a health professional who had to learn by experience, along with everyone else, but who knows that there are far easier ways to pick up these essential skills.
These no-fuss practical guides promote confidence and competence in several key areas of clinical practice, including:
Haemodynamic Monitoring and Manipulation
Arterial Blood Gas Analysis
Cardiac Arrhythmia Recognition
To find out more about these and other books published by M K, as well as their wide range of clinical training courses, visit: www.mkupdate.co.uk
Cardiac Arrhythmia Recognition
An easy learning guide
Fiona Foxall MA, RGN, ENB 100, DPSN, BSc, PGCE
Lecturer in Nursing, Curtin University, Perth, Western Australia
With original artwork by Helen Blackburn
Cardiac Arrhythmia Recognition: An Easy Learning Guide Fiona Foxall
ISBN: 978-1-905539-53-6
First published 2010
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Permissions may be sought directly from M K Publishing, phone: 01768 773030, fax: 01768 781099 or email: publishing@mkupdate.co.uk
Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.
British Library Catalogue in Publication Data A catalogue record for this book is available from the British Library
Notice:
Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the Publisher. Neither the Publisher nor the author assume any liability for any injury and/or damage to persons or property arising from this publication.
The Publisher To contact M K Publishing write to:
M K Update Ltd The Old Bakery St. John s Street
Keswick Cumbria CA12 5AS
Tel: 01768 773030 Fax: 01768 781099
publishing@mkupdate.co.uk
www.mkupdate.co.uk
Designed and typeset in Adobe Garamond 10/12 by S. Maria Hampshire. Cover design by Luke Kelsey.
Printed in England by Reeds Printers, Penrith, Cumbria.
DEDICATION
For Mom and Dad.
Love always.
Contents
Acknowledgements
Introduction
How to use this workbook
Aims of this workbook
Chapter 1: Anatomy and physiology of the heart
Chapter 2: Principles of cardiac monitoring and the normal ECG
Chapter 3: Recognising common arrhythmias
Chapter 4: Arrhythmia interventions
Chapter 5: Putting it all together
Answers and Teaching Notes
References
Index
Acknowledgements
I would like to thank Mel Humphreys for her help with parts of this book and Maria Hampshire for her unfailing support and special friendship. Thanks as always, too, to Helen, Chris and Matthew Blackburn for their help and support.
Introduction
The adequacy of the cardiorespiratory system can generally be gauged from basic clinical signs such as heart rate, blood pressure, respiratory rate and depth, the skin s texture and colour, the use of accessory muscles of respiration and the patient s mental status. These basic signs should never be ignored but in critical illness, basic clinical assessment alone may be unreliable and misleading, therefore further monitoring techniques are usually required (Foxall, 2009).
Cardiac monitoring is essential when caring for the critically ill patient, as it provides highly valuable information. Abnormal cardiac rhythms can be recognised immediately, providing earlier diagnosis and therefore allowing quick and appropriate treatment (Jevon and Ewens, 2007). However, you should always remember that machines are fallible and only as safe as the person who is operating them! You must also remember that you should care for and treat the patient - not the machine!
There are hundreds of potential cardiac arrhythmias which is why this workbook considers the most common, important and potentially dangerous arrhythmias seen in the critically ill patient.
Many healthcare professionals find it difficult to get to grips with cardiac monitoring and arrhythmia recognition because it can be very complex and rather daunting. If you work your way through this book and carry out the exercises as you go, you will soon become more confident and competent at arrhythmia recognition and monitoring and will understand all the information on the subject that initially seems so complicated.
Here s to easy learning!
How to use this workbook
Accurate clinical assessment is particularly important in critically ill patients because haemodynamic status may change rapidly. Continuous cardiac monitoring will provide clear information that allows rapid adjustment of therapy (Jansen, 2002). This book is aimed at nurses working in critical care and high-dependency care areas, as well as other healthcare professionals who require an easy-to-understand introduction to cardiac arrhythmia recognition and management. It will provide a good foundation on which to build your knowledge.
If you are going to use a cardiac monitor, it is important to be able to interpret what you are seeing! So start at the beginning of the book, even if you feel quite happy about cardiac monitoring and arrhythmia recognition, because it will be good revision. Steadily work through the material, ensuring you understand all the information in each chapter before moving on to the next. Once you have read each chapter, complete the consolidation section to ensure you understand the information sufficiently. There is no specific consolidation section for Chapter 3 ; you will consolidate your learning from this chapter when you reach Chapter 5 , where you can answer the questions and interpret the arrhythmias as you go. It will be good for you to find a mentor who will help you with any of the exercises you are unsure about.
If you don t know an answer or don t recognise an arrhythmia, try to work it out, based on the information you have already read. If you still can t, try discussing it with your chosen mentor. And if it is still not clear, then look up the answer in the answer section at the back of the book. Of course, if you do look up the answer, make sure you understand it - don t just accept it. If you have any problems, talk to your mentor. Use the answer section as a last resort and for checking purposes only! You ll learn far more by working things out for yourself. Those of you who already have a reasonable knowledge and understanding of cardiac monitoring and arrhythmia recognition, could attempt - if wished - the consolidation sections before reading the explanatory text. You will get a good idea of your current level of knowledge and be able to identify any gaps, which you can then concentrate on filling.
Aims of this workbook
The prime aim of this book is to extend your knowledge and clinical application of cardiac arrhythmia recognition.
After completing this workbook you will be able to:

discuss the normal anatomy and physiology of the heart
describe the principles of cardiac monitoring
describe the normal ECG
recognise common atrial, junctional and ventricular arrhythmias and atrioventricular blocks, state their effects on the body and what action should be taken - if any.
Management of the patient with life-threatening cardiac arrhythmias should always follow the Resuscitation Council (UK) guidelines and algorithms listed below.

Adult Basic Life Support.
AED Algorithm.
In-Hospital Resuscitation.
Adult Advanced Life Support.
Adult Bradycardia Algorithm.
Adult Tachycardia Algorithm.
These algorithms can be found at http://www.resus.org.uk .
Chapter 1
Anatomy and physiology of the heart
The cardiovascular system exists to provide tissue perfusion, to ensure the body s cells are provided with oxygen and nutrients at the same time as removing metabolic wastes (Gonce-Morton et al ., 2005).
Position of the heart
The heart can be described as a hollow organ located centrally in the chest directly behind the sternum, between the lungs, and it is a component of the mediastinum. It is supported at its base (which is at the top) by the great vessels and it rests on the diaphragm with its apex (which is at the bottom) directed anteriorly and to the left. Two-thirds of the mass of the heart lies to the left of the body s midline (Martini, 2006). See Fig. 1.1 .

The heart provides the impetus to drive blood flow throughout the body.
The function of the heart is to circulate blood and therefore oxygen and nutrients to the tissues; the blood then removes metabolic wastes from the tissues. It is a four-chambered double-pump. The atria receive returning blood and direct it to the ventricles. The ventricles provide the impetus to circulate the blood through the systemic and pulmonary circulations (Janson-Cohen, 2005).
The systemic and pulmona