Nursing Diagnosis and Intervention for Abnormal Heart Rhythms (Arrhythmias)

Heart Rhythm Disorders or Arrhythmia is a common complication in myocardial infarction. Arrhythmias or dysrhythmias are changes in the frequency and heart rhythm caused by abnormal electrolyte conduction or automatic (Doenges, 1999). Arrhythmias arising from electrophysiological changes in the cells of the myocardium. These electrophysiological changes manifest as changes in the form of an action potential is a graph recording the electrical activity of cells (Price, 1994). Heart rhythm disorder is not confined to the irregularity of the heart rate but also including rate and conduction disturbances (Hanafi, 1996)

Etiology of cardiac arrhythmias in the outline can be caused by:

• Inflammation of the heart, such as rheumatic fever, myocardial inflammation (myocarditis due to infection).
• Disorders of coronary circulation (coronary atherosclerosis or coronary artery spasm), such as myocardial ischemia, myocardial infarction.
• Because the drug (intoxication), among others by digitalis, quinidine and anti-arrhythmia drugs other.
• Electrolyte balance disorders (hyperkalemia, hypokalemia).
• Disorders of the autonomic nervous system settings that affect the work and heart rhythm.
• Ganggguan psychoneurotic and central nervous.
• Metabolic disorders (acidosis, alkalosis).
• Endocrine disorders (hyperthyroidism, hypothyroidism).
• Heart rhythm disorders due to cardiomyopathy or heart tumor.
• Heart rhythm disorders due to degeneration (fibrosis of the conduction system of the heart).

Clinical Manifestations

• Change in BP (hypertension or hypotension); The pulse may be irregular; pulse deficit; irregular heart rhythm sound, extra sound, pulse decreased; pale skin, cyanosis, sweating; edema; Urine output decreases as weight decreases cardiac output.
• Syncope, dizziness, throbbing, headache, disorientation, confusion, lethargy, change in pupil.
• Mild to severe chest pain, may be lost or not with antianginal drugs, anxiety.
• Shortness of breath, cough, change of speed / depth of respiration; additional breath sounds (krekels, crackles, wheezing) may exist indicate respiratory complications such as left heart failure (pulmonary edema) or pulmonary tromboembolitik phenomena; hemoptysis.
• Fever; redness of the skin (adverse drug reactions); inflammation, erythema, edema (thrombosis siperfisial); loss of muscle tone / strength.

Nursing Diagnosis and Intervention for Abnormal Heart Rhythms (Arrhythmias)

Risk for decreased cardiac output related to electrical conduction disturbances, decreased myocardial contractility.

Expected outcomes:

• Maintain / increase cardiac output adequate as evidenced by blood pressure / pulse in the normal range, adequate urine output, palpable pulse same, usual mental status.
• Showed a decrease in the frequency / absence of dysrhythmias.
• Participate in activities that decrease myocardial work.

Intervention:

• Raba pulse (radial, femoral, dorsalis pedis) record the frequency, regularity, amplitude and symmetrical.
• Auscultation of heart sounds, note the frequency, rhythm. Note the extra heart rate, decreased pulse.
• Monitor vital signs and examine the adequacy of cardiac output / tissue perfusion.
• Determine the type of dysrhythmias and note the rhythm: tachycardia; bradycardia; atrial dysrhythmias; ventricular dysrhythmias; heart block.
• Provide quiet environment. Assess the reason for limiting the activity during the acute phase.
• Demonstrate / encourage use of behavioral stress management ie deep breathing relaxation, guided imagery.
• Investigate reports of pain, note the location, duration, intensity and relieving factors / ballast.
• Note the non-verbal instructions pain, for example; facial frown, cry, change in BP
• Prepare / do cardiopulmonary resuscitation as indicated.

Collaboration:

• Monitor laboratory tests, for example; electrolyte.
• Give supplemental oxygen as indicated.
• Give the drug as indicated: potassium, anti-dysrhythmia.
• Prepare for elective cardioversion aids.
• Help installation / maintain pacemaker function.
• Enter / maintain input IV.
• Prepare for invasive diagnostic procedures.
• Prepare for the installation of automatic cardioverter or defibrillator.

Diagnostic Examination in Patients with Bronchiectasis

Bronchiectasis is a permanent abnormal dilation of one or more branches of a large bronchus (Barbara, 1998).

Classification

Based on bronchography and bronchiectasis pathology can be divided into three, namely:

• Cylindrical bronchiectasis
• Fusiform bronchiectasis
• Cystic or saccular bronchiectasis.

Etiology

• Infection
• Heriditer abnormalities or congenital abnormalities
• Mechanical factors that facilitate the onset of infection
• Patients often have a history of pneumonia as a complication of measles, whooping cough, or other infectious diseases in childhood.

Diagnostic Examination in Patients with Bronchiectasis

1. Examination of sputum
Sputum examination include; sputum volume, sputum color, cells and bacteria in the sputum. When there is an infection sputum volume will increase and become purulent and contains more leukocytes and bacteria. Sputum culture can produce the normal flora of the nasopharynx, streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aereus, Klebsiella, aerobacter, Proteus, Pseudomonas aeruginosa. If found foul-smelling sputum showed anaerobic infection.

2. Examination of peripheral blood.
Usually found in the normal range. Sometimes found any leukocytosis showed suppuration active and anemia showed that chronic infection.

3. Examination of urine
Found within normal limits, sometimes found any significant proteinuria caused by amyloidosis, however serum immunoglobulins are usually within normal limits, can sometimes increase or decrease.

4. Examination of ECG
Regular ECG within normal limits except in advanced cases existing cor pulmonary complications or signs of cardiac stimulation. Spirometry in mild cases may be normal, but in severe cases there is an abnormality of obstruction by a decrease in expiratory volume 1 minute or decrease in vital capacity, usually accompanied by respiratory insufficiency which can lead to:

• Ventilation and perfusion imbalance.
• Increase the pressure difference alveoli-arterial PO2.
• Hypoxemia.
• Hypercapnia.

5. Additional examination to determine the predisposing factors examined:

• Immunological examination.
• Examination of spermatozoa.
• Bronchial biopsies and nasal mucosa (bronchopulmonary repeated).

6. PA and Lateral chest radiograph
Lung markings are usually found to be more rugged and boundaries become blurred markings, clustered, sometimes there is a wasp nest picture and description of the boundaries of cystic and fluid air surface. Most of the left lung lobe, because it has a smaller diameter and located right crosses mediastinum, lingual segment of the left upper lobe and medial lobes of the right lung.

7. Examination of bronchography
Bronchography not routinely done, but if there is any indication of where to evaluate the patient to be operated on, ie patients with pneumonia are limited to somewhere and repetitive who showed no clinical improvement after receiving conservative treatment or patients with massive hemoptysis.
Bronchography done after a steady state, after the administration of antibiotics and postural drainage is adequate so that the net bronchial secretions.

Ineffective Airway Clearance related to Bronchiectasis