Now

Study.Study.Study

Ni Luh Widani
Dysrhythmias
Adalah rekaman potensial dari satu titik dipermukaan dada.

Sandapan V1 : ICS IV garis sternal kanan.

Sandapan V2 : ICS IV garis sternal kiri.
Sandapan V3 : antara V2 dan V4.
Sandapan V4 : ICS V garis midklavikular kiri.
Sandapan V5 : Setinggi V4 garis aksilaris anterior kiri.
Sandapan V6 : Setinggi V4 garis aksilaris media kiri
PPKC
 This is the normal pathway for electricity
to travel through the heart

SA node

AV node

Bundle of His

Left bundle branch

Right bundle branch

=
Myocardium
contracts
 12 Lead (views) of the Heart
Lateral leads

AVR AVL

V6
I

V5
V1
V2
V3 V4
III II
AVF
Anterior leads
Inferior leads
 Tentukan irama teratur/tidak
Tentukan berapa rate QRS /HR/frekuensi
Morfologi gelombang P Normal/tidak
Tentukan interval PR Normal/tidak
Durasi QRS Normal/tidak?
Aksis defiasi?
Morfologi gelombang T dan segmen ST
Lain-lain: LVH, BBB

Interpretasi ?
1. IRAMA
Teratur / tidak?
teratur : jarak R- R intervalnya sama
Irma sinus/bukan?
gam. EKG didahului dg Gel P dan selalu
diikuti kompleks QRS
Kriteria irama sinus (SR) atau EKG normal adalah sbb :
Irama teratur.
Frekwensi jantung (HR) antara 60-100 x/menit.
Gel P normal, setiap gel P diikuti gel QRS dan T.
Interval PR normal ( 0,12 0,20 detik ).
Gel QRS normal ( 0,06 0,12 detik ).
Semua gel sama.
Irama EKG yg tidak mempunyai kriteria tersebut disebut disritmia
atau aritmia.
 Normal Sinus Rhythm (NSR)

The SA node has generated an impulse that followed the

normal pathway of the electrical conduction system

Rate normal 60-100

PR normal .12-.20
QRS normal < .11
Tentukan apakah reguler atau irreguler
Reguler
300/Jml kotak besar R R atau 1500/Jml kotak kecil R R

Irreguler/Reguler
Ambil EKG 6 detik (30 kt besar), hitung jumlah QRS
Kompleks X 10
 www.uptodate.com

(300 / 6) = 50 bpm
Normal axis: -30 - +110o
> -30 : axis LAD
>+110 : axis RAD
> +180 : axis ekstrem RAD
1. Examine the QRS complex in leads I and aVF to determine if
they are predominantly positive or predominantly
negative. The combination should place the axis into one
of the 4 quadrants below.
 The Alan E. Lindsay
ECG Learning Center
http://medstat.med.uta
h.edu/kw/ecg/

Negative in I, positive in aVF RAD

 The Alan E. Lindsay
ECG Learning Center
http://medstat.med.uta
h.edu/kw/ecg/

Positive in I, negative in aVF Predominantly positive in II

Normal Axis (non-pathologic LAD)
Gambaran yang ditimbulkan oleh
depolarisasi atrium
Apakah gel P bentuk normal?
Apakah selalu diikuti QRS?
Gelombang P

Normal : Normal Positif kecuali

Negatif di aVR
Tinggi : < 0,3 mvolt
P : QRS 1: 1 atau 2 : 1 dst
Lebar : < 0,12 detik
Selalu positif di L II
Selalu negatif di aVR

Kepentingan : Mengetahui kelainan di Atrium

 PR interval
Normal : 0,12 - 0,20 detik
Memendek/memanjang ?

Kepentingan :
Kelainan sistem konduksi
Normal gelombang Q
Lebar : < 0,04 detik
Dalam : < 1/3 tinggi R
Gelombang QRS

Sempit/ lebar ?
Normal QRS :
Lebar : 0,06 - 0,12 detik
Tinggi : Tergantung lead
 Normal : Isoelektris
Diatas garis isoelektrik ST Elevasi Pada injuri/infark
akut
Dibawah grs isioelektrik STDepresi Pada iskemia
Gambaran yang ditimbulkan oleh repolarisasi ventrikel

Nilai normal :
* 1 MV di lead dada
* 0,5 MV di lead ekstrimitas
* Minimal ada 0,1 MV

Gel T positif kecuali di aVR

 Diluar kriteria tadi

disebut

ARITMIA ( DISRITMIA )
Gangguan pembentukan impuls

Gangguan penghantaran impuls

 AXIOM
ALL RHYTHM INTERPERTATION MUST BE
CORRELATED WITH SIGNS & SYMPTOMS AND
PATIENT CONDITION

TREAT THE PATIENT,

NOT THE MONITOR
 Definisi
Dysritmia adl gangguan pembentukan atau
hantaran (atau keduanya) impuls listrik jantung
akibat penyakit jantung, gangguan irama atau
keduanya.
Dapat mempengaruhi hemodimik (penurunan
tekanan darah
Dapat didiagnosa dari gambaran EKG
 Arrhythmia Presentation
Palpitation.
Dizziness.
Chest Pain.
Dyspnea.
Fainting.
Sudden cardiac death.
 Etiology
Physiological
Pathological:
Valvular heart disease.
Ischemic heart disease.
Hypertensive heart diseases.
Congenital heart disease.
Cardiomyopathies.
Carditis.
RV dysplasia.
Drug related.
Pericarditis.
Pulmonary diseases.
Others.
 Arrhythmia Assessment
ECG
24h Holter monitor
Echocardiogram
Stress test
Coronary angiography
Electrophysiology study
 DISRITMIA
1. Disritmia yg disebabkan oleh gangguan pembentukan
impuls.
Impuls yang berasal dari Sino Atrial Node (SA) Node ):

SINUS HR 60 100 X/mnt : SR

SAN
HR >100 X/mnt : ( ST )
P QRS
HR < 60 : ( SB )
HR 60 100 X/mnt : Sinus Aritmi
Asistole
Pulseless Electrical Activity
Regions of
the Heart

Sinus

Atrial

Junctional

Ventricular
Sinus Tachycardia (ST)
Normal except HR >100 bpm
Penatalaksanaan:
sesuai dengan penyebab
obat dengan efek menurunkan rate:
DIGOXIN, -BLOCKERS
CAROTID MASSAGE
VAGAL MANEUVER
Sinus Bradycardia (SB)
Everything measures normal
except the HR is less than 60
 Sinus Bradycardia

VENTRICULAR RATE = 60
ETIOLOGY:
RESPONSE TO MYOCARDIAL ISCHEMIA
VAGAL STIMULATION
ELECTROLYTE IMBALANCE
DRUGS (beta bloker)
I.C.P.
Hipotermi, Hipotiroid
HIGHLY TRAINED ATHLETE
 CLINICAL SIGNS

C.O. IF BODY CANT COMPENSATE

ARRHYTHMIA
Penatalaksanaan tergantung penyebab:
ATROPINE
hindari VALSALVA
Batasi obat-obat yang menurunkan rate spt:
I.E.: DIGOXIN, blockers
 Asystole
No electrical
activity
Code Blue
 Pulseless Electrical Activity (PEA)
Normal rhythm, butNo Pulse*
Electrical activity is present but there is no pulse, so
the heart is not beating! Something has happened
to prevent the muscular tissue from responding to the
electrical activity
(i.e. K+, hypothermia, Pneumothorax, cardiac tampanode,
hypovolemia, drug overdose, pulmonary or coronary thrombosis)

Code BLUE!
Regions of
the Heart

Sinus

Atrial

Junctional

Ventricular
 Sinus
PR Interval will be
normal

Junctional
PR Interval will be
Less than normal

Or
There will
Be no P Wave
 Junctional Rhythm

No P

or

PR< .12
 DISRITMIA LANJUTAN

JUNCTIONAL

P TERBALIK DI DEPAN / DIBELAKANG QRS / P (-)

AVN

( HR 40 60 ) ; Junctional Ritem (JR )

( HR 60 100 ) ; Akseleratid JR
( HR > 100 ) : Junctional Takikardi
Junctional rhythm:
- AV junction as a pace maker (40-60
x/min).
- The failure of sinus node to initiate
timed
impulse or conduction problem.
- Normal-looking QRS.
- Retrograde P wave.
- P wave may precede, coincide with, or
follow the QRS
 JUNCTIONAL DYSRHYTHMIAS
IMPULSE BEGINS IN AV NODE

VENTRICULAR RATE IS EXTREMELY SLOW

MONITOR FOR SYMPTOMS OF REDUCED

CARDIAC OUTPUT AND HEMODYNAMIC
INSTABILITY
DISRITMIA LANJUTAN

ATRIUM KA/KI ( ATRIAL )

P : Keriting = Atrial Fibrilasi.
P : GIGI GERGAJI = Atrial Flutter
DISRITMIA LANJUTAN

SUPRA VENTRIKEL
P (-) SVT HR > 150 X/MNT
 DISRITMIA LANJUTAN

VENTRIKEL

P : (-)
QRS LEBAR

SP

HR 24-40 : IVR
SP
HR 40-100 : AIVR
HR > 100 : VT
HR > 350 : AREGUREL : VF
 Irama :Teratur, kecuali pada yg hilang
Frekwensi HR :Biasanya kurang dari 60 x/menit
Gel. P :Normal, kecuali pada yg hilang
Interval PR :Normal,kecuali pada yg hilang
Gel. QRS :Normal ( 0,06 0,12 detik )
Catatan :Hilang gel P,QRS,T ( fase arrest ) bukan merupakan
kelipatan kelipatan dari irama dasar

Penatalaksanaan tergantung penyebab

Bila ada indikasi peningkatan tonus vagal atropin mungkin indikasi
 Irama : Biasanya teratur, bisa juga tidak
Frekwensi HR : Bervariasi ( bisa normal, lambat/ cepat )
Gel. P : Tidak normal, seperti gigi gergaji ( saw tooth ),
teratur dan dapat dihitung tidak semua gel P
diikuti QRS ,shg frequensi atrial tidak sama dengan
ventrikel bisa 2:1, 3:1 atau 4:1
Interval PR : Tidak dapat dihitung
Gel. QRS : Normal ,
 Atrial Flutter
ATRIAL RATE = 250 400 IMPULSES/ MINUTE
ETIOLOGY:
OCCURS /W HEART DISEASE
CAD
VALVE DISORDERS
CLINICAL SIGNS
SAW TOOTH P-WAVES, CALLED F-WAVES
ATRIAL RATE = 250 400/ MIN
AV NODE BLOCKS SOME IMPULSES
INCOMPLETE EMPTYING OF ATRIA CAUSE RISK FOR
THROMBUS GIVE ANTICOAGULANTS
 Atrial Flutter

TREATMENT
TREAT UNDERLYING CAUSE
IRRITABILITY, RAPID VENTRICULAR
RESPONSE
DIGOXIN SLOWS RATE BY ENHANCING AV BLOCK
QUINIDINE SUPRESSES ATRIAL ECTOPIC BEATS
AMIODARONE
CALCIUM CHANNEL & -BLOCKERS
CONSIDER CARDIOVERSION
 Irama : Tidak teratur.
Frekwensi HR : Bervariasi ( bisa normal, lambat / cepat)
Gel. P : Tidak dapat diidentifikasi, sering terlihat
keriting pada garis base line.
Interval PR : Tidak dapat dihitung
Gel. QRS : Normal ( 0.06 0.12 )

AF RVR
 Atrial Fibrillation

CHAOTIC ELECTRICAL ACTIVITY IN ATRIA

ATRIA QUIVER (>500 beats/minute) INSTEAD
OF CONTRACTING AS A UNIT
ETIOLOGY: ADVANCED AGE
VALVE DISORDERS
CARDIOMYOPATHY
 Atrial Fibrillation

TREATMENT
1. Amiodarone-may cause liver, lung damage and
worsening of arrhythmias. Pt to report SOB, wheezing,
jaundice, palpitations, lightheadedness
2. Pronestyl, Ca channel blockers, beta blockers, digoxin
3. Synchronized cardioversion if unstable
4. Radio frequency catheter ablation
5. Anticoagulation therapy
Atrial Rhythms
Ventricular Arrhythmias
 Ventricular Arrhythmias

ORIGINATES IN VENTRICLES
PATIENT MAY BE SYMPTOMATIC, REQUIRES
IMMEDIATE ATTENTION
PVC, couplet, bigeminy, trigeminy
V-TACH (ventricular tachycardia)
V-Fib (Ventricular fibrillation)
PREMATURE VENTRICULAR CONTRACTION (PVC)

CLINICAL SIGNS:
DEPEND ON FREQUENCY
PVC SHORT DIASTOLIC FILLING TIME
C.O.
FREQUENT PVC SENSATION OF PALPATIONS,
SKIPPED BEATS
BIGEMINY PVC EVERY OTHER BEAT
TRIGEMINY PVC EVERY 3RD BEAT
 When are PVCs a Problem?
Increase from the patients normal amount
Multiple PVCs in a row
PVC falls on the T wave of previous beat
Multifocal (they arise from different cells, therefore they are
different shapes)

Multifocal PVCs
 PVC Troubles
Bigeminy = every other beat is a PVC

Trigeminy = every 3rd beat is a PVC

Multiple PVCs
Couplet

Triplet
 Ventricular Tachycardia (VT)
4 or more ventricular beats in a row
Rate > 150 bpm
If you step on
A Tack, you will
Get off of it fast!

6 beats of VTach
 Sustained VTach

Pt stays in VTach & needs our help to

switch (defibrillate or cardiovert)
Code BLUE !
Idioventricular Rhythm
Ventricular beats, but.
slow rate
 Torsades de Pointes

A form of VTach which looks like the rhythm

strip is twisting
Code BLUE !
 Paroxysmal Supraventricular Tachycardia

ABRUPT ONSET OF HR
ETIOLOGY: SNS STIMULATION
CARDIOMYOPATHY
CLINICAL SIGNS:
ABRUPT ONSET/ CESSATION
S/S ARE RELATED TO C.O.
RATE = 150 250 bpm
 PSVT
TREAT UNDERLYING CAUSE
DRUGS: ADENOSINE, -BLOCKERS,
DIGOXIN, MS, QUINIDINE
CAROTID / VAGAL MANEUVERS
SYNCHRONIZED CARDIOVERSION IF UNSTABLE
PREMATURE VENTRICULAR CONTRACTION
(PVC)
EARLY IRREGULAR VENTRICULAR BEATS
QRS IS WIDE /BIZZARE
CAN BE CHRONIC ASYMPTOMATIC
ABNORMALITY OR WARNING OF SERIOUS
DYSRHYTHMIA
PREMATURE VENTRICULAR CONTRACTION (PVC)

ETIOLOGY:
HYPOXIA
DIGOXIN TOXICITY
MECHANICAL STIMULATION
ELECTROLYTE (K) IMBALANCE
MI
PVCs
 PREMATURE VENTRICULAR CONTRACTION (PVC)

TREATMENT:
TREAT IMPAIRED HEMODYNAMICS
ANTIARRHYTHMICS
OXYGEN
MONITOR FOR PVC LANDING ON
T-WAVE
OBSERVE FOR UNIFOCAL (VS) MULTIFOCAL
 Ventricular Arrhythmias
VENTRICULAR TACHYCARDIA
3 OR MORE PVCs
QRS IS WIDE/ BIZARRE

EXTREMELY SERIOUS
MAY LEAD TO LETHAL RHYTHMS

ETIOLOGY: SAME CAUSES AS PVC, ALSO

CARDIOMYOPATHY, MYOCARDIAL
IRRITABILITY
Ventricular Tachycardia
 Treatment
VT /W PULSE - CARDIOVERT
MONITOR MORE CLOSELY
PREPARE FOR CARDIOVERSION
(O2, LIDOCAINE, TREAT CAUSE)
VT W/O PULSE - DEFIBRILLATE
 VENTRICULAR FIBRILLATION
TOTAL UNORGANIZED MULTIFOCAL
RHYTHM, VENTRICLES QUIVER,
NO CARDIAC OUTPUT
Ventricular Fibrillation (VF)

Squiggly line
Code BLUE !
SR

VES
Sinus Rhythm with VES couplet
 Irama : Teratur
Frekwensi HR : 100 250 x/menit
Gel. P : Tidak ada
Interval PR : Tidak ada
Gel. QRS : Lebar lebih dari 0,12 detik
 Irama : Tidak teratur
Frekwensi HR : < 350 x/menit shg tdk dpt dihitung
Gel. P : Tidak ada
Interval PR : Tidak ada
Gel. QRS : Lebar dan tidak teratur
@ VF kasar (Coarse VF)
@ VF halus (Fine VF)
 V-fib
ETIOLOGY:
SAME AS VT, PVC
SURGICAL MANIPULATION OF HEART
FAILED CARDIOVERSION
CLINICAL SIGNS:
SAME AS CARDIAC ARREST
EKG SHOWS DISORGANIZED
RHYTHM
 V-fib
TREATMENT
IMMEDIATE DEFIBRILLATION X3
CPR
SURVIVAL IS < 10% FOR EVERY MINUTE
THE PATIENT REMAINS IN V-fib
SCREAM for Vfib and Pulseless VTach
1.Shock360J* monophasic, 1st and subsequent
shocks.(Shock every 2 minutes if indicated)
2.CPR After shock, immediately begin chest
compressions followed by respirations (30:2
ratio) for 2 minutes.
3.Rhythm check after 2 minutes of CPR (and after
every 2 minutes of CPR thereafter) and shock
again if indicated. Check pulse only if an
organized or non-shockable rhythm is present.
 CARDIAC ARREST
VENTRICULAR ASYSTOLE
80 90% DUE TO V-fib
TOTAL ABSENCE OF ELECTRICAL AND
MECHANICAL ACTIVITY
ETIOLOGY
TRAUMA
OVERDOSE
MI
CLINICAL SIGNS
ASYSTOLE or V-fib
NO DEFINABLE WAVE FORMS
ABSENCE OF VITAL SIGNS
 Ventricular Asystole

Acronym Comments
T Only effective with
Transcutaneous early implementaion
Pacemaker
E Epinephrine 1 mg IV q3-5 min
A Atropine 1 mg IV q3-5 min
 PEA- Pulseless Electrical Activity
Asystole Algorithm
PEA
Problem search
Epinephrine 1mg IV/IO q3-5min
Atropine- with a slow HR, I mg IV/IO q3-5min
Consider termination of efforts if asystole
persists despite appropriate interventions.
 TORSADE DE POINTES
Rate: usually between 150 to 220/bpm,
P wave: obscured if present
QRS: wide and bizarre morphology
Conduction: as with PVCs
Rhythm: Irregular
Paroxysmal starting and stopping suddenly
Hallmark of this rhythm is the upward and downward deflection of the QRS
complexes around the baseline. The term Torsade de Pointes means "twisting
about the points."
Consider it V-tach if it doesnt respond to antiarrythmic therapy or treatments
Caused by:
drugs which lengthen the QT interval such as quinidine
electrolyte imbalances, particularly hypokalemia
myocardial ischemia
Treatment:
Synchronized cardioversion is indicated when the patient is unstable.
IV magnesium
IV Potassium to correct an electrolyte imbalance
Overdrive pacing
ST Changes: Heart Attack in Progress
R

P T
The QRS should enter & exit on the baseline Q S

ST Depression (Ischemia) ST segment

(QRS exits lower than it starts)
enters
exits

ST Elevation (Infarction)
(QRS exits higher than it starts)
exits
enters
 ST Elevation

I would probably
have a heart attack if I
had to climb this!

ST Depression

He sure is down
and depressed !
Heart Blocks
 DISRITMIA KARENA GANGGUAN SISTEM KONDUKSI ATAU HANTARAN:
Impuls yang berasal dari Sino Atrial Node :
Sino Atrial Blok
Impulsyang berasal dari Atrio Ventrikular Node :
AV Blok Derajat 1 / First Degree AV Blok
AV Blok Derajat 2 Mobit I / Secon Degree AV Blok mobitz 1
AV Blok Derajat 2 Mobit II / Secon Degree AV Blok mobitz II
AV Blok Derajat 3 / Total AV Blok / Third Degree AV Blok.
Impuls yang berasal dari Inter Ventrikuler
RBBB ( Right Bundle Branch Block )
LBBB ( Left Bundle Branch Block )
- LPHB ( Left Posterior Hemi Block )
- LAHB ( Left Anterior Hemi Block )
Bifasikuler Block
Trifasikuler Block
 Irama : Teratur,kecuali pada gel. Yg hilang
Frekwensi HR : Umumnya kurang dari 60 x/menit
Gel. P : Normal,dan hilang pada saat terjadi blok
Interval PR : Normal,dan hilnag pada saat terjadi blok
Gel. QRS : Normal ( 0,06 0,12 )
Catatan : Hilang satu atau dua gel.P,QRS dan T
menyebabkan kelipatan jarak antara R -R
SA blok biasanya tanpa gejala. Dapat terjadi pd orang sehat,
bisa juga pada klien CAD, inferior MI, dan digitalis toxicity
 Irama : Teratur
Frekwensi HR : Umumnya normal antara 60 - 100
x/menit
Gel. P : Normal
Interval PR : Memanjang,lebih dari 0,20 detik
Gel. QRS : Normal
 Irama : Tidak teratur
Frekwensi HR : Normal dan kurang dari 60 X/mt
Gel. P : Normal tapi ada satu gel.P yg tidak diikuti gel
QRS
Interval PR : Makin lama makin panjang, sampai ada
gel.P yg tidak diikuti gel. QRS,
kemudian siklus makin panjang berulang.
Gel. QRS : Normal
 Irama : Umumnya tidak teratur, kadang bisa
teratur
Frekwensi HR : Umumnya lambat kurang dari 60 x/menit
Gel. P : Normal / tapi ada satu gel.p yg tidak diikuti
gel qrs
Interval PR : Normal atau memanjang secara konstan.

Gel. QRS : Normal

 Irama : Teratur
Frekwensi HR : Kurang dari 60 x/menit
Gel. P : Normal, tetapi gel P dan QRS berdiri
sendiri-sendiri sehingga gel P kadang
diikuti gel QRS kadang tidak.
Interval PR : Berubah-ubah
Gel. QRS : Normal / memanjang lebih dari 0,12 detik
 Irama : Teratur
Frekwensi HR : Umumnya normal antara 60 - 100
x/menit
Gel. P : Normal, setiap gel.p selalu diikuti gel
qrs dan t.
Interval PR : Normal
Gel. QRS : Lebar lebih dari 0,12 detik

Catatan : Ada bentuk rsR ( M shape ) di V1 dan

V2. Gel S yg lebar dan dalam di lead 1 , II, aVl , V5 dan V6.
Perubhan ST segmen dan gel T di V1 dan V2
 Irama : Teratur
Frekwensi HR : Umumnya normal
antara 60 - 100 x/menit
Gel. P : Normal, setiap gel.P selalu diikuti
gel QRS dan T
Interval PR : Normal
Gel. QRS : Lebar lebih dari 0,12 detik

Catatan : Ada bentuk rsR ( M Shape ) di V5

dan V6. Gel Q yg lebar dan dlam di V1
dan V2. Perubhan ST segmen dan gel
t di V5 dan V6
Which rhythms are a
CODE Blue?
VT
VFib
Asystole
Torsades
PEA
HIPERTROPHY
 Hipertrofi Atrium Kanan ( RAH )

Ditandai dengan adanya

Gel. P yg lancip dan tinggi yg jelas terlihat di lead I dan II,
disebut ( P -Pulmonal )
 Hipertrofi Atrium Kiri ( LAH )

Ditandai dengan adanya

Gel P yg lebar dan berlekuk, paling jelas terlihat di lead I
dan II, disebut ( P- Mitral )
 Hipertrofi Ventrikel Kanan (RVH )
Gel R > besar dari gel. S pada lead prekordial kanan
Gel S menetap di V5dan V6
Depresi segmen ST dan gel T terbalik dib V1-V3
RAD
 Hipertrofi Ventrikel Kiri ( LVH )
Gel R pada V5/V6 > dari 27 mm / gel.S di V1 + gel.R di
V5/V6 > dari 35 mm.
Depresi segmen ST dan gel.T terbalik di V5/V6.
LAD
EKG Pada Inbalance Elektrolit
 HYPERKALEMIA

Tall, thin and peaked T waves

Increased duration of the QRS complex
Wider P waves and prolongation PR interval
Severe HYPERKALEMIA
( K = 8.8 mEq/L )

marked widening of the

QRS complex and T wave
with a sine wave pattern
 Peaking T
Shortening QT interval

Widening P wave,
QRS complex
Prolongation PR interval
HYPOKALEMIA

Decrease in amplitude, flattening or inversion of the T wave

Prominent U wave
ST segment depression
 HYPOCALCEMIA

II

III

Prolonged QT interval ( QT = 480 ms, QTc = 520 ms )

Lengthened ST segment
T waves may be flat or inverted
HYPOCALCEMIA HYPERCALCEMIA
 Nursing Management of a Patient With Dysrhythmias
Pengkajian :
Kaji penurunan CO : syncope, kelelahan, pusing, nyeri dada
dan jantung berdebar
Kaji penyebab disritmia: penyakit jantung, PPOK
Kaji penggunaan obat spt; digoxin
PF tanda penurunan CO: penurunan tk. Kesadaran, kulit pucat
dan acral dingin, tanda retensi cairan (distensi vena dan
clekles), suara jantung tambahan S3 dan S4, TD dan Nadi
Penurunan tekanan nadi, tanda penurunan CO

127
 Nursing Management of a Patient With Dysrhythmias
Nursing Diagnoses:
penurunand cardiac output
Kecemasan b.d adanya ketakutan yang tidak jelas
Kurang pengetahuan ttg disritmia dan tatalaksananya

Planning and Goals

Penurunkan faktor risiko
mempertahankan cardiac output
Meminimalkan kecemasan
Pengetahuan tentang disritmia dan tatalaksana meningkat

128
 Nursing Management of a Patient With Dysrhythmias
Nursing Interventions:
Monitoring and managing dysrhythmias
Record BP, HR and rhythm, rate and depth of respirations,
and breath sounds to determine the dysrhythmias
hemodynamic effect.
Ask patients about episodes of lightheadedness, dizziness, or
fainting.
Obtain a 12-lead ECG to continuously monitor the patient
and to track the dysrhythmia.
Administer antiarrhythmic medications as prescribed.
Assess for factors that contribute to the dysrhythmia (eg,
caffeine, stress, nonadherence to the medication regimen)
and assist the patient in making lifestyle changes that adress
these issuses.
129
 Nursing Management of a Patient With Dysrhythmias
Nursing Interventions (Continued..):
Minimising anxiety
At the time of dysrhythmic event, maintain a calm and
reassuring attitude to foster a trusting relationship with the
patient and assists in reducing anxiety.
Promote a sense of confidence in living with a dysrhythmia.
For example, while administering a medication at a
dysrhythmia event and it begins to reduce the incidence of
dysrhythmia, communicate that information to the patient.

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 Nursing Management of a Patient With Dysrhythmias
Nursing Interventions (Continued..):
Teaching patient self-care
Present the information in terms that are understandable and
in a manner that is not frightening or threatening.
Explain the importance of taking medications regularly to
maintain therapeutic serum levels of antiarrhythmic agents
If dysrhythmia is potentially lethal, establish with the patient
and family a plan of action to take in case of an emergency.

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 Nursing Management of a Patient With Dysrhythmias
Evaluation: The patient
Maintains cardiac output
Demonstrates HR, BP, RR, and LOC within normal ranges
Demonstrates no or decreased episodes of dysrhythmia
Has reduced anxiety
Expresses a positive attitude about living with the dysrhythmia
Expresses confidence in ability to take appropriate actions in an emergency
Expresses understanding of the dysrhythmia and its treatment
Explains the dysrhythmia and its effects
Describes the medication regimen and its rationale
Explains the need for therapeutic serum level of the medication
Describes a plan to eradicate or limit factors that contribute to the occurrence of the dysrhythmia
States actions to take in the event of an emergency

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