1. Chapter 27
Management of Patients
With Dysrhythmias and
Conduction Problems

2. Dysrhythmias
• Disorders of the formation and/or
conduction of electrical impulses in
the heart
• Cause disturbances of heart rate
and/or heart rhythm
• May be evidenced by changes in
hemodynamics
• Diagnosed by analyzing
electrocardiogram

3. ECG Interpretation
• P wave represents atrial depolarization
• QRS complex represents ventricular
depolarization
• T wave represents ventricular
repolarization
• U wave may represent repolarization
of Purkinje fibers. May also be seen in
hypokalemia, hypertension, or heart
disease

5. • PR interval normal range is 0.12-0.20
seconds
• ST segment is identified as isoelectric, or
above or below isoelectric line
• QT interval normal range is 0.32-0.40
seconds
• TP interval is isoelectric period
• PP interval signifies atrial rhythm and
rate
• RR interval signifies ventricular rate and
rhythm

7. Analyzing the ECG Rhythm Strip
1. Determine ventricular rate
2. Determine ventricular rhythm
3. Determine QRS duration
4. Determine whether QRS
duration is consistent
5. Identify QRS shape

8. Analyzing the ECG Rhythm Strip
(cont’d)
6. Identify P waves, is there a P in
front of every QRS?
7. Identify P wave shape
8. Determine atrial rate
9. Determine atrial rhythm

9. Analyzing the ECG Rhythm Strip
(cont’d)
10. Determine PR interval
11. Determine if PR intervals are
consistent, irregular but with a
pattern, or just irregular
12. Determine how many P waves
for each QRS (P:QRS ratio)

11. Sinus Node Dysrhythmias
•Sinus Bradycardia
•Sinus Tachycardia
•Sinus Arrhythmia

13. Atrial Dysrhythmias
• Premature Atrial Complex
• Atrial Flutter
• Atrial Fibrillation

15. Junctional Dysrhythmias
• Premature Junctional Complex
• Junctional Rhythm
• Atrioventricular Nodal Reentry
Tachycardia
–Supraventricular tachycardia

16. Ventricular Dysrhythmias
• Premature Ventricular Complex
• Ventricular Tachycardia
• Ventricular Fibrillation
• Idioventricular Rhythm
• Ventricular Asystole

19. Conduction Abnormalities
• First-Degree Atrioventricular Block
• Second-Degree Atrioventricular
Block, Type I
• Second-Degree Atrioventricular
Block, Type II
• Third-Degree Atrioventricular Block

20. Nursing Interventions
• Monitoring and managing the
dysrhythmia
• Minimizing anxiety
• Teaching self-care

21. Pacemaker Therapy
• Provides electrical stimuli to heart
muscle
• Used for slower-than-normal
impulse formation, to control
some tachycardias, or for
advanced heart failure

22. Pacemaker Therapy (cont’d)• NASPE-BPEG code
–First letter identifies chambers being
paced
–Second letter describes the chambers
being sensed
–Third letter describes type of response
by pacemaker to what is sensed

24. Cardioversion and Defibrillation
• Delivery of electrical current to
depolarize a critical mass of
myocardial cells
• When cells repolarize the SA node, is
usually able to recapture its role as
pacemaker of heart
• Cardioversion involves use of “timed”
electrical current to terminate a
tachydysrhythmia

25. Cardioversion and Defibrillation
(cont’d)• Defibrillation is used in
emergency situations as
treatment for ventricular
fibrillation and pulseless VT