40 beats per minute
Normal Sinus Rhythm
Your 45-year old patient is admitted post operatively from a gall bladder removal. The surgery went well. Upon arrival to your unit, you attach the telemetry monitor. This rhythm appears. What are your nursing actions?
Assess your patient! (alertness, VS, peripheral pulses, color of skin, cap refill).
Document and notify the provider.
70 beats per minute
Atrial Fibrillation
Your patient was admitted for palpitations and fluttering in their chest. They were feeling dizzy at home and called 911. This rhythm is on the monitor. What nursing assessments are most important?
VS
Cardiac: (pulses, cap refill, auscultation, skin color),
Neuro: (stroke) assessments
170 beats per minute
Ventricular Tachycardia
You are the charge nurse for the day and notice one of the patient's monitors starts alarming. You walk over to the monitor and notice this rhythm. What are your nursing actions?
What if the patient has a pulse?
120 beats per minute
Ventricular Fibrillation
Upon entering your patient's room, you find your patient unresponsive without a pulse. Here is the rhythm on the monitor. What nursing actions should you perform first?
High quality CPR, call for help (code Blue).
10 beats per minute
Asystole
Your patient was brought by ambulance for chest pain. This is the rhythm on the 12-lead ECG. What are your nursing actions?
Immediately contact a physician as this patient will need the cath lab.
VS, administer nitro, oxygen, aspirin, insert an IV