What is the heart rate?
What is this rhythm?
Nursing assessments/actions
100


40 beats per minute

100


Normal Sinus Rhythm

100

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.

200


70 beats per minute

200


Atrial Fibrillation

200

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

300


170 beats per minute

300


Ventricular Tachycardia

300

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? 

Even though this is not your assigned patient, you need to assess this patient immediately.  If the patient does not have a pulse, start CPR.


What if the patient has a pulse?

400


120 beats per minute

400


Ventricular Fibrillation

400

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). 

500


10 beats per minute

500


Asystole

500

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

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