Other Assessment Findings Should you Anticipate

module 05 Written Assignment – Case Study.

Module 05 Content

Top of Form

A 60-year-old male patient is admitted with chest pain to the telemetry unit where you work. While having a bowel movement on the bedside commode, the patient becomes short of breath and diaphoretic. The ECG waveform shows bradycardia.

1. • What other assessment findings should you anticipate?
   • Why does this patient probably have bradycardia?
   • Does this dysrhythmia need treatment? Why or why not? What intervention would you implement first?
   • What is the drug treatment and dosage of choice for symptomatic bradycardia? How does this drug increase heart rate?

Please use complete sentences to answer the questions. Ensure that you are using correct grammar. In additions, support your answers by using your textbooks, scholarly journals, and credible Internet sources. All citations must be in APA format.

NOTE

APA, CITATION, AND REFERENCING

Strictly PLAGIARISM-CHECK

1. When a patient presents with chest pain, shortness of breath, and diaphoresis, in addition to bradycardia, it is important to anticipate other assessment findings related to potential underlying causes. These may include signs of hypotension, such as decreased blood pressure, weak peripheral pulses, and lightheadedness or syncope. Additionally, the patient may exhibit signs of decreased cardiac output, such as cool and clammy skin, altered mental status, and decreased urine output. Assessment should also include evaluation for potential cardiac ischemia or infarction, such as changes in the ST segment or T wave on the ECG, elevated cardiac biomarkers, and evidence of myocardial dysfunction on echocardiogram or other imaging studies.
2. The presence of bradycardia in this patient is likely due to a vagal response triggered by the act of having a bowel movement. This is known as the Valsalva maneuver, which increases intra-abdominal pressure and stimulates the vagus nerve, leading to bradycardia and potentially hypotension. Additionally, the patient’s age may contribute to decreased autonomic tone and diminished sympathetic response, further predisposing to bradycardia.
3. Symptomatic bradycardia necessitates treatment, particularly if the patient is experiencing hemodynamic compromise. Bradycardia can lead to decreased cardiac output, hypotension, and compromised tissue perfusion, potentially resulting in serious complications such as myocardial ischemia, hypoxia, or even cardiac arrest. The initial intervention for symptomatic bradycardia involves addressing the underlying cause, such as discontinuing vagal stimulation by assisting the patient back to bed and ensuring adequate hydration and oxygenation. If these measures are insufficient, pharmacological interventions may be necessary to increase heart rate and improve hemodynamic stability.
4. The drug treatment of choice for symptomatic bradycardia is atropine sulfate. The initial recommended dosage for adults is 0.5 to 1 mg IV every 3 to 5 minutes, up to a total dose of 3 mg. Atropine acts by blocking the effects of acetylcholine on muscarinic receptors, thereby inhibiting vagal tone and increasing heart rate. By antagonizing the parasympathetic nervous system, atropine effectively counteracts the bradycardic effects of vagal stimulation, leading to improved cardiac output and perfusion pressure.

References:

• American Heart Association. (2020). Advanced Cardiovascular Life Support: Provider Manual. Dallas, TX: American Heart Association.
• Katzung, B. G., Masters, S. B., & Trevor, A. J. (2021). Basic & Clinical Pharmacology (15th ed.). New York, NY: McGraw-Hill Education.