Medical Surgical Critical Care Cardiac Critical Care #1

Question

A client was brought to the emergency department with a heart rate of 42, RR of 30, and BP of 80/50. The client’s skin is pale, cool and clammy, with confusion and irritability. Which action is priority for the nurse to implement?

Answers

  1. Warfarin
    • Rationale:

      This answer is not correct because warfarin is an anticoagulant used for atrial fibrillation to help prevent stroke, not normally used for bradycardia.

  2. Atropine
    • Rationale:

      This answer is correct because the priority intervention for symptomatic bradycardia is atropine. Atropine is an anticholinergic and speeds up the heart rate and vital signs making the body dry. Atropine increases the atrioventricular conduction or the heart by obstructing the hearts parasympathetic influences.

  3. Cardioversion
    • Rationale:

      This answer is not correct because cardioversion is not the priority intervention for symptomatic bradycardia. The second intervention could be external pacing if atropine does not work to increase the client’s vital signs.

  4. Defibrillation
    • Rationale:

      This answer is not correct because defibrillation transfers an electrical shock so every heart cell contracts all at once. Defibrillation is completed with deadly rhythms such ventricular tachycardia and ventricular fibrillation when the client has no pulse.

Overview

This client is exhibiting symptomatic bradycardia. Bradycardia is defined as a heart rate less than 60 beats/min. Symptomatic bradycardia includes a low heart rate, pale, cool and clammy skin, mental status changes with confusion, irritability, and agitation due to low oxygen perfusion.

Explanation

Learning Outcomes

The priority intervention for symptomatic bradycardia is atropine. Atropine is an anticholinergic and speeds up the heart rate and vital signs making the body dry. Atropine increases the atrioventricular conduction or the heart by obstructing the hearts parasympathetic influences. This client is exhibiting symptomatic bradycardia. Bradycardia is defined as a heart rate less than 60 beats/min. Symptomatic bradycardia includes a low heart rate, pale, cool and clammy skin, mental status changes with confusion, irritability, and agitation due to low oxygen perfusion.

Test Taking Tip

Know the signs of symptomatic bradycardia and the priority treatments.

Video Rationale