Pharmacologic Highlights

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Medication or Drug Class

Dosage

Description

Rationale

Antidysrhythmics

Varies with drug

Quinidine sulfate, phenytoln, lidocaine

Suppress frequent PJCs

Calcium channel blockers and beta-adrenergic blockers

Varies with drug

Verapamil, diltiazem, propranolol, esmolol, sotalol

Treat junctional tachycardia

Adenosine

6 mg IV over 1-3 sec; may repeat in 1-2 min

Antiarrhythmic

Suppresses paroxysmal junctional tachycardia

Other Drugs: Atropine sulfate, digitalis, dopamine, epinephrine. Other drugs used for continuing significant bradycardias no matter what the origin, particularly when accompanied by hypotension, are dopamine (5 to 20 pg/kg per minute of IV infusion) and epinephrine (2 to 10 pg/kg per minute of IV infusion).

Independent

The nurse's role is one of monitoring and support. Support the patient who is experiencing symptoms from any rhythm disturbance. Maintain the patient's airway, breathing, and circulation. To maximize oxygen available to the myocardium, encourage the patient to rest in bed until the symptoms are treated and subside. Remain with the patient to ensure rest and to allay anxiety. Discuss any potential precipitating factors with the patient. For some patients, strategies to reduce stress or lifestyle changes help limit the incidence of dysrhythmias. Teach the patient to reduce the amount of caffeine intake in the diet. If appropriate, encourage the patient to become involved in an exercise program or a smoking cessation group. Provide emotional support and

548 Junctional Dysrhythmias information about the dysrhythmia, the precipitating factors, and mechanisms to limit the dysrhythmia. If the patient is at risk for electrolyte imbalance, teach the patient any dietary considerations to prevent electrolyte depletion.

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