Primary Nursing Diagnosis

Altered tissue perfusion (cardiopulmonary, cerebral, renal, peripheral) related to rapid or slow heart rates

OUTCOMES. Circulation status; Cardiac pump effectiveness; Tissue perfusion: Cardiopulmonary, Cerebral, Renal, Peripheral; Vital sign status

INTERVENTIONS. Circulatory care; Dysrhythmia management; Emergency care; Vital signs monitoring; Cardiac care; Cardiac precautions; Oxygen therapy; Fluid/electrolyte management; Surveillance

U PLANNING AND IMPLEMENTATION Collaborative

Treatment of junctional dysrhythmias usually depends on the heart rate. Unless the cardiac output is compromised, treatment may not be initiated. Infrequent PJCs may be tolerated as benign.

PJCs are treated by attempting to alleviate the cause. Stimulants such as caffeine, tobacco, and sympathomimetic drugs may be discontinued. If digitalis toxicity is the cause, digitalis may be withheld. If PJCs are frequent, they may be suppressed by administration of an antidysrhyth-mic such as quinidine sulfate. Infrequent PJCs may not be treated.

Junctional escape rhythm is a marked bradycardia that may be treated with atropine sulfate intravenously (IV) to increase the rate. In rare circumstances, a temporary cardiac pacemaker is necessary if the bradycardia does not respond to treatment.

An accelerated junctional rhythm, with a rate between 60 and 100 beats per minute, rarely compromises the cardiac output. The rhythm is usually just observed.

Paroxysmal junctional tachycardia is treated the same as any narrow QRS complex tachycardia. If the ventricular rate is faster than 150 beats per minute, cardioversion may be indicated. If the rate is less than 150, vagal maneuvers may be attempted. The drug of choice for emergency treatment is adenosine. The nurse has an important role in the collaborative management of the patient by administering medications as ordered or according to protocol in emergency situations.

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