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.
· 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.
A 60-year-old male patient is admitted with chest pain to the telemetry unit where you work
Other assessment findings to anticipate in this patient include:
**Hypotension**: Bradycardia can lead to decreased cardiac output, resulting in hypotension. Therefore, assessing blood pressure for any signs of hypotension, such as a systolic blood pressure <90 mmHg, is crucial.
**Decreased Level of Consciousness**: Inadequate perfusion to the brain due to decreased cardiac output may lead to altered mental status or decreased level of consciousness.
**Pale, Cool, Clammy Skin**: Poor perfusion to the peripheral tissues may result in pale, cool, and clammy skin.
**Weak or Absent Peripheral Pulses**: Bradycardia can lead to decreased peripheral perfusion, resulting in weak or absent peripheral pulses.
This patient likely has bradycardia due to vagal stimulation, also known as the vasovagal response. Straining during a bowel movement can stimulate the vagus nerve, leading to increased parasympathetic activity and subsequent bradycardia. Additionally, this patient may have an underlying cardiac condition contributing to the bradycardia, such as sinus node dysfunction or heart block.
While not all cases of bradycardia require immediate treatment, symptomatic bradycardia with associated hemodynamic compromise, such as hypotension or altered mental status, necessitates intervention. In this scenario, the patient’s symptoms of shortness of breath, diaphoresis, and bradycardia indicate significant hemodynamic compromise and warrant treatment. The first intervention would be to ensure adequate oxygenation and ventilation by providing supplemental oxygen and assessing the patient’s airway and breathing.
The drug treatment of choice for symptomatic bradycardia is atropine sulfate. The recommended dosage is 0.5 mg IV bolus, which may be repeated every 3 to 5 minutes as needed, up to a total dose of 3 mg. Atropine sulfate is an anticholinergic medication that blocks the action of acetylcholine at muscarinic receptors in the heart, thereby inhibiting vagal stimulation and increasing heart rate. This action results in the reversal of bradycardia and improvement in cardiac output.
References:
American Heart Association. (2020). ACLS Provider Manual. Dallas, TX: American Heart Association.
UpToDate. (n.d.). Bradycardia: Management and prognosis. Retrieved from https://www.uptodate.com/contents/bradycardia-management-and-prognosis
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