Medical-Surgical Nursing

Harding: Lewis’s Medical-Surgical Nursing, 11th Edition. Dysrhythmia and Pacemaker (Ch. 35) A 38-year-old female is admitted to the emergency department after “feeling palpitations and almost fainting.” She states that this started a few hours ago and got progressively worse as she tried to get ready for work.

The ECG reveals nonconducted P waves without progressive PR intervals.

On conducted beats, the PR interval is constant, with a ratio of 3:1 (three P waves to one conducted QRS interval). The ventricular rate ranges from 50 to 60.

The PR interval is slightly prolonged; the QRS complex is greater than 0.12 seconds. Blood pressure is 108/54 mm hg, temperature 97.8°F (36.6°C), respirations 18 breaths/minute.

Currently she is not feeling faint but reports feeling occasional palpitations. She reports that she has felt extremely tired for the past few days. The patient states that she has a family history of heart disease and that her mother had a heart attack at age 35. She denies having any chest pain or tightness.

The patient states that she has smoked 1 pack of cigarettes a day for years but stopped smoking a month ago. Her skin is warm and dry, and capillary refill is brisk.

1. NGN Item Type: Highlighting/Enhanced Hot Spot

Highlight or place a check mark next to the assessment findings that require follow-up by the nurse