NORTHWESTERN UNIVERSITY

College of Allied Health Sciences

Department of Nursing
Laoag City

Alternative Learning Activities

VENTRICULAR TACHYCARDIA

Nursing Care of Clients with Life Threat Condition, Acutelly III/ Multi Organ
Problem, High Acuity & Emergency NCM118

Presented to:

KRISTEL GAIL A. VALENCIA, RN

Clinical Instructor

Presented by:

Agdeppa, Raquel O. Daguio, Sherry-Lyn F.

Aguilar, Justine Grace M. Enriquez, Erika Gaile G.
Ancheta, Rizza Dianne R. Mitsutome, Lauren A.
Bacudio, Janelle D. Muñoz, Mary Angel G.
Bacudio, Rustica D. Puriran, Kim Howard B.

Alternative Learning Activity| BSN III-B Group 1

Firsy Semester – AY 2021-2022
 TABLE OF CONTENTS

PAGE

1 I. CLINICAL CASE SITUATION

2 II.NTRODUCTION

5 III. PATHOPSHYSIOLOGY AND MANAGEMENT

23 IV. DISCHARGE PLANNING

25 V. RELATED NURSING THEORY

27 VI. REVIEW OF RELATED LITERATURE

30 VII. REFERENCES
 I. CLINICAL CASE SITUATION

CASE SCENARIO

A male patient, 60 years old was rushed to the emergency department by the

first aiders in Mariano Marcos Memorial Hospital for an unknown medical chief of

complaint. Upon arrival, nurse Raquel finds out that the male patient is clutching his

chest and gasping for air. He is awake, but only able to speak one word at a time. He

is pale and diaphoretic. The first aider loosened his shirt and put him in high-flow

oxygen and tells that he began having crushing chest pain a minute before the

respiratory distress. The nurse immediately asses the patient with the following vital

signs; Blood Pressure of 80/60, Respiratory rate of 28 and Radial pulse of 92 and

bounding. The patient is unstable due to the combination of worsening chest pain and

respiratory distress, diaphoretic with shortness of breath and being able to speak one

word at a time that are signs of hemodynamic compromise. The cardiac monitor

shows ventricular tachycardia at a rate of 198 b/pm. ALS treatment is immediate

synchronized cardio version. Delaying cardio version for sedatives would be unwise,

as he is unlikely to compensate much longer.

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II. INTRODUCTION

Ventricular tachycardia is a heart rhythm disorder (arrhythmia) caused by

abnormal electrical signals in the lower chambers of the heart (ventricles). This

condition may also be called V-tach or VT. A healthy heart normally beats about 60

to 100 times a minute at rest. In ventricular tachycardia, the heart beats faster than

normal, usually 100 or more beats a minute. The chaotic heartbeats prevent the heart

chambers from properly filling with blood. As a result, the heart can’t be able to pump

enough blood in the body and lungs. Ventricular tachycardia may last for only a few

seconds, or it can last for much longer. It may feel dizzy or short of breath, or have

chest pain. Sometimes, ventricular tachycardia can cause the heart to stop (sudden

cardiac arrest), which is a life-threatening medical emergency. (Mayo Clinic, 2020)

According to Foth et.al, (2021), VT was characterized as a wide complex

(QRS duration greater than 120 milliseconds) tachyarrhythmia at a heart rate greater

than 100 beats per minute. It is classified by duration as non-sustained or sustained.

When the rhythm lasts longer than 30 seconds or hemodynamic instability occurs in

less than 30 seconds, it is considered sustained ventricular tachycardia. Non-sustained

ventricular tachycardia is defined as more than 3 beats of ventricular origin at a

rate greater than 100 beats per minute that lasts less than 30 seconds in duration.

When the rhythm lasts longer than 30 seconds or hemodynamic instability occurs in

less than 30 seconds, it is considered sustained ventricular tachycardia. Further

classification is made into monomorphic and polymorphic on the basis of QRS

morphology. Monomorphic ventricular tachycardia demonstrates a stable QRS

morphology from beat to beat while polymorphic ventricular tachycardia has

changing or multiform QRS variance from beat to beat. Torsades de pointes is a

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polymorphic ventricular tachycardia that occurs in the setting of a long QT interval

and appears as waxing and waxing QRS amplitude on ECG. The final form of

ventricular tachycardia was bidirectional ventricular tachycardia which has a beat-to-

beat alternation in the QRS frontal plane axis. It was associated with digitalis toxicity

or catecholaminergic polymorphic VT.

According to Chapson (2017) in the study of Ventricular Tachycardia, the

incidence in the United States was not well quantified, because of the clinical overlap

of VT with ventricular fibrillation (VF), but examination of sudden death data

provides a rough estimate of VT incidence. Most sudden cardiac deaths were caused

by VT or VF, at an estimated rate of approximately 300,000 deaths per year in the

United States, or about half of the estimated cardiac mortality. A prospective

surveillance study gave a sudden death incidence of 53 per 100,000 population,

accounting for 5.6% of all mortality. This was only a rough estimate of VT incidence,

both because many patients have nonfatal VT and because arrhythmic sudden deaths

may be associated with VF or bradycardia rather than with VT. In patients with

ischemic cardiomyopathy and nonsustained VT, sudden death mortality approaches

30% in 2 years.

According to Gibson (2021) in the study of “Ventricular Tachycardia

epidemiology and demographics”, the prevalence of ventricular tachycardia was

approximately 54,000 per 100,000 in men and 55,000 per 100,000in women with

hypertension, valvular heart disease, or cardiomyopathy without coronary artery

disease and 31000 per 100,000 in men and 30,000 per 100,000 in women with no

cardiovascular disease.

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 For Nursing Education, this will help to provide students and

clinical instructors to expand and improve essential knowledge about effective ways

to deliver health care to patients toward nursing education for the development

of the nursing profession.

For Nursing Practice, this will help health care providers determine

effective best practices, correct old misunderstood studies, pave new treatment,

procedure protocols, and create new methodology, all which improve patient

care with a diagnosis of Ventricular Tachycardia.

For Nursing Research, this will serve as a guideline for future

researchers, students, clinical instructors and health care providers to provide

services and treatments for future generations to help develop new test for

diagnosis, treatments and procedures.

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II. PATHOPHYSIOLOGY AND MANAGEMENT
A. DIAGRAM

ETIOLOGY SIGNS AND SYMPTOMS

(Causative/Predisposing/Precipitating)
(SPECIFIC TO THE DISEASE MECHANISM)

MANAGEMENT
specific to the
S/S
DIAGNOSTIC 1. Medical
DISEASE EVALUATION/TOOLS 2. Pharmacological

3. Nursing
PROCESS

IF NOT TREATED
MEDICAL
IF TREATED SURGICAL PROGNOSIS
PROGNOSIS
NURSING

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PATHOPHYSIOLOGY AND MANAGEMENT
A. DIAGRAM

MODIFIABLE NON-MODIFIABLE

1. Stress - Emotional or physical stress causes 1. Age – Heart rhythm disorders, including
an increase in heart rate, elevation of blood bradyarrythmias, atrial fibrillation and
pressure and release of stress hormones that ventricular tachycardia become increasingly
triggers ventricular tachycardia. common with aging and represents important
causes of morbidity and mortality among older.
2. Alcohol abuse – studies have found that
excessive alcohol intake can lead to high blood 2. Hereditary (congenital heart disease) – If
pressure, heart failure or stroke. This can also this person have a family history of ventricular
contribute to a disorder that affects heart muscle. tachycardia or other heart rhythm disorders, the
person may have a high risk of the disease. This
3. Medication – certain drugs can induce
is a genetic condition that passed down through
ventricular tachycardia by creating re-entry,
families.
ventricular often potential or exaggerate. One
example of this is digoxin toxicity. This is 3. Previous heart condition – previous heart
associated with adverse cardiac effects including condition such as heart attack, cardiomyopathy,
ventricular arrhythmias which most commonly or heart failure may trigger ventricular
seen in chronic toxicity. tachycardia at any time. V tach most often occurs
when the heart muscle has been damaged and
scar tissue creates abnormal electrical pathways
in ventricles.

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 Abnormal Ventricle
Automacity

Focal Re-entrant

Irritation of cardiomyocyte Scar tissue damage

Disrupts the normal firing in SA Scar tissue irritating myocardial

node tissue firing new currents

Ventricular pacemaker trigger

to fire/beat in increase rate
signal

Fast heart contraction

Increase Ventricle
Depolarization

Long time of refractory period

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 Results in less filling of blood in
the heart

Less pumped out each heart beat

Less blood distribution to

BODY BRAIN

Decrease oxygen in the blood

Hypotension Hypoxia

Increase RR & PR *Light Headedness

*Faintness(Syncope)

 Chest Pain
 SOB
 Pale
 Diaphoretic Alternative Learning Activity | Ventricular Tachycardia
IF NOT TREATED & PROGNOSIS

The outlook for people with

ventricular tachycardia is usually
good if treatment is received
immediately. If the disorder is left
untreated it can disrupt normal
heart functions and it may lead to
serious complications such as
Heart failure, stroke, and sudden
cardiac arrest that may eventually
lead to death.

Alternative Learning Activity | Ventricular Tachycardia

 IF TREATED: MEDICAL SURGICAL NURSING
MANAGEMENT AND PROGNOSIS

1. Radiofrequency Catheter Ablation

Radiofrequency catheter ablation is a procedure performed by a cardiac electrophysiologist, which is a cardiologist who specializes in
treating patients with heart rhythm disorders. Ablation of ventricular tachycardia has a long history of safety and success. Ablation
completely cures the abnormal rhythm. Ablation can also improve treatment with an implantable cardioverter defibrillator.
Purpose:
This is used for patient to correct the disorder and improve quality of heart. Some types of ablation therapy are used instead of open
surgery in order to spare healthy tissue and lower the risks of surgery.
Nursing Responsibilities:

 Assure that patient was obtained consent prior to the surgery. This is for legal purposes.

 Advice patient to stay in bed and have leg straight for about 3-4 hours. Advice the patient to wait when told to get up, asked nurse
assistance if you need help during this time. Because dizziness is most likely after the surgery this will prevent injury

2. Implantation of ventricular Assist device (VAD)

A ventricular assist device (VAD) is a mechanical device that supports the lower left heart chamber (left ventricular assist device, or
LVAD), the lower right heart chamber (right ventricular assist device, or RVAD) or both lower heart chambers (biventricular assist
device, or BIVAD)
Purpose:
This is used for the patient to provide adequate cardiac output to perfuse target end-organs, while unloading the heart.
Nursing Responsibilities:

 Monitor frequent Vital signs specially heart rate because this serves as a baseline.

 Monitor ECG for rate, rhythm, and conduction to determine the electric signal waves is in within normal range.

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GOOD PROGNOSIS
 SIGNS AND SYMPTOMS NURSING DIAGNOSIS

 Increase RR and PR – in ventricle  Decrease cardiac output

tachycardia, abnormal electrical r/t alteration in cardiac
impulse start in lower chamber of the
heart causes it to beat faster. rhythm
 Chest Pain – due to exacerbation that  Risk for cardiac arrest
causes the patient to feel chest pain.
 Risk for ineffective
 SOB – the heart cannot pump enough
oxygen to every part of the body tissue perfusion
because the heart pumps so fast that the  Anxiety r/t
upper chamber cannot collect enough
blood to pass through the different breathlessness from
organs of the body. inadequate oxygen
 Pale – pale come because of the drops
 Risk for fluid volume
of blood pressure that the heart cannot
provide enough blood in the body. deficit
 Diaphoretic – this is in line with the
chest pain and is due to the overwork
of the heart muscle.
 Hypotension – when the heart beats so
fast , the SA node cannot collect
enough blood to supply the parts of the
body so the pressure drops.
 Faintness/Lightheadedness- This is due
to lack of oxygen supply in the brain
because of decrease blood distribution.

Alternative Learning Activity | Ventricular Tachycardia

 DIAGNOSTIC EVALUATION/TOOLS

A. Physical Assessment

 V/s: BP (80/60 mmHg; RR 28bpm; PR 92bpm

 Cardiac Monitor shows Ventricular Tachycardia rate of
192bpm
 Pale
 Presence of bounding pulse
 Speaks one word at a time
 Diaphoretic
 Shortness of breath
 Clutching chest & grasping for air
 Crushing chest pain

Alternative Learning Activity | Ventricular Tachycardia

B. DIAGNOSTIC TEST (Laboratory)

1. Potassium, Magnesium, Calcium, and Phosphate are all electrolytes that maintain the normal functions of the
heart such as heart rhythm and contraction. Imbalance of these electrolytes can cause irregular heartbeat and heart
weakness.
Purpose: Rule out electrolyte imbalance in diagnosis of VT.
Analysis: Severe hyperkalemia (>7 mEq/L), causes cardiac arrest. Severe hypokalemia (<3.5 mEq/L) will alter
cardiac tissue excitability and conduction. Severe hypermagnesemia (>15 mg/dL) and hypomagnesemia (<1.25
mg/dL) cause cardiac arrythmias. Severe hypercalcemia (>15 mg/dL) and severe hypocalcemia (<2.5 mg/dL) cause
cardiac arrythmias, abnormal contractility, and heart failure. Severe hyperphosphatemia (>6.5 mg/dL) and severe
hypophosphatemia (<1 mg/dL) cause ventricular arrythmias, abnormal contractility and heart failure.

2. Digoxin Test is a blood test for digitalis levels. To determine if the concentration of digoxin in the blood is at a
therapeutic level or to detect toxic levels of the drug. Digoxin is a medication to control irregular heartbeats by
affecting sodium and potassium inside heart cells reducing strain on the heart.

Purpose: Digitalis toxicity is checked to rule out digoxin as the cause of VT.
Analysis: Therapeutic range is 0.5-0.8 ng/mL although, toxicity can still occur when the serum digoxin concentration
is within the therapeutic range (seen in long-term medication).

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 DIAGNOSTIC TEST (Non- Laboratory)

1. Electrocardiogram (ECG) is a non-invasive test that detects heart problems by measuring the electrical activity
generated by the heart as it contracts. Sensors attached to the skin are used to detect the electrical signals produced by
the heart each time it beats. These signals are recorded by a machine. There are three main types of ECG: resting ECG
(carried out while lying down), stress ECG (carried out while using treadmill or exercise bike), and ambulatory ECG
also known as an event monitor (Holter monitor-generally 24 hours, wearable cardiac event monitor-monitor for weeks).
ECG tracings normally consist of three identifiable waveforms: the P wave, the QRS complex, and the T wave. The P
wave depicts atrial depolarization; the QRS complex, ventricular depolarization; and the T wave, ventricular
repolarization.
Purpose: The most reliable tool in diagnosing tachycardia and types of VT.
Analysis: Positive diagnosis for VT is characterized by more than or equal to 3 consecutive ventricular beats with rate
.
of 100-250 beats per minute. VT with rate of 100-120 bpm is referred to as slow ventricular tachycardia. VT with rate of
more than 250 bpm is referred to as ventricular flutter. Another characteristic of VT is wide QRS complexes.

2. Echocardiogram (EKG) is a non-invasive imaging of the heart via ultrasound or Doppler. A small probe is used to
send out high-frequency sound waves that create echoes when bounced off the heart. EKG creates a moving picture of
the heart. It can identify areas of poor blood flow, abnormal heart valves and heart muscle that are not working
normally.
Purpose: Used for diagnosis and monitoring VT.
Analysis: Confirmation of VT is when the ventricle beats rapidly and independently of normal sinus rhythm and the
origin of the rapid depolarizations is in the ventricles. EKG can assess clients at risk for sudden death by detecting
ejection fraction, myocardial infiltrative disease, and presence of any wall motion abnormality.

Alternative Learning Activity | Ventricular Tachycardia

 3. Magnetic Resonance Imaging (MRI). Cardiac MRI is a non-invasive procedure that uses a powerful magnetic field,

radio waves and a computer to produce detailed pictures of the structures within and around the heart. It enables evaluation

of the anatomy and function of the heart chambers, heart valves, size of and blood flow through major vessels, and the

surrounding structures such as the pericardium. MRI provides a good assessment of the right ventricular structure and

function.

Purpose: MRI can be useful for clients with ventricular tachycardia when echocardiography fails to provide accurate

evaluation of left or right ventricular function or when the assessment provided by echocardiography is not satisfactory.

Analysis: Presents as still or moving pictures of how the blood is flowing through the heart with irregularity.

. 4. Computed Tomography (CT) is a non-invasive scan with an x-ray beam that moves in a circle around the heart. It

produces signals that are processed by the machine’s computer to generate cross-sectional image, or “slices,” these slices

are called tomographic images and contain more detailed information than conventional x-rays. Once a number of

successive slices are collected by the machine’s computer, they can be digitally “stacked” together to form a 2-dimensional

image of the patient that allows for easier identification and location of basic structures as well as possible tumors or

abnormalities.

Purpose: 2-dimensional characterization of VT and detailed anatomic model of the heart. Useful for planning and

preparation for VT ablation.

Analysis: VT scarring can be visualized with CT.

Alternative Learning Activity | Ventricular Tachycardia

 5. Cardiovascular Magnetic Resonance Imaging (CMR) It is derived from and based on the same basic principles as
MRI but with optimization for use in the cardiovascular system. These optimizations are principally in the use of ECG gating
and rapid imaging techniques or sequences. By combining a variety of such techniques into protocols, key functional and
morphological features of the cardiovascular system can be assessed.
Purpose: Most accurate diagnostic tool of VT. Evaluates the anatomy and function of the heart chambers, heart valves, size
of and blood flow through major vessels, and the surrounding structures such as the pericardium.
Analysis: CMR provides still or moving pictures of how the blood is flowing through the heart and detects irregularities
such as anomalies of the ventricles like ventricular septal defects, left and right ventricular mass and volumes.

6. Coronary Angiogram is an invasive procedure that uses x-ray imaging to see the heart's blood vessels. It is the most
common type of cardiac catherization procedure. A type of dye that is visible by x-ray is injected into the blood vessels of
. the heart. The machine rapidly takes a series of images (angiograms).
Purpose: Coronary angiogram is used as a diagnostic tool and can be used to treat heart and blood vessel conditions.
Analysis: Visualization of potential blockages or restrictions of blood flow to the heart and other abnormalities.

7. Chest X-ray, less commonly known as x-radiation, is non-invasive procedure a penetrating form of high-energy
electromagnetic radiation. X-ray imaging creates pictures of the inside of the body. More specifically a chest x-ray can
produce images of the heart and blood vessels.

Purpose: Helpful in the diagnosis of the underlying cause of VT such as congestive heart failure, sternotomy suture, ICD
wires and pocket.
Analysis: Reveals changes in size and outline of the heart that can indicate heart failure or fluid around the heart, aortic
aneurysms and presence of calcium in the heart or blood vessels.
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 OTHER TESTS

1. Stress Test is also known as an exercise test. It involves walking on a treadmill or riding a stationary bike while heart

rhythm, blood pressure and respiration are monitored. The stress test involves several electrodes placed on the client’s skin

over the chest. The electrodes are connected to an EKG that records the electrical activity of the heart during the test.

Purpose: To assess cardiac function in relation to increased workload, evidenced by dysrhythmia or pain during exercise.

Analysis: Pain during exercise, dysrhythmias or abnormality in electrical signals that coordinate heart rate.

. 2. Tilt Test, also known as tilt table test, is a test in which the client lies flat on a special bed or table with special safety belts

and a footrest while connected to an ECG and blood pressure monitors to measure the changes during position changes. The

bed or table is then elevated to an almost standing position (60° to 80° vertical angle) to simulate standing up from a lying

position. An adhesive defibrillator is attached for safety along with a pulse oximeter.

Purpose: A tilt table test is a test done to evaluate symptoms of syncope. Does not provide a diagnosis independently.

Analysis: Syncope can be caused by arrhythmia, weakness or failure of the pumping function of the ventricles of the heart or

malfunction of the heart valves.

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 MANAGEMENTS

A. MEDICAL MANAGEMENT

 Intravenous Fluid Therapy

Normal Saline Solution
This ensures that the administered fluid remains in the extracellular (intravascular) compartment, where it will do the
most good o support blood pressure and peripheral perfusion.
D5Water
This solution dissolved in water used to dehydration caused by electrolyte imbalances as well as fluid loss from
diaphoresis.

 Diet.
Avoid foods and beverages that might trigger a faster heartbeat, such as Alcohol, Caffeine in coffee, chocolate, and some
sodas and tea, spicy foods, and Very cold drinks.

 Synchronized Cardio Version

Used to terminate a life threatening or unstable tachycardia arrhythmia, atrial fibrillation, and atrial flutter when medications
have failed to convert the rhythm. It is performed on patients that have still pulse but are hemodynamically unstable.

 Implantable cardioverter defibrillator therapy. The pager-sized device is surgically implanted in the chest.
The ICD continuously monitors the heartbeat, detects an increase in heart rate and delivers precisely calibrated electrical
shocks, if needed, to restore a normal heart rhythm. Also able to perform cardioversion, defibrillation and pacing of the heart.
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 B. PHARMACOLOGICAL MANAGEMENT

1. Antiarrhythmics Class IA
 Procainamide
Mechanism of Action: Binds to fast sodium channels inhibiting recovery after repolarization. It also prolongs the action potential and reduces the
speed of impulse conduction. This action results in decreased myocardial excitability, slowed conduction velocity, and reduced myocardial
contractility.

Desired Effect: This drug is given for patient to treat irregular heartbeats and to slow an overactive heart. When the heart has a normal heartbeat
(rhythm), it will work more efficiently.

Nursing Interventions & Rationale

Independent:
 Check the physicians order, identify the patient and explain the importance of the drug to ensure patient receive the appropriate
drug for treatment.
 Assess the patient of any allergies or previous adverse reaction to the drug to prevent any allergic response.
 Monitor v/s especially BP during drug administration because precipitous hypotension may occur during drug reaction. Keep
patient in supine position.
 Monitor electrolytes especially potassium level because hypokalemia may exacerbate arrhythmia.
 Monitor patient for side effects such as n/v, drowsiness and GI upset.
 Advise patient to notify physician immediately when adverse reaction occur such as fever, rash, seizure, n/v to respond medical
assistance immediately.

Dependent:
 Administer medication as prescribed by the physician:
- For Oral. Give first PO dose at least 4 hours after last IV dose, Give oral preparation on empty stomach, 1 hour before or 2 hours
after meals, with a full glass of water to enhance absorption. If drug causes gastric distress, give with food.
- For IV. Dilute each 100 mg with 5–10 mL of D5W or sterile water for injection. It should be done slowly at a rate not to exceed
50mg/minute.
-For IV Infusion. Add 1 g of procainamide to 250–500 mL of D5W solution to yield 4 mg/mL in 250 mL or 2 mg/mL in 500 mL

Interdependent:
 Collaborate with laboratory to monitor AST, ALT and alkaline phosphatase levels. Elevation of liver enzymes may occur and may
lead to liver failure.
 Collaborate with the laboratory to monitor the serum K level because hypokalemia can cause arrhythmias.
 Collaborate with the technician to monitor ECG closely because widening of QRS (> 50%) and prolonged QT interval indicates
toxicity. Stop infusion immediately. Monitor level of potassium level because hypokalemia as insulin facilitates the
intracellular uptake of potassium. This should be monitored closely for these effects, and potassium should be replaced as
clinically indicate. Alternative Learning Activity | Ventricular Tachycardia
2. Anti-arrhythmics Class IB
 Potassium Chloride

Mechanism of Action: Decreases the depolarization, automaticity, and excitability in the ventricles during the diastolic phase by
direct action on the tissues, especially Purkinje network.
Desired Effect: This drug is given to treat irregular heart rhythms that may signal a possible heart attack.

Nursing Intervention & Rationale:

Independent:
 Assess the patient of any allergies or previous adverse reaction to the drug to prevent any allergic response
 Monitor BP and ECG constantly; assess respiratory and neurologic status frequently to avoid potential over dosage
and toxicity.
 Monitor signs of lidocaine toxicity such as Slurred speech, altered central nervous system, muscle twitching and
seizures. Simply stop the infusion.
 Instruct patient to promptly report adverse effects such as palpitations, dyspnea, tinnitus, and n/v because toxicity can
occur and to respond medical assistance immediately.
 Educate lactating patient that drug appears in human milk. Advice to consult first to physician to prevent serious
effect to breastfeeding child.
Dependent:
 Administer medication as prescribed by the physician:
Prepare IV infusion by adding 1 g to 1 L of D5W injection to provide a solution containing 1mg/mL. Put patient on a cardiac
monitor during IV infusion at must attend pt. all times. Use an infusion control device to give infusion precisely. Don’t
exceed 4mg/minute: faster rate greatly increases risk of toxicity.
Interdependent:
 Collaborate with technician to closely monitor ECG because it may indicate excessive cardiac depression (e.g.,
prolongation of PR interval or QRS complex and the appearance or aggravation of arrhythmias). Stop infusion
immediately.

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3. Anti-aarrhytmics Class III
 Amiodarone

Mechanism of Action: It blocks potassium currents that cause repolarization of the heart muscle during the third phase of the
cardiac action potential.

Desired Effect: This drug is given to patient to treat heart rate problems that are life threatening. It is also given to restore
normal heart rhythm and maintain a regular, steady heartbeat.

Nursing Intervention & Rationale:

Independent:
 Assess the patient of any allergies or previous adverse reaction to the drug to prevent any allergic response.
 Correct preexisting hypokalemia or hyperkalemia before treatment is initiated.
 Monitor BP carefully during infusion and slow the infusion if significant hypotension occurs
 Instruct patient to take drug as prescribed and prevent skip doses to prevent risk for serious heart problems.
 Instruct patient to avoid grapefruit or grapefruit juices when taking the drug because grapefruit can increase the levels
of amiodarone in the body and may lead to dangerous side effects.
 Educate lactating patient that amiodarone can pass through breast milk and can cause serious effect in breastfeeding
child.

Dependent:
 Administer medication as prescribed by the physician:
- Oral: This drug is given with a starting dose of 800–1,600 mg per day taken orally in either a single dose or separated
doses for 1–3 weeks and continuing dosage of 600–800 mg per day taken orally in a single dose or separated doses
for 1 month. This drug is given with meals to prevent GI Intolerance.
- IV Infusion: Rapidly infuse initial 150 mg dose over the first 10 min at a rate of 15 mg/min. Over next 6 hours,
infuse 360 mg at a rate of 1 mg/min. Over the remaining 18 hours, infuse 540 mg at a rate of 0.5 mg/min. After the
first 24 hours, infuse maintenance doses of 720 mg/24 h at a rate of 0.5 mg/min.

Interdependent:
 Collaborate with laboratory to monitor AST and ALT levels. If elevations persist or if results are 2–3 times above
normal baseline readings, reduce dosage or withdraw drug promptly to prevent hepatotoxicity and liver damage.
 Collaborate with technician to closely monitor ECG because bradycardia mayAlternative
occur. StopLearning
medication immediately.
Activity | Ventricular Tachycardia
 C. NURSING MANAGEMENT

 Independent:

1. Frequently monitor vital signs specially heart rate because this is the baseline to determine the abnormality.

2. Monitor ECG for rate, rhythm, and conduction to determine and assess if any cardiac problem occurs.

3. Explain the importance of rapidly reducing the heart rate to the patient and family. To inform them about the
patient situation, and should tell the family the positive and the negative outcome.

4. Monitor vital signs and complete the EWS (Early Warning Score) chart following hospital protocols. This is to
monitor patient who are at risk at death.

5. Lay down patients in Semi fowler if they are hypotensive or feeling lightheaded. This is to facilitate breathing and
circulation.

6. In assisting physician with Cardioversion, remember to do this responsiblity ;

-Explain properly the important of cardioversion procedure to the patient.
-Encourage verbalization of fears and concerns
- Place emergency crash cart with drugs and airway, management supplies near the patient’s room.
-Check and monitor V/S specially heart rate.
-Ensure CPR and defibrillators are available at bedside
-Document pretreatment vital signs, level of consciousness, level of sedation, capillary refill, cardiovascular, and
respiratory status following cardioversion.
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 Dependent:

7. Administer medication of antiaarrthymias as prescribed by the physician to help treat underlying cause of

the disease.

8. Administer oxygen as prescribed to the patient to provide adequate oxygen supply to the body and brain.

9. Administer IVF to maintain hydration and adequate nutrition.

 Interdependent:

10. Collaborate with the cardiologst to monitor ECG/EKG level in the prevention of cardiac arrest.

11. Collaborate with Dietitian and Nutritionist to provide proper and adequate nutrition needed in the body.

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IV. DISCHARGE PLANNING
GOALS
 Maintain a well-balanced diet
 Control stress
 Maintain physical activity and
healthy weight
 Manage medications
 Educate the importance of follow
up check up
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PLANNING
 Instruct the Patient to eat heart-
healthy foods such as fruits,
vegetables, lean meats and fish.
Include low fat dairy products and
use of olive or canola oil. Instruct to
avoid caffeine drinks and alcohol.
Rationale: To improve heart health and
reduced risk of heart disease
 Instruct the patient to avoid
unnecessary stress and learn coping
techniques to handle normal stress in
a healthy way.
Rationale: A really tense stress can
make the heart rate soar.
 Advise to have a physical activity
that is safe and recommended by a
physician.
Rationale: Being overweight increases
risk of developing another heart
diseases. It’s an important to keep the
heart strong and healthy.
 Take prescribed medications and
don’t skip or stop taking the
medications without checking first
to the physician.
Rationale: Taking prescribed
medications can help keep the heart
pumping at the right pace. Taking non-
prescribed or stop taking medications
can trigger a rapid heartbeat.
 Emphasize the importance of follow
up checkup. Advice to write or note
the date of every follow up checkup
date in a calendar for his not to
forget.

23

 Monitoring signs and symptoms
Alternative Learning Activity | Ventricular Tachycardia
Rationale: For the patient to be aware
about importance of follow up checkup,
and for the patient to adhere.
 Instruct the patient to take down
notes for any signs and symptoms
she may experience at home.
Instruct on how to monitor pulse
rate.
Rationale:This will be shown to the
physician for the next visit and will help
determine any further treatment to
patient.
24
V. NURSING RELATED THEORY

Lydia Eloise Hall (1906 –1969) was a nursing theorist who developed

the Care, Cure, Core Model of nursing. Her theory defined Nursing as “a participation

in care, core and cure aspects of patient care, where CARE is the sole function of

nurses, whereas the CORE and CURE are shared with other members of the health

team.

Lydia Hall’s model theory define Nursing as the “participation in care, core

and cure aspects of patient care, where CARE is the sole function of nurses, whereas

the CORE and CURE are shared with other members of the health team.” The major

purpose of care is to achieve an interpersonal relationship with the individual to

facilitate the development of the care.

Lydia Hall used her knowledge of psychiatry and nursing experiences in the

Loeb Center to formulate her theory. Also known as “the Three Cs of Lydia Hall,” it

contains three independent but interconnected circles: The core, the care, and the cure.

The core is the patient receiving nursing care. The core has goals set by him or herself

rather than by any other person and behaves according to their feelings and values.

The cure is the attention given to patients by medical professionals. Hall explains in

the model that the nurse shares the cure circle with other health professionals, such as

physicians or physical therapists. These are the interventions or actions geared toward

treating the patient for whatever illness or disease they are suffering from. The care

circle addresses the role of nurses and is focused on performing the task of nurturing

patients. This means the “motherly” care provided by nurses, which may include

comfort measures, patient instruction, and helping the patient meet his or her needs

when help is needed.

Alternative Learning Activity | Ventricular Tachycardia 25

 Care, Core, Cure Model was used to guide this study. Since Ventricular

Tachycardia is a serious condition. The care is where the patient met his needs,

experience comfort measures and patient instructed by the nurses. The core is when

the patient has goals involves maintaining a well-balanced diet, control stress,

maintain physical activity, manage medications, and monitoring sign and symptoms

in order to have a healthy and strong heart. The cure, the patient with Ventricular

Tachycardia is given attention by medical professionals. Following all the

intervention or actions to get treated immediately and not getting another heart

disease.

Alternative Learning Activity | Ventricular Tachycardia 26

VI. RELATED LITERATURE/STUDIES

Ventricular tachycardia and coronary artery disease are common throughout

most of the developed world. In developing countries, Ventricular tachycardia and

other heart diseases are relatively less common.

Ventricular Tachycardia Epidemiology and Demographics (Gibson 2021)

According to this study, the prevalence of ventricular tachycardia is

approximately 54,000 per 100,000 in men and 55,000 per 100,000in women with

hypertension, valvular heart disease, or cardiomyopathy without coronary artery

disease and 31000 per 100,000 in men and 30,000 per 100,000 in women with no

cardiovascular disease.

Ventricular Tachycardia (Chapson, 2017)

The incidence of ventricular tachycardia in the United States is not well

quantified, because of the clinical overlap of ventricular tachycardia with ventricular

fibrillation, but examination of sudden death data provides a rough estimate of

ventricular tachycardia incidence. Most sudden cardiac deaths are caused by

ventricular tachycardia or ventricular fibrillation , at an estimated rate of

approximately 300,000 deaths per year in the United States, or about half of the

estimated cardiac mortality.

A prospective surveillance study gave a sudden death incidence of 53 per

100,000 population, accounting for 5.6% of all mortality. This was only a rough

estimate of ventricular tachycardia incidence, both because many patients have

nonfatal ventricular tachycardia and because arrhythmic sudden deaths may be

associated with ventricular fibrillation or bradycardia rather than with ventricular

tachycardia.

Alternative Learning Activity | Ventricular Tachycardia 27

 In patients with ischemic cardiomyopathy and non-sustained ventricular

tachycardia, sudden death mortality approaches 30% in 2 years. Morbidity from

ventricular tachycardia was associated with hemodynamic collapse. Resuscitated

survivors may suffer ischemic encephalopathy, acute renal insufficiency, transient

ventricular dysfunction, aspiration pneumonitis, and trauma related to resuscitative

efforts.

Mechanisms by which an ischemic heart disease can cause SCD because of lethal

ventricular arrhythmias (Spaulding et.al, 2017)

This study published in , there are three major mechanisms by which an

ischemic heart disease can cause SCD because of lethal ventricular arrhythmias:

ischemia-induced electrical instability leading to fast VT or VF, macro re-entry in

relation to a postinfarction scar in a re-modeled left ventricle and bundle branch re-

entry usually in patients with intraventricular conduction defects and a dilated left

ventricle from Paris, France, demonstrated that there were signs of an acute coronary

artery occlusion in 48% of 81 patients resuscitated from an out-of-hospital cardiac

arrest undergoing an immediate coronary artery.

Ischemic causes by (Boukens et.al 2015)

This study showed the life-threatening arrhythmias ventricular tachycardia and

ventricular fibrillation were usually initiated by mechanisms of reentry in the

ventricular myocardium. Reentry depends on the coexistence of an arrhythmogenic

substrate, which was a preexistent structural pathological condition in the heart, and a

“trigger” such as acute ischemia that initiates the electrical abnormality. In addition,

there are electrophysiological heterogeneitieswithin the normal ventricular

myocardium, originating from early heart development as has been proposed recently

that further facilitate onset of ventricular tachycardia.

Alternative Learning Activity | Ventricular Tachycardia 28

 Between 2010 and 2015, 485 patients underwent successful Chronic Total

Occlusion and Percutaneous Coronary Intervention at Heart Center Leipzig. Of them,

342 had complete follow-up and were further analyzed. Ventricular tachycardias were

detected in 9 (2.6%) patients. All of them were monomorphic ventricular tachycardias

occurring in median 1 day (interquartile range 0.25–4.75 days) after PCI

(Percutaneous Coronary Intervention) and caused prolongation of the hospital stay.

Patients with ventricular tachycardia were older, had worse left ventricular ejection

fraction (mean 33.1%, SD 5.9%) and more frequently a CTO (Chronic Total

Occlusion) of an infarct-related artery. The target vessel was not associated with the

occurrence of ventricular arrhythmias.

Ventricular tachycardia can occur early after CTO-PCI as possible reperfusion

arrhythmia and poorer left ventricular ejection fraction is the only independent

predictor for onset. Although the occurrence of ventricular tachycardia after CTO-PCI

seems not to influence mortality, awareness of this possible complication and longer

monitoring may be recommended.

Alternative Learning Activity | Ventricular Tachycardia 29

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