Question

A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythum strip reveals the following characteristics: atrial rate - 74 and regular; ventricular rate - 62 and irregular; P wave - normal shape; PR interval - lengthens progressively until a P wave is not conducted; QRS - normal shape. The priority nursing intervention would involve?

A) performing synchronized cardioversion
B) administering epinephrine 1 mg IV push
C) observing for symptoms of hypotension or angina
D) preparing the patient for a transcutaneous pacemaker

Answer 1

The patient with signs of a second-degree AV block requires close cardiac monitoring and preparation for transcutaneous pacing, as the risk of asystole or bradycardia is significant.

Step-by-step explanation:

The patient described is exhibiting signs of a second-degree atrioventricular (AV) block, specifically Mobitz Type I or Wenckebach heart block, as evidenced by the progressive lengthening of the PR interval until a P wave is not conducted, coupled with a normal shaped P wave and QRS complex. The priority nursing intervention would most likely include continuously monitoring the patient's cardiac status and preparing for the possibility of transcutaneous pacing.

A transcutaneous pacemaker is used when the heart rate drops to dangerously low levels or when there is a significant risk of asystole due to blocked electrical impulses. Moreover, in anticipation of potential complications, it's crucial to have emergency resuscitation equipment on hand and to closely observe the patient's heart rate (pulse) and symptoms, anticipating potential progression to a more severe form of heart block or bradycardia.