University:
West Coast University
Course:
NURS 110 | Introduction to Professional Nursing
Academic year:

2021
Views:

247

Pages:

1
Author:

Jarrett Richard

Atrial Flutter Rate: Atrial rate is 250-350 bpm. Ventricular rate varies according to AV node conduction. Rhythm: Atrial regular; ventricular may be regular or irregular (again, depending on AV node conduction). P waves: Absent. Only flutter or saw tooth looking waveforms PR Interval: Not applicable QRS Width: VHFRQGV Characteristics: Atrial Flutter is a dysrhythmia, which is the result of a flawed reentry circuit within the atria. It is often described as resembling a sawtooth or picket fence. These flutter waves should not be confused for P waves. The AV node is a wonderful protective mechanism. Imagine the atria depolarizing at a rate of 250 to 350 bpm. If all of these atrial depolarizations were conducted down into the ventricle, the patient’s ventricles would likely begin to fibrillate. Think of the AV node as the central train station where numerous train tracks merge. The central station only lets some of the trains through to avoid congestion. The AV node helps to protect the ventricles by only allowing some of the atrial depolarizations to conduct down through the bundle of His into the bundle branches and on to the ventricles. When the ventricular rate is < 100 bpm, we call this “controlled atrial flutter.” If the ventricular rate is > 100 bpm, it is labeled “uncontrolled atrial flutter.” Since the ventricles always have more time to fill during diastole when the HR is under 100, our goal is to have controlled atrial flutter. This can often be accomplished with drug therapy. In the setting of atrial flutter, coordinated contraction of the atria is absent. The patient has therefore lost their atrial kick with potential loss of cardiac output and lower blood pressure. Causes: Acute or chronic cardiac disorder, mitral or tricuspid valve disorder, cor pulmonale, pericarditis, Post MI complication (usually transient), Hyperthyroidism, Alcoholism, Post cardiac surgery (usually transient) Nursing Priorities: Check your patient’s blood pressure, assess for syncope, palpitations, or SOB. Your patient may need to lie down to prevent potential falls. Patient may have lower B/P due to loss of atrial kick. Potential Treatments Asymptomatic: Observation and rate control. Normal heart function: control ventricular rate by administering beta blockers (esmolol) or calcium channel blockers (diltiazem or verapamil). Impaired heart function: control ventricular rate by administering digoxin, diltiazem, or amiodarone. Symptomatic: If hemodynamically unstable, synchronized cardioversion at 100-200 monophasic joules. 25