Question

A client comes into the ER complaining of "his heart racing." Cardiac monitor shows atrial tachycardia with a ventricular rate of \(190 \mathrm{bpm}\). The nurse anticipates that the physician will order adenosine (Adenocard) to be given. Prior to giving the medication the nurse should do which of the following? a. Determine when the client last ate b. Ask the laboratory to draw serum BUN and creatinine levels c. Ask the client if he/she has a history of asthma d. Have the client sign a consent

Short answer

c. Ask the client if he/she has a history of asthma

Step-by-step solution

Understanding Atrial Tachycardia and Adenosine

Atrial tachycardia is a condition where the heart's atria beat very quickly. Adenosine (Adenocard) is often used to help restore normal heart rhythm. Before administering adenosine, it is important to check for any contraindications.

Identify Contraindications for Adenosine

Adenosine should not be administered to patients with certain conditions. Specifically, it is contraindicated in patients with a history of asthma or other significant respiratory conditions, due to potential risks of bronchospasm.

Evaluating Answer Choices

Given the information about contraindications for adenosine, review each answer choice:- a) Determining when the client last ate is not directly relevant to adenosine administration.- b) Drawing serum BUN and creatinine levels is not directly related to adenosine's immediate use.- c) Asking if the client has a history of asthma is crucial to ensure there is no contraindication.- d) Having the client sign a consent is important but it doesn’t address the immediate safety check required for adenosine.

Selecting the Correct Answer

Based on Step 3, the most critical step before administering adenosine is to ask if the client has a history of asthma. Therefore, the correct answer is:c) Ask the client if he/she has a history of asthma

Key concepts

Atrial Tachycardia

Atrial tachycardia is a condition where the heart's atria beat very quickly, often causing symptoms like palpitations, chest pain, dizziness, and shortness of breath. This condition can be detected on a cardiac monitor showing a high ventricular rate, such as 190 beats per minute (bpm), which is quite elevated. Early identification and treatment are essential to prevent complications. The rapid heart rate can lead to inadequate blood flow and oxygen delivery throughout the body.

• Causes: Atrial tachycardia can be caused by various factors including stress, excessive caffeine intake, heart diseases, electrolyte imbalances, and use of stimulant medications.
• Symptoms: Common symptoms are feeling like your heart is racing, dizziness, shortness of breath, and sometimes fainting.
• Treatment: Treatment aims to slow down the heart rate and may include medications, lifestyle changes, or procedures like catheter ablation in severe cases.

Understanding the fundamentals of atrial tachycardia helps in managing the condition promptly and effectively.

Adenosine Administration

Adenosine, also known by its brand name Adenocard, plays a crucial role in the medical management of certain types of tachycardia. When administered, it can temporarily slow down the heart rate to help restore a normal rhythm. However, proper administration and understanding of this medication are vital to ensure patient safety.

• Function: Adenosine works by slowing down the conduction of electrical impulses through the AV node, thus helping to normalize the heart's rhythm.
• Dosage: It is typically administered intravenously and due to its short half-life, it must be injected quickly followed by a saline flush.
• Side Effects: Common side effects may include chest pain, shortness of breath, flushing, and a sense of impending doom. These effects are usually short-lived.

Prior to administration, it’s crucial to question the patient regarding any potential contraindications to prevent adverse effects.

Asthma Contraindication

Adenosine can be contraindicated in patients with certain conditions, including those with a history of asthma. This is essential knowledge for healthcare providers to ensure patient safety.

• Reason: Administering adenosine to a patient with asthma can cause severe bronchospasm, leading to difficulty in breathing and potentially life-threatening situations.
• Screening: It’s imperative to screen patients for any respiratory conditions before administration of the drug. A detailed medical history should be taken to identify any contraindications.
• Alternative Treatments: If a patient with asthma requires treatment for tachycardia, alternative medications or treatments that don't carry the same risks should be considered.

Always prioritize patient history to anticipate any adverse effects that might compromise their respiratory function.

ER Protocols

Emergency Room (ER) protocols are critical guidelines designed to manage patient care effectively, ensuring safety and efficiency in high-stress environments. When handling cases like atrial tachycardia, specific protocols must be followed.

• Initial Assessment: Rapid initial assessment involves monitoring vital signs, conducting a quick patient history, and understanding the chief complaint.
• Medication Administration: Before administering medications like adenosine, verify all contraindications, obtain necessary consents, and prepare for possible side effects.
• Patient Monitoring: Continual monitoring is crucial post-administration. Be ready to handle any adverse reactions swiftly by having emergency equipment and medications on hand.

Following established ER protocols helps ensure the patient receives prompt and effective care, minimizing risks and improving outcomes.