A nurse working in the cardiac icu is caring for client with suspected left sided heart failure. For which clinical manifestation should the nurse assess for?

A. Synchronized cardioversion: Synchronized cardioversion is indicated for unstable supraventricular tachycardia (SVT), especially when the client shows signs of hemodynamic instability, such as hypotension, altered mental status, or chest pain. This intervention delivers a timed shock to restore normal rhythm, prioritizing the client's immediate stabilization.

B. Adenosine infusion over 30 minutes: Adenosine is typically administered as a rapid intravenous push to terminate SVT by temporarily blocking atrioventricular nodal conduction. However, this client is unstable, and synchronized cardioversion is the preferred intervention in cases of hemodynamic compromise.

C. Immediate defibrillation: Defibrillation is used for life-threatening arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia. In this case, the rhythm is SVT, and the client is not in cardiac arrest, so defibrillation is inappropriate.

D. Vagal maneuvers: Vagal maneuvers, such as carotid sinus massage or the Valsalva maneuver, are first-line interventions for stable SVT. However, in unstable clients with severe symptoms or hemodynamic compromise, these measures are insufficient, and synchronized cardioversion is urgently required.

Unstable Supraventricular Tachycardia: Synchronized Cardioversion

Unstable Bradycardia: Transcutaneous Pacing

Ventricular Fibrillation: Defibrillation

Ventricular Tachycardia with No Pulse: Defibrillation

Unstable Atrial Flutter: Synchronized Cardioversion

Rationales:

Unstable Supraventricular Tachycardia – Synchronized Cardioversion:

Synchronized cardioversion delivers a timed electrical shock to the heart during the R wave, avoiding the vulnerable T wave, which minimizes the risk of inducing ventricular fibrillation. This intervention is preferred for unstable SVT unresponsive to medications, as it restores normal sinus rhythm effectively.

Unstable Bradycardia – Transcutaneous Pacing:

Transcutaneous pacing provides electrical impulses to stimulate the heart when intrinsic conduction is insufficient. It is the recommended treatment for symptomatic bradycardia that does not respond to medications, ensuring adequate cardiac output while awaiting more definitive treatment.

Ventricular Fibrillation – Defibrillation:

Defibrillation delivers an unsynchronized shock to depolarize the entire myocardium, allowing the heart to reset and resume an organized rhythm. It is the first-line intervention for ventricular fibrillation, as the chaotic electrical activity makes the heart incapable of pumping blood.

Ventricular Tachycardia with No Pulse – Defibrillation:

Pulseless ventricular tachycardia requires defibrillation, as the rhythm is life-threatening and the absence of a pulse indicates the heart is not effectively pumping. This unsynchronized shock interrupts the abnormal rhythm, allowing normal sinus rhythm to potentially resume.

Unstable Atrial Flutter – Synchronized Cardioversion:

Synchronized cardioversion is used for unstable atrial flutter to restore sinus rhythm by delivering a precisely timed electrical shock. It is effective when pharmacological measures have not worked or are inappropriate, especially in cases of hemodynamic instability.