HR drop/rhythm change during sleep..Would you call Doc? - pg.2 | allnurses

HR drop/rhythm change during sleep..Would you call Doc? - page 2

OK experienced Cardiac nurses..Quick question for you... A pt came to hospital complaining of "feeling dizzy" normal BP, HR around 60s-70s NSR. No cardiac history. She was being admitted under dx... Read More

  1. Visit  turnforthenurse profile page
    #13 0
    If the patient was asymptomatic, I wouldn't have called, just would have kept a close eye on the patient. It is normal for your HR to drop when you're asleep and a lot of young, healthy individuals (such as athletes) have a resting HR in the 40's.

    But you're saying the HR is "irregular." Sinus bradycardia is not irregular. Was there a block? A first degree is pretty insignificant and just needs to be watched but very rarely progresses to a 2nd or 3rd degree. If you noticed a Wenckebach, Mobitz II or 3rd degree, I definitely would have called.
  2. Visit  Vespertinas profile page
    #14 2
    Sinus arrhythmia, folks. It's not that crazy
  3. Visit  CCL RN profile page
    #15 3
    Quote from BandaidBunny
    By "brady, irregular SR" I'm trying to best describe the patients sinus ARRYTHMIA.

    Yes, vitals were taken the first few times it happened but the pt was completely asymptomatic so after the first few times, I just kept an eye on her. EKG/ CEs normal.

    I appreciate everyones advice. I didnt call the doctor and I think I made the right decision. I feel the strongest reason why I would have ever called the doc in this case is for legal reasons. Yes, he set parameter for this pt, but thats because he HAS to set some sort of parameters for every patient. Instead of calling, I documented my assessment, printed rhythm strips and documented my reassessment. I agree its worthy of communicating to him, but not at 0300.

    Yes, it may have been the best choice legally, but was it professionally? As a RN, I did not think the doctor needed to be aware of this right now.

    At some point we should be "legally" allowed to use our nursing judgement!! I didnt go to school for 4 years to ignore my critical thinking!
    You absolutely made the right choice!

    You were there, assessing your pt and using your nursing judgement....and you were right.
  4. Visit  brainkandy87 profile page
    #16 1
    Yup, that's definitely a call to the doc if this has not been previously documented. It could simply be a normal process for that person, apnea, or an imminently emergent situation. As the nurse, it's not your job to try and diagnose what it is. It's your job to assess and notify the doc. Many times, it'll be nothing. I once had a lady that would brady down to the 30's when she slept with 5-7 second pauses. Absolutely asymptomatic. Turns out it was her baseline (albeit a very abnormal one, lol). However, someone that bradys down to 50 can suddenly just drop to 0. Always cover yourself and notify if it's a new process!
  5. Visit  surferbettycrocker profile page
    #17 1
    to the OP- iwould not have called at 3am for 'sinus' arrhythmia 40-50 which is not crazy for a sleeping person at all. again i know let's get the background and the whole story first./

    for the person who replied that they "once had a lady brady to the 30's with 5-7 second pauses" i would have called the doc on that one for sure without hesitation and likely had my eye on a code cart at the same time i was dialing the number :redpinkhe. can any experienced cards nurses out there tell me how safe that kind of a a baseline is? cuzz i think a pacemaker would be on the short list for that one.
    sorry off topic but that makes the "sleeping hr of 50 and rock stable bp look like tiddly winks
    Last edit by surferbettycrocker on Apr 6, '12 : Reason: ,
  6. Visit  Vespertinas profile page
    #18 1
    That's so odd. I could have sworn I typed a similar response but I don't see it now. In my head it went something like this:

    Quote from brady
    I once had a lady that would brady down to the 30's when she slept with 5-7 second pauses. Absolutely asymptomatic. Turns out it was her baseline
    I will bet that lady will pass away in her sleep one day (not that that's a bad thing). But if we're thinking nursing interventions here, by golly I'd have atropine at her bedside and maybe even have her sleep with the sticky pads on. Did no one consider a PPM as an option for her? Is she DNR?

    So Bettycrocker, I'm with you on this one. Except I wouldn't have come up with a phrase as cute as 'tiddly winks'.
  7. Visit  brainkandy87 profile page
    #19 2
    Quote from surferbettycrocker
    to the OP- iwould not have called at 3am for 'sinus' arrhythmia 40-50 which is not crazy for a sleeping person at all. again i know let's get the background and the whole story first./

    for the person who replied that they "once had a lady brady to the 30's with 5-7 second pauses" i would have called the doc on that one for sure without hesitation and likely had my eye on a code cart at the same time i was dialing the number :redpinkhe. can any experienced cards nurses out there tell me how safe that kind of a a baseline is? cuzz i think a pacemaker would be on the short list for that one.
    sorry off topic but that makes the "sleeping hr of 50 and rock stable bp look like tiddly winks
    Um.. my point was that I notified the doc. I wasn't using this pt as a case study, lol. Jesus, I'm not that dense that I was letting her go that way without intervention.
  8. Visit  luvmyhubbybunches profile page
    #20 0
    Regardless of assessment findings, if there were parameters set, I would have called! If anything, just to CYA.
  9. Visit  corazonRN1828 profile page
    #21 0
    Would definitely not have called for a sinus brady/sinus arrhythmia. Yes, there were parameters, but as nurses, we are taught to critically think. And if the pt is stable, good VS, asymptomatic...there is no reason to call.

    However, had it been a fib, second or third-degree block, junctional escape, ventricular escape, etc. would definitely have called, atropine in one hand, pacer pads in the others.


    p.s. a good clue was that the HR came up when pt awoke. I see tons of patients on metoprolol brady down to 40s when they are deep asleep, once they wake up their rates go up too.

close