Interventions for high pulse rate? Help.

[changeofpaceRN]

This problem happened on my 11-7 shift..

What would YOU do if your pt had a high resting pulse rate of 123? She has a history of CVA. BP, T and R were all within normal limits.

Not usually her normal either.. she's very sick and many health issues.

What nursing interventions can I do first to see if it lowers on its own before a call to the doc at 3am. I noticed her foley cath bag was filled to the top and urine was in the tubing so I know urine can elevate things- I emptied it and waited 15 min, her pluse came down to about 114. She needs to have the HOB at 35 degrees because she's on continous tube feeding and no PRN meds to give for this.

Thoughts on anything to look for and actions to do?

Last night, I took her apical pulse to verify the number and it was in the 120's. About 30 min later, it got down to 108 BUT I might not be so lucky next time. The 2 other nurses on with me are not very knowledgeable and I honestly don't trust their judgement.

[muffie, RN]

did you do an o2 sat ?

and what were the other health issues ?

[leslie :-D]

what's her baseline?

if it normally runs around 100/min, then i would monitor.

if it's normal in the 60's, i would call.

leslie

[cardiacRN2006, ADN, RN]

Was she in pain? Was she dry? You said there was a lot of urine in the bag-did she just get a dose of lasix?

[ocb_dave_ocb, LPN]

Was her tube feeding compramised? Did she need flushed?

[leslie :-D]

was she constipated?

that will raise hr also.

leslie

[Tweety, BSN, RN]

To treat tachycardia you have to figure out what is causing it. As mentioned above there are many causes from cardiogenic (a. fib) to anxiety and every system in between.

[deeDawntee, RN]

If the foley bag was full was it backed-up into her bladder? Perhaps she were in pain from a full bladder... this could cause her to be tachy...

a prior poster asked if she were dry...I would verify her I's and O's and get a weight. What did her last labs look like? What was the trending of her WBC's and HGB? Was the pt anxious? Anxiety can certainly cause tachycardia. Perhaps it was just your presence that calmed her down and brought down her pulse. If she had no other symptoms or changes in her EKG, I may either wait and call toward the end of my shift (I work nights too, or have the next nurse address it with the Doc when he rounded). I may ask for something for anxiety, a CBC if it isn't ordered ... if the patient was symptomatic, like light headed or short of breath, I would definitely call.

[changeofpaceRN]

Wow I should have checked back sooner! Thanks for the responses.. some more info about the pt. Her O2 was 96 WITH O2 on. She had a trach collar running 35% at 5 L. She has diabetes, heart disease, a trach, tube feeding, foley cath, depression, history of CVA, HTN, seizures and drug abuse.

Pt is also unable to respond, has no control of her movements, does not response to stimuli. I still talk to her and make sure she looks comfy. Her tube feeding was intact. She also ended up having a large BM during my morning med pass. She is not on a diuretic and I have no idea when the last time her cath bag was drained :-/

I just hate not knowing what to look for.. last time I called a doc, he asked a few things and I didn't know because I didn't think to look for those things. I always have vitals and their chart read to go for questions. I can't wait for more experience!

[deeDawntee, RN]

OMG, well that is a very sick patient...that pulse could have been from a myriad of different sources. Phew, good for you for asking questions and for caring...

[leslie :-D]

is she getting neb txs, albuterol, atrovent?

is she on dilantin? if so, when's the last time she got a level drawn?

leslie

[gt4everpn, BSN, RN]

was her tube feeding compramised? did she need flushed?

how would compromised tube feeding affect the pulse??