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.

[leslie :-D]

how would compromised tube feeding affect the pulse??

a clogged/obstructed tube would elevate hr.

esp when progressed to distended abd and accompanying gi stressors.

leslie

[november17, ASN, RN]

Honestly the first thing I would do as a new nurse myself would be to put 2L of O2 via NC on the pt (especially if it was far above the normal baseline), then continue to assess. Really, a high pulse rate isn't much to go on (even with other VS being stable). Maybe that's not the choice an experienced nurse would make, but that's just my gut instinct, and it certainly wouldn't hurt. I'd rather try to stave off A. Fib. or something like that.

If the pt was already on O2 I'd encourage C+DB through their nose (if they were on an NC) and maybe grab them a voldyne - stuff you can do right off the bat. Otherwise I'd probably start thinking about calling the doc for some ASAP lab draws and maybe review their med sheets to see if any of their HTN meds had been held by the previous nurse.

edit: I know it's not that helpful with that particular patient though

[ocb_dave_ocb, LPN]

a clogged/obstructed tube would elevate hr.

esp when progressed to distended abd and accompanying gi stressors.

leslie

Thank you, I just now got back on, and hadn't seen the post in a while.. But any way a clogged tube can most definately cause tachycardia. Trust me I have worked on an SNF floor for 2 years.

[truern]

How about Valsalva maneuver to lower the rate??

[babynurselsa, RN]

Start with the easy stuff first. Did she have a fever? Was she hurting? could she be dehydrated? Was she anxious? What did her other VS look like?

Then I would move on to slightly more complicated issues. Does she have a history of atrial fib? Did you check placement of the feeding?

Think about those ABC's Is she also dyspneic? What are her lung sounds like? Has she recently been more acutely ill such as cold/flu/gasto?

I agree with leslie, what is her baseline? Though 123 is elevated and indeed tachycardic, I am not going to get extremely agitated about it IF

a) it isn't a huge deviation from their baseline

b) I can readily find a nondangerous cause

Good luck