Telemetry HR - 170, within minutes 199, and stabilized in the 160s for 30+ minutes
Supine BP (L) - 163/102
RR - 60/bpm & shallow
O2 sat (NC 4L/min, but she was mouth breathing)- 96%
I'd like to use a diagnosis of Risk for Hyperpyrexia, as opposed to Hyperthermia (which the pt actually was experiencing). It's silly, but mostly because I have never heard of hyperpyrexia until I started doing research for the care plan, it sounds cool, and I kind of want to impress my instructor with something I found on my own. Hyperpyrexia is a temp of 106.7F. My pt was scary close to that temperature, so I believe it is appropriate.
My problem is, that Dx is not in NANDA, and I've never been taught whether RNs are allowed to use a Dx outside of NANDA. My instructor allows us freedom with our choices, so long as we show that we are able to stand by our choices in en educated way (evidence, goals, interventions, etc.). That being said, I don't want to just start making stuff up! I'd rather use the Hyperthermia, than make something up--even if that something is pretty damn cool.
So, short story turned long... Are RNs allowed to use non-NANDA diagnoses? and also, What do you think of my choices of diagnoses?
Thanks!
Ps. This was the most exciting situation I have ever seen in the hospital! I even got to transfer the patient to the ICU. I'm borderline obsessed with this situation, and it makes me want to work in the ICU STAT! Of course I feel bad for this person, and I hope they get well, but I learned so much by observing this crisis!
You know, this whole time I have been wondering what the hell happens next with this patient?? I've never heard of all of these vitals elevated. For example, usually the HR is elevated if the BP is dropping, but in this case they are BOTH elevated... what does that mean??? And what happens with this elevated temperature?? Shouldn't her brain be fried? This patient came in 6 days ago with a temp of 103.2, and it had been elevated since then (minus only a few hours in the middle of the night around 0200 where it was WNL, before this severe episode at 1700). Also had the elevated HR of 159 when coming in, and it had never been under 130--from what I saw in the chart. I didn't even know a heart could beat that fast (199 bpm!)! I mean, how fast can it go? What happens when it hits that one extra beat per minute that it takes to, what ?, Stop?... Is that what happens? No explosion, like an engine... just stopping? This experience has reinvigorated my interest in the human body. I see all these stats... and I'm talking to this person, trying to make them not freak out---even laugh and smile (which I DID accomplish while waiting for transport to and on the way to the ICU)... But if I was reading it in a book, I would have assumed this poor bastard was in a coma or something really terrible. I am just so damn curious.
So SMF, you are definitely correct in that I am just starting to put the pieces together. I am in Med/Surg, and this is my first real clinical. I had one last semester, but it was mostly to get acclimated to the hospital environment--it wasn't even the whole semester.
NICU- I see you are a CNA, so you probably see a lot out there. I don't work in the field, so my only experience is through lectures, books, and this is my third week in clinical. I'm sure I will miss a lot. I appreciate you pointing out this information, however, because it gives me something to look into, and an apparent lesson on priority setting.
You asked what was the fastest a human heart could beat -
"The maximum human heart rate conduction is primarily limited by the absolute refractory period of the AV junction which theoretically limits the maximum conduction rate to about 300 beats per minute. However there have been several cases in the literature which have reported the heart rates of above 300 beats per minute."
This article reports a case where the average ventricular rate was about 600 beats per minute and was associated with a transient syncope:
You also asked what happens when it beats too fast. When the heart is beating too fast, the chambers are contracting so fast that they are unable to fill with blood before contracting. The heart won't be able to pump enough blood to meet the body's needs. If you think about how the heart works, this will make sense to you.
Wow, thanks for providing that case study. It's actually good timing because my patient for tonight has afib, so I was reading into that last night.
In the case of this man with intermittent extreme tachycardia, would you monitor for tissue perfusion? I saw that they unblocked a coronary artery, was that the cause? Is finding the cause the only way to slow it down? He didn't have any further tele issues after that. I saw he was on nitrates and heparin, but I thought those meds only addressed pain and clotting (I'm going to give those a quick look up to see if they can also slow the heart).
I don't know how to read EKGs though, so there could have been something in that I didn't pick up.
Thanks again for for that example. I love the mobile formatting of it, too.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Wow, thanks for providing that case study. It's actually good timing because my patient for tonight has afib, so I was reading into that last night.
In the case of this man with intermittent extreme tachycardia, would you monitor for tissue perfusion? I saw that they unblocked a coronary artery, was that the cause? Is finding the cause the only way to slow it down? He didn't have any further tele issues after that. I saw he was on nitrates and heparin, but I thought those meds only addressed pain and clotting (I'm going to give those a quick look up to see if they can also slow the heart).
I don't know how to read EKGs though, so there could have been something in that I didn't pick up.
Thanks again for for that example. I love the mobile formatting of it, too.
This patient is unique. Normally the heart does not beat faster than 300BPM. However when dealing with the human body never say never and never say always....the human body does as it wishes.
This patient in particular had pre-existing CAD (coronary disease) and cardiac arrhythmia (atrial fib). He already had a stent (tiny coil with medicine on them). He presented initially with chest pain and syncope. Which was why he was started on a nitrate (for chest pain) IV nitro also dilates the blood vessels and reduces the hearts work load.
The causes of tachycardia can be from an ischemic issue, an electrical issue, or both. In this case this patient suffered an episode of self terminating extreme tachycardia accompanied by chest pain and syncope. It was decided to take this gentleman to the cath lab where they found the RCA (right coronary artery) blocked. In a large percentage of the population the SA node (the pacemaker of the heart) is off the RCA so this may be the reason for his rapid heart rate....the family refused an EPS (electro-physiology) study to maybe get rid of the pathway that causes the heart arrhythmia.
In patients with quadriplegia there is a disturbance in the parasympathetic/sympathetic nervous system. They can experience high blood pressure, fever, and tachycardia...it is called autonomic dysreflexia.....Autonomic Dysreflexia and Hyperreflexia
Autonomic dysreflexia, also known as hyperreflexia is a potentially life threatening condition which is considered a medical emergency requiring immediate attention. This condition occurs due to an exaggerated autonomic response to pain below the level of spinal cord injury resulting in the blood pressure becoming excessively high.
The most common symptoms of autonomic dysreflexia are sweating, pounding headache, tingling sensation on the face and neck, blotchy skin around the neck and goose bumps. Not all the symptoms always appear at once, and their severity may vary. In untreated and extreme cases it can lead to a stroke and death.
Your assessment is like any other patient. ABC....DO they have a patent airway? Are they breathing? DO they have a pulse? What is their color? Are they talking to you? What is their O2Sat
Esme, are you a teacher? I just read your linked cardiac post, and WOW. You have a way with simplifying and explaining. You really comprehend the questions, and explain in a special way. I can see you've helped lots of us!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Esme, are you a teacher? I just read your linked cardiac post, and WOW. You have a way with simplifying and explaining. You really comprehend the questions, and explain in a special way. I can see you've helped lots of us!
I teach here. AND....I have been a nurse a LONG TIME. However, Nursing doesn't want me anymore as I lack a masters.
It really is crazy. The professors in my school can be hired with a masters, but must work towards their DNP/phD. One of my professors (with a DNP) called it a joke, but that's a whole 'nother can of worms...
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Well, we're happy to have you here!
It really is crazy. The professors in my school can be hired with a masters, but must work towards their DNP/phD. One of my professors (with a DNP) called it a joke, but that's a whole 'nother can of worms...
I wonder if posting here will give a notification to the nurses who commented to help me. I don’t know what made me go back and read the few old posts I have. I just wanted to say thank you again for your help. Who would have thought I’d be a medical cardiology/tele nurse now? I’m still fascinated by the wild things that go on with the human body! And I totally get the “never say never” phrase too. It’s amazing, the development of critical thinking as we can knowledge and experience. Thank you for having a hand in guiding me. I’m still learning every day! ♥️
Anonymous865
483 Posts
You asked what was the fastest a human heart could beat -
"The maximum human heart rate conduction is primarily limited by the absolute refractory period of the AV junction which theoretically limits the maximum conduction rate to about 300 beats per minute. However there have been several cases in the literature which have reported the heart rates of above 300 beats per minute."
This article reports a case where the average ventricular rate was about 600 beats per minute and was associated with a transient syncope:
Mouse Heart Rate in a Human: Diagnostic Mystery of an Extreme Tachyarrhythmia
You also asked what happens when it beats too fast. When the heart is beating too fast, the chambers are contracting so fast that they are unable to fill with blood before contracting. The heart won't be able to pump enough blood to meet the body's needs. If you think about how the heart works, this will make sense to you.