Page 1685 - Saunders Comprehensive Review For NCLEX-RN

D. Atrial fibrillation (Fig. 52-7)

1. Description

a. Multiple rapid impulses from many foci
depolarize in the atria in a totally
disorganized manner at a rate of 350 to
600 times per minute.
b. The atria quiver, which can lead to the
formation of thrombi.
c. Usually no definitive P wave can be
observed, only fibrillatory waves
before each QRS.

2. Interventions

a. Administer oxygen.
b. Administer anticoagulants as
prescribed because of the risk of
emboli.
c. Administer cardiac medications as
prescribed to control the ventricular
rhythm and assist in the maintenance
of cardiac output.
d. Prepare the client for cardioversion as
prescribed.
e. Instruct the client in the use of
medications as prescribed to control
the dysrhythmia.
E. Premature ventricular contractions (PVCs; Fig. 52-8 and Box 52-4)
1. Description
a. Early ventricular contractions result
from increased irritability of the
ventricles.
b. PVCs frequently occur in repetitive
patterns such as bigeminy, trigeminy,
and quadrigeminy.
c. The QRS complexes may be unifocal or
multifocal.

2. Interventions

a. Identify the cause and treat on the basis
of the cause.
b. Evaluate oxygen saturation to assess for
hypoxemia, which can cause PVCs.
c. Evaluate electrolytes, particularly the
potassium level, because hypokalemia
can cause PVCs.
d. Oxygen and medication may be

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