Page 1688 - Saunders Comprehensive Review For NCLEX-RN

9. For updated information, refer to American Heart
Association: Guidelines for CPR and ECC, 2015 and
Focused Updates, 2017. Retrieved from
https://eccguidelines.heart.org/index.php/circulation/cpr-
ecc-guidelines-2/

V. Management of Dysrhythmias
A. Vagal maneuvers
1. Description: Vagal maneuvers induce vagal
stimulation of the cardiac conduction system and are
used to terminate supraventricular
tachydysrhythmias.
2. Carotid sinus massage
a. The PHCP instructs the client to turn
the head away from the side to be
massaged.
b. The PHCP massages over 1 carotid
artery for a few seconds to determine
whether a change in cardiac rhythm
occurs.
c. The client must be on a cardiac monitor;
an electrocardiographic rhythm strip
before, during, and after the procedure
should be documented on the chart.
d. Have a defibrillator and resuscitative
equipment available.
e. Monitor vital signs, cardiac rhythm, and
level of consciousness following the
procedure.
3. Valsalva maneuver
a. The PHCP instructs the client to bear
down or induces a gag reflex in the
client to stimulate a vagal response.
b. Monitor the heart rate, rhythm, and BP.
c. Observe the cardiac monitor for a
change in rhythm.
d. Record an electrocardiographic rhythm
strip before, during, and after the
procedure.
e. Provide an emesis basin if the gag reflex
is stimulated, and initiate precautions
to prevent aspiration.
f. Have a defibrillator and resuscitative
equipment available.
B. Cardioversion
1. Description
a. Cardioversion is synchronized
countershock to convert an

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