What other assessment findings should you anticipate?

A 60-year-old male patient is admitted with chest pain to the telemetry unit where you work. While having a bowel movement on the bedside commode, the patient becomes short of breath and diaphoretic. The ECG waveform shows bradycardia.

• What other assessment findings should you anticipate?
• Why does this patient probably have bradycardia?
• Does this dysrhythmia need treatment? Why or why not? What intervention would you implement first?
• What is the drug treatment and dosage of choice for symptomatic bradycardia? How does this drug increase heart rate?

Sample Solution

When a patient with chest pain experiences bradycardia while on the bedside commode, it is important to anticipate and assess for additional findings. These may include:

1. Hypotension: The patient may have a drop in blood pressure due to decreased cardiac output caused by the bradycardia.
2. Cyanosis: The patient may have bluish discoloration of the skin and mucous membranes due to inadequate oxygenation.
3. Altered mental status: Reduced blood flow to the brain caused by bradycardia may result in confusion, dizziness, or loss of consciousness.
4. Pale and cool extremities: Inadequate blood perfusion to the periphery may cause pallor and coolness of the skin.

This patient likely has bradycardia as a result of a vagal response. The act of straining during a bowel movement can stimulate the vagus nerve, leading to increased parasympathetic activity and subsequent bradycardia.

Symptomatic bradycardia requires treatment due to the potential for inadequate cardiac output and compromised perfusion. In this case, the patient’s shortness of breath, diaphoresis, and chest pain indicate that the bradycardia is causing hemodynamic compromise.

The first intervention to implement is to stimulate the patient’s vagus nerve further to relieve the bradycardia. This can be done by having the patient bear down, as if having a…ORDER CUSTOMIZED ANSWER HERE