The nurse is providing discharge teaching for a client discharged following a diagnosis of premature ventricular contractions. What should the nurse instruct the client to avoid in the future to reduce occurrences of this condition? Select all that apply.

Arrhythmias - Premature ventricular contractions (PVCs): Nursing

Revisores de contenido

Viviana Popa, MD,Lisa Miklush PhD, RN, CNS,Gabrielle Proper, RN, BScN, MN

Colaboradores/as

Ahmed A. Abu Ajeene, M.B.B.S,Bailey Opsal, RN,Mike Cothren,Matchbox Film Co.,Talia Ingram, MSMI, CMI,Jung Hee Lee, MScBMC

Premature ventricular contractions, or simply PVCs, are a type of arrhythmia, where an extra beat starts in a point in the ventricles, causing the ventricles to contract earlier than normal in the cardiac cycle.

Now, the cardiac conduction system is made up of specialized myocardial cells that can create and transport electrical potential, also called an action potential. These cells have many special features, including automaticity, meaning that they can generate an impulse; excitability, which is the ability to respond to a stimulus by creating an electrical impulse; conductivity meaning they can carry the impulse to other cells; and contractility, which is the ability to shorten the length of their fibers, causing a contraction.

Alright, now let’s look at the normal electrical conduction pathway in the heart on an ECG, which shows how the depolarization wave flows through the heart during each heartbeat. The normal electrical activity of the heart starts in the sinoatrial or SA node, which is considered the pacemaker of the heart. Then, the impulse is conducted through the atria, causing depolarization and creating the P wave on an ECG. When the atrial muscle cells get depolarized, they contract, pushing blood from the atria into the ventricles. From the atria, the impulse goes to the atrioventricular, or AV node, where the impulse propagation speed slows way down. The interval from the atrial depolarization to just before ventricular depolarization is the PR interval on an ECG. This delay allows the atria to contract while the ventricles fill with blood. From the AV node, the impulse goes through the Bundle of His, then to the right and left bundle branches, and finally through the Purkinje fibers, which deliver the impulse to the right and left ventricles, causing them to depolarize, and is represented by the QRS complex on an ECG. This triggers simultaneous contraction of both ventricles, pushing blood into the systemic and pulmonary circulations. Finally, the ventricles repolarize to prepare for the next cycle, which allows them to relax and fill with blood, called diastole. And on ECG, ventricular repolarization will create a T wave, while the phase between ventricular depolarization and repolarization is represented by the ST segment. Sometimes, immediately after the T wave, there’s a U wave, which represents late repolarization of the ventricles.

ARRHYTHMIAS - PREMATURE VENTRICULAR CONTRACTIONS (PVCs)
	KEY POINTS	NOTES
DEFINITION	Type of arrhythmia Extra beat originating in ventricles
PHYSIOLOGY	Impulse begins in sinoatrial (SA) node Conducts through atrium: P wave Through atrioventricular (AV) node, propagation slows: PR interval Bundle of His Right and left branches Purkinje fibers Right and left ventricles contract: QRS complex Ventricles depolarize: T wave Late ventricular depolarization: U wave
CAUSES AND RISK FACTORS	Causes Enhanced automaticity Triggered activity Reentry Risk factors Electrolyte imbalances Hypoxia Underlying cardiovascular disease Increased sympathetic activity
PATHOPHYSIOLOGY	Impulse from ectopic beat Travels back to the atrium If ectopic beat happens right after atrial depolarization No extra contraction If ectopic beat occurs later Extra contraction
SIGNS AND SYMPTOMS	Asymptomatic Symptomatic Palpitations Diminished or absent peripheral pulses Anxiety Lightheadedness Dyspnea Chest pain
DIAGNOSIS	History Physical assessment Electrocardiogram (ECG) Holter monitor
TREATMENT	Asymptomatic None Symptomatic Address underlying cause Oxygen supplementation Electrolyte replacement Medications Radiofrequency ablation
MANAGEMENT OF CARE	Goals of care Monitor for complications Institute continuous cardiac monitoring Assess vital signs and symptoms of decreased cardiac output Notify HCP 3+ consecutive PVCs Lightheadedness Hypotension Chest pain Tachypnea Shortness of breath Administer oxygen and prescribed medications Assist with identifying underlying cause
PATIENT AND FAMILY TEACHING	Explain condition, plan of care, and how to safely self-administer medications Lifestyle modifications Healthy weight Moderate physical activity Diet high in fruits, vegetables, whole grains, lean meats, low-fat or fat-free dairy products; low in sodium Provide a list of foods to select from Avoid triggers Adequate sleep Smoking cessation Stress reduction Instruct how to take pulse and BP Notify HCP Changes in heart rate or BP Fatigue Exercise intolerance Shortness of breath Chest pain

Arrhythmias - Premature ventricular contractions (PVCs): Nursing

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