Heart Rate(HR) : Though Normal is 60-100 Beats per minute, in questions it is related to the nurse’s understanding of the underlying causes Tachycardia is >90. Since tachycardia is the Boat coming (acute situation) it is important to understand that the heart is functioning normally but is responding to a problem outside the heart.
RULE NUMBER 2: Never ignore heart rates in questions, since it is there for a reason. This DATA directs the nurse to assess or implement or acknowledge it as a normal process.
General Causes of Increased heart rate are below- If you see an elevated HR in a question or in practice THINK WHAT IS THE UNDERLYING CAUSE? OR ASSESS the patient to get more Data (Diaphoretic, Pallor)
In questions when the heart rate is presented with several other vitals, think, is there enough DATA to make a decision about what is going on with the patient? Is the patient in distress?
If they are in distress… the nurse should IMPLEMENT, or do an action, ie. High FOWLERS
In questions about whether the HR is High or Low - each has a reason as it is presented and should be evaluated.
These are some causes of tachycardia. Remember in tachycardia that the heart is functioning normally though it is reacting to something going wrong in the body.
“MOST PT WISH” – Other Underlying Causes of Tachycardia (LM) (SEN)
Medication- Albuterol (Expected)Oxygen Deprivation – High fowlers (B) before vitals if you think your patient is SOB (A)Sepsis- Causes increased vasodilation (C) decreasing volume so pulse increases(Expected)Thyroid-HIGH Hyper- is the history in the question or a thyroid medication(Expected)Pain -Sympathetic Nervous System-Post-op(Expected)Trauma-Hypovolemia(c)-history in the question(Expected)Withdrawal-historyInfection- Vasodilation Stress (c)Stress- Look at higher Maslow interventionsHemorrhage(c)
Bradycardia –Less than 60 is called “Blacks 3d Glass” (SEN) since these are causes of low heart rate
Bradycardia is different than Tachycardia since the body generally doesn’t want the heart rate to slow down. This is because a low heart rate would cause poor perfusion. That’s an important concept when looking at a low heart rate, since there are only a handful of actual problems causing it.
Healthy Heart- Athletes may have a natural lower heart rate so a low heart with an athlete is generally a normal finding. (ask is the Data in the question)
Broken electricity- Blocks, 2, 3 and 3rd degree is always acute and if symptomatic they need to be paced
Medications- Beta Blockers, Ca Blockers and Digoxin can all cause a low heart rate.
Bradycardia in questions center around whether patients are symptomatic or not, so always look at patient and underlying cause and whether they are symptomatic.
Generally, high heart rate is telling you to look somewhere else as there is an underlying situation going on requiring further assessment or distress requiring immediate action of intervention.
Low heart rate is usually or most likely related to medications or a problem with electricity. The NCLEX focuses on a nurse’s understanding of medications and their adverse effects. So, if the patient is symptomatic and there is a medication in the question, it is about the medication.