Question

Case Study, Chapter 27, Drug Therapy for Dysrhythmias

Tom Drummel is a 28-year-old client who was diagnosed with ventricular dysrhythmias 2 years ago when he collapsed during a soccer game. He has had several additional episodes of ventricular dysrhythmias over the past 2 years, all precipitated by exercise. He has not had an episode since beginning his current medication, oral propranolol. Tom presents to the medical clinic with complaints of frequent dizziness. (Learning Objectives 2, 4, 6, 7, and 8)

1. Describe the possible relationship between the propranolol and Tom’s reports dizziness. As the nurse discusses this issue with Tom, what teaching should be included?
2. What additional teaching should be completed with Tom related to his medical therapy?
3. Tom develops PSVT accompanied by dizziness and hypotension. He is hospitalized and receives orders for IV diltiazem. The nurse should monitor Tom for what potential adverse effects while he is receiving the IV diltiazem?
4. Tom’s physician recommends a radiofrequency ablation for control of his dysrhythmias. Tom tells the nurse that he is hesitant to undergo the procedure and asks why he cannot just continue to use medications. How should the nurse respond?

Answer 1

The main side effects of propranolol are feeling dizzy or tired, cold hands or feet, difficulties sleeping and nightmares. Tom should be instructed that dose of propranolol may make you feel dizzy, so take it at bedtime. After that, if he don't feel dizzy, he can take it in the morning.

Additional Teaching includes:

• blistering, peeling, or loose skin, red skin lesions, severe acne or skin rash
• Some products that may interact with this drug include: alpha blockers (e.g., prazosin), aluminum hydroxide, anticholinergics (e.g., atropine, scopolamine), chlorpromazine, drugs affecting liver enzymes that remove propranolol from your body (such as cimetidine.
• Propanolol may be taken with or without food. However, you should take it the same way each time.

Adverse Effects of Diltiazem:

• dizziness,
• lightheadedness,
• weakness,
• tired feeling,
• nausea,
• upset stomach,
• flushing (warmth, redness, or tingly feeling),
• sore throat

The Nurse should explain Tom that Radio Frequency Ablation procedure treats the heart rate problem called supraventricular tachycardia (SVT) ,might be done if you have symptoms that bother you a lot and you do not want to take medicine, or medicine has not worked. Catheter ablation is considered safe ,ablation improved quality of life in more general health categories than medication.