Question

First-degree AV block

1.Specify the type of dysrhythmia

2. Explain how this dysrhythmia affects perfusion, activity tolerance, and vital signs.

3.You are caring for a patient who has had this rhythm on a chronic basis but is non-compliant with medication. How could you, as the RN, help them maintain compliance with their treatment regimen for this dysrhythmia?

Answer 1

1)First degree AV block is the slowing conduction in the AV junction.The site of delay is typically in the AV node.This causes prolongation of PR interval to >200ms.The rhythm is regular with constant P-P and R -R interval.Atrial: ventricular rate is 1:1.

2)Heart contractions will be weak and lack sufficient force to pump blood from atria to ventricles.However they remain asymptomatic in most of the cases.If they progress to higher degree AV blocks, symptoms of under perfusion such as fatigue and syncope will be seen.Though they may remain asymptomatic at rest, exercise intolerance is usually seen.Pulse rate may go as low as 30 /min

3)Medications are usually not indicated in asymptomatic first degree AV block.In those who shows severe bradycardia and progression to higher degree of block, atropine and isoprotenerol can be considered. Temporary or permanent pacemaker should be considered as a permanent solution in long term.

If the patient is not compliant, educate the patient about the nature of the disease, how it can affect the body systems and what will happen if the disease is not controlled.If the patient continue to be non compliant, prepare him for pacing.Explain about this treatment method,the different types of pacemakers etc.Once pacemaker is introduced, teach him to count the pulse rate and report any abnormalities.Keep away from electric interferences if the patient experience dizziness.