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Nursing III case study

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Rebecca Ballard
11-1-2017
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?
Other assessment findings I may anticipate finding include: low blood pressure, altered mental
status, pale skin that is cool to touch, nausea, dizziness and headache.
Why does this patient probably have bradycardia?
During defecation a person may strain or bear down this then causes inhaling, closing the glottis,
and tightening of chest and abdominal muscles. These bodily actions increase the intra-
abdominal pressure that assists with colon evacuation, but also increases intrathoracic pressure
and produces the decrease in cerebral blood flow and cerebral perfusion. This is even more
predominant in patients with cardiovascular disease.
Does this dysrhythmia need treatment?
Dysrhythmia brought on by defecation does not need treatment. Although, if the patient is
having a considerable number of episodes, treatment would be necessary.
Why or why not?
Bradycardia that is asymptomatic does not require treatment/intervention. However, bradycardia
may be a sign of a problem with the heart’s electrical system and may require a pacemaker, but a
single episode from having a bowel movement, does not bring on the need for treatment of the
bradycardic episode (Healthwise, 2011).
What intervention would you implement first?
Interventions I would implement first include: elevating the lower extremties above heart level,
providing oxygen to patient and monitoring the patients cardiac status. In addition, if the patient
already has an IV, i would comfirm the IV is patent and ready to use for any ordered medications
by physician.
What is the drug treatment and dosage of choice for symptomatic bradycardia?
The drug treatment of choice for symptomatic bradycardia includes: IV administered atropine
0.5mg, given the patients ECG reveals no signs an MI. If the patient does not respond to the first
dose, then a second dose can be administered until a total of 3 mg is given. Infusion of
dopamine or epinephrine can also be prescribed if needed to raise his heart rate after the max
dosage of atropine has been given.

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Rebecca Ballard 11-1-2017 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? Other assessment findings I may anticipate finding include: low blood pressure, altered mental status, pale skin that is cool to touch, nausea, dizziness and headache. Why does this patient probably have bradycardia? During defecation a person may strain or bear down this then causes ...
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