NUR 4310Dysrhythmias Case Study
Dysrhythmias Case Study
J.R. is a 63-year-old white man who visits his health care provider with complaints of "heart racing." He states this has
been happening periodically over the last several weeks. J.R. reports "just feeling lousy" during these episodes. When
asked to further describe how he feels, he states "a little lightheaded and sick to my stomach at times."
J.R.'s past medical history is negative for heart disease. Although he was recently diagnosed with hypertension, he
refused treatment because he thought he could control it with diet and exercise. He has had arthroscopic knee surgery
related to osteoarthritis. His father died at the age of 40 from complications related to alcoholism and his mother died
at the age of 64 of a massive stroke. He has no siblings. J.R. is a businessman who travels extensively and is constantly
under stress. He is happily married with two sons in college. J.R. drinks a cup of coffee in the morning and then several
diet colas during the day. Initial assessment of J.R. includes the following: height 6'1", weight 229 lb (104 kg), BP
160/95, heart rate (HR) 84 and regular, respiration rate (RR) 18, Temp 37.2° C (99.0° F). Awake, alert, and oriented ×3.
Color pink. Skin warm and dry. Lungs clear to auscultation. Abdomen soft with positive bowel sounds.
1. Based on J.R.'s subjective symptoms, which diagnostic test would you expect the health care
provider to order first?
a. Chest x-ray
b. Electrocardiogram
c. Cardiac catheterization
d. Dobutamine stress test
2. What is the rhythm
3. Based on your analysis of J.R.'s ECG and his symptoms, which diagnostic test would now be
most appropriate for the health care provider to order?
a. Holter monitor
b. Cardiac enzymes
c. Cardiac catheterization
d. Dobutamine stress test
Rationale: Since J.R.'s symptoms occur intermittently, a standard 12-lead ECG will not identify
the dysrhythmia if it is not occurring during the time of the recording. A Holter monitor records
heart rhythm for 24 to 48 hours and is more likely to identify the cause of J.R.'s palpitations.
4. J.R.'s health care provider orders a Holter monitor. It is your responsibility to provide patient
instructions regarding the test. Select the appropriate teaching statements. There are 4
correct answers.
a. You will need to wear the Holter monitor for a minimum of 24 hours.
b. If you have any symptoms, you will need to press the red button on the monitor to
document this occurrence.
c. You will need to keep a diary and record any symptoms that you may experience as well
as your related activities.
d. Normal patient activity is encouraged to simulate conditions that may produce
your symptoms.
e. You may remove the monitor only to shower.
f. This test will record the electrical activity of your heart for the entire testing period.
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, NUR 4310Dysrhythmias Case Study
g. You will need to be NPO for 12 hours during this test to prevent false-positive results.
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Dysrhythmias Case Study
J.R. is a 63-year-old white man who visits his health care provider with complaints of "heart racing." He states this has
been happening periodically over the last several weeks. J.R. reports "just feeling lousy" during these episodes. When
asked to further describe how he feels, he states "a little lightheaded and sick to my stomach at times."
J.R.'s past medical history is negative for heart disease. Although he was recently diagnosed with hypertension, he
refused treatment because he thought he could control it with diet and exercise. He has had arthroscopic knee surgery
related to osteoarthritis. His father died at the age of 40 from complications related to alcoholism and his mother died
at the age of 64 of a massive stroke. He has no siblings. J.R. is a businessman who travels extensively and is constantly
under stress. He is happily married with two sons in college. J.R. drinks a cup of coffee in the morning and then several
diet colas during the day. Initial assessment of J.R. includes the following: height 6'1", weight 229 lb (104 kg), BP
160/95, heart rate (HR) 84 and regular, respiration rate (RR) 18, Temp 37.2° C (99.0° F). Awake, alert, and oriented ×3.
Color pink. Skin warm and dry. Lungs clear to auscultation. Abdomen soft with positive bowel sounds.
1. Based on J.R.'s subjective symptoms, which diagnostic test would you expect the health care
provider to order first?
a. Chest x-ray
b. Electrocardiogram
c. Cardiac catheterization
d. Dobutamine stress test
2. What is the rhythm
3. Based on your analysis of J.R.'s ECG and his symptoms, which diagnostic test would now be
most appropriate for the health care provider to order?
a. Holter monitor
b. Cardiac enzymes
c. Cardiac catheterization
d. Dobutamine stress test
Rationale: Since J.R.'s symptoms occur intermittently, a standard 12-lead ECG will not identify
the dysrhythmia if it is not occurring during the time of the recording. A Holter monitor records
heart rhythm for 24 to 48 hours and is more likely to identify the cause of J.R.'s palpitations.
4. J.R.'s health care provider orders a Holter monitor. It is your responsibility to provide patient
instructions regarding the test. Select the appropriate teaching statements. There are 4
correct answers.
a. You will need to wear the Holter monitor for a minimum of 24 hours.
b. If you have any symptoms, you will need to press the red button on the monitor to
document this occurrence.
c. You will need to keep a diary and record any symptoms that you may experience as well
as your related activities.
d. Normal patient activity is encouraged to simulate conditions that may produce
your symptoms.
e. You may remove the monitor only to shower.
f. This test will record the electrical activity of your heart for the entire testing period.
This study source was downloaded by 100000832558064 from CourseHero.com on 05-23-2022 01:02:54 GMT -05:00
https://www.coursehero.com/file/59274860/Dysrhythmias-Case-Studydocx/
, NUR 4310Dysrhythmias Case Study
g. You will need to be NPO for 12 hours during this test to prevent false-positive results.
This study source was downloaded by 100000832558064 from CourseHero.com on 05-23-2022 01:02:54 GMT -05:00
https://www.coursehero.com/file/59274860/Dysrhythmias-Case-Studydocx/
