A client is having frequent premature ventricular contractions. A nurse would place a priority on the assessment of which of the following items?
A. Blood pressure and peripheral perfusion.
B. Sensation of palpitations.
C. Causative factors such as caffeine.
D. Precipitating factors such as infection.
Correct Answer: A. Blood pressure and peripheral perfusion.
Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent enough, to decreased cardiac output. Physical examination findings would reveal an irregular heart rhythm upon auscultation if the patient is experiencing PVCs during the examination. In some patients, cannon A waves may cause chest or neck discomfort. Otherwise, there would not be any direct physical examination findings. A prolonged run of PVCs can result in hypotension.
Option B: The client may be asymptomatic or may feel palpitations. A thorough history should include any associated symptoms with the palpitations, the patient’s medical history, medication, and supplement usage as well as a detailed social history. It is crucial to inquire about any illicit drug use in those who frequently experience PVCs.
Option C: Common known etiologies include excess caffeine consumption, excess catecholamines, high levels of anxiety, and electrolyte abnormalities. Specific electrolyte changes found in those who experience PVCs are low blood potassium, low blood magnesium, and high blood calcium. Alcohol, tobacco, and illicit drugs are also associated with PVCs as are stimulant-based medications. Patients suffering from sleep deprivation also experience PVCs.
Option D: PVCs can be caused by cardiac disorders or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by the intake of caffeine, alcohol, or nicotine. There are numerous cardiac and non-cardiac pathologies that are causative of PVCs. Examples include cardiomyopathy, mitral valve prolapse, and myocardial infarction. Any structural heart disease that alters conduction pathways due to tissue alterations can cause PVCs. Non-cardiac examples are hyperthyroidism, anemia, and even hypertension.
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