While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. The nurse’s first course of action should be to:
A. Increase the IV infusion rate.
B. Notify the physician promptly.
C. Increase the oxygen concentration.
D. Administer a prescribed analgesic.
Correct Answer: B. Notify the physician promptly.
PVCs are often a precursor of life-threatening dysrhythmias, including ventricular tachycardia and ventricular fibrillation. An occasional PVC is not considered dangerous, but if PVCs occur at a rate greater than 5 or 6 per minute in the post-MI client, the physician should be notified immediately. More than 6 PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine.
Option A: Increasing the IV infusion rate would not decrease the number of PVCs. Those experiencing frequent PVCs or symptomatic PVCs should be evaluated to identify the etiology. In many cases, excess intake of stimulants and/or lower levels of potassium and magnesium is the cause of the PVCs. These patients can be easily managed via minimization of stimulants and/or repletion of electrolytes.
Option C: Increasing the oxygen concentration should not be the nurse’s first course of action; rather, the nurse should notify the physician promptly. In the emergency room, hypoxic patients need to be provided with oxygen, the electrolyte imbalance should be corrected and drug toxicity should be ruled out. At the same time, an acute MI must be ruled out.
Option D: Administering a prescribed analgesic would not decrease ventricular irritability. The medication classes used to treat frequent and/or symptomatic PVCs include antiarrhythmics, beta-blockers, and calcium channel blockers. Commonly used antiarrhythmics include amiodarone and flecainide.
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