NCLEX RN Practice Question 431

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Cardioversion

Description

  • Cardioversion is synchronized countershock to convert an undesirable rhythm to a stable rhythm.
  • Cardioversion can be an elective procedure performed by the physician for stable tachydysrhythmias resistant to medical therapies or an emergent procedure for hemodynamically unstable ventricular or supraventricular tachydysrhythmias.
  • A lower amount of energy is used than with defibrillation.
  • The defibrillator is synchronized to the client’s R wave to avoid discharging the shock during the vulnerable period (T wave).
  • If the defibrillator were not synchronized, it could discharge on the T wave and cause VF.

 Preprocedure interventions

  • Obtain an informed consent if an elective procedure.
  • Administer sedation as prescribed.
  • If an elective procedure, hold digoxin (Lanoxin) 48 hours preprocedure as prescribed to prevent postcardioversion ventricular irritability.
  • If an elective procedure for atrial fibrillation or atrial flutter, the client should receive anticoagulant therapy for 4 to 6 weeks preprocedure.

During the procedure

  • Ensure that the skin is clean and dry in the area where the electrode paddles will be placed.
  • Stop the oxygen during the procedure to avoid the hazard of fire.
  • Be sure that no one is touching the bed or the client when delivering the countershock.

Postprocedure interventions

  • Priority assessment includes ability of the client to maintain the airway and breathing.
  • Resume oxygen administration as prescribed.
  • Assess vital signs.
  • Assess level of consciousness.
  • Monitor cardiac rhythm.
  • Monitor for indications of successful response, such as conversion to sinus rhythm, strong peripheral pulses, an adequate BP, and adequate urine output.
  • Assess the skin on the chest for evidence of burns from the edges of the paddles.

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