Respond to signs and symptoms of cardiopulmonary distress

Signs and symptoms of cardiopulmonary distress can include the following:

• Tachycardia or bradycardia

• Pallor

• Diaphoresis

• Low blood pressure

• Fast, labored, shallow, or slow respirations

• Anxiety or confusion

• Cyanosis

• Chest pain that radiates to the back, arms, or jaw

• Chest tightness (squeezing sensation)

• Shortness of breath

• Nausea and vomiting

• Lightheadedness

• Weakness

• Syncope

Immediately notify the physician if the patient experiences any of the above symptoms before, during, or after stress testing.

Monitor Patient Condition During Stress Testing

During stress testing, monitor the patient for abnormal vital signs, dysrhythmias, and signs of cardiopulmonary compromise. The heart rate increases with physical activity, but extremely high rates may be of concern. Observe the EKG for arrhythmias such as unifocal or multifocal PVCs, ventricular tachycardia, supraventricular tachycardia, and heart blocks. Look for signs of ischemia, including T wave inversion and ST segment changes.

If the patient complains of dizziness, lightheadedness, nausea, severe shortness of breath, chest pain, or fatigue, stop the test and notify the physician.

Respond to Complications During Stress Testing

Complications of stress testing include hypotension and dysrhythmias. These usually resolve with rest. If hypotension persists, have the patient lie supine with legs elevated and notify the physician. Also notify the physician of persistent dysrhythmias. On rare occasions, patients suffer cardiac arrest or ventricular dysrhythmias requiring resuscitation. Continuously monitor the patient during and after the stress test, and immediately report any concerning findings to the physician.

Verify Patient Understanding of Ambulatory Care (Holter) Monitor

Procedures

Patients undergoing continuous heart monitoring in the outpatient setting should receive information about the device and how to troubleshoot common problems. To ensure patient understanding of ambulatory care (Holter) monitor procedures, ask the patient to verbalize the correct response to the following question:

• Is it okay to remove the electrodes? (No.)

• Is it okay to remove the battery? (No.)

• Is it okay to disconnect the leads or move them to a different location? (No.)

• What should you do if you experience itching, swelling, or redness at the site of electrode placement? (Call the physician's office.)

• Is it okay to go to work or to exercise while wearing the ambulatory care (Holter) monitor? (Yes.)

• What do you need to do when you experience any symptoms while wearing the ambulatory care (Holter) monitor? (Write the date, time, and duration of symptoms, and what the symptoms were.)

• What should you do if your symptoms include chest pain, shortness of breath, unexplained profuse sweating, or passing out? (Call 911.)