LEARNING MODULE FOR ADULT CARDIOVERSION, ASSISTING PHYSICIAN WITH. (SHARED COMPETENCY) CC 10-004 and EMERGENCY ADULT CARDIOVERSION (DELEGATED MEDICAL FUNCTION) CC 10-028 Revised by: Linda Benn, Nurse Educator Heart Health & Emergency Date: August 2004 RVS Date: August 2007 Cardioversion Learning Module CC 10-004 1
TABLE OF CONTENTS PAGE Purpose.......................................................... 3 Learning Objectives................................................. 3 Method........................................................... 3 Theory/References.................................................. 3 Proficiency Standards................................................ 3 Test............................................................... 4 Proficiency Standard Skills Checklist.................................... 6 Cardioversion Learning Module CC 10-004 2
PURPOSE This learning module will provide the Registered Nurse (RN) with the theory and practice necessary for Adult Cardioversion, Assisting the Physician with. After completing the learning objectives, the RN will demonstrate competency according to the proficiency standards. PREQUISITE KNOWLEDGE The registered Nurse (RN) seeking competence in assisting the physician with Cardioversion must demonstrate prior knowledge of the following: 1. ECG interpretation 2. Principles of Advanced Cardiac Life Support (ACLS) 3. Principles of emergency pharmacologic agents and their dosage calculations LEARNING OBJECTIVES Upon completion of the learning package, the Registered Nurse will be able to perform the following objectives: 1. The RN will demonstrate principles of electrical safety. 2. The RN will demonstrate correct sequence of events of cardioversion. METHOD 1. Independent Study 2. Demonstration/Return Demonstration 3. Simulated Clinical Situations THEORY/REQUIRED READINGS Operators Manual for defibrillator in your area Cummins, R., (ed.). (2001). ACLS Provider Manual (p. 37 & 180). American/Canadian Heart Association. Hambach, C., (2001). Cardioversion. In D. Lynn-McHale & K.Carlson (Eds.). AACN Procedure Manual For Critical Care (3 rd ed.). (pp. 211-217). Philadelphia: WB Saunders Co. Hazinski, M., Cummins, R., Field, J. (Eds.). (2000). 2000 Handbook of Emergency Cardiovascular Care for HealthCare Providers (p.20). American/Canadian Heart Association. PROFICIENCY STANDARDS To be certified as competent to perform the procedure, the RN will successfully: complete the learning objectives complete a written and/or verbal test perform all aspects of the Proficiency Standard Skills Checklist Cardioversion Learning Module CC 10-004 3
TEST 1. Synchronized cardioversion may be used for the management of: a. atrial fibrillation with rapid ventricular response. b. ventricular fibrillation c. ventricular tachycardia with a pulse d. third degree heart block 1. a and b 2. a and c 3. a and d 4. c and d 2. Cardioversion and defibrillation differ in these ways: a. synchronized as opposed to nonsynchronized charge b. every R wave is marked in cardioversion c. complete versus incomplete depolarization of the myocardium d. patient's age 1. a and b 2. b and c 3. a and c 4. a and d 3. The initial energy recommended to treat paroxysmal supraventricular tachycardia is: a. 200-300 joules b. 10-40 joules c. 300-360 joules d. 50-100 joules 1. a 2. b 3. c 4. d 4. The following have been identified as factors that enhance electrical instability of the myocardium: a. hypokalemia b. digitalization c. hypoxia d. all of the above 1. a and b 2. b and c 3. c and d 4. d Cardioversion Learning Module CC 10-004 4
5. A synchronized charge would not fire during ventricular fibrillation. 1. True 2. False Cardioversion Learning Module CC 10-004 5
ANSWERS TO QUESTIONS 1. 2 2. 1 3. 4 4. 4 5. 1 Cardioversion Learning Module CC 10-004 6
Capital District Health Authority PROFICIENCY STANDARD SKILLS CHECKLIST TITLE: Adult Cardioversion (with paddles) NAME/NURSING UNIT: 1. Ensure written consent if elective procedure. 2. Assesses patient's responsiveness and v/s. 3. Assembles equipment, applies oxygen, pulse oximeter and IV line. 4. Turns defibrillator power on. Applies electrodes and assesses cardiac rhythm on monitor. 5. Administers premedication, if ordered. 6. Applies conductive medium on defib paddles, or uses defibrillator pads. 7. Sets joules as determined by the supervising physician. 8. Sets defibrillator in synchronized mode. 9. Places paddles in antero-lateral position. 10. Charges the defibrillator. 11. Gives command for personnel to stand clear. Visually surveys area. 12. Discharges defibrillator by simultaneously pressing buttons on both paddles and holding until charge is delivered. 13. Reassesses cardiac rhythm and Checks for pulse. Repeat above as directed. YES NO Cardioversion Learning Module CC 10-004 7
Capital District Health Authority PROFICIENCY STANDARD SKILLS CHECKLIST TITLE: Adult Cardioversion (Hands-free) NAME/NURSING UNIT: 1. Ensure written consent if elective procedure. 2. Assesses patient s responsiveness and vital signs. 3. Assembles equipment, applies oxygen, pulse oximeter and IV line. 4. Turn on defibrillator and applies electrodes, assesses cardiac rhythm on monitor selecting desired lead. 5. Administers pre-medication, if ordered 6. Correctly places therapy electrodes (Quik-combi) in the desired position: antero-lateral or anterior posterior as specified by the physician. Connects therapy electrodes to multifunction cable. 7. Selects energy level as determined by the physician. 8. Presses SYNC button and ensures appropriate synchronization. 9. Charges the defibrillator. 10. Gives command for personnel to stand clear. Visually surveys the area. 11. Simultaneously pressed DISCHARGE button or SHOCK button and holds until charge is delivered. 12. Reassesses cardiac rhythm and checks for pulse. Repeat above as directed. YES NO Cardioversion Learning Module CC 10-004 8