Tachycardia Nursing Care Plans Diagnosis and Interventions
Tachycardia NCLEX Review and Nursing Care Plans
Tachycardia is characterized by an increase in heart rate above normal which in turn causes an increase in cardiac output. Tachycardia is a typical compensatory response to stress or activity, but when it happens while an individual is at rest, it is a cause for concern.
Adults’ normal resting heart rates range from 60 to 100 beats per minute, depending on the degree of fitness or the presence of medical comorbidities.
The range varies with age in pediatric clients, but is often higher than the resting heart rate of adults. It ranges from 100 to 150 beats per minute in infants with a gradual reduction over the next six years.
Signs and Symptoms of Tachycardia
Although patients with tachycardia are frequently asymptomatic, they may be conscious of their faster heartbeat and complain of heart palpitations. Depending on the underlying cause, tachycardia may also be correlated with other symptoms. Regardless of the type of tachycardia, an individual may present the following signs and symptoms:
- shortness of breath
- dizziness
- chest pain
- cardiac palpitations
- syncope
- presyncope
In severe cases, the hemodynamic status of patients may be critically compromised, thereby precipitating cardiovascular collapse due to shock.
Types of Tachycardia
Tachycardia can take many distinct forms. A common increase in heart rate that is frequently brought on by stress or exertion is referred to as sinus tachycardia.
Other forms of tachycardia are categorized based on the area of the heart and the underlying reason for the rapid heartbeat. The following are typical examples of tachycardia brought on by arrhythmias:
- Atrial fibrillation (A-fib). This is the most common type of tachycardia and is characterized by a rapid heartbeat brought on by chaotic, irregular electrical signals in the atria. Atrial fibrillation may be temporary, but certain episodes won’t stop unless medical attention is given.
- Atrial flutter. Similar to atrial fibrillation, atrial flutter has more regular heartbeats. Atrial flutter episodes may go away on their own or may need medical attention. Patients with atrial flutter frequently experience atrial fibrillation at other periods.
- Ventricular tachycardia. This type of tachycardia commences in the ventricles. Due to the rapid heart rate, the ventricles cannot fill and contract fully to pump enough blood to the body. Episodes of ventricular tachycardia that last only a few seconds can occur without any negative effects. However, prolonged bouts that last longer than a few seconds can be fatal.
- Supraventricular tachycardia (SVT). Arrhythmias that begin above the ventricles are included in the broad category of supraventricular tachycardia. SVT causes palpitations, or episodes of a pounding heartbeat that start and stop suddenly.
- Ventricular fibrillation. Instead of contracting in a coordinated manner, the ventricles quiver in response to rapid, erratic electrical signals. If the cardiac rhythm is not corrected in a matter of minutes, this type of tachycardia could result in death. Most individuals with ventricular fibrillation have a history of an underlying cardiac disease or major trauma, such as being struck by lightning.
Cause of Tachycardia
Both physiological and pathological conditions can produce tachycardia. Exercise, stress, pain, and anxiety are some typical catecholaminergic triggers that are physiologically linked to it. Pathologically, there are cardiac and non-cardiac etiologies that are as follows:
- Cardiac etiologies. These are underlying causes of tachycardia that originate in the heart.
- Supraventricular tachycardia
- Ventricular tachycardia
- Torsades de pointes
- Non-cardiac etiologies. These are underlying causes of tachycardia that originate from other parts of the body other than the heart.
- Hypoxia
- Electrolyte imbalances (e.g., hyperkalemia, hypomagnesemia, or hypocalcemia)
- Infectious disease (e.g., sepsis)
- Vascular abnormalities (e.g., shock)
- Hematologic abnormalities (e.g., hemorrhage or anemia)
- Toxicologic causes (e.g., ingestion of medications causing tachycardia or withdrawal from substances or medications)
- Endocrinological causes (e.g., pregnancy, hyperthyroidism, or pheochromocytoma)
Risk Factors to Tachycardia
In general, the risk of arrhythmias that frequently induce tachycardia may rise with age or with a family history of specific cardiac rhythm issues (eg., arrhythmias). The risk of tachycardia may be reduced by making lifestyle adjustments or receiving medical care for associated cardiac or other health issues. Other factors that may increase the risk of developing tachycardia are as follows:
- Genetic factors
- A personal or family history of cardiac disease
- Anxiety
- Hypertension
- Excessive consumption of caffeine and alcohol
- Smoking
- Mental stress
- Recreational drug use
- Thyroid disease
Complications of Tachycardia
Complications associated with tachycardia may be the following:
- Complications of undiagnosed tachycardia. Undiagnosed prolonged sinus tachycardia with a pathologic etiology can cause myocardial ischemia, slowed ventricular filling time, decreased cardiac output, failure of the end organ systems, cardiomyopathy, cardiac arrest, and death.
- Complications of tachycardia treatment. Following an ablation, the patient may experience bruising, redness, or swelling. Other risks include bleeding, infection, blood clots, and damage to heart or blood vessels. There is a chance of infection, chest discomfort, dizziness, or shortness of breath following the implantation of an implantable cardioverter-defibrillator (ICD).
Diagnosis of Tachycardia
Diagnostic tests for tachycardia should usually include:
- Comprehensive history taking and physical examination. A detailed and comprehensive history is vital in making decisions regarding the appropriate management of tachycardia. Precipitating events (such as fever or exertion), recent medications, hazardous exposures, caffeine or drug use, a medical history, a history of heart disease or recent heart surgery, and family history must be elucidated. On physical examination, the patient’s hemodynamic status must be assessed to ensure that the patient is not on the edge of a cardiovascular collapse due to shock. A cardiovascular examination is required to establish the presence of tachycardia and to check for murmurs (i.e., seen in structural heart disease), pulsus paradoxus, third or fourth heart sounds, or gallop rhythm (i.e., seen in myocardial dysfunction), as well as presence distant heart sounds (e.g., seen in pericardial effusions with tamponade).
- Electrocardiogram (ECG or EKG). This test records the electrical activity of the heart which aids in identifying cardiac abnormalities. To establish the presence of sinus tachycardia and rule out the presence of other tachydysrhythmias, clinicians frequently do an electrocardiogram first.
- 24-hour Holter recording. Patients are asked to wear a holter monitor which is a portable machine that records electrocardiogram signals over 24 hours. An inappropriate sinus tachycardia can be detected with a 24-hour Holter recording.
- Pulse oximetry and arterial blood gases measurement. Hypoxia can be quickly determined with pulse oximetry. In order to assess whether acidity is present and whether it is connected to carbon dioxide levels or metabolic disturbances, arterial blood gases are taken.
Treatment for Tachycardia
The cornerstone of management is the identification and treatment of the underlying cause of tachycardia. Benign causes, such as physical activity or stress, frequently do not need any special cardiac care.
If tachycardia is secondary to a medical condition that puts the patient at risk for clinical deterioration (such as sepsis, shock, hypoxia, metabolic acidosis, or acute myocardial ischemia), the patient should be admitted for further assessment.
The underlying reason should be properly addressed throughout treatment.
The treatment for tachycardia should usually include the following:
- Medications. If an individual has sinus tachycardia, measures should be employed to decrease the heart rate, such as giving medications to lower fever. In patients with ventricular tachycardia, medications should be given to restore the normal electrical signals of the heart.
- Lifestyle modifications. In patients with supraventricular tachycardia, it is recommended to consume less caffeine or alcohol, increase the hours of sleep, and quit smoking. Employing measures to ease stress is also recommended.
- Ablation. In patients with ventricular tachycardia, ablation may be performed. Ablation is a procedure that uses heat to destroy abnormal cardiac tissue.
- Defibrillation. A tiny battery-operated device known as an implanted cardioverter-defibrillator (ICD) is inserted into the chest to identify and treat abnormal heartbeats (arrhythmias). When necessary, an ICD administers electric shocks to the heart to help it return to a normal rhythm.
Nursing Diagnosis for Tachycardia
Tachycardia Nursing Care Plan 1
Nursing Diagnosis: Decreased Cardiac Output related to episodes of tachycardia secondary to metabolic alkalosis as evidenced by increased pH and plasma bicarbonate levels, and slow and shallow breathing.
Desired Outcomes:
- The patient will demonstrate serum bicarbonate and electrolyte levels within the normal range.
- The patient will demonstrate absence of metabolic derangements as evidenced by absence of neurological impairment or irritability.
| Nursing Interventions for Tachycardia | Rationale |
| Monitor the patient’s respiratory rate, depth, and rhythm. | Hypoventilation is a compensatory mechanism to conserve the limited amounts of carbonic acid in the body. However, this may pose a risk to the patient as this may lead to hypoxemia and respiratory failure. |
| Monitor the patient’s heart rate and rhythm. | Ectopic beats in the atrium and ventricles as well as tachydysrhythmias could form. |
| Evaluate the patient’s state of consciousness, neuromuscular condition, strength, tone, and movement; take note of any Chvostek or Trousseau signals. | A hypersensitive CNS may manifest as tingling, numbness, dizziness, restlessness, apathy, and disorientation (increased pH of CNS fluid). Tetany may be exacerbated by hypocalcemia (although occurrence is rare). |
| Note the patient’s source of output and its volume. Monitor also the patient’s input and daily weight. | This is helpful in determining the source of ion loss. Potassium and hydrochloric acid are lost in vomiting and gastrointestinal suctioning. |
| Reduce unpleasant environmental stimuli and oral intake. Use intermittent suctioning with low pressure during nasogastric suctioning; and irrigate the gastric tube with isotonic solutions rather than water. | This limits hydrochloric acid, potassium, and calcium losses during digestion. |
Tachycardia Nursing Care Plan 2
Risk for Decreased Cardiac Perfusion
Nursing Diagnosis: Risk for Decreased Cardiac Perfusion related to tachycardia secondary to heart failure
Desired Outcomes:
- The patient will maintain adequate tissue perfusion as evidenced by blood pressure, pulse rate and rhythm, respiratory rate, and capillary refill within the normal range.
- The patient will demonstrate improvement in mental status.
| Nursing Interventions for Tachycardia | Rationale |
| Monitor the patient’s heart rate. Assess for any changes, such tachycardia or arrhythmia. | The presence of tachycardia or arrhythmia is an indication of cardiac dysfunction and decompensation. |
| Monitor the patient’s blood pressure. If it becomes unstable, check blood pressure every 15 minutes or more frequently. Assess for any drop in blood pressure beyond 20 mmHg from the patient’s baseline or any associated abnormalities, like dizziness and alterations in mental status. | Hypotension, which can also be a complication of the condition, is one of the main side effects of medications indicated for heart failure. |
| Evaluate the patient’s skin color, temperature, capillary refill time, pulse rate and amplitude. | Pallor, chills, delayed capillary refill time (greater than 2 seconds), and decreased pulse amplitude are symptoms of peripheral vasoconstriction brought on by sympathetic nervous system compensation. Fluid excess may result in the presence of edema in the extremities. |
| Evaluate any alterations in the patient’s mental status, including anxiety, confusion, memory loss, depression, restlessness, lethargy, stupor, and coma. | These symptoms may indicate poor oxygenation and brain perfusion. |
| Administer vasodilators and inotropic medications, as prescribed. Monitor for adverse effects such as hypotension and arrhythmia. | In acute decompensated heart failure (ADHF), vasodilators are used to lower ventricular filling pressures and systemic vascular resistance, thereby reducing the workload on the heart. Patients with low output HF, cardiogenic shock, or a systemic blood pressure less than 90 mm Hg are not advised to take these drugs. Inotropic medications are maintained on hand for use in acute decompensated heart failure associated with reduced cardiac output and cardiogenic shock until the patient is stabilized. They strengthen contractions. They may be used for a protracted amount of time during advanced-stage HF as a stopgap measure before transplantation or to relieve symptoms. |
Tachycardia Nursing Care Plan 3
Nursing Diagnosis: Acute Pain related to tissue ischemia and tachycardia secondary to myocardial infarction as possibly evidenced by facial grimacing, restlessness, reports of chest pain with or without radiation, alteration in blood pressure and pulse rate, and changes in mentation
Desired Outcomes:
- The patient will verbalize relief/control of chest pain within the appropriate time frame for administered medications.
- The patient will demonstrate reduced tension, a relaxed disposition, and ease of movement.
- The patient will employ relaxation techniques.
| Nursing Interventions for Tachycardia | Rationale |
| Monitor and record signs of pain, taking note of vocal reports, nonverbal indicators (groaning, sobbing, grimacing, restlessness, diaphoresis, clutching of the chest), and changes in blood pressure or heart rate. | The variability of a patient’s appearance and behavior when they are in pain might make assessment difficult. The majority of acute myocardial infarction patients present as sick, disoriented, and pain-focused. It is best to wait until the pain has subsided before taking a verbal history and looking further into the possible causes. Pain accompanied by anxiety may cause increased breathing. The release of catecholamines brought on by stress raises heart rate and blood pressure. |
| Review and identify if there is a history of previous angina, angina-like discomfort, or myocardial infarction pain. If appropriate, bring up the family history. | Delays in reporting pain prevent it from being relieved and may necessitate a higher dosage of medication. Additionally, extreme pain can cause shock by activating the sympathetic nervous system, causing additional damage and obstructing the ability to diagnose and treat pain. |
| Instruct the patient to report pain promptly. Create a peaceful setting and offer comfort measures. Approach the patient calmly and offer reassurance. | This reduces external stimuli, which could exacerbate anxiety and heart strain. This further limits coping mechanisms and situational adaptability. |
| Give the patient instructions on how to practice deep, calm breathing, distraction methods, visualization, and guided imagery. Assist when required. | These measures reduce the perception of and reaction to pain. It also reinforces a positive attitude and gives a sense of having some control over the circumstance. |
| Apply supplemental oxygen using a face mask or nasal cannula, as necessary. | This increases the quantity of oxygen that is available for myocardial uptake, which may reduce pain brought on by cardiac tissue ischemia. |
Tachycardia Nursing Care Plan 4
Risk for Decreased Cardiac Output
Nursing Diagnosis: Risk for Decreased Cardiac Output related to tachycardia secondary to digitalis toxicity
Desired Outcomes:
- The patient will maintain an adequate cardiac output as evidenced by blood pressure and pulse rate measurements within the normal range, an adequate urinary output, palpable pulses of equal quality, and a normal level of mentation.
- The patient will demonstrate a decreased frequency or absence of dysrhythmia(s).
- The patient will participate in activities that decrease myocardial workload.
| Nursing Interventions for Tachycardia | Rationale |
| Observe the rhythm, regularity, amplitude (full or thready), and symmetry of your pulses (radial, carotid, femoral, and dorsalis pedis). Record the existence of a bigeminal pulse, pulsus alternans, or pulse deficit. | Variations in pulse equality, rate, and regularity are a sign of how changing cardiac output may affect the peripheral or systemic circulation. |
| Auscultate the patient’s heart sounds. Take note of the rhythm, pace, and presence of additional or missed beats. | Particular dysrhythmias can be heard more easily than they can be felt. Identifying if dysrhythmia is present in an unmonitored patient is made easier by auscultating for additional or missed heart beats. |
| Monitor the patient’s vital signs. During episodes of dysrhythmia, evaluate the adequateness of cardiac output and tissue perfusion. Take note of any substantial alterations in blood pressure/pulse rate equality, respirations, changes in skin color, temperature, state of awareness, sensorium, and urine output. | Although not all dysrhythmias are life-threatening, they might need to be treated promptly if there are changes in cardiac output or tissue perfusion. |
| Examine complaints of chest pain. Note its location, duration, intensity (0–10), and variables that either relieve or aggravate it. Take note of nonverbal signs of pain such as sobbing, grimacing faces, and changes in blood pressure and pulse rate. | Chest pain can have a variety of causes, depending on the underlying etiology. However, chest pain may be indicative of ischemia due to disrupted electrical conduction, reduced myocardial perfusion, or increased oxygen demand. |
| When necessary, be prepared to begin cardiopulmonary resuscitation (CPR). | To avoid ischemic damage or death, life-threatening dysrhythmias must be treated promptly. |
Tachycardia Nursing Care Plan 5
Nursing Diagnosis: Anxiety related to persistent tachycardia secondary to coronary artery disease as possible evidenced by expressed worry over evolving life events, heightened anxiety or powerlessness, fear, hesitancy and restlessness, association of diagnosis with loss of positive body image, loss of position/influence, self-perception as a non-contributing member of family/society, and fear of death as an imminent reality.
Desired Outcomes:
- The patient will verbalize awareness of feelings of anxiety and healthy ways to deal with them.
- The patient will demonstrate a decrease in anxiety to a manageable level.
- The patient will express concerns about the effect of the disease on lifestyle and position within family and society.
- The patient will demonstrate effective coping strategies/problem-solving skills.
| Nursing Interventions for Tachycardia | Rationale |
| Describe the purpose of tests and procedures such as stress testing. | This reduces anxiety caused by the worry of receiving an unknown diagnosis and prognosis. |
| Encourage the expression of emotions and phobias. Inform the patient or their significant other that these are normal reactions. | Unspoken emotions can cause internal conflict and have an impact on one’s self-image. Speaking out about worries eases tension, confirms degree of coping, and facilitates dealing with emotions. The presence of negative self-talk might raise anxiety levels and may aggravate anginal episodes. |
| Encourage the patient’s family and friends to continue to care for the patient as usual. | This way the patient is reassured that their place in the family and business has not changed. |
| Inform the patient that the treatment plan has been created to reduce the likelihood of future attacks and boost cardiac stability. | This encourages the patient to experiment with symptom control, to have more faith in the medical treatment, and to incorporate abilities into self-perceptions. |
| As needed, administer sedatives and tranquilizers. | It may be desirable to aid the patient in relaxing until they are physically able to rebuild effective coping mechanisms. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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