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Book Review
The nurse's guide to cardiac rhythm interpretation: Implications for patient care
Sara Paul and Jennifer D. Hebra
ISBN: 0-721659-06-3 1998 Harcourt Brace
Thea van de Mortel
Associate Lecturer, School of Nursing and Health Care Practices, Southern Cross University, Lismore NSW
The stated aim of this text is to provide nurses-from the student nurse through to the advanced cardiac practitioner-with the knowledge to make informed decisions regarding the care of the patient suffering a cardiac dysrhythmia. The authors hope to enable nurses to recognise and diagnose disturbances in cardiac rhythms, to understand the physiologic processes underlying dysrhythmia formation and the implications for patient care in terms of pharmacologic management, other medical treatments and the nursing actions required to adequately treat these patients.
The book is devoted to interpreting cardiac rhythms from continuous cardiac rhythm strips and, although much of the information needed to interpret a 12-lead ECG is present, it is scattered throughout the book and novices could find it difficult to assimilate. In order to cater to the needs of both the novice and the advanced practitioner, the book has been divided into four sections:
- 'Review of the basics'-which is aimed at those readers without a fundamental understanding of the underlying anatomy and physiology of the cardiovascular system and the rudiments of lead placement and selection and rhythm interpretation;
- 'Interpreting Basic Rhythms'-which deals systematically with sinus, atrial, junctional and ventricular rhythms and atrioventricular block and dissociation;
- 'Cardiac Rhythms in the Paediatric Population'-which deals with supraventricular and ventricular dysrhythmias specific to the paetiatric patient; and
- 'Advanced Concepts in Cardiac Rhythms'-which deals with more complicated dysrhythmias, in addition to the treatment of life-threatening rhythms, and the education of staff regarding continuous cardiac monitoring. This section also contains practice case studies.
The text generally lives up to its stated aims; however, from the perspective of someone who teaches cardiac pathophysiology to student nurses, the level at which the text is pitched is not really suitable for the student nurse. The section on anatomy and physiology assumes some knowledge on the part of the reader; for example, in later chapters b-blockers are suggested as a therapy, however, no mention is made of the role of b-receptors in affecting heart rate in the section on cardiac physiology. The use of figures in the text is poor in places; some figures are used without adequate explanation of the content of the figure, and a number of figures are either overly detailed in structure and difficult to follow, or poorly reproduced.
For those readers with a good understanding of the anatomy and physiology of the cardiac system, the textbook delivers on its promise to present a holistic view of care of the patient with a cardiac dysrhythmia.The second section on interpreting basic rhythms is very comprehensive. Each dysrhythmia is illustrated, the pathophysiology of formation is discussed, and treatment and nursing implications are outlined. In addition, the authors explain the best method of monitoring for a particular dysrhymia. At the end of each chapter, a set of practice rhythm strips and an answer sheet allow readers to test their understanding of the concepts they have covered.
Section three, which deals with rhythm abnormalities in paediatric patients, is useful for those practitioners who work specifically with children in emergency situations regularly; however, several of the figures in this section are poorly reproduced and difficult to read.
The final section contains several chapters of aberrant conduction and accessory pathways which will be useful to those nurses working in a specialist cardiac area. The section also covers rhythms associated with cardiac drugs, and treatment of life-threatening rhythms. Although this is an American text, most of the drug names are the same as those used in Australia, so confusion with drug names should not be an issue for an Australian reader.
The chapter on preparing and education nurses for continuous cardiac monitoring will be useful to anyone considering initiating such a program. Some information regarding licensure and continuing education program requirements is specific to the American audience; however, such non-relevant information does not make up a large proportion of the material covered in this chapter. The final chapter in the text includes case studies and practice strips that allow readers to test their understanding of the material covered.
The strongest features of the text are that the subject matter is well organised, the information is easy to locate, and the structure of the text allows the reader to select the level at which he/she wishes to learn. The text could be improved by expanding the section on cardiac anatomy and physiology, and by selecting clearer figures, using more figures to illustrate relevant points and by better explanation of the material presented in figures.
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