Tachycardia is a rapid heart rate over 100 bpm that can lead to signs of reduced perfusion. Nursing priorities for tachycardia focus on stabilizing circulation, ensuring adequate oxygenation, and alleviating causes. Key assessment cues include a fast pulse (often bounding or irregular if an arrhythmia), patient complaints of palpitations or lightheadedness, and possibly chest pain or shortness of breath.
Always check blood pressure – tachycardia may cause it to drop if cardiac output is compromised. Identify and address common causes (fever, anxiety, pain, dehydration). In terms of prioritization (think NCLEX!), use ABCs: while tachycardia primarily affects Circulation, severe cases can impact Breathing (due to shortness of breath) and even Airway if consciousness is altered.
Typically, you’ll intervene by monitoring the patient, administering medications or oxygen as ordered, and providing calming reassurance. Below are three high-priority nursing diagnoses and care plans for tachycardia that are useful for quick reference and exam preparation.
Nursing Care Plan #1: Decreased Cardiac Output
Diagnosis Statement: Decreased cardiac output related to inadequate ventricular filling time (rapid heart rate) as evidenced by hypotension, weak pulses, and dizziness.
Related Factors: Tachycardia reduces diastolic filling, leading to less blood being pumped out; irregular rhythms (if present) further impair effective pumping.
Interventions & Rationales:
- Assess hemodynamic status frequently: Monitor blood pressure, pulse quality, mentation, and urine output. Rationale: These are direct indicators of cardiac output. For example, declining urine output or altered mental status can signal that organs aren’t being perfused well.
- Position supine with legs elevated if BP is low: If the patient’s blood pressure drops, lying them flat and raising the legs (Trendelenburg or a modified position) can improve venous return. Rationale: This maneuver helps redirect blood to the vital organs and temporarily improves cardiac output during episodes of hypotension caused by tachycardia.
- Administer cardiac medications as prescribed: This may include antiarrhythmic drugs or beta-blockers to slow the heart rate, or IV fluids if the patient is dehydrated. Rationale: Slowing the heart rate will increase filling time and stroke volume, directly improving cardiac output. IV fluids increase circulating volume, which can help maintain blood pressure and output, especially if tachycardia is due to volume loss.
- Monitor ECG for changes: Keep an eye on the heart rhythm for any deterioration (such as development of more severe arrhythmias like ventricular tachycardia). Rationale: Tachycardia can escalate to dangerous dysrhythmias. Early detection allows quick intervention (like preparing for defibrillation or advanced cardiac life support measures) to prevent cardiac arrest.
Desired Outcome: The patient will maintain adequate cardiac output as evidenced by stable blood pressure, alert mental status, urine output ≥ 30 mL/hr, and relief from dizziness or weakness.
Nursing Care Plan #2: Acute Pain (Chest Pain)
Diagnosis Statement: Acute pain related to decreased cardiac perfusion secondary to tachycardia as evidenced by patient reporting chest pain rated 7/10 and clutching their chest.
Related Factors: When the heart beats too fast, the coronary arteries may not fill properly, leading to ischemic chest pain. Also, tachycardia increases oxygen demand of the heart muscle. If the patient has underlying coronary artery disease, tachycardia can trigger angina.
Interventions & Rationales:
- Immediately assess the chest pain: Use PQRST (Provocation, Quality, Radiation, Severity, Timing) to characterize the pain and take vital signs. Rationale: Determining if the pain is cardiac in nature (pressure-like, radiating to arm or jaw) and its severity guides urgency. Chest pain with tachycardia could indicate angina or even infarction. Vital signs (especially blood pressure) tell you how stable the patient is.
- Administer oxygen and pain relief as ordered: Give supplemental oxygen, and if prescribed, administer nitroglycerin for chest pain or morphine per protocol. Rationale: Oxygen helps ensure the heart muscle gets as much O₂ as possible, potentially relieving ischemic pain. Nitroglycerin will dilate coronary arteries and reduce cardiac workload, addressing the likely cause of pain. Pain relief not only comforts the patient but also decreases stress (and catecholamine release) which can help slow the heart rate.
- Encourage the patient to rest and minimize exertion: At the onset of chest pain, have the patient stop any activity and lie down in a semi-Fowler’s position. Rationale: Rest reduces oxygen demand of the heart. Semi-Fowler’s (head elevated) can improve breathing and comfort. Decreasing the workload on the heart can help alleviate angina pain associated with tachycardia.
- Prepare for emergency measures if pain persists: Keep emergency equipment nearby and be ready to alert the healthcare provider or rapid response team if chest pain is unrelieved by initial interventions. Rationale: Unrelieved chest pain in the context of tachycardia may signal an acute coronary syndrome (heart attack). The nurse should anticipate orders like obtaining a stat ECG, drawing cardiac enzymes, or even preparing for transfer to a higher level of care (e.g., ICU or cardiac cath lab). Early action can be life-saving.
Desired Outcome: The patient’s chest pain will be relieved (reporting pain 0/10 or significantly improved) shortly after interventions, and there will be no signs of ongoing myocardial ischemia (such as ECG changes or rising cardiac biomarkers). The patient will verbalize comfort and exhibit reduced distress (no longer clutching chest, able to rest).
Nursing Care Plan #3: Risk for Decreased Cardiac Tissue Perfusion
Diagnosis Statement: Risk for decreased cardiac tissue perfusion related to tachycardia and potential coronary artery perfusion deficits. (This is a risk diagnosis – the aim is to prevent cardiac ischemia or damage.)
Risk Factors: Sustained high heart rate reducing coronary blood flow, possible underlying heart disease (e.g., atherosclerosis), hypertension, or any factor that might compromise oxygen delivery to heart muscle during tachycardia.
Interventions & Rationales:
- Continuous cardiac monitoring: Observe for any ECG indicators of ischemia (ST segment changes, T-wave inversions) while the patient is tachycardic. Rationale: Real-time ECG changes can be the first sign that the heart muscle is not getting enough blood. Catching ischemia early means interventions (like medications or procedure) can be done to restore perfusion and prevent a full-blown infarction.
- Keep patient NPO if severe tachyarrhythmia is ongoing: If the patient is having a significant tachycardic episode, hold oral intake as per physician order. Rationale: In case urgent interventions (like cardioversion or cardiac catheterization) are needed, having the patient NPO (nothing by mouth) helps reduce aspiration risk. It’s a preparatory measure for potential invasive treatment to restore perfusion.
- Administer anti-ischemic medications as ordered: This might include beta-blockers (to slow heart rate and reduce oxygen demand), antiplatelet agents like aspirin (if suspecting acute coronary syndrome, to improve flow in coronary arteries), or IV nitrates. Rationale: Beta-blockers will slow the tachycardia, directly improving the time for coronary perfusion. Aspirin and nitrates help improve blood flow to the heart muscle. These medications together reduce the risk that tachycardia will cause significant cardiac ischemia.
- Educate on warning signs: Even in the hospital (and certainly for discharge), teach the patient to report any new chest pressure, extreme shortness of breath, or unusual fatigue immediately. Rationale: Patients need to be partners in their care. If they recognize early symptoms of poor cardiac perfusion, they can alert the staff right away. Early reporting leads to early intervention, which is key in preventing heart muscle damage.
Desired Outcome: The patient will remain free of myocardial injury. In the hospital, they will have no episodes of acute coronary ischemia: ECG will show no ischemic changes, and cardiac enzyme levels will remain normal. The goal is preventative – by discharge, the patient (and nurse) will have successfully avoided any decrease in cardiac tissue perfusion despite episodes of tachycardia.
FAQ – Quick Answers for NCLEX-Style Questions
Q1: What is the first nursing action if a patient’s heart rate suddenly jumps to 150 bpm?
A: The first action is to assess the patient’s overall condition and stability. This means check the blood pressure, look at the patient’s level of consciousness, and ask how they feel (any chest pain or dizziness?). If the patient is unstable (e.g., low BP, feeling faint or severe pain), you would call for emergency assistance immediately while ensuring airway, breathing, circulation support.
If the patient is stable, you can then proceed with interventions like asking them to rest, doing a 12-lead ECG, and following any standing orders for managing tachycardia (such as a vagal maneuver or medication). Remember, NCLEX wants to see that you assess first unless there’s an obvious life-threatening condition requiring immediate intervention.
Q2: Why do we give beta-blockers for tachycardia?
A: Beta-blockers (like metoprolol or atenolol) slow down the heart rate by blocking the beta-adrenergic receptors in the heart. For a tachycardic patient, a slower heart rate means the heart has more time to fill with blood between beats, which can improve cardiac output and lower blood pressure to normal.
It also reduces the heart’s oxygen consumption, which is beneficial if tachycardia is putting stress on the heart muscle. In essence, beta-blockers help “calm” the heart. For exam purposes, remember that you should always check the patient’s blood pressure and heart rate before giving a beta-blocker (don’t give it if heart rate or BP is too low).
Also, monitor for side effects like bradycardia, hypotension, or wheezing (some beta-blockers can affect the lungs).
Q3: When should a nurse consider tachycardia as the primary problem versus a symptom of something else?
A: Tachycardia is often a symptom of an underlying issue. For example, if a patient is hemorrhaging (losing blood), they will be tachycardic as a compensatory mechanism; in that case, the real problem is the bleeding, and stopping it is the priority, while tachycardia is a sign.
However, tachycardia itself becomes the primary problem when it’s causing hemodynamic instability or risk (like in arrhythmias where the heart rhythm is the issue, such as SVT or ventricular tachycardia).
So, consider tachycardia the primary problem when: (1) it’s an arrhythmia that needs direct treatment (like a sudden SVT that isn’t due to another cause), or (2) it persists and leads to symptoms that themselves need intervention (like chest pain, low BP).
In many cases on exams, you’ll treat the cause (e.g., give pain medication if pain caused the tachycardia, or cool a feverish patient). But if no obvious cause is fixable in the moment, then you focus on controlling the heart rate directly.
Peer-Reviewed References:
- Carpenito, L. J. (2022). Handbook of Nursing Diagnosis (16th ed.). Wolters Kluwer.
- Silvestri, L. A. (2023). Saunders Comprehensive Review for the NCLEX-RN Examination (9th ed.). Elsevier.
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). (2022). LWW.
- Potter, P. A., & Perry, A. G. (2021). Fundamentals of Nursing (10th ed.). Elsevier.
- NANDA International. (2024). NANDA-I Nursing Diagnoses: Definitions & Classification, 2024–2026. Thieme.