solved My interpretation of this rhythm is an atrial paced rhythm

My interpretation of this rhythm is an atrial paced rhythm with an episode of failure to pace. Atrial pacing can be used if the patient has failure of the SA node, but normal function of the AV node and ventricular conduction system, whereas if an AV block was also present, ventricular pacing may be needed as well (Dubin, 2016, p. 322). Atrial pacing allows artificial atrial stimuli to be successfully conducted to the ventricles (Dubin, 2016, p. 323). Between the two QRS complexes are 3.5 large boxes for an atrial paced rate of about 86 beats per minute. During the period of failure to pace, we see no spikes for a few cycles. That is when the patient goes into their intrinsic rhythm which appears to be a (barely) accelerated idioventricular rhythm with a rate of about 41 to 42 beats per minute using the small box method. When failure to pace occurs, there is an absence of pacer spikes and the patient returns to their intrinsic rhythm for which the pacer was placed (Ahlert, 2018, p. 228). Causes for failure to pace include displacement of an electrode tip, battery or generator failure, fracture of the pacing lead wire, sensitivity settings too high, or electromagnetic interference (Ahlert, 2018, p. 229). Treatment of this pacemaker malfunction includes adjusting the sensitivity settings of the pacemaker, replacing leads, tightening lead connections, and replacing the battery or generator unit (Ahlert, 2018, p. 230). Nursing implications of this patient prior to treatment and intervention include monitoring the patient’s hemodynamic stability and looking for signs and symptoms as to how they are tolerating the malfunction. The nurse should anticipate a consult with the patient’s cardiologist/electrophysiologist and expect orders for pacemaker interrogation.Aehlert, B. (2018). ECGs made easy. Elsevier.Dubin, D. (2016). Rapid interpretation of Ekg’s: Dr Dubin’s classic, simplified methodology for understanding Ekg’s. Cover Publishing.