Educational Theory: Cognitive behaviour - Essay Example

?Educational Theory: Cognitive behaviour Educational Theory: Cognitive behaviour An arrhythmia, also called dysrhythmia simply refers to a problem with the heartbeat’s rhythm or rate. The purpose of this paper is to focus on the cognitive behaviour of learners and how this will be applied in learning the lesson – recognition of arrhythmia – and how this lesson is planned. The thought process of 12 junior doctors would be looked into in order to recognize common arrhythmia. The basic knowledge of junior doctors would be tested in addition to exploring their long-term and short-term memory. Furthermore, their behaviour in emergency and stressful situation would be assessed if they were faced with a similar situation. This paper also provides a comprehensive discussion on the appropriate management of the common arrhythmia. Arrhythmia According to Nordqvist (2009, p. 11), arrhythmia is a problem with the heartbeat’s rhythm or rate. For the period of this problem, the heart could beat very slow, with an irregular rhythm, or very fast. A heart-rate that is normal has 50-100 beats for every minute. A heartbeat, which is very slow, is often referred to as bradyarrhythmias or bradycardia with less that 50 beats per minute, whilst a very fast heartbeat is known as tachyarrythmias or tachycardia with faster than 100 beats per minute. Too irregular heartbeat is known as fibrillation, whereas too early heartbeat is called premature contraction. Body organs such as the heart and the brain could be damaged if there is no blood flow (Kastor 2010, p. 11). Arrhythmias refer to problems with the heart-rhythm and typically happen whenever the electrical impulses to the heart which coordinate the heartbeats do not work correctly, thereby making the heart to beat in an inconsistent manner, or very slow/rapid. It is of note that the majority of arrhythmias are not dangerous although some could be grave or very serious to one’s life (Marriott & Covoner 2006, p. 8). Everyone intermittently gets to experience heartbeats which are not regular that might feel like quivering or like a racing heart. Nonetheless, some arrhythmias, particularly when they veer very far from a usual heartbeat or lead to a damaged or weak heart, might result in worrying or possibly mortal symptoms. For the duration of arrhythmia, the heart might be unable to pump adequate blood to the body (Moses 2008, p. 13). Thought process of junior doctors in recognition of common arrhythmia In evaluating a patient with arrhythmia, the first question that a junior doctor asks himself/herself is: what type of arrhythmia is it? Is it tachycardia or bradycardia? There are various arrhythmias that the junior doctor will come across in clinical practice such as tachycardia, when the heart is beating very rapidly; and bradycardia, when the heart is beating in a very slow manner. Whenever the pumping function is decreased greatly for more than a few seconds, the circulation of blood is stopped, and there could be organ damage shortly afterwards. The junior doctor also asks himself/herself if the arrhythmia is harmless or life-threatening. If the identified arrhythmia is ventricular fibrillation or ventricular tachycardia, the junior doctor will note them as life-threatening. In recognizing common arrhythmias, the doctor’s cognitive behaviour will also concentrate on where they happen within the heart, that is, ventricles or atria, and by what occurs to the rhythm of the heart whenever they happen. Those that begin within the atria are generally referred to as supraventricular, that is, above the ventricles. Conversely, those that start within the ventricles are called ventricular arrhythmias (Sinz 2008, p. 19). Cognitive behaviour of junior doctors in recognition of supraventricular arrhythmias The junior doctor tries to establish if the arrhythmias start above the ventricles and will ask him/her the following question: is it atrial flutter, atrial fibrillation, paroxysmal supraventricular tachycardias (PSVT), Wolff-Parkinson-White syndrome, premature atrial contraction (PAC), sinus arrhythmia or multifocal atrial tachycardia (MAT). Atrial flutter: to recognize this arrhythmia, the junior doctor; first, finds out if it leads to a fast and uncoordinated electrical stimulation of the heart’s upper chamber, thereby causing a fast impulse. Secondly, the doctor establishes if the atria are stimulated in a very rapid manner such that they are unable to squeeze or contract. It is of note that this type of arrhythmia is essentially caused by a loop of electricity within the heart’s upper chambers. With ablation, atrial flutter is curable (Tsiperfal et al. 2011, p. 33). Atrial fibrillation: this is the most common kind of arrhythmia. In recognizing this type of arrhythmias, the junior doctor first asks himself/herself is the heart’s electrical activity uncoordinated and is electricity moving about in the upper chambers of the heart in a chaotic manner? This typically causes the heart’s upper chambers to shudder and then contract ineffectually or not to contract at all (Fuster, Ryden & Asinger 2009, p. 30). In other words, to recognize atrial fibrillation, the junior doctor seeks to determine if electrical impulses in a person’s atria has become disorganized, and overrides the normal rhythm and rate of the individual. He will also ask himself if this has caused the atria to contract in an irregular fashion or fibrillate. The junior doctor will ask the patient if his/her heartbeat feels uneven and if is quicker than usual, and for how long the patient has had the condition (Marriott & Covoner 2006, p. 41). It is notable that atrial fibrillation attacks could last from just a few seconds to more than 7 days. Moreover, in recognizing atrial fibrillation, the doctor will ask himself/herself: are the following symptoms present in the patient, chest pain, breathlessness, fainting or dizziness and tiredness – being unable to do as much physical activity as usual? Palpitations are also another symptom; that is, an unpleasant awareness of the heartbeat, the thumping within the patient’s chest (Garcia & Miller 2004, p. 23). Furthermore, is the patient an elderly or an individual who has heart disease? Does the patient has heart valve disease who might need surgical procedure in order to replace or repair the mitral valve? (Fuster, Ryden & Asinger 2009, p. 31). Paroxysmal supraventricular tachycardias (PSVT): To recognize this type of arrhythmia, the junior doctor asks himself, are there fast heart rhythms from the heart’s top part? Secondly, recurring periods of very rapid heartbeats start and then stop abruptly (Walraven 2010, p. 35). It is noteworthy that these types of arrhythmias are normally caused by extra connections between the heart’s lower and upper chambers. PSVT is usually hard to control with the use of drugs or medication, but is curable using an ablation. Wolff-Parkinson-White syndrome: this is simply a special kind of supraventricular tachycardias. The junior doctor essentially seeks to determine episodes of tachycardia, that is, fast heart rate due to anomalous electrical connection within the heart. For a patient presenting with this condition, the doctor asks himself; is there an additional/accessory connection between the heart’s bottom and top chambers? (Wolf, Parkinson & White 2000, p. 23) This syndrome happens in roughly 4 in 100,000 individuals, and is a frequent cause of tachyarrhythmias or rapid heart rate disorders in children as well as infants (Wolf, Parkinson & White 2000, p. 23). Premature atrial contraction (PAC) or premature supraventricular contractions: In recognizing this type of arrhythmia, the junior doctor asks himself/herself; does the patient have premature beats or extra beats leading to irregular heart rhythms? (Podrid & Kowey 2001, p. 36). Does the arrhythmia begin within the heart’s upper chambers? The doctor will establish that they are rather common and they are benign and harmless. Normally, no cause could be found and there is no particular treatment required. Sinus tachycardia: To recognize this type of arrhythmia, the junior doctor essentially asks himself/herself; does the arrhythmia occur whenever the sinus node sends out quicker than normal and thereby speeding up the heart rate? It is of note that sinus tachycardia is a normal response to exercise. Sinus arrhythmia: in the recognition of sinus arrhythmia, the cognitive behaviour of the junior doctor focuses on establishing cyclic alters in the heart rate when the individual is breathing. The junior doctor asks himself/herself: is the patient a healthy and normal adult? Is the patient a child (Walraven 2010, p. 49). The condition can be found in both children and healthy, normal adults. Multifocal atrial tachycardia (MAT): to recognize this condition in a patient, the junior doctor asks himself/herself; do several locations in the atria fire and begin an electrical impulse? (Tsiperfal et al. 2011, p. 59). The second question will be: are the majority of these impulses conducted to the ventricals thereby causing fast heart rate that ranges from 100 – 250 heartbeats for every minute? Third, does the patient presenting with this condition an individual of at least 50 years of age? Fourth, does the individual has lung disease (Tsiperfal et al. 2011, p. 59; Conover 2009, p. 71). Learners’ cognitive behaviour in recognition of ventricular arrhythmias To recognize ventricular arrhythmias, the junior doctor concentrates on identifying ventricular fibrillation, pre-mature ventricular contraction, ventricular tachycardia and the Long QT syndrome. Ventricular fibrillation: in order to recognize this type of arrhythmia, the learner will ask himself/herself: does the arrhythmia occur when electrical signals within the ventricles fire in a very uncontrolled and rapid fashion, thus causing the lower chambers of the heart to shudder, and not to pump blood? Ventricular fibrillation is an emergency. In case the individual does not get medical attention immediately and a normal rhythm is not reinstated speedily, the person would suffer heart as well as brain damage and then pass away (Rajskina 2008, p. 16). As a medical emergency, the junior doctor quickly aims to give the patient cardiopulmonary resuscitation (CPR) as well as defibrillation. For individuals that survive this, the junior doctor needs to implant them with defibrillator (ICD) arrhythmia (Nordqvist 2009, p. 16). Pre-mature ventricular contraction (PVC): to recognize this type of arrhythmia, the junior doctor asks himself: is there a signal from the ventricles leading to an early heart beat which might go without being noticed? Does the heart then pauses until the subsequent beat of the ventricle takes place in a regular manner? Is the patient a healthy and normal adult? Essentially, the learner will seek to determine early extra beats that begin from the heart’s lower chambers or ventricles. In most cases, PVCs do not cause any symptoms and do not require any kind of treatment (Rajskina 2008, p. 19). The learner will also ask himself/herself: does the patient presenting with this condition often has stress, too much nicotine, caffeine, or exercise? Does the patient has electrolyte imbalance or heart disease? Individuals with many PVCs, and/or symptoms related to them need to be evaluated by a heart doctor (Hebbar & Hueston 2002, p. 32). Ventricular tachycardia (V-tach): to recognize V-tach, the junior doctor will first ask himself/herself: is the condition an irregular and fast heartbeat that starts within the ventricles – the heart’s bottom chamber? Is the condition fatal? Does the fast rate serve to prevent the heart from filling sufficiently with blood, and less amount of blood is able to pump throughout the body? (Sinz 2008, p. 71). The learner also seeks to find out if the patient has heart disease, if so, then v-tach is a particularly grave condition for such a patient. This type of arrhythmia needs to be evaluated by a heart doctor. The appropriate treatment comprises an implantable defibrillator and/or medication and/or interventions such as ablation so as to attempt to limit or reduce the number of shocks (Fuster, Ryden & Asinger 2009, p. 44). Long QT syndrome: the QT interval refers to the area on the electrocardiogram (EKG/ECG) that signifies the time taken for the heart muscle to contract and then recover. It is also the electrical impulse to fire impulses and then recharge. In recognizing this syndrome, the junior doctor asks himself: Is the QT interval longer than normal? Secondly, does it raise the risk of a life-threatening type of ventricular tachycardia known as torsade de pointes or cardiac arrhythmias (Nordqvist 2009, p. 44). The name of this syndrome arises from the QT segment in the tracing on the EKG that lasts a bit longer in the syndrome than normal. Third, could the fast heartbeats cause fainting that might be life-threatening? Fourthly, is the heart rhythm very chaotic such that it may lead to abrupt bereavement? Finally, is the patient’s condition hereditary, or was it as a result of several medications that might also lead to this syndrome (Moses 2008, p. 38). Cognitive behaviour of junior doctors in the recognition of bradyarrhythmias To recognize this type of arrhythmia, the learner will first ask himself/herself: does the patient have slow heart rhythms, or heartbeats that are abnormally slow – less than 50 beats per minute? Does the patient have heart disease within the conduction system of the heart like HIS-Purkinje system, antrioventricular (AV) node or SA node? Heart block: in recognition of this type of bradyarrhythmia, the junior doctor will ask himself: is there a delay or total block of the electrical impulse as it moves to the ventricles from the sinus node? (Kastor 2010, p. 55). Does the level of delay or block take place within the HIS-Purkinje system or antrioventricular node? Is the heart beating in an irregular fashion – more slowly? (Nordqvist 2009, p. 61). Sick sinus syndrome: to effectively recognize this type of arrhythmia, the junior doctor will ask himself: does the pacemaker of the heart, that is, the sinus node, fire its signals in an improper fashion, thereby slowing the heart rate? Secondly, does the rate alter back and forth between tachycardia/fast rate, and bradycardia/slow rate? Is the patient an elderly who has degenerative alters to the heart’s conduction pathways? (Kastor 2010, p. 57). How the cognitive behaviour of learners will be applied in learning the lesson With regards to learning the lesson – recognition of arrhythmia –, the cognitive behaviour or thought process of junior doctors will be applied primarily in the identification of common arrhythmia. With the thought process, the learner will be able to ask himself/herself pertinent questions regarding the condition and from the answers obtains, the junior doctor will have the capacity of distinguishing one type of arrhythmia from another. For instance, in the identification of atrial fibrillation, the learner will ask himself: is the heart’s electrical activity uncoordinated and is electricity moving about in the upper chambers of the heart in a chaotic manner? This typically causes the heart’s upper chambers to shudder and then contract ineffectually or not to contract at all. The junior doctor would seek to establish if electrical impulses in the atria has become disorganized, and overrides the normal rhythm and rate of the individual. If this is so, then the arrhythmis is definitely atrial fibrillation. To recognize either bradycardia or tachycardia, the learner will simply look on the ECG to determine the heartbeat rate: he/she will simply ask himself, is the heart beating at less than 60 beats per minute, if yes, then the arrhythmia is bradycardia. Conversely, if the heat is beating at over 100 beats for every minute, then the arrhythmia is tachycardia. In the recognition of atrial flutter arrhythmia, the learner will apply cognitive behaviour by first determining if the arrhythmia causes a fast and uncoordinated electrical stimulation of the atria, thereby causing a fast impulse. The learner will then establish if the atria are stimulated in a very rapid manner such that they are unable to contract. In the recognition of PSVT or paroxysmal supraventricular tachycardias, the learner will apply cognitive behaviour by asking herself 2 vital questions: first, are there fast heart rhythms from the atria? Secondly, are recurring periods of very rapid heartbeats start and then stop abruptly? The answers are yes, then the arrhythmia is certainly PSVT. In the recognition of premature atrial contraction/PAC, the learner will apply thought process by first asking himself: does the patient have premature or extra beats leading to irregular heart rhythms? Secondly, does the arrhythmia begin within the heart’s upper chambers? If the answers are positive, then the arrhythmia is identified as PAC. To recognize sinus tachycardia, the learner would apply cognitive behaviour by seeking to answer the question: does the arrhythmia occur whenever the sinus node sends out signals/impulses quicker than normal and thereby speeding up the heart rate? If yes, then the arrhythmia is sinus tachycardia. To recognize sinus arrhythmia during the lesson, the learners will apply cognitive behaviour in determining cyclic alters in the heart rate when the individual is breathing. The junior doctor asks himself/herself; is the patient a healthy and normal adult, or a child? Furthermore, in recognizing MAT in the lesson, the learner will seek to answer the following questions: first, do several locations in the atria trigger and begin an electrical impulse? Secondly, are these impulses conducted to the ventricles thus causing fast heart rate that ranges from 100 – 250 heartbeats for every minute? If the answers are positive, then the arrhythmia is without doubt, multifocal atrial tachycardia. In recognizing ventricular fibrillation in the lesson, learner will apply cognitive behaviour is aiming to answer the following question: does the arrhythmia take place when electrical signals within the ventricles fire in a very uncontrolled and rapid manner, consequently causing the lower chambers of the heart to shudder, and not to pump blood? If the answer is yes, then the arrhythmia is positively identified as ventricular fibrillation. To recognize pre-mature ventricular contraction in the lesson, the learner will apply cognitive behaviour by first asking herself: is there an electric signal from the ventricles leading to an early heart beat? Does the heart then pauses until the subsequent beat of the ventricle takes place in a regular manner? If the answers obtained are positive, then the arrhythmia identified is definitely PVC. In the recognition of v-tach arrhythmia, the learner will apply cognitive behaviour by seeking the answers to the questions: is the condition an irregular and fast heartbeat that starts within the heart’s bottom chamber? Is the condition fatal? Does the fast rate serve to prevent the heart from filling amply with blood, and less amount of blood is able to pump throughout the body? The condition is v-tach arrhythmia if the answers to these questions are positive. In addition, to apply cognitive behaviour in identifying Long QT syndrome in the lesson, the learner will simply ask herself: Is the QT interval longer than normal? If yes, then the arrhythmia is certainly Long QT syndrome. To recognize heart block in the lesson, the learner will apply cognitive behaviour by seeking to answer the questions: is there a delay or total block of the electrical impulse as it moves to the ventricles from the sinus node? Secondly, does the level of delay or block take place within the HIS-Purkinje system or antrioventricular node? Third, is the heart beating more slowly? If yes, then the arrhythmia is heart block. To successfully recognize sick sinus syndrome in the lesson, the learner would apply cognitive behaviour in seeking to answer 2 vital questions: first, does the sinus node fire its signals in an improper fashion, thus slowing the heart rate? Secondly, does the rate alter back and forth between fast rate and slow rate? If the answers are positive, then the arrhythmia is sick sinus syndrome. Finally, the cognitive behaviour of learners will be applied in learning the lesson by helping the learners to identify the suitable management of the common arrhythmia. How the lesson is planned 1. Lesson Plan Title Recognition of Common Arrhythmia 2. Aims and Objectives (or learning outcomes) a. By the end of the lesson the learners should be able to identify common arrhythmia seen in day to day clinical practice. b. They should be able to able to discuss the appropriate management of these common arrhythmia. 3. Learners Junior doctors 4. Size Of Group 10-12 5. Environment Classroom Power point Flip chart Actual ECG tracings Time Teacher Activity Learner Activity Resources  5 minutes  Introduction      5 minutes  Assessing the knowledge of students before the start of the session.  Students’ participation in answering simple questions and coming out with their current level of understanding arrhythmia.    10 minutes  Introducing basic concept using power point      20 minutes  Explaining ECGs and re-enforcing basic concepts using flip chart      10 minutes Checking understanding One ECG each distributed amongst students.  Students asked to identify certain arrhythmia on ECG    10 minutes   QUIZ      5 minutes  Feedback  Students provide written feedback on prescribed proforma   References List Conover, MB 2009, Electrocardiography. London, England: Jones & Bartlett Learning. Fuster, V., Ryden, LE & Asinger, RW 2009, Guidelines for the Management of Patients with Atrial Fibrillation. American Heart Association 87(4). Garcia, T & Miller, G 2004, Arrhythmia Recognition: The Art of Interpretation. London, England: Jones & Bartlett Learning. Hebbar, KA & Hueston, WJ 2002, Management of Common Arrhythmias: Part 1. Supraventricular Arrhythmias. American Family Physician 65(12). Huszar, RJ 2007, Basic Dysrhythmias. Cleveland, OH: Jones & Bartlett Learning. Kastor, JA 2010, You and Your Arrhythmia. Albany, NY: Penguin Publishers. Marriott, HJL & Covoner, MB 2006, Advanced Concepts in Arrhythmias (3rd ed.). Bristol, England: Mosby Publishers. Moses, HW 2008, A Practical Guide to Cardiac Pacing. Crescent City, CA: Springer Publishers. Nordqvist, C 2009, Arrhythmia. Boston, MA: CRC Press. Podrid, PJ & Kowey, PR 2001, Cardiac Arrhythmia: Mechanisms, Diagnosis, and Management. Denver, CO: Lippincott Williams & Wilkins Publishers. Rajkina, M 2008, Ventricular Fibrillation and Sudden Coronary Death. Denver, CO: Lippincott Williams & Wilkins Publishers. Sinz, E 2008, Advanced Cardiovascular Life Support: Provider Manual. Columbus, OH: Prentice Hall. Tsiperfal, A., Ottoboni, L., Beheiry, S., Al-Ahmad, A., Natale, A & Wang, P 2011, Cardiac Arrhythmia Management: A Practical Guide for Nurses and Allied Professionals. Denver, CO: Lippincott Williams & Wilkins Publishers. Walraven, G 2010, Basic Arrhythmias (7th ed.). New York City, NY: Prentice Hall. Wolff, L., Parkinson, J & White PD 2000. Bundle-branch Block with Short P-R Interval in Healthy Young People Prone to Paroxysmal Tachyardia. Am Heart J. PubMed:(5)68. Read More