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Bradycardia: Nursing Diagnoses & Care Plans

Bradycardia is an abnormally slow heart rhythm. A normal heart rate is between 60 to 100 beats per minute. With bradycardia, the rate is less than 60 beats per minute.

Bradycardia results from an abnormality in the sinus node, the heart’s natural pacemaker. A disruption in the sinus node can cause slow or missed beats. Bradycardia may also occur from first, second, or third-degree heart blocks when electrical impulses fail to reach the atria.

Symptoms and Causes

Bradycardia can prevent organs from receiving adequate oxygenated blood to function. It may cause additional signs and symptoms, including: 

Bradycardia may be caused by an underlying condition like heart tissue damage related to aging, myocardial infarction, congenital heart defects, myocarditis, hypothyroidism, electrolyte imbalances, obstructive sleep apnea, inflammatory diseases like lupus, and certain medications such as sedatives. 

Some patients may have asymptomatic bradycardia. Young adults, athletes, and patients in restful sleep commonly experience a lower heart rate without cause for concern.

Tests that can help confirm bradycardia include electrocardiogram, Holter or event monitoring, tilt table test, and stress exercise test. Laboratory tests can assess underlying causes such as imbalanced electrolyte levels.

Nursing Process

The treatment for this condition will depend on the severity of the symptoms and their underlying cause. Nursing care for patients with bradycardia includes initial stabilization, respiratory and circulation support, continuous telemetry monitoring, management of any symptoms and underlying causes, and the prevention of complications.

Nursing Care Plans

Once the nurse identifies nursing diagnoses for bradycardia, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for bradycardia.

Deficient Knowledge

Patient education is a vital part of the effective management of bradycardia. Certain lifestyle modifications may be needed to help control the symptoms and prevent complications.

Nursing Diagnosis: Deficient Knowledge

  • Inadequate access to accurate healthcare information
  • Misinformation 
  • Inadequate interest in learning
  • Inadequate knowledge of resources
  • Inadequate participation in care planning
  • Deficient instructions on testing or procedures

As evidenced by:

  • Inaccurate follow-through of instructions 
  • Inaccurate statements about bradycardia
  • Poor adherence to wearing a Holter monitor
  • Misuse of medications
  • Development of complications

Expected outcomes:

  • Patient will verbalize lifestyle modifications to prevent bradycardia.
  • Patient will verbalize the symptoms and complications of bradycardia.


1. Assess the patient’s knowledge about bradycardia.
Understanding what the patient knows and understands about their current condition can help determine areas and topics to include in patient education.

2. Assess for substance use.
Smoking, excessive alcohol use, misuse of narcotics, and cannabis use can alter the heart rate.

3. Review the patient’s medications.
If the patient is taking medication to lower their blood pressure, such as a beta blocker or calcium channel blocker, these medications also reduce the heart rate. The patient may need the medications discontinued, or the dosage changed.


1. Teach the patient how to monitor their pulse.
Devices such as a pulse oximeter can quickly assess the heart rate, but the patient can also be taught how to count their radial pulse.

2. Teach symptoms related to bradycardia.
Not all patients will experience symptoms of a slow heart rate. Ensure the patient understands that symptoms of dizziness, chest pain, shortness of breath, and exercise intolerance should be reported to their healthcare provider.

3. Encourage the patient to quit smoking and limit alcohol use.
A healthier lifestyle can reduce the risk of developing bradycardia and other complications.

4. Refer the patient to a cardiologist.
The patient with symptomatic bradycardia should receive follow-up care from a cardiologist.

Ineffective Peripheral Tissue Perfusion

With bradycardia or a slow heart rate, ineffective peripheral tissue perfusion may cause complications if oxygenated blood cannot reach organs and extremities.

Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral)

  • Disease process
  • Decreased cardiac output

As evidenced by:

  • Absence of peripheral pulses
  • Decreased blood pressure 
  • Delayed peripheral wound healing
  • Edema
  • Generalized weakness
  • Paresthesia
  • Dyspnea
  • Dizziness
  • Confusion

Expected outcomes:

  • Patient will demonstrate adequate tissue perfusion with warm extremities, palpable peripheral pulses, and blood pressure within acceptable limits.
  • Patient will remain alert and oriented without confusion or dizziness.


1. Assess peripheral pulses bilaterally.
Bradycardia causes decreased peripheral pulses due to the inability of the heart to contract effectively and provide adequate oxygenated blood to the extremities.

2. Assess capillary refill.
Capillary refill can indicate ineffective peripheral tissue perfusion. Capillary refill time of more than 3 seconds is abnormal.

3. Assess skin integrity.
Skin color, temperature, and moisture can indicate compromised tissue perfusion and may manifest as cold, clammy, mottled, and pale skin.


1. Encourage the patient to wear compression stockings while ambulating.
Compression stockings can help increase venous return and promote peripheral circulation.

2. Administer medications as indicated.
Symptomatic bradycardia may require atropine, epinephrine, or dopamine to increase the heart rate.

3. Treat electrolyte imbalances.
If bradycardia is caused by hyper or hypokalemia, medications can help increase or lower the electrolyte.

4. Assist with testing.
A tilt table test assesses if the patient is predisposed to fainting or syncope with position changes. A stress exercise test measures the heart’s activity during exercise.

(Risk for) Decreased Cardiac Output

Decreased cardiac output associated with bradycardia can be caused by poor cardiac function resulting in inadequate cardiac output. Bradycardia can be serious if the heart rate is too slow to pump blood to the rest of the body.

Nursing Diagnosis: (Risk for) Decreased Cardiac Output

  • Bradycardia
  • Decreased heart rate 
  • Altered afterload 
  • Altered contractility 
  • Altered heart rhythm 
  • Altered preload 
  • Altered stroke volume
  • Age
  • Heart disease
  • Congenital heart defect
  • Myocarditis
  • Side effects of cardiac treatments such as surgery
  • Hypothyroidism
  • Electrolyte imbalance 
  • Obstructive sleep apnea
  • Inflammatory conditions like lupus or rheumatic fever

As evidenced by (only with an actual diagnosis):

Note: A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at preventing signs and symptoms.

  • Hypotension
  • Decreased peripheral pulses
  • Increased central venous pressure (CVP)
  • Increased pulmonary artery pressure (PAP)
  • Tachycardia
  • Dysrhythmias
  • Ejection fraction less than 40%
  • Decreased oxygen saturation
  • S3 and S4 heart sounds upon auscultation
  • Chest pain
  • Difficulty breathing (dyspnea)
  • Rapid breathing (tachypnea)
  • Alteration in the level of consciousness
  • Restlessness
  • Fatigue
  • Activity intolerance
  • Cold and clammy skin
  • Prolonged capillary refill time

Expected outcomes:

  • Patient will demonstrate adequate cardiac output with blood pressure and heart rate within normal limits.
  • Patient will demonstrate normal sinus rhythm on EKG.
  • Patient will be able to tolerate activities without chest pain, dyspnea, or changes in the level of consciousness.
  • Patient will not experience complications of bradycardia and decreased cardiac output, such as heart failure.


1. Determine cardiovascular status.
Heart rate (HR) and stroke volume (SV) are the components of cardiac output. Bradycardia directly reduces cardiac output and may result in shock. Diastolic filling increases with a decreased heart rate, leading to increased stroke volume.

2. Assess symptoms of hypoperfusion and acute coronary syndrome.
Patients experiencing bradycardia are at risk of experiencing sudden and reduced blood flow to the heart, leading to acute coronary syndrome. Manifestations may include chest pain, dyspnea, dizziness, nausea, and fatigue.

3. Obtain a thorough cardiac history.
Cardiac conditions, such as myocardial infarction, heart failure, or congenital defects, can further affect cardiac output and alterations in perfusion.

4. Note any signs and symptoms caused by bradycardia.
The following symptoms may result from bradycardia, which might hinder the brain and other organs from receiving adequate oxygen:

  • Angina
  • Confusion
  • Change in level of consciousness
  • Activity intolerance
  • Fatigue
  • Syncope
  • Dyspnea

5. Auscultate the apical pulse.
The fifth intercostal space is the landmark for auscultating the apical pulse. Palpate the radial pulse after auscultating the apical pulse. Do this simultaneously and notice if both pulses are equal.

6. Draw a sample for a blood test.
Laboratory tests should include the following to determine a possible cause of bradycardia:

  • Glucose level
  • Electrolytes
  • Thyroid function
  • Troponin levels
  • Toxicology drug screen

7. Obtain ECG.
An electrocardiogram (ECG) is the primary test to diagnose bradycardia. Sinus bradycardia occurs when an upright P wave precedes every QRS complex on an ECG in the lead II, known as a sinus P wave, and the ventricular rhythm is fewer than 60 beats per minute.

8. Investigate further bradycardia episodes.
Investigate further using portable ECG equipment (Holter monitor or event recorder) and other tests (such as tilt table test and stress exercise test) since an ECG cannot immediately identify bradycardia unless the slow heartbeat happens during the exam.


1. Perform continuous telemetry monitoring.
For safe assessment, the client with a cardiac history or symptomatic bradycardia should be connected to continuous telemetry monitoring.

2. Monitor the use of sedatives.
Carefully administer opioid analgesia, sedatives, and benzodiazepines, as these medications can further reduce the heart rate and cause respiratory depression.

3. Administer supplemental oxygenation.
Emergency cardiovascular care includes supplemental oxygenation for respiratory distress associated with decreased cardiac output and bradycardia.

4. Instruct on the use of a Holter monitor or an event recorder.
A Holter monitor is a wearable device that records the heart rate and rhythm to detect abnormalities when the patient is experiencing symptoms like chest pain, dizziness, and dyspnea to help pinpoint the cause and assist with treatment planning. An event recorder is similar but isn’t worn at all times.

5. Administer medications as ordered.
For patients with bradycardia who are hemodynamically unstable, push 0.5 mg of atropine intravenously (IV) every 3 to 5 minutes, up to a maximum dose of 3 mg as prescribed.

6. Prepare for pacemaker insertion.
A pacemaker is implanted in the chest to control the heart rate and prevent bradycardia. The nurse assists with preparing the patient prior to surgery, monitoring for complications post-op, and providing discharge instructions.

Risk for Unstable Blood Pressure

Risk for unstable blood pressure (BP) can occur when the heart’s electrical system is out of balance.

Nursing Diagnosis: Risk for Unstable Blood Pressure

  • Aging-related deterioration of heart tissue
  • Coronary artery disease
  • Congenital heart defects
  • Myocarditis
  • Side effects of cardiac treatments such as surgery
  • Hypothyroidism
  • Electrolyte imbalances 
  • Inflammatory conditions like lupus or rheumatic fever
  • Medications, such as sedatives, opioids, and cardiac medications

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.

Expected outcomes:

  • Patient will maintain blood pressure and pulse rate within normal limits.
  • Patient will be able to perform activities with no significant changes in blood pressure.
  • Patient will not experience dangerous drops in heart rate or blood pressure from medications.


1. Monitor the patient’s blood pressure and pulse rate.
Heart rate and peripheral blood pressure are directly correlated. However, heart rate and central blood pressure are inversely related.

2. Check the cardiovascular status.
Heart failure and unstable blood pressure can all result from severe or persistent bradycardia if left undiagnosed and untreated.

3. Review current medications.
Digoxin, beta-blockers, alpha/beta-adrenergic blockers, and calcium channel blockers are cardiovascular drugs that can cause bradycardia.

4. Determine the underlying condition.
The slow heart rate may be caused by an underlying health problem, such as heart disease or thyroid disease, which can be treated.


1. Highlight treatment adherence.
Ensure that the patient receives follow-ups at regular intervals and highlight adherence to medications and routine testing. 

2. Consider a mediation change.
Medications prescribed to lower blood pressure, beta-blockers or calcium channel blockers, also lower the pulse. If these medications lower blood pressure or pulse too much, the dose or medication may need to be adjusted. 

3. Have the patient log their blood pressure and pulse.
The patient can be instructed to log their blood pressure and pulse every day at the same time for the provider to review for concerns and treatment effectiveness.

4. Reiterate the importance of healthy living.
Advise methods to lower the chance of developing heart diseases, such as exercise, a balanced diet, quitting smoking, consuming alcohol in moderation, and stress management. Underlying conditions that may lead to bradycardia and alterations in blood pressure can be avoided.


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Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.