Question

Case Study: Atrial Fibrillation

Patient Profile

E.W., a 76-year-old white man, comes to the emergency department after a syncopal episode at a local restaurant. He is accompanied by two friends.

Subjective Data

• Has been feeling weak for a few days
• Became dizzy and fainted while awaiting his dinner
• Takes one medication, a “water pill” for high blood pressure

Objective Data

Physical Examination

• Blood pressure 92/50, pulse 125 and irregular, respirations 24, temperature 97° F

• Alert and oriented
• Lung sounds clear in all fields

Diagnostic Studies

• ECG monitor shows atrial fibrillation

Discussion Questions

1. What is atrial fibrillation?
2. What are your priority actions at this time?
3. What additional history should you obtain from E.W.?
4. Describe the risks associated with atrial fibrillation.

5. W. is placed on diltiazem, warfarin, and dronedarone. What is the purpose of each of these medications in treating E.W.’s atrial fibrillation?

Case Study Progress

E.W. is admitted with a diagnosis of new onset of atrial fibrillation. Despite medical therapy, 12 hours later, he is still experiencing dizziness, and his systolic blood pressure remains below 100. A transesophageal echocardiogram is done, showing E.W. does not have any blood clots, so the provider elects to perform a cardioversion.

6. What instructions should you give E.W. to prepare for a cardioversion? What do you tell him to expect during the procedure and what nursing assessments will you be performing?

  

Answer 1

Discussion questions-----

WHAT IS ATRIAL FIBRILLATION- atrial fibrillation is a typd of arrhythmia characterized by tapid, irregular heart beats.

The two atrium can not maintain their normal contractibility and as a result irregular heartbeat is seen.

PRIORITY ACTION----

As the diagnosis of atrial fibrillation is done using ECG. The patient is able to cooperate .

Firstly, we can give medication like anti arrhythmic drug ( amiodarone, ibutilide,propafenone) . If not benefits is found then cardioversion can be done by using putting paddles on chest and electrical shock is being transmitted through it. The shock which is transmitted by paddles will stop the rhythm( irregular) for a moment and then the heart will do with its own normal rhythm.

If cardioversion is not beneficial then we have to go for surgical procedures like atrioventricular node ablation.

Once the patient condition becomes stable follow up of heart rate shall be advised by using calcium channel blockers , beta blockers.

ADDITIONAL HISTORY OBTAINED -----

E.W has a history of high blood pressure. As his history stated he has to take waater pill for high blood pressure also elderly aged people are more prone to develop atrial fibrillation.

RISK ASSOCIATED WITH ATRIAL FIBRILLATION----

Heart failure, stroke , arrhythmia can be persist , sudden cardiac arrest, heart attack.

PURPOSE OF MEDICATION-----

Rationale ofuse of diltiazem-- diltiazem is a calcium channel blocker. It mainly scts through by increasing period of refraction of atrioventricular node and also helps in decreasing velocity of conduction.

Rationale of use of warfarin-- it is an oral anticoagulant means used for to treatment of blood clot if present. As in atrial fibrillation have a potential role in clot formation . For prevention of blood clotting within heart it is being used.

Rationale of uae of dronedarone-- it acts on potassium channel present in heart so increse refractory period , also sodium channel blocking is also another function which leads to conduction decrease. Which ultimately helps in reducing the arrhythmia.

6.

INSTRUCTIONS FOR CARDIOVERSION--give the instructions to the E.W that not do drink or eat minimum 8 hours befor the cardioversion is performed . Don't get panic about it . Don't apply lotion , oil on chest because it can creat problem during paddles attachment on chest, If he has wear any jewellery please keep it aside untill the cadioversion is not performed.

DURING PROCEDURE INSTRUCTIONS-- tell him toLay down on the bed. While the cardioversion he should take normal breathing. Also tell the patient that during this procedure , electrical shock will be given and you can feel the shock just about 1 seconds .

NURSING ASSESSMENT -- firstly, we have to give intravenous line to his arm and also gjve him sedatives for which the patient can't feel any pain during the procedure. Also monitoring on the paddles's pressure. Nurse should also surveillance on the patient heart rate, respiration rate, blood pressure and changes in ' R' wave of ECG.