Question

N-CLASS/ONLINE CASE STUDY CHAPTER 35 Atrial Fibrillation Patient Profile E.W, a 76-year-old white man, comes to the emergency department after a syncopa 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 97F . Alert and oriented Lung sounds clear in all fields Diagnostic Studies . ECG monitor shows atrial fibrillation . What is atrial fibrillation? What are your priority actions at this time? What additional history should you obtain from E.W.? Describe the risks associated with atrial fibrillation. . E.W. is placed on diltiazem, warfarin, and dronedarone. What is the purpose of each of these medications in treating E.W.'s atrial fibrillation? E.W. is admitted with a diagnosis of new onset of atrial fibrillation. Despite medical therapy, 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 Case Study Progress blood clots,so the provider elects to perform a cardioversion. 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

Instruction given to the patient during the procedure-

1. First inform consent should be taken from the patient.Get the contact number of the immediate family member on consent form.

2. Patient electrolyte level should be checked. potassium level must be greater than 4 and magnesium level should be greater than 2.

3. E.w is ongoing warfarin treatment so E.w must be sent for chequing the INR level and the final level must be consistently therapeutic (2-3) for at least 4 weeks.

4. Appropriate sedation must be given to the patient.

5. There is a chance of aspiration so always keep ready the suction apparatus.

6. If skin burn or irritation occure inform on duty Nurse or doctor.

7.Explain the patient about the procedure.possible complication.

8. Inform the patient he will be able to go home once he awake,alert, oriented and able to swallow well.

9.patient will not be allowed to drive before 24 hours after cardiovertion.

10. Advice given to the patient to continue taking anticoagulation pill for next 4 weeks.

11. Resume activities as tolerated

12. Advice given to the patient for maintaining adequate hydration and regular activities and exercise.

Assessment-

1. History of the patient should be taken regarding diet ,premedication, previous surgery,any previous disease.

2. Physical Examination should be done.

3. Blood test for complete blood count,potassium, magnesium,sugar,liver function test.

4.cheque the dose of the sidation before administration.

5.Count the number of shock.

6. Cheque the temperature,pulse,respiration,heartbeat.

7 .cheque if patient has hypotension or hypertension.

8. Cheque the mental status ,shortness of breath,chest pain of the patient.