Question

Active Learning Template: System Disorder

ATI Ch. 28

1) Electrocardiography and Dysrhythmia Monitoring: Assessing a Client who has Atrial Fibrillation

2) Electrocardiography and Dysrhythmia Monitoring: Medications Used to Treat Atrial Fibrillation

NT System Disorder

Alterations in Health (Diagnosis)

Patho related to problem

health promotion & disease prevention

risk factors

expected findings

safety considerations

laboratory test

diagnostic procedure

nursing care

therapeutic procedures

medications

client education

interprofessional care

complications

if you can fill in the boxes for these two topics about assess a patient with A-fib

and a medication that would treat a patient with A-fib.

Answer 1

ATRIAL FIBRILLATION

It is an irregular heart beat that can lead to blood clots, stroke,heart failure and other heart related complications,

PATHO PHYSIOLOGY

Heart contract and relaxes to a regular heart beat,In atrial fibrillation the upper chambers of the heart beat irregularly instead to beating effectively to move blood in to the ventricles.If a blood clot breaks off and enter in to the blood stream,and lodges in to the artery leading to stoke.

RISK FACTORS

Age-The old age people are greater at risk of developing it

High blood pressure-uncontrolled blood pressure can increase the risk of atrial fibrillation

Chronic conditions-Such as thyroid problems,sleep apnea,metabolic syndrome,diabetes,chronic kidney disease,lung disease,abnormal heart valves,sick sinus syndrome,

Drinking Alcohol-Drinking alcohol trigger the episodes of atrial fibrillation

Obesity-People who are obese are at high risk

Family history-Increased risk of atrial fibrillation found in some families

Exposure to stimulants

EXPECTED FINDINGS

1. Palpitations
2. weakness
3. reduced ability to exercise
4. dizziness
5. confusion
6. shortness of breath
7. chest pain
8. fatigue
9. light headedness

HEALTH PROMOTION AND DISEASE PREVENTION

• Quit smoking-double the risk of atrial fibrillation
• Exercise-keep the muscles strong,improve circulation
• Weight reduction-obesity causes hypertension followed by atrial fibrillation
• Careful use of medication that increases the heart rat
• eating healthy food
• healthy lifestyle

LABORATORY TESTS

• CBC,electrolytes
• Thyroid function tests
• LFT
• RFT
• Cardiac enzyme monitoring-Trop I andcreatine kinase MB

DIAGNOSTIC PROCEDURES

1. Electrocardiogram -To find out rate and rhythm of heart beat.
2. Chest X ray-to make sure lung diseases is not the cause of symptoms
3. Echo cardiogram-to know the chambers and pumping of heart
4. CT scan
5. MRI
6. Exercise stress test-to see how the heart works when we are active

MEDICATIONS

• Beta blockers-propranolol,metaprolol,atenolol
• Calcium channel blockers-diltiazem,verapamil,
• Anticoagulants-Coumadin,Aspirin
• Cardic glycosides-Digoxin

THERAPEUTIC PROCEDURES

• Electrical cardioversion-using special pads to the chest and send an electrical shock to the heart
• Ablation
• Maze procedure
• Mini maze procedure
• Convergent procedure-it uses radio frequency ablation in the pulmonary vein,and makes a small cut under the breast bone to use radio frequency energy on outside of the heart
• Medical devices like pacemakers-help to keep the heart rate steady

COMPLICATIONS

Stroke-In atrial fibrillation ,the chaotic rhythm may cause blood to pool in heart chambers and forms clots.It could dislodge from the heart and travel to the brain,There it block the blood flow and causing stroke

Heart failure-uncontrolled atrial fibrillation may weaken the heart and lead to heart failure.

PREVENTION

1. Eating healthy diet
2. limiting or avoiding caffeine  and alcohol
3. avoid smoking
4. maintaining healthy weight
5. Reduce stress
6. Increase physical activity
7. Use over counter medications with caution

NURSING CARE

• Assess for irregular heart beat and tachycardia
• Obtain 12 lead ECG
• Assist in cardioversion
• make sure over environmental hazards such as good lightning
• If emergency cardioversion required explain the procedure and reassure the patient
• Careful positioning of the patient to avoid exacerbating their condition.
• Nurse the patient in a semi recumbent position and avoid lying flat
• Help he patient to reduce the anxiety by proper explanation
• Patient should be asked for chest discomfort and if needed provide oxygen
• Patient on anti coagulant therapy should need continuous monitoring

CLIENT EDUCATION

Educate the client about

1. controlling blood pressure
2. Avoid drinking alcohol
3. Reduction of weight in case of obesity
4. Reduction of stress
5. Healthy eating habits
6. Provide information regarding pace makes and its working
7. information regarding prompt use of medications
8. Stroke assessment