Question

I. Read Chapters 34 and 35 from your Text Book and PP

II. NCLEX Review Question Chapters 34 and 35 from Evolve Resources

III. 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

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.

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

ANSWER

In this scenario , the patient is male and old age , and complaints of dizziness and fainting attack. he had history of consumption of antihypertensive medication , because he may be thought that  this may be due to high bp . on examination bp is low , heart rate is irregular and high , ecg shows atrial fibrillation .

in this condition , the upper chambers of heart namely atrial contractions are not in synchronous with the lower parts of heart , namely ventricular contraction . the atria will contract very fast and in an ineffecient contraction , that means only like vibration , without actual normal contraction , so that blood flow to the ventricle will be reduced and they will stay in the atrium and chances of formation of blood clots within these chambers increases , theses can leads to embolism and stroke , peripheral vascular disorders ..

priority action is to restore the heart rhythm backs to normal , maintain the vitals namely bp backs to normal , prevent the chances of embolism and its complications using anticoagulant medications .

past history like coronary artery disease , hypertension , heart valve diseases , congenital heart defects , medication history , past heart surgeries , substance abuse like alcohol , tobaco , caffeine , heart attack history ... as these factors increase the chance of developing atrial fibrilation and complication

usaulay atrial fibrilation not very emergency , it will come and go , but some time it can be fatal .some complication with this condition includes development of heart failure , embolism chances and develop stroke , mesentric ischemia, peripheral vascular disorders , chronic fatigue state , developing other heart rhythm problems , brain problems like dementia , cognitive problems ., cardiac arrest ..

diltiazam is a drug comming under class calcium channel blocker , it helps to control the heart rate

warfarin is anticoagulant medication helps to prevent the formation of blood clots in heart chamber and embolism

dronedarone is medicine come under antiarryhtmic class, it helps to restore the normal rhytm of heart .

cardioversion is used to restore the normal heart rate in case of irregular rhythm conditions . it is with the help of electric machine which send eletrical signal to heart by pades placed on chest . this procedure usualy sheduled in advance compared to defebrilation , which is emergency procedure .

before cardioversion make the patient nill per orally atleast 8 hours prior . take medications with sip of water , before procedure transesophageal echo done to rule out blood clots to prevent the complications develeping during the procedure . remove all ornaments before procedure . during procedure intravenous sedation used to prevent the feeling of pain while applying shocks . this procedure take only few minutes and results are faster than with the medications .