Question

ut References Mailings Review View AAAA XXAAO ! Abte Autote AaBbccbe Aalbed . A AaBb Sre Start your true one month office 365 or sign in to t o an existing subscription A Fib Case Study A 67-year-old man presents to the ER with palpitations and dyspnea which began approximately 4 hours ago. He has a history of HTN, left ventricular hypertrophy, Diabetes, and GERD. His current medications are lisinopril, metformin, and omeprazole. He has no history of stroke or TIA. He is accompanied by his wife who reports drinking 1 pot of coffee daily and 1-2 beers on the week-ends. He does not binge drink or use herbal or alternative mediations. His wife reports he snores and has daytime sleepiness. He quit smoking 10 years ago. He appears to be in mild respiratory distress. Blood pressure is 88/60mmHg, pulse rate is 140 bpm, respiratory rate is 24/min, and temperature is normal. Oxygen saturation is 90% on 40% oxygen by face mask. His BMI is 36. Cardiac exam reveals tachycardia with an irregularly irregular tachycardic rhythm. There are crackles in the lower lung fields. A chest radiograph does not show Infiltrates, pleural effusions, masses, blebs, or hyperinflation Laboratory analysis reveals normal thyroid function, D-dimer and cardiac biomarkers. Electrocardiogram demonstrates atrial fibrillation (AF) with rapid ventricular rate. This patient is determined to need acute management of AF with hemodynamic instability Questions: 1. As the nurse caring for this patient, the family asks you what will be the primary treatment modality. Provide an explanation of what you would tell the family. Be specific on what is involved in the procedure. 2. Describe why it is important to convert this particular patient. 3. Following the treatment, he converts to normal sinus rhythm. What is the patient at risk for now and how would this risk be reduced? Describe the nursing management of this medical intervention 4. What other primary medications do you anticipate the patient to be discharged home on to help control his heart rate? MacBook Air EL BIE:

Answer 1

1. Primary treatment modality :-

1) Control or cure precipitating CAUSE

2) Control rapid ventricular RATE

3) Prevent thromboembolic complications

4) Convert AF to normal sinus RHYTHM

5) Reduce RECURRENCE of AF by attempting to maintain NSR

If patient has serious, life-threatening symptoms then :-

- Check O2 sat

- Pre-medicate

- electrical cardioversion

2. It is important to convert this particular patient because it causes thrombus formation

3. Patient is at risk for recurrent Adib , embolism ,and this can be managed by antiarythmics and anticoagulants .

4. Other medications to be given are :-

- beta blocker

- digoxin

- amiodarone as an alternative