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Chapter 2
•
Cardiovascular Care
51
Signs and Symptoms
•
Shortness of breath
•
Irregular palpitations
•
Pulse deficit
•
Weakness or problems exercising
•
Chest pain
•
Dizziness or fainting
•
Fatigue
•
Confusion
Treatment
•
Anticoagulants such as warfarin
(Coumadin), dabigatran
(Pradaxa), rivaroxaban (Xarelto),
and apixaban (Eliquis).
•
Beta blockers to slow the heart
rate. Example: metoprolol
(Lopressor).
•
Calcium channel blockers: Slows
the heart rate and reduces the
strength contraction. Example:
diltiazem (Cardizem).
•
Antiarrhythmics: slows the rate at
which the electrical currents are
conducted from the atria to the
ventricle. Example: digoxin.
•
Cardioversion: Electrodes are
placed on the patient’s chest to
send electric shocks through the
heart to establish a normal sinus
rhythm.
•
Radiofrequency catheter ablation:
the use of radiofrequency energy
to destroy a small area of heart
tissue that is causing rapid and
irregular heartbeats.
•
Maze procedure: creates new
pathways for the electrical
impulses to travel easier through
the heart.
Nursing Considerations
•
Recognize that patients with AF
are at high risk to develop a clot.
•
Patients with AF may be
asymptomatic and diagnosis is
dependent on the EKG.
•
Most accurate assessment of heart
rate is the atrial rate as there may
be a pulse deficit.
•
Patients need to be taught
that adhering to medication
regimen is important to prevent
complications.
TIP:
Most accurate assessment of
heart rate is the atrial rate as there
may be a pulse deficit.
Pathophysiology
In AF, ectopic sites within the atria
disrupt the normal pathway between
the SA node and the AV node causing
the atria to quiver. This results in
incomplete emptying of the atria
which may lead to the formation of
clots and consequently a stroke and
other cardiac complications.
Teaching About
Atrial Fibrillation
•
If patient has been
prescribed digoxin,
teach how to count
the pulse rate.
•
If patient has been
prescribed a beta
blocker, remind the patient to
change positions slowly to avoid
becoming dizzy.
•
Remind the patient that
bleeding may occur more easily
due to anticoagulation therapy.
Patient should be advised to use
a soft-bristled toothbrush and
use an electric shaver instead of
a razor.
•
If Coumadin has been
prescribed, teach the patient
to maintain a
consistent
daily
intake of green leafy vegetables
because of the interaction
of Coumadin and foods
containing Vitamin K. In
addition, advise the patient
to take the Coumadin as
prescribed by the health care
practitioner and to take the
medication at the same time
each day and that regular INR
studies are essential to prevent
an overdose of the drug which
can lead to excessive bleeding.
LESSON PLANS