Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

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.

Teaching About Atrial Fibrillation

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.

• If patient has been prescribed digoxin, teach how to count the pulse rate. • If patient has been prescribed a beta

LESSON PLANS

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.