Case Study – Atrial Fibrillation
Instructions:
Please complete the following case study: Chapter 35 Patient with Atrial Fibrillation; and submit your assignment here by the due date October 9th 1159pm.
Answer each objective thoroughly below in your own words, you will receive a zero for copy and pasting
Cite all references. References must be from a Medical Surgical Nursing Textbook
Overview
A normal cardiac impulse begins in the sinoatrial (SA) node in the upper right atrium. It spreads over the atrial myocardium via interatrial and internodal pathways. At this point, the impulse pauses momentarily at the AV node to allow the atria to contract. It then spreads quickly through the Bundle of His, right and left bundle branches, and Purkinje fibers, resulting in ventricular contraction. This coordination between the atria and ventricular contractions allows the atria to empty additional blood into the ventricles before ventricular systole, increasing cardiac output by 10% to 25%. This additional volume is referred to as the “atrial kick.”
Dysrhythmias of the atria can lead to a loss of this atrial kick and thus a decrease in cardiac output. One such dysrhythmia is atrial fibrillation. Atrial fibrillation is characterized by a total disorganization of electrical atrial activity due to multiple ectopic foci resulting in loss of effective atrial contraction. Several risk factors can lead to atrial fibrillation and significant complications that can result from this dysrhythmia. The goals of treatment for atrial fibrillation include a decrease in ventricular response (to <100 beats/min), prevention of stroke, and conversion to sinus rhythm, if possible. Treatment options include pharmacologic and electrical therapies.
Objectives
1. Describe the pathophysiology related to atrial fibrillation.
2. Identify precipitating factors for atrial fibrillation.
3. Evaluate results of diagnostic testing in a patient with atrial fibrillation.
4. Identify relevant assessment data for a patient with atrial fibrillation.
5. Prioritize nursing care of a patient with atrial fibrillation.
6. Appropriately delegate nursing care of a patient with atrial fibrillation.
7. Describe the interprofessional care of a patient with atrial fibrillation.
8. Formulate an individualized teaching plan for a patient with atrial fibrillation.
Case Study
J.R. is a 63-year-old white man who visits his health care provider with complaints of “heart racing.” He states this has been happening periodically over the last several weeks. J.R. reports “just feeling lousy” during these episodes. When asked to further describe how he feels, he states “a little lightheaded and sick to my stomach at times.”
J.R.’s past medical history is negative for heart disease. Although he was recently diagnosed with hypertension, he refused treatment because he thought he could control it with diet and exercise. He has had arthroscopic knee surgery related to osteoarthritis. His father died at the age of 40 from complications related to alcoholism and his mother died at the age of 64 of a massive stroke. He has no siblings. J.R. is a businessman who travels extensively and is constantly under stress. He is happily married with two sons in college. J.R. drinks a cup of coffee in the morning and then several diet colas during the day. Initial assessment of J.R. includes the following: height 6’1″, weight 229 lb (104 kg), BP 160/95, heart rate (HR) 84 and regular, respiration rate (RR) 18, Temp 37.2°C (99.0°F). Awake, alert, and oriented ×3. Color pink. Skin warm and dry. Lungs clear to auscultation. Abdomen soft with positive bowel sounds.
