Atrial Fibrillation RVR Concept Map

Signs/Symptoms: Heart rhythm irregular due to dx of afib. S1 and S2 are audible. No murmur noted. Capillary refill <3 seconds in UE and LE. No peripheral edema noted. Denies calf pain and tenderness. Bilateral upper and lower extremities pulses are regular, palpable, +2. Nursing Diagnosis: (2 actual & 1 risk; Prioritized) 1. Imbalanced nutrition: less than body requirement related to impaired swallowing as evidenced by difficulty swallowing with coughing 2. Anxiety related to cancer of tongue and tonsil as evidenced by voicing out concerns regarding changes in life events. 3. Risk for fall related to multiple antihypertensive medications. Respirations regular, even, unlabored, and symmetrical. O2 sat 98% via room air. Pathophysiology: Atrial Fibrillation is a common arrhythmia and it is caused by cerebrovascular events, progressive ventricular function, and increased coronary mortality (Markides & Schilling, 2003). AF affects the hemodynamics because of the irregularities of the ventricle and it is initiated by rapid electric activity in the atria, which further expedite the continuance of the arrhythmia (Markides & Schilling, 2003). The electrical conduction is not properly working and both atria and ventricles are unable to push blood out to the pulmonary and systemically. Potential complication includes stoke, myocardial infarction due to the blood clot that could be dislodge due to the quivering of the heart. Diagnostics/Lab Results: CBC, BMP, BNP (WBC 3.12, RBC 5.7, Hgb 10.0, Hct 29.8%, Na 132, Ca 8.6, Mg 2.1, K 4.3, Plt 332) Chest x-ray and EKG (Complains of coughing with weakness and fatigue; Dx: atrial fibrillation and PNA) Patient Story: Name: J.C. Age/Gender: 70 / Male Race/Ethnicity: White Admission Date: 6/20/21 Primary Dx: Atrial Fibrillation (AFIB) with Rapid Ventricular Response (RVR) Medical History: Hyperlipidemia, HTN, degenerative joint disease, dysphagia, carcinoma in situ, malignant tumor. Surgical History: bilateral knee replacement, gastrostomy placement, and other wound procedure acquired during the war, but was not able to provide the year he had his surgical procedures. Home Medications: Sertraline 50mg qd Ipratropium 0.5/3mL neb q4h Tramadol 25mg q8h prn Hospital Medications: Doxazosin 8mgPO daily Digoxin 0.125mg PO daily Enoxaparin 40mg/0.4mL subq q12h Furosemide 40mg PO daily Metoprolol 25mg PO daily Nursing Interventions (3) Weigh patient as indicated and compare with admission weight to establish baseline and aid in monitoring effectiveness; Document intake and output Provide a calm and quiet environement to enhance coping skills and facilitate rest; Schedule activities with adequate rest periods to converve energy and reduce calorie needs; Encourage patient to share thoughts and feelings to examine realistic fear/anxiety Keep bed in lowest position to reduce fall risk, allow patient to participate in regular exercise and gait training to strengthen muscles and improve gait; use assistive devices for safety Evaluation: J.C. complained of coughing, vomiting, and fatigue. Was recently on chemotherapy. EKG was done, showed and diagnosed with Atrial Fibrillation with Rapid Ventricular Response (RVR). Code status DNR, self responsible with no living will. On enoxaparin; H&H levels are being monitored closely. Patient’s WBC has increased, patient has pneumonia, on antibiotic azithromycin. Diagnosed with VS: BP 102/70, HR 98, RR 23, T 97.8F, 96% o2 RA, 0/10 pain. Provider Orders: PT/OT/ST Closely monitor PT/INR Continue close cardiac monitoring; report extreme changes in HR and BP IV therapy; IVF NS @ 75mL/hr x3 L Re-check CBC/BMP in AM Possible cardiac heart cath; F/U with cardio