AFIB 65 year old male

AFIB 65 year old male

1. Pathophysiology

   • Signs/Symptoms
     • palpitations, dizziness, and occasional shortness of breath. He reports these symptoms have been occurring intermittently over the past three month
       • He describes the palpitations as "quick" which can last minutes to hours. He becomes dizzy, especially when standing up too quickly. He denies any chest pain or syncope
         • 10 bpm, irregularly irregular upon auscultation, no murmurs or bruits heard
           • Irregularly irregular heartbeat with no distinct S1 or S2 sounds
   • There are many mechanisms responsible for and contributory to development of atrial fibrillation (AF). these include hypertension, coronary artery disease, heart failure, valvular heart disease, obesity], and sleep-apnea syndrome. It is well established that high levels of alcohol can increase the probability of developing AF, and that hyperthyroidism can cause AF (Olshansky et al.,2025).

2. Medications

   • Metoprolol XL 50 mg po daily ,Metoprolol is a cardioselective β-blocker medication that acts on the β-1 adrenergic receptors in the heart and reduces the effects of catecholamines (such as adrenaline and noradrenaline) on cardiac function.
     • Apixaban 5 mg PO twice Apixaban is classified as an anticoagulant medication, specifically a factor Xa inhibitor. It is used to prevent blood clots and stroke in patients with certain heart conditions and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) after surgeries like hip or knee replacement.
       • Nurse should monitor for signs of bleeding, implement precautions to reduce risk to paitent
     • Nurse should teach patient to get up slowly, watch for orthostatic hypotension, along with how to take BP/Pulse. Nurse should also be administering within parameters and know when to hold med.

3. LABS

   • Laboratory work is required to evaluate for the causes of atrial fibrillation, for example, a complete blood count (CBC) for infection, basic metabolic panel (BMP) for electrolyte abnormalities, thyroid function tests to evaluate for hyperthyroidism, and a chest x-ray to evaluate the thorax for any abnormality.
     • Laboratory Tests: Complete Blood Count (CBC): WNL Comprehensive Metabolic Panel (CMP): Normal electrolytes, normal kidney function Thyroid Function Tests: Normal TSH, T3, & T4 levels BNP (B-type Natriueptic Peptide): 28 mg/dl
       • Electrocardiogram (ECG): Shows irregularly irregular rhythm, no evidence of P waves, and a rapid ventricular rate 3. Chest X-Ray: No acute abnormalities; mild cardiomegaly noted 4. Echocardiogram: Mild left atrial enlargement, normal left ventricular ejection fraction, no significant valvular disease. ECG Assessment: Clinical presentation and ECG findings are consistent with atrial fibrillation (AF).
         • I would want to throw in a D-Dimer on the side to see if there is any indication of any embulus already present.

4. Nursing Interventions

   • Assess risk. Hemodynamic stability and risk reduction are vital for this patient. It’s important to assess the patient for hemodynamic stability including vital signs, a focused cardiovascular assessment and assessment of level of consciousness. Urgent cardioversion may be needed if the patient is unstable.
     • Provide safety education about anticoagulants. The most significant complication of anticoagulants is bleeding, which can lead to hemorrhage and shock. It’s important to educate the patient about how they can reduce their risk of significant bleeds
       • educate patient on lifestyle changes, exercise and diet, follow up care, management of stress ect.
   • NURSING PRIORITIES
     • Assess risk/stability of patient, assess for compilations linked to afib such as pulmonary embolism or stroke and bleeding due to new meds
       • Provide oxygenation as needed for impaired moblity tolerance due to DECREASED CARDIAC OUTPUT
         • Fall precautions for patient during hospital stay due to risk for activity intolerance