65 yo M, A-Fib

65 yo M, A-Fib

1. Pathophysiology

   • Age 65 --->Hypertension --->Hyperlipidemia ---> Diabetes ---> SOB/Dizziness/Fatigue/Palpitations ---Atrial Fibrillation(A-FIB)

2. Signs/Symptoms

   • Palpitations
   • SOB
   • Dizziness/Orthostatic
   • Increased Fatigue
   • Decreased tolerance to exercise
   • HR: 110 bpm - Rhythm is irregularly irregular

3. Lab & Diagnostics

   • ECG: irregularly irregular rhythm, absence of P wave, RVR: Interpreted as A-fib
   • Echocardiogram showing left atrial enlargement, this can be a consequence of Afib as the atrium can not sufficiently pump blood to the left ventricle leading to high pressures in the atria
   • EP Study (May be Ordered): Determine where the signal interruption in the heart is that can be a potential cause of the Afib

4. Safety

   • Patient is at increased risk for falls due to feeling dizzy with position changes
   • Patient is at high risk of bleeding due to the Apixaban and his risk for falls

5. Nursing Priorities/Problems

   • 1. Alteration in perfusion due to Afib as evidence by enlarged left atrium
   • 3. Risk for thrombus due to Afib as evidence by need to anticoagulant
   • 2. Risk for cardiac dysrhythmias due to Afib/RVR as evidence by irregularly irregular rhythm

6. Interventions

   • 2. Monitor continuous Telemetry on patient for dysrhythmias
   • 3. Place SCD's on bilateral legs, administer ordered anticoagulant for patient, Mobilize patient as tolerated
   • 1. Assess peripheral pulses, and frequent skin checks for changes in color/temperature/Monitor I&O for euvolemia, Monitor Kidney function and LOC

7. Medications

   • Metoprolol XL 50 mg
     • Beta Blocker, Selective Beta-1, Antihypertensive/Rate control
     • Side effects: Bradycardia, Bronchospasms, hypotension
     • Nursing Implication: Monitor HR and BP
   • Apixaban 5 mg
     • Anticoagulant, Factor Xa Inhibitor/ Blood Thinner
     • Side effects: Bleeding, Bruising, Hemorrhage
     • Nursing Implications: Monitor for signs/symptoms of bleeding