Branching Exercise: Cardiac Case 1 Assignment

Branching Exercise: Cardiac Case 1 Assignment

Branching Exercise: Cardiac Case 1 Assignment
Primary Diagnosis:  Atrial Fibrillation with Rapid Ventricular Response

Status/Condition (Critical, Guarded, Stable, etc.): Critical

Code Status: Defibrillate

Allergies: No food or drug allergies

Admit to Unit: ICU

Activity Level: Complete bed rest

Diet: High protein, Low-fat and low-sodium diet.

IV Fluids: 

• Critical Drips:9% Normal saline 2L in 2 hours.

Respiratory: Humidified oxygen 4L/minute

Medications: Metoprolol tartrate 2.5 mg IV bolus over 2 minutes. Metoprolol will be prescribed for acute control of the ventricular rate (rate control) since it slows the sinus rate and decreases atrioventricular nodal conduction (Kelly et al., 2019).

Warfarin 2mg orally once daily for 2 days. Warfarin is the cornerstone of anticoagulant therapy and will be essential in reducing the risk of thromboembolic events.

Nursing Orders

Monitor blood pressure and heart during IV administration of Metoprolol since the drug decreases the automaticity of contractions (Moskowitz et al., 2018).

Vital signs monitoring every hourly.

Administer medications as prescribed.

Turn the patient four-hourly to prevent pressure ulcers Moskowitz et al., 2018).

Follow-Up Lab Tests:

• Diagnostic testing:

Periodic ECG monitoring: The test is recommended for patients taking antiarrhythmic agents to assess for paroxysmal atrial fibrillation and rate control (Kelly et al., 2019).

Holter monitoring to assess for paroxysmal atrial fibrillation and rate control.

Consults:

Consultation with a cardiac electrophysiologist before initiating Metoprolol for evaluation of arrhythmias Moskowitz et al., 2018).

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Patient Education and Health Promotion: Patient education will focus on lifestyle modification including increased physical activity and diet modification. Weight loss is recommended in overweight and obese patients with atrial fibrillation.

According to Fanous and Dorian (2020), weight loss achieved and sustained through diet and exercise, is connected with fewer atrial fibrillation recurrences. Besides, recreational exercise offer cardioprotective benefits in atrial fibrillation independently of weight loss. The patient will be advised against smoking and excessive alcohol consumption. Fanous and Dorian (2020) assert that decreasing alcohol consumption, in persons who take ≥ 14 drinks per week, is associated with a reduced burden of atrial fibrillation and related hospital admissions.

Patient education will also focus on educating the patient on medication compliance for coronary disease and hypertension, and adhere to clinic follow-up at regular intervals. The patient will also be educated about the symptoms of a stroke and when to seek emergency medical care.

Discharge Planning and Required Follow-Up Care: The patient will be discharged if she gets to a stable condition and if she achieves a heart rate control < 80 bpm at rest and 90-115 bpm with moderate exercise, and  if her left ventricular systolic function is preserved (Kelly et al., 2019).

Scheduled follow-up two weeks after discharge then every 4 weeks for 12 months.

References

Fanous, Y., & Dorian, P. (2020). Lifestyle modification for the management of atrial fibrillation. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 192(46), E1469. https://doi.org/10.1503/cmaj.201084

Kelly, J. P., DeVore, A. D., Wu, J., Hammill, B. G., Sharma, A., Cooper, L. B., … & Hernandez, A. F. (2019). Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines—Heart Failure. Journal of the American Heart Association, 8(24), e011560. https://doi.org/10.1161/JAHA.118.011560

Moskowitz, A., Chen, K. P., Cooper, A. Z., Chahin, A., Ghassemi, M. M., & Celi, L. A. (2018). Management of Atrial Fibrillation with Rapid Ventricular Response in the Intensive Care Unit: A Secondary Analysis of Electronic Health Record Data. Shock (Augusta, Ga.), 48(4), 436–440. https://doi.org/10.1097/SHK.0000000000000869

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Assignment: Branching Exercise: Cardiac Case 1
• Review the interactive media piece/branching exercise provided in the Learning Resources.
(Will attach in files).
• Using the Required Admission Orders Template Will attach in files), write a full set of admission orders for the patient in the branching exercise.
• Be sure to address each aspect of the order template
• Write the orders as you would in the patient’s chart
• Make sure the order is complete and applicable to the patient
• Any rationale you feel the need to supply should be done at the end of the order set – not included with the order
• Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.

• A minimum of three current, evidenced based references are required.