ATRIAL FIBRILLATIONBY: EMMA FLECK

OBJECTI

VES

♥ What is A-Fib?♥ Types♥ Risk factors♥ Signs/symptoms♥ Tests♥ Treatment/medications♥ Patient scenario ♥ Review questions

A-FIBhttp://

www.youtube.com/watch?v=GYFiAcjbEuU

♥Is a dysrhythmia characterized by a disorganized, rapid, and irregular atrial rhythm resulting in an irregular ventricular rhythm

♥It’s a heart condition in which the upper chambers of the heart (the atria) beat too rapidly and cause the lower chambers of the heart (ventricles) to pump the blood abnormally and ineffectively throughout the body.

(Julia Heisler,2009)

CAUSES♥ Acute MI♥ Left atrial stretch ♥ Heart failure♥ Temporary after open-heart surgery♥ Long-standing hypertension♥ Digoxin toxicity♥ Alcohol intake, chronic or acute♥ Stress, pain, anxiety ♥ Idiopathic

(Osborn, Wraa & Watson, 2009)

PREVALENCE

“A-Fib is the most common cardiac arrhythmia, currently affecting more than 2 million people in the USA”

“Expected to affect 12 million by 2050”

(Jensen, 2013)

♥ Age

White

♥Male

Family history

♥Cardiomyopathy

Hypertension

♥Smoking

pulmonary embolism.

♥Caffeine

Alcohol

♥Mitral valve disease

Previous MI

♥Heart failure

Diabetes

♥Rheumatic heart disease

arteriosclerotic heart disease

♥hyperthyroidism

acute and chronic obstructive lung disease

(Richards, 2012)

RISK FACTORS

SIGNS AND SYMPTOMS

♥ Irregular pulse

♥ Lower than normal BP

♥ Angina

♥ Syncope

♥ Dizziness

(Richards, 2012)

♥ Exercise intolerance

♥ Weakness

♥ Shortness of breath

♥ Altered mental state

♥ May not have any symptoms

TYPES♥ paroxysmal AF – usually self-terminating within 48 hours

♥ persistent AF – defined as an episode that lasts more than 7 days and requires termination by cardioversion

♥ chronic AF the heart is always in A-fib. Usually not responsive to cardioversion

(Lee,2012)

DIAGNOSIS /TESTS

12-lead EKG where there is an absence of P waves ,loss of atrial kick,

and a completely irregular rhythm will confirm the diagnosis. (Lee,2012)

TREAT

MENTS

♥ Rate Control.♥ Anticoagulation.♥ Cardioversion. http://www.youtube.com/watch?v=rSusgpskmzk

♥Ablation♥ Maze Procedure- http://www.youtube.com/watch?v=FHiV31Xee5M

MEDICATIONSFor rhythm control, many patients will require

antiarrhythmic

drug therapy to maintain sinus rhythm. Antiarrhythmic

drugs include the Rythmol or flecainide, Betapace, dofetilide, or amiodarone.

Medications to achieve rate control include:

digoxin, beta-blockers, and calcium channel blockers

It should be noted that,

for rate control patients, digoxin therapy slows resting but

not exercise heart rate, and this agent does not prevent

recurrent episodes of atrial fibrillation, although betablocker

administration can accomplish this goal. Digoxin

also should be used cautiously in the elderly and in patients

with chronic kidney disease(Julia Heisler, 2009)

ANTICOAGULA

TI

ON

The presence of atrial fibrillation increases the

patient’s risk for developing arterial embolism and stroke,

depending on the presence of other clinical conditions, such

as hypertension and diabetes. Most patients

with atrial fibrillation should receive antithrombotic therapy

with warfarin. Even patients in whom rhythm control is

established should continue on warfarin because silent episodes

of atrial fibrillation may still be occurring, (Julia Heisler, 2009)

PACEMAKER Pacemaker implantation with AV node

ablationcan be considered. Ablation of the AV node

does not restore sinus rhythm, but controls the consequence of atrial fibrillation,

Pacemakers stimulate the heart to speed up when it beats too slowly or reset the rate when the heart beats too fast. They can also substitute for the natural pacemaker of the heart (AV or SA node).

(Julia Heisler, 2009)

PROGNOSIS♥ Those with A-Fib are 5 x more likely to have a

stroke than someone without atrial fibrillation. You also have a risk of eventual heart failure due to the weakening of the heart muscle.

♥ Many patients do well for years and even decades. Therefore, the prognosis for the individual patient is variable. excellent rate control with beta blockers, calcium blockers and digoxin, along with anticoagulation and control of other cardiovascular risk factors, can stabilize patients with atrial fibrillation for years.

♥ Not acutely life threatening ,Reduced quality of life, stroke, heart failure, long term mortality increase

(Julia Heisler, 2009)

PATIENT SCENARIOMale, age 83, white

Arrived to ER vomiting with abdominal pain, hypertensive

Patient drinks occasionally, was a smoker for 40 years,

PMI- A-fib, COPD, hypercholesterolemia, HTN, kidney stone, pacemaker

Vitals (on my shift) - 97.7, HR 70, BP 128/59 O2SAT 95, RR 18, pain 4

CA 8.0, HCT L 39.3, Hgb L 12.7 PT 19.4 H

INR 1.67 RBC 4.33L Hgb 12.7L HCT 39.3L platelet 127L

Medications-

• pantoprazole

• bisoprolol,

• enoxaparin

• levothyroxine

• terazosin (hypertension)

• tiotropium bromide (anticholinergic),

• valsartan

NURSING DIAGNOSIS

Risk for decreased cardiac output r/t dysrhythmia

Risk for bleeding r/t treatment-related side effects

Fall risk r/t treatment-related side effects

Risk of electrolyte imbalance

QUESTION 1 A common arrhythmia found in some older

clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered?

Aspirin (acetylsalicylic acid)

Warfarin sodium (Coumadin)

Simvastatin (Zocor)

Vinorelbine tartrate (Navelbine)

QUESTION 2

Which EKG shows A-Fib?

A.

B.

C.

QUESTION 3

In caring for a patient with atrial fib, which of the following goals would be a priority?

A.Reduce the ventricular rate to below 100 beats per minute

B.Identify and treat the underlying cause

C.Control the heart rate and maintain cardiac output

D.Increase the heart rate

QUESTION 4

When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would expect to hear a rhythm that is characterized by:

A. The presence of occasional coupled beats

B. Long pauses in an otherwise regular rhythm

C. A continuous and totally unpredictable irregularity

D. Slow but strong and regular beats

REFERENCESJensen, P. N., Thacker, E. L., Dublin, S., Psaty, B. M., & Heckbert, S. R. (2013).

Racial Differences in the Incidence of and Risk Factors for Atrial Fibrillation in Older Adults: The Cardiovascular Health Study. Journal Of The American Geriatrics Society, 61(2), 276-280. doi:http://dx.doi.org.ezproxy.lib.usf.edu/10.1111/jgs.12085

Julia Heisler, I., & Joseph S., A. (n.d). Review: The Patient with Atrial Fibrillation. The American Journal Of Medicine, 122415-418. doi:10.1016/j.amjmed.2008.12.012

Lee, G. A., Stub, D., & Ling, H. (2012). Atrial fibrillation in the elderly – Not a benign condition. International Emergency Nursing, 20(4), 221-227. doi:http://dx.doi.org.ezproxy.lib.usf.edu/10.1016/j.ienj.2012.05.003

Osborn, K. S., Wraa, C. E., & Watson, A. B. (2009). Medical-surgical nursing, preparation for practice. (Vol. 1). Prentice Hall.

Richards, G. (2012). An overview of atrial fibrillation. Nursing Standard, 26(52), 47-56.

http://amy47.com/nclex-style-practice-questions/cardiac-mi-and-hf/cardiac/

https://docs.google.com/viewer?a=v&q=cache:NdnZNvwSCzgJ:www.aacc.edu/nursing/file/NCLEXReviewQuestionsSP2010Set%25202.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEESj7hvGLAcw8aLUV5VFarwSV0CwVjtamuCK-mQfiNP-Bi9Le5WHupUHwr6wpiaqVVMo6Z5V6Lni7CUQUFGhPCsoZGF0k0niRoN92E5aTReWCtEvNGeVuecY4KlaBi5dTuNy9ALHy&sig=AHIEtbRFvb-czS6sA-A6IjK1wPzZinfIVg

http://wps.prenhall.com/chet_tabloski_gerontolog_1/40/10304/2638022.cw/content/index.html