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Cardiovascular Discussion

  1. What is the rationale for each of the orders written by the provider?

The patient's new Afib puts Mrs. Jones at danger for blood clots. Atrial myocardial dysfunction and irregular atrial contraction enhance the chance of an embolic event, according to Hinkle and Cheever. The doctor arranged a TEE screening before her morning cardioversion to rule out blood clots. According to Hinkle & Cheever (2018), prolonged arterial fibrillation should not be cardioverted owing to the possibility of atrial thrombi embolization. TEE may confirm there is no thrombus and heparin can be delivered immediately prior to cardioversion if the patient has not had Warfrain for 3-4 weeks.

Mrs. Jones should have had Warfarin 5 mg PO Q HS before to cardioversion, however this did not occur. Mrs. Jones will be administered an anticoagulant before and after the cardioversion. Warfarin should be administered for at least 4 weeks after cardioversion since it may alter arterial function (Hinkle & Cheever, 2018).

Sotalol 10mg po BID is a beta-blocker used to treat Afib. This device may also be used for cardioversion. Prior to cardioversion, the patient may be given amiodarone, propafenone, or sotalol to prevent AF recurrence (Hinkle & Cheever, 2018).

The practitioner requested blood testing to examine the patient's hemodynamic stability. A CBC may detect infection, hyperglycemia, or anemia. As well as glucose and liver functioning are tested with a metabolic panel (Hinkle & Cheever, 2018). These labs may influence the heart if they are normal. Afib patients may be hyperthyroid, with elevated TSH, T3, and T4. Atrial fibrillation is a well-known cause of hyperthyroidism, with an incidence of 16% – 60% in people with hyperthyroidism (Reddy et al., 2017).

2. What are three potential nursing diagnoses for Mrs. Jones?

1. Decreased cardiac output related to alteration in heart rate, rhythm as evidence based of new onset rapid Afib, HR is 126 and irregular.

2. Risk for bleeding due to altered clotting factor from anticoagulant use as evidence based pt. was stared on Warfarin to prevent thrombosis.

3. Activity intolerance r/t to new onset Afib as evidence based patient is on oxygen 2 liters nasal cannula and has an O2 sat of 91%

3. What are the nursing responsibilities in preparing the client for the transesophageal echocardiogram and potential synchronized cardioversion?

 Nursing responsibilities to prepare the client for a TEE are as follows;

The nurse should educate the patient as much as possible make sure the patient has an understanding of what is going to take place before. This will also ensure that the patient has an understanding of the procedure prior to signing consents with all providers and allow time to ask any last minute questions. Ensure that the patient is NPO 6 hours prior to testing

There will need to be an IV to give medication for moderate sedation. The nurse can insert the IV or if the IV is inserted they need to check for patency, and ask the provider what type of IV fluid is preferred for the procedure.

Asses the patient's dentition, have patients remove partials or dentures and place them in a labeled denture cup.

Asses the patient’s vitals prior to the procedure. (Hinkle & Cheever, 2018).

Nursing responsibilities to prepare the client for a potential synchronized cardioversion are as follows: Educate the patient and ensure they have an understanding of the procedure.

Have consents printed and ready to be signed by the provider. NPO 4 hours prior to the procedure.

Asses if the patient has an IV site if not place one, if the patient does make sure that it is patent. Make sure there is supplemental oxygen, suction and emergency equipment available. (Hinkle & Cheever, 2018).

4. The physician has elected to perform synchronized cardioversion on Mrs. Jones. What are the essential nursing functions during the synchronized cardioversion and immediately following? 

When assisting the physician with a cardioversion on Mrs. Jones during and immediately after the nurse to obtain base line vital signs. Make sure Mrs. Jones is connected to her supplemental oxygen, she is currently on 2 liters of O2 this needs to be maintained through the procedure.

Place gel- covered paddled or conductor pads the front and back of her body.

Ensure that the pads are place away from clothing, bed linen, medication patches and O2 tubing.

The patients vitals need to be monitored, level of consciousnesses, O2 saturation, and ECO monitoring until the patient is stable post procedure. (Hinkle & Cheever, 2018)

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Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd.

Reddy, V., Taha, W., Kundumadam, S., & Khan, M. (2017). Atrial Fibrillation and Hyperthyroidism: A Literature Review. Indian Heart Journal, 69(4), 32-40.