A. Fib (M4E) Flashcards
risk factors
- advanced age w/ valvular heart disease
- HTN
- inflammatory or infiltrative disease
- CAD
- congenital disorder
- HF
- diabetes
- obesity
- hyperthyroidism
- pulmonary HTN
- embolism
- obstructive sleep apnea
- alcohol consumption
- post- open heart Sx
S&S
- irreg pulse
- dizziness
- weakness
- dyspnea
- syncope
- palpitations (skipped or extra beats)
- dec BP
- asymptomatic (sometimes)
nursing considerations
- assess VS, electrolytes, hepatic/renal Fx
- monitor for HF
- monitor for S&S of clots (risk of stroke)
- teaching on drug-drug interactions, ADE
diagnostic tests
- 12 lead ECG
- Holter Monitor
- platelets, PTT, PT-INR
- digoxin level
- electrolytes
cardioversion
- using electricity or drugs to make HR back to normal
- for onset less than 48 hrs or on anticoagulants for 4 wks or for unstable pt
maze procedure
- open heart Sx
- small incisions made through atria - creates scar tissue
- only used when having heart Sx for other reasons
dysrhythmias/arrhythmias
- abnormalities of electrical conduction which can affect HR or cardiac rhythm
- associated w/ certain conds such as MI, HTN, valve problems, digoxin toxicity, dec and high K+, CHF, stroke, pulm disease
paroxysmal a. fib
- when HR converts to normal sinus rhythm spontaneously or with interventions in 7 or less days
- sudden onset
persistent a. fib
- continuous
- symptoms last over 7 dats
- may need to have procedures to convert to NSR
long-standing a. fib
- continuous
- symptoms over 12 mo
- cardioversion won’t stop it
- may be awaiting procedures
permanent a. fib
- persistent
- decision made to not restore HSR
- procedures failed or are contraindicated or not wanted
goal of interventions
- convert or maintain NSR
- slow ventricular rate (optimize CO)
- prevent embolic events
drugs used to treat A. fib
- beta blockers
- Ca+ channel blockers
- antidysrhythmic drugs
- anticoagulants
beta blockers
- multiple indications
metoprolol: - beta 1 blockage –> reduces HR, contractility
- ADE: bradycardia, reduced CO, AV heart block, rebound cardiac excitation when discontinued
- nursing considerations: apical HR, BP, not likely to cause bronchoconstriction or hypoglycemia
Ca+ channel blockers
diltiazem:
- drug and food interactions: digoxin, grapefruit juice
- lower BP by arteriolar dilation and directly dec HR
- ADE: constipation, compromised cardiac Fx (bradycardia, dec contractility)
- nursing considerations: cardiac assessments, GI assessments
antiarrhythmics
amiodarone:
- complex effects on heart
- serious toxicity that can last a long time
- oral therapy focus- effective but not “approved for use”
- drug interactions can be serious
- pulmonary, cardio, thyroid, liver toxicities
inotropic agents
digoxin:
- effects on mechanical and electrical aspects of heart
- inc contractility = pos inotropic effects
- dec in K+ can cause toxicity
- ADE: cardiac dysrhythmias, toxicity, CNS effects, nausea, dec appetite
- nursing considerations: monitor for toxicity (digoxin levels), drug interactions, monitor K+ levels, renal Fx, pt education, be cautious w/ dosage
anticoagulant s
- short-term use until cardioversion or long-term use with paroxysmal –> persistent
- PO
- w/ A.fib there is risk for pooling in atria
- inc clotting time to prevent thrombi from forming/growing larger
- inhibit specific clotting factors in coagulation cascade
- they do not “breakdown” a clot
- interfere w/ platelet aggregation
- ex. ASA, Clopidogrel (usually reserved for pts who cannot tolerate ASA)
why is someone on anticoagulants?
- immobility (post-op)
- Hx of DVT/PE
- prevent VTE
- dysrhythmias (A. fib)
- mechanical heart valve
- post-MI or stroke
examples of anticoagulants
- heparin (subQ or IV)
- LMW heparin (subQ)
- warfarin (PO)
- direct thrombin inhibitors
- direct factor Xa inhibitors
- thrombolytics (only use in acute events)
nursing considerations for admin anticoagulants
- monitor for S&S of bleeding (hematuria, epistaxis, bloody stools, bruising)
- monitor VS
- monitor lab values (triad, PTT, PT-INR, Hg, Hct)
- hepatic/renal failure
- drug-drug interactions
- avoid/limit IM injections
- pt teaching
