Module Four: Atrial Fibrillation + DVT

Question 1

What is an arrhythmia?

Answer 1

irregular heartbeat is an arrhythmia (also called dysrhythmia). May or may not include a change in heart rate

Question 2

What might cause an arrhythmia?

Answer 2

Dec K+, CHF, stroke, pulmonaray disease.

Pretty much anything that may cause CAD, HTN, ETC

Question 3

Normal Sinus Rhythm (NSR) vs Afib heart Rate

Answer 3

NSR- 75 and AFIB 150-300

AFIB often Irregular irregular, no P wave distinction

Question 4

Risk factors for Afib?

Answer 4

Risk factors:
Age 
inflammation
enlarged atria
Hormonal Abnormalities
Alcohol abuse

Question 5

Signs ans Symptoms of Afib?

Answer 5

!  HR 100bpm(Dec CO)
!  Dizzy
!  Weakness
!  SOB
!  Fainting
!  Palpitations (skipped beats)
!  Irregular pulse

Question 6

Interventions for Afib?

Answer 6

Dependent on severity and symptoms but…

Non-Pharmacological
! Cardioversion and defibrillation
! Electrical shock stops all electrical impulses. ( requires Ventricuar tachycardia)
! SA node to restart at normal sinus rhythm
! Pharmacology
! Rate Control
! Decrease risk of complications

Question 7

Nursing considerations for Afib?

Answer 7

! Heath History (Heart failure/HTN/CAD/ Allergies?)
! Is cardiac alteration producing symptoms???
-> Can they walk with the traid of symptoms Fatigue, dizziness, palpatations
! Vitals (BP/HR/SpO2)
-> Bp not key factor, HR more important
! Electrolytes (k+ levels, other ions, dec urine?)
! Baseline ECG

Question 8

What is a palpitation?

Answer 8

a noticeably rapid, strong, or irregular heartbeat

Question 9

Common pharmacological tx

Class 1-5

Answer 9

1) Sodium channel blockers (class1)
2) Beta-Blockers
3) Potassium channel blockers
4) Calcium channel blockers
5) Positive inotrope- digoxin

Question 10

Other key Medications in Afib?

Answer 10

Antiplatelet- prevents thrombus/embolus

Anticoagulant

Question 11

What is the most common medication for Afib?

What does it do?

What’s bad about it?

Answer 11

Digoxin

! Increases force of myocardial contraction
! Prolongs conduction through SA and AV nodes ! Slows and strengthens myocardial contraction
! Therapeuticeffect -$CO,useful for CHF

Can be toxic, watch for bradycardia

Question 12

Do anticoagulants break up clots?

Answer 12

Not really
They clotting time (seconds) to prevent thrombi from
forming, or growing larger by Inhibit specific clotting factors in the coagulation cascade

clot busters are called thrombolytics

Question 13

When do you avoid thrombolytics?

Answer 13

Post Sx or with any new clot formation preventing excessive bleeding

Question 14

Reasons someone might be on anticoagulants

Answer 14

!  Immobility (post surgical)
!  Hx. DVT/pulmonary embolus 
!  Dysrhythmias ( A-Fib)
!  Mechanical heart valve
!  Post MI or stroke

Question 15

Why might the Doc order LMWH and not heparin?

Answer 15

! Duration is 2-4 times longer then heparin (heparin half life 90mins)
! Produce more stable response than heparin
! Reduced risk thrombocytopenia
! Dosages based on patient weight
! Dec follow up lab tests
! Patient/family member can be taught to self administer

Question 16

Pro and Cons of Warfarin as anticoagulant?

Answer 16

! Can be taken only oral
! Can take 3-5 days to reach therapeutic level
! Long half life ! 1-3 days
! Must Monitor PT-INR

NOTE
! Antidote is Vitamin K

Question 17

Two most common Antiplatelet Meds?

Answer 17

ASA
! Anticoagulant properties can last up to a week after one single dose

Clopidogrel (Plavix)

! Anticoagulant properties can last up to 5 days after
last dose
! Usually reserved for patients who cannot tolerate ASA
! Given to patients with recent MI or stroke

Question 18

Nursing Considerations for Anticoagulants?

Answer 18

•  Monitoring for S & S of bleeding
–  Hematuria, epitaxis, bloody stools, bruising
•  Monitor vital signs
•  Monitor lab values
–  CBC, PTT, PT-INR
•  Hepatic/renal failure (can they metabolize and excrete the med?)
•  Drug to drug interactions
•  Patient teaching

Question 19

What is the D-Dimer Test for?

Answer 19

Detecting fibrin degradation product- small protein fragment detectable in blood after clot breakup. Allows you to know if a thrombus has recently broke possibly causing embolus to be circulating in blood

Question 20

Why is Thrombus formation a concern in Afib?

Answer 20

Anything that causes pooling can lead to platelets aggregation

Question 21

Diagnostics Associated with Anticoagulant therapy?

Answer 21

! Platelets
! D-Dimer
! PTT, PT, INR
! Ultrasound (Monitoring for clots in vasculature DVT)
! CT Scan (monitor for pulmonary embolism, or stroke)

Question 22

Risk Factors for DVT?

AKA Virchow’s triad

Answer 22

Blood stasis
Vessel wall injury
Altered blood coagulation

Question 23

Conditions associated with Blood Clotting?

Answer 23

Immobility
AFIB
Heart failure
Obesity
Vericose veins

Question 24

Conditions associated with Vessel Wall injury?

Answer 24

Sx
Atherosclerosis
Central venous catheters CVC
Dialysis
TRAUMA
Diabetes

Question 25

Conditions associated with Altered blood coagulation?

Answer 25

Cancer
pregnancy
Oral contraceptives
Polycythemia

Question 26

Major complications of DVT

Answer 26

CVA or MI

Embolus travelling through body causing major blockage

Question 27

Signs ans Symptoms

Answer 27

Swelling (calf, foot)
Pain
Cool or warm to touch 
Redness
Can be non-specific..... hard to diagnose

Question 28

Common tx for DVT Prevention

Answer 28

! Increasing mobility (post surgical++)
! Compression stockings
! Intermittent Pneumatic Compression Devices
! Prophylactic Anticoagulation Therapy