Module Four: Atrial Fibrillation + DVT Flashcards
What is an arrhythmia?
irregular heartbeat is an arrhythmia (also called dysrhythmia). May or may not include a change in heart rate
What might cause an arrhythmia?
Dec K+, CHF, stroke, pulmonaray disease.
Pretty much anything that may cause CAD, HTN, ETC
Normal Sinus Rhythm (NSR) vs Afib heart Rate
NSR- 75 and AFIB 150-300
AFIB often Irregular irregular, no P wave distinction
Risk factors for Afib?
Risk factors: Age inflammation enlarged atria Hormonal Abnormalities Alcohol abuse
Signs ans Symptoms of Afib?
! HR 100bpm(Dec CO) ! Dizzy ! Weakness ! SOB ! Fainting ! Palpitations (skipped beats) ! Irregular pulse
Interventions for Afib?
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
Nursing considerations for Afib?
! 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
What is a palpitation?
a noticeably rapid, strong, or irregular heartbeat
Common pharmacological tx
Class 1-5
1) Sodium channel blockers (class1)
2) Beta-Blockers
3) Potassium channel blockers
4) Calcium channel blockers
5) Positive inotrope- digoxin
Other key Medications in Afib?
Antiplatelet- prevents thrombus/embolus
Anticoagulant
What is the most common medication for Afib?
What does it do?
What’s bad about it?
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
Do anticoagulants break up clots?
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
When do you avoid thrombolytics?
Post Sx or with any new clot formation preventing excessive bleeding
Reasons someone might be on anticoagulants
! Immobility (post surgical) ! Hx. DVT/pulmonary embolus ! Dysrhythmias ( A-Fib) ! Mechanical heart valve ! Post MI or stroke
Why might the Doc order LMWH and not heparin?
! 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
Pro and Cons of Warfarin as anticoagulant?
! 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
Two most common Antiplatelet Meds?
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
Nursing Considerations for Anticoagulants?
• 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
What is the D-Dimer Test for?
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
Why is Thrombus formation a concern in Afib?
Anything that causes pooling can lead to platelets aggregation
Diagnostics Associated with Anticoagulant therapy?
! Platelets
! D-Dimer
! PTT, PT, INR
! Ultrasound (Monitoring for clots in vasculature DVT)
! CT Scan (monitor for pulmonary embolism, or stroke)
Risk Factors for DVT?
AKA Virchow’s triad
Blood stasis
Vessel wall injury
Altered blood coagulation
Conditions associated with Blood Clotting?
Immobility AFIB Heart failure Obesity Vericose veins
Conditions associated with Vessel Wall injury?
Sx Atherosclerosis Central venous catheters CVC Dialysis TRAUMA Diabetes
Conditions associated with Altered blood coagulation?
Cancer
pregnancy
Oral contraceptives
Polycythemia
Major complications of DVT
CVA or MI
Embolus travelling through body causing major blockage
Signs ans Symptoms
Swelling (calf, foot) Pain Cool or warm to touch Redness Can be non-specific..... hard to diagnose
Common tx for DVT Prevention
! Increasing mobility (post surgical++)
! Compression stockings
! Intermittent Pneumatic Compression Devices
! Prophylactic Anticoagulation Therapy
