Interdisciplinary Care Plan
Marcia Garcia Enriquez
Chamberlain College of Nursing
Critical Care Nursing: NR 340
January 2016
Interdisciplinary Care Plan M.S. presented to the Emergency Room on February 2, 2016 with complaints of abdominal pain with chronic shortness of breath. M.S. revealed tachycardia during triage. EKG presented new onset atrial fibrillation, atrial flutter, and labs expressed elevated troponin I levels. M.S. was transferred to the telemetry unit for further treatment. M.S. is an 80 year-old Black American born on August 29, 1936. Upon report on February 3, 2016 M.S. has no known allergies and has elected to be a status full code. Overnight M.S. came out of atrial fibrillation with rapid ventricular
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is divorced and lives with one of his biological daughters. M.S. has two biological daughters and four stepchildren. M.S. is retired from labored employment. M.S. has no history of elicit drug or alcohol abuse. M.S. weighs in at 86.5 kg and stands at 180 cm. M.S. has a history of hypertension, hyperlipidemia, and diabetes mellitus. M.S. surgical history includes a tendon repair of the left knee when he was age 78, a bunionectomy of the left knee and bilateral carpel tunnel at age 60.
Review of Systems
Cardiovascular
BP 106/74 Blood pressure may be affected due to Rx
Pulses 2+ WDL
Rhythm Regular/Tachycardia WDL
Apical Rate 106 As a result of disease process
Radial 108 As a result of disease process
Capillary Refill < 3 seconds WDL
Heart Sounds S1 S2 heard. No murmur on auscultation WDL Respiratory
Rate 16 WDL
Rhythm Regular WDL
Effort Symmetrical chest wall expansion, nonlabored. WDL
Pulse Oximetry 100% Room air WDL
Breath Sounds Equal bilaterally, diminished. WDL
Cough None, no secretions present WDL
Mucous Membranes Pink, moist WDL
Gastrointestinal
Abdominal Contour Rounded, nontender, nondistended
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Bleeding, HIT, anemia Make sure patient is placed on high bleed risk. Advise patient to report any signs of unusual bleeding or bruising to HCP immediately. Atrial fibrillation is known to place the patient at high risk for formation of blood clots (Sole, 2013)
Digoxin
Lanoxin 250 mg
1 tab
PO
BID Antiarrythmics
Inotropics Atrial fibrillation and atrial flutter (slows ventricular rate). Increases cardiac output and slowing of the heart rate Arrhythmias, fatigue, bradycardia, anorexia, nausea, vomiting, weakness Monitor ECG throughout IV administration
Withhold if pulse is s diagnostic and laboratory test reference (11th ed.). St. Louis, MO: Elsevier Mosby.
Parwani, A.S., Boldt, L, Huemer, M, et al. (2013). Atrial fibrillation – induced cardiac troponin I release. International Journal of Cardiology. 2013;168(3):2734-7. DOI:10.1016/j.ijcard.2013.03.087.
Sole, M.L., Klein, D.G., & Moseley, M.J. (2013). Introduction to critical care nursing (6th ed). St. Louis, MO: Elsevier.
Vallerand, A.H., Sanoski, C.A., & Deglin, J.H. (2013). Davis’s Drug Guide for Nurses. (13th ed). Philadelphia, PA: F.A
In this lab, I took two recordings of my heart using an electrocardiogram. An electrocardiogram, EKG pg. 628 Y and pg. 688 D, is a recording of the heart's electrical impulses, action potentials, going through the heart. The different phases of the EKG are referred to as waves; the P wave, QRS Complex, and the T wave. These waves each signify the different things that are occurring in the heart. For example, the P wave occurs when the sinoatrial (SA) node, aka the pacemaker, fires an action potential. This causes the atria, which is currently full of blood, to depolarize and to contract, aka atrial systole. The signal travels from the SA node to the atrioventricular (AV) node during the P-Q segment of the EKG. The AV node purposefully delays
Atrial fibrillation (AF) is a cardiac arrhythmia. It is the most common arrhythmia and it has implications for patients and anaesthetists alike. The anaesthetist must take into consideration the physiological and pharmacological implications of this common arrhythmia.
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
Hochadel, M. (2014). Mosby's Drug Reference for Health Care Professionals (fourth edition ed.). : Elsevier.
In today days Atrial Fibrillation (AF) is the most common cardiac dysrhythmia that is often seen in clinical practice. There are 700,000 strokes in the USA each year and 15% of it caused by Atrial Fibrillation. For a long period of time warfarin was the only oral anticoagulant available in the US for patients with atrial fibrillation to prevent stroke events. Recently a new oral anticoagulants, including apixaban, dabigatran, and rivaroxaban have been developed and became available in the US for the stoke prevention and systemic embolism for patients with atrial fibrillation. Now, when all three new anticoagulants are available as an alternative to warfarin for the same indication, they make the health care providers question which agent is the best and for which patients. New agents have practical advantages over warfarin that has many limitations such as need for monitoring, regular dose adjustment, food and drug interaction and side effects. The major goal of the health care providers is to prescribe the safest and the most effective alternative drug and dose to each individual patient with AF. However, the approval for clinical use by the Food and Drug Administration (FDA) and the European Medicine Agency differ for anticoagulants and their dosages, and for the individual indication (Harenberg & Kraemer, 2012). Thus, more research needs to be done regarding the monitoring tools for new anticoagulant agents, and extend the use of these agents to other patient population.
759. Mr. Miller is likely presenting with an acute myocardial infarction. Based on his past medical history of hypertension, hyperlipidemia, obesity, and diabetes, along with his current symptoms of chest pain, shortness of breath, pale skin with beads of sweat on the forehead, as well as elevated lab 's Troponin, CK, and CK-MB, he is most likely presenting with an acute myocardial infarction.
“Extreme high heart rate, ‘cold’ sweat, and dizziness,” is what Kevin Olinger, a person living with atrial fibrillation (afib), experiences during an afib episode (1). Atrial fibrillation, a very serious heart arrhythmia, is found in over two million people living in the United States (2 What is 1). According to Gary Riddle, doctor at Memorial Hospital Health Care Center, he cares for roughly 40 patients diagnosed with afib each year in Ferdinand, Indiana (Riddle 1). People the age of 40 and over have a one in four chance of getting atrial fibrillation (2 What is). Knowing the risk factors, causes, symptoms, and treatment options for atrial fibrillation may help save one’s life in the future.
Arrhythmia I am doing my report on Arrhythmia. It affects the cardiac muscle, the heart. Arrhythmia causes three types of problems. It causes the heart to pump too slowly (bradycardia), it causes the heart to pump too fast (tachycardis), and it causes the heart to skip beats (palipations).
I completely agree with Courtney about performing pulmonary vein ablation on this patient. Radiofrequency catheter ablation for AF has become a common used second-line therapy after failure of at least one antiarrhythmic drug (Bunch & Cutler, 2015). The authors stated that multiple clinical trials report arrhythmia free survival of 50-75% at 1-year post ablation in contrast to only 10-30% with antiarrhythmic drugs. Hence, there is a chance that in near future, pulmonary vein ablation should become a first-line therapy for atrial fibrillation (AF).
A review of his medical records indicates that he had his first CVA later March of 2016 then one week later he had another CVA. His last CVA resulted in a stay in ICU with a tracheostomy and peg tube placement. He no longer has a tracheostomy and he recently loss his peg tube and refused to have it replaced. He was recently hospitalized at SLMC with complaints of fatigue and neck pain. He suffers from co-morbidities of DM which is stable with insulin, HTN which is stable and hyperlipidemia which is stable.
Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
When a person has Atrial Fibrillation, the sinoatrial node releases multiple quick impulses at a rate of 350 -600 times per minute. When this happens, the ventricles respond by beating around 120- 200 beats per minute, making it tough to identify an accurate heart rate. This arrhythmia can be the result of various things. During a normal heart beat, the electrical impulse begins at the sinoatrial node and travels down the conduction pathway until the ventricles contract. Once that happens, the SA node fires again and the process keeps on cycling (Ignatavicius & Workman, 2013).
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
Firstly, nurses are expected to practice evidence-based health care hence a mastery of information about the essential and safe dose of drugs for a patient is very important for a nurse. Consequently, it could be the determinant between the life and the death of the patient. Pharmacology is a discipline which is mandatory for the nurse to excel in to be efficient in discharging his/her duties. Understanding which drug to use, the right dosage, the expected side effects which may occur and the contra-indications of the various drugs are key in the preservation of