First Action of the Practical Nurse
The nurse would ask the patient further questions to help make a proper diagnosis of the appropriate action. For instance, the practical nurse would ask if the patient experiences chest pain or discomfort; if yes, what causes it, and what exacerbates it? Also, whether the pain is sharp or dull, whether the pain worsens when she breathes in deeply and how long it lasts. Besides, whether the pain radiates from the chest to other areas and is localized (Riley, 2015), the practical act can also ask the patient if anyone in her family has had a history of heart attack or any cardiovascular diseases, and if she experiences palpitations.
Additional Data that the Practical Nurse Would Collect
The practical nurse would do a diastolic and systolic blood pressure monitoring for the patient to determine her hemodynamic status. Besides, the nurse would conduct a 12-lead electrocardiogram and an objective measurement of the severity of dyspnea by conducting a history check. This can be done by assessing the breathing effort, tolerance of lying prone, and dyspnea severity scale. Moreover, the practical nurse would determine the patient's urine output, body temperature, mental stats, and peripheral perfusion (Riley, 2015). The nurse would also look for clinical signs of congestion by checking the jugular venous pressure, peripheral edema, and pulmonary rales. Conducting laboratory tests to determine creatinine, glucose, urea, natriuretic peptide, troponin levels, and full blood count, are also important.
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Potential Complications of Cardioversion and Patient Preparation for an Elective Cardioversion
The most important complication of cardioversion is embolization. Therefore, before cardioversion is performed, anticoagulants should be provided 3-4 weeks. Besides, trans-esophageal echocardiography can be performed to rule out thrombus in the heart. Other complications include stasis and stunning of the atria. As a result, the patient may develop thrombus even though she may be in sinus rhythm. Therefore, the patient should be given anticoagulants for four weeks post-procedure (DeWit et al., 2016). Myocardial dysfunction, skin burns, pulmonary edema, and hypotension are other complications of electrical cardioversion. However, the use of steroid cream may avoid these complications.
To prepare for the cardioversion, the patient should avoid eating for at least eight hours before the procedure. Besides, the patient should prepare so that she does not have to make any critical decisions throughout the day or drive herself to the appointment. The patient should leave all jewelry at home and carry all her medicines, including OTCs to the procedure.
Reasons for the Patient’s Worsening Condition
The patient was most likely having a heart attack. There are many reasons for the exacerbation of symptoms in individuals who have chronic heart failure. However, the signs in the patient might have worsened due to cardiac arrhythmias. The co-existence of cardiac arrhythmias and CHF has been reported to elevate the adverse effects of each other. Moreover, CHF is characterized by episodic clinical exacerbations during periods of stability since it is a progressive disease (DeWit et al., 2016). The condition may have also worsened due to poor response to medications.
Actions to Assist the Patient
To reverse these manifestations, the nurse should administer digoxin or any other effective ionotropic agents to treat atrial fibrillation in the patient. The nurse should also administer diuretics for blood pressure control, vasodilators, and anticoagulants to limit the manifestations (Tsuyuki et al., 2001). The use of pacemakers and oxygen therapy is also advised to assist the patient in breathing due to increased shortness of breath. Other non-pharmacological interventions that the nurse should use include restriction of fluid and intake of dietary sodium.
References
DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice . Elsevier Health Sciences.
Riley, J. (2015). The key roles for the nurse in acute heart failure management. Cardiac Failure Review , 1 (2), 123.
Tsuyuki, R. T., McKelvie, R. S., Arnold, J. M. O., Avezum Jr, A., Barretto, A. C., Carvalho, A. C., ... & Yusuf, S. (2001). Acute precipitants of congestive heart failure exacerbations. Archives of internal medicine , 161 (19), 2337-2342.
