Mrs. Jones. is a 75 year old female who lives with her eldest daughter. Her daughter is married and has two children. Mrs. Jones had been married for forty years before her husband passed away two years ago and her daughter decided to take her in because she was now staying alone in their family home. According to her daughter, Mrs. Jones woke up one morning complaining of general weakness, fatigue, and chest pain. Her daughter decided to call the paramedics from Victorian Ambulance Australia decided to come and attend to her before transferring her to emergency department. On arrival the paramedics examined her and recorded her symptoms before taking her through various examinations to help in establishing her condition. They conducted a 12 lead ECG to determine the problem so that they could stabilize her. The test provided a representation of her heart’s electrical activity. The paramedics were not able to view the P waves and also noted an irregularly irregular ventricular rate. The results indicated an inconsistent rhythm. The paramedics provided her with an IV as well as a fluid bolus of normal saline. She was then transported to hospital.
Findings on Patient Assessment
The patient was taken through a comprehensive assessment that included determining her medical background, doing physical assessments, and taking her through a thorough chest assessment. The patient chief complaint was the pain in the left side of her chest. The patient also complained of palpitations. She claimed that she was having irregular and uncomfortable heartbeat. She felt as if her heart was struggling to come out of its position.
Delegate your assignment to our experts and they will do the rest.
The medical history of the patient indicated that she has had no serious illnesses before in her life. In all the cases that she visited a hospital due to a medical condition, she was treated and discharged. However, she noted that one year after her husband’s death, she has been experiencing bouts of general weakness, dizziness, fatigue, and shortness of breath that does not last for more than one hour. She has been managing the episodes by taking a rest whenever she felt the symptoms. In the past one year, she has had such episodes thrice. However, she has been taking them lightly because they come and last for few minutes then disappears. However, in this instance, occurrence of the symptoms had gone for two days. Despite taking a rest, she still felt fatigued and dizzy. The conditions that created a lot of discomfort included chest pain and the occurrence of palpations. From the interview assessment, the physician suspected that Mrs. Jones could be having a chest complication.
The patient was then taken through palpation. The physician disrobed the patient and placed the entire palms of both hands on her hemithoraces. She then moved her hand around the chest of the patient and asked her to identify the area that she felt most pain (Mayo Clinic, 2019). Mrs. Jones noted that she felt the pain on the left part of her chest. The physician noted that the patient had irregular and strong heartbeats. The chest could be seen by eye as flip-flopping. The irregular heart rhythms prompted the physician to carry an auscultation test on the patient (Acharya et al., 2015). The results indicated that there was no wheezing sound. However, the stethoscope examination revealed that the patient had an irregular heart rhythm, with a heartbeat of 130 beats per minute. The normal heartbeat rate should be range between 60 to 100 beats per minute (Potter & Le Lorier, 2015). The patient’s blood pressure was 119/80, implying that it was in the normal level. The irregular heart rhythm was accompanied by inconsistent R-R interval.
She was taken through other assessments that included electrocardiogram (ECG), echocardiogram, blood tests, and chest X-ray. The ECG test revealed that the patient had faulty electrical signals travelling through his heart. The abnormal ECG pointed out to a possibility of rapid atrial fibrillation. An echocardiogram test was also conducted to help in establishing the structure of the heart. The results indicated that the structure of the heart of Mrs. Jones was normal. There were no blood clots noticed in the heart. The blood tests were also necessary to diagnose if the patient had any thyroid problems or any other substances that may be harmful. The blood tests indicated that the patient had no thyroid problems or any other foreign materials in her blood. The test results included Glucose: 65-110 mg/dL and blood urea nitrogen: 8-21 mg/dL. The chest X-ray helped the physician to establish the patient’s heart condition. The assessment results indicated that her heart had no structural problems. However, there were abnormal electrical impulses in the atria. The lower chambers of the heart were beating very fast.
Management
The patient was diagnosed with rapid atrial fibrillation. Therefore, the treatment goal focused on helping her regain her normal heart rhythm, preventing occurrence of any blood clots, controlling heart rate, and reducing the risk of stroke. The condition of Mrs. Jones was managed through medications and lifestyle changes. The medications were the initial stage of treatment. Failure of the medications would lead to surgery or catheter-based procedures. The medications given to the patient were aimed at controlling the heart rhythm. The physicians recommended Mrs. Jones to take a dose of Sotalol to help restore her heart rhythm (Heist, Mansour, & Ruskin, 2017). The drug was administered alongside a calcium channel blocker known as verapamil. The drug was used to help slow down the heart rate. Rapid atrial fibrillation presents a risk of blood clot. Therefore, Mrs. Jones was also given an anticoagulant medication (Yox et al., 2016). She took aspirin to help reduce the risk of blood clot and stroke.
Apart from the medications, it was recommended that the patient should engage in lifestyle changes that will help in restoring her normal heart rhythm and prevent worsening of her condition. Mrs. Jones noted that she sometimes liked to help with the household chores to avoid being inactive. She had experienced the symptoms of atrial fibrillation when performing duties involved a lot of bending. The physicians advised her to avoid such tasks to improve her heart rhythm. During the medication period, she was advised to engage in rest with occasional physical exercises, such as walking (Myrstad et al., 2016). She was also advised to limit her intake of caffeine to prevent exacerbation of symptoms. She was instructed to avoid other medications during management of the disease period for example drugs such as cough and cold medications that contain stimulants. Such drugs can enhance the heart rhythm. Although Mrs. Jones had a good weight of 65 kg., she was instructed to engage is mild exercises and a healthy diet to reduce chances of obesity (Sposato et al., 2018). She was also advised to control her blood sugar levels to prevent a situation where her blood would exceed beyond the normal rate. Lifestyle adjustments have been found by researchers to be the best way of managing the disease.
An alternative pathway that could have been taken to help manage the disease include surgery or catheter-based procedures. The procedures are used when the other medication procedures fail to correct the patient’s problem. The physician can use electrical cardioversion, pulmonary vein ablation, and a permanent pacemaker (Peacock & Clark, 2016). Surgery can include maze procedure where incisions are made to help confine electrical impulses to specific pathways so that they reach the atrioventricular node.
Patient Outcome
The patient was given medications to control her heart rhythm and slow down the heart rate. She was then examined after four weeks to determine her progress. The assessment revealed that her heart rhythm and heart rate had dropped although they had not gone back to normal levels.. The patient reported feeling better than when he was brought to the hospital. She did not experience feelings of weakness, fatigue, or shortness of breath. Since the patient had completed the recommended dose of the medications, she was advised to continue managing her heart through lifestyle changes (McCabe, Rhudy & Devon, 2015). The physician emphasized on the importance of eating a healthy diet and engaging in mild exercises to eventually help Mrs. Jones restore her heart condition to healthy levels.
Learning Point
I have learnt from the clinical case study that it is essential to conduct comprehensive assessments to diagnose the right disease in a patient. Atrial fibrillation symptoms can easily be confused to another condition without proper tests. It is also important to seek medication during early stages of a disease to promote easy and effective management of the condition (Benito et al., 2015). The medications worked in the patient as the condition had not extensively affected her heart.
References
Acharya, T., Tringali, S., Bhullar, M., Nalbandyan, M., Ilineni, V. K., Carbajal, E., & Deedwania, P. (2015). Frequent atrial premature complexes and their association with risk of atrial fibrillation. The American journal of cardiology , 116 (12), 1852-1857.
Benito, L., Coll-Vinent, B., Gómez, E., Martí, D., Mitjavila, J., Torres, F., & Mont, L. (2015). EARLY: a pilot study on early diagnosis of atrial fibrillation in a primary healthcare centre. Ep Europace , 17 (11), 1688-1693.
Heist, E. K., Mansour, M., & Ruskin, J. N. (2017). Clinical Management of Atrial Fibrillation. In Cardiac Arrhythmias, Pacing and Sudden Death (pp. 183-190). Springer, Cham.
Mayo Clinic (2019). Atrial Fibrillation. Retrieved from https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
McCabe, P. J., Rhudy, L. M., & DeVon, H. A. (2015). Patients’ experiences from symptom onset to initial treatment for atrial fibrillation. Journal of Clinical Nursing , 24 (5-6), 786-796.
Myrstad, M., Aarønæs, M., Graff-Iversen, S., Ariansen, I., Nystad, W., & Ranhoff, A. H. (2016). Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clinical Research in Cardiology , 105 (2), 154-161.
Peacock, W. F., & Clark, C. L. (2016). Short stay management of atrial fibrillation . Springer International Publishing.
Potter, B. J., & Le Lorier, J. (2015). Taking the pulse of atrial fibrillation. The Lancet , 386 (9989), 113-115.
Sposato, L. A., Cipriano, L. E., Saposnik, G., Vargas, E. R., Riccio, P. M., & Hachinski, V. (2015). Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. The Lancet Neurology , 14 (4), 377-387.
Yao, X., Abraham, N. S., Alexander, G. C., Crown, W., Montori, V. M., Sangaralingham, L. R., & Noseworthy, P. A. (2016). Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. Journal of the American Heart Association , 5 (2), e003074.
