Essay plan for Atrial fibrillation PDF

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Plan for essay including notes on intro, assessment, planning, symptoms. has sub heading critical analysis, evaluation and conclusion, ...

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Intro 200This assignment is based on the experiences of a second-year nursing student whilst on placement at a cardiac ward. The assignment guidelines require a service user to be selected for the creation of a case study. I will use this case study as a base of reflection on the assessment, planning, implementation and evaluation of the care received. Case studies encourage holistic nursing decisions to be made (Feo and Kitson, 2016). This assignment will analysis an assessment tool undertaken of a chosen service user, they’re problems, needs and the decisions made to provide person centred holistic nursing care. In addition to this the pathophysiology of a condition and the pharmacology of one specific medication applicable to the chosen service user will be discussed. Multidisciplinary working will be discussed alongside a critical discussion of how this plan of care was implemented. In consideration of confidentiality under the Nursing and Midwifery council (NMC), pseudonyms will be used to safeguard patients’ identities and consent was also gained by the service user in regard to the assignment. HOLLISTIC CARE MODEL FOR EVALUATION Finally, an evaluation of the evidence-based care delivered and recommendations that will enhance the student nurse’s future nursing practice. Evidence based nursing practice is used continuously in the development of patient care. Critically analysing the ‘grade, strength and quality of evidence’ generated from research studies and reports, allowing informed decisions to be made regarding patient care. https://www.nurse.com/evidence-basedpractice Assessment 900 – The service user David Smith is a 55-year-old male who works on the railway. David went to his general practitioner (GP) as he was experiencing angina, chest pain. David’s GP organised a meeting with Claire, a heart failure nurse whom was the cardiology sister, to perform an assessment and diagnose David’s condition. After this assessment David was to return for a meeting with Claire to discuss Claire the heart failure nurse introduced herself to David and Susie gaining permission for myself, student nurse, to observe the meeting. It is important to gain trust from the patient as this is the basis of a therapeutic relationship. Claire observed how David entered the room, she could see that he was not short of breath and had a healthy pallor. Claire’s visual assessment of David was important as it allowed her to make visual observations to ensure evidence-based nursing practice. By visually assessing David it allows her to gather initial evidence which is untainted by what he believes the assessment tool requires. Claire gained a holistic nursing assessment of David. David’s physical symptoms of AF was the angina he was experiencing along with the general feeling of being unwell and extreme fatigue. This coupled with the psychological fear of losing his job due to his condition was making his physical symptoms worse. David explained that if he went ahead with the cardioversion the results would have to appear on his medical assessment, explaining the railway is very strict and he would most likely lose his job due to ill health. Claire discussed with David and his wife the results from his previous ECG and blood tests which confirmed his AF and she stated that his ejection fraction was 40%. Although this meant that David was in heart failure he was only in the early stages, this combined with physical factors such as his age and his healthy BMI meant that his AF could be treated with medication for a few years as David stated he was retiring at the age of 67.

AF is a disease of the heart, where it is not running in a regular rhythm. REF To correct David’s condition it is advised that he under goes cardioversion to correct the impulses in his heart. Cardioversion does not always guarantee correction of AF as this condition can naturally subside as well as return. David has a past medical history of diabetes, uncontrolled hypertension and peripheral arterial disease (which is linked to coronary arterial disease) and a poor ejection fraction of 40% PUT IN GUIDELINE HERE, therefore he is also in heart failure. David attended his pre-assessment for the cardioversion where under nice guidelines for arterial fibrillation 1.1 diagnosis and assessment are performed prior to elective cardiogram being undertaken. As stated within NICE guidelines, the heart failure nurse who led the pre-assessment manually palpated David’s pulse to ensure the irregular heart beat was still present as AF does occasionally naturally correct itself. Also following NICE guidelines, the nurse performed another ECG which confirmed David’s heart was beating in AF. Once AF had been reconfirmed with the heart failure nurse she was able to continue her preassessment for cardioversion. Under 1.4 NICE guidelines for AF, a CHAD2-DS2-VASc (CHAD2) score must be calculated to assesses the likelihood that David may encounter a stroke due to his AF. Alongside this a HAS-BLED score is also required to calculate David’s risk of bleeding as he will need to be started on an anticoagulant to prepare for the cardioversion to ensure he does not pass a thrombus once the cardioversion has begun. The nice guidelines suggest Apixaban be prescribed to David as he is presenting with 1 or more risk factors being hypertension and his diabetes. https://www.nice.org.uk/guidance/ta275/chapter/1Guidance NICE have also have produced a ‘patient decision aid about anticoagulation in arterial fibrillation’ to ensure safety netting to the patient and enabling a holistic approach. After an informed discussion between the nurse and David we concluded that Rivaroxaban would better suit David. Due to David’s occupation on the railway he worked a variety or hours and did not always have access to food. Apixaban required David to take it twice a day 2.5mg with 12 hours in between, after discussion we decided that this would not work with occupation as he could not guarantee he would be able to take the medication 12 hours apart or twice a day. The nurse and David decided that rivaroxaban would be a good alternative for David, the only requirement being that he took it at the same time every day, with or without food.

Planning 900Condition – David has been found to have arterial fibrillation for this condition he is on rivaroxaban in planning to undergo cardioversion. Arterial fibrillation is where the heart is beating in a nonregular irregular rhythm, this mean that David may have experienced a sudden thump or felt a skipped heartbeat https://www.stopafib.org/know.cfm when at rest or whilst at work. This happens when the hearts

electrical impulses fire off from different places in the atria (which is the top chamber of the heart), causing the atria to twitch and this is felt as an irregular heartbeat. This irregular heart beat can also be felt through palpation of the pulse. If this condition is not corrected through medication or surgery, it can lead to a stroke or pulmonary embolism as the heart is not clearing the chambers fully of blood. There are many possible causes of arterial fibrillation that range from every day to extreme, some cases maybe congenital heart defects, someone who has been born with a defective heart. Other causes can be high blood pressure or a previous heart attack. David has never had a heart attack although through the CHAD2 assessment tool he does exceed the weekly recommended alcohol intake. As part of David’s daily routine, working on the railway, the hours can be quite demanding therefore David drinks a lot coffee every day. Simply excess coffee or alcohol are large participants to the cause or continuation of AF. Despite these theories sometimes there is no definite reason as to why a person is suffering from AF. PathophysiologyIn a normal healthy heart, we have a natural pacemaker called a sinoatrial node, more commonly known as the sinus node or SA. The SA node causes an electrical impulse that travels through the atria and causes the right and left atria to contract and pump blood into the ventricles. The electrical impulse is transmitted from the atria to the ventricles through the atrioventricular node, known as the AV node. This means that the atria and the ventricles are synchronized meaning the heart is functioning to optimal efficiency. When the heart is beating in AF it means the atria and ventricles are not synchronized, uncoordinated and chaotic. This means rather than the chambers emptying and filling completely, some blood remains as the ejection fraction of the heart has been weakened (TALK ABOUT EF HERE). This means the hearts ability to pump blood around the body has been compromised.

SymptomsAs the heart is not efficiently pumping blood around the body this leaves a patient with symptoms if they are in AF. Symptoms such as: fatigue, weakness and reduced ability to exercise. My patient suffered with palpitations, another common symptom of AF. This is where you can feel your heart beating in your chest and the pain can range from uncomfortable to very painful. Therefore, his symptoms where coupled with chest pain and shortness of breath as a racing heart beat can often affect your breathing. Other symptoms may be dizziness and often getting light headed or just the general feeling of being unwell. There are two different forms of AF, one is where the heart rhythm is not consistent with AF, this is called paroxysmal meaning the symptoms come and go. My patient however suffered with full AF meaning his symptoms where consistent…..

Critical analysis 900-

Evaluation 900-

Conclusion 200-

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