Patient profile: R.S. is a 78-year-old woman

Patient profile: R.S. is a 78-year-old woman who is admitted to the telemetry unit with a diagnosis of new onset atrial fibrillation. Subjective data: Has a history of hypothyroidism and HTN Has no previous history of afib Is taking levothyroxine (Synthroid) 0.125mg PO daily and enalapril (Vasotec) 5mg PO daily Experiences palpitations, dizziness SOB, and mild chest pressure Has been drinking more coffee since her husband died last month Objective data: Alert and anxious older woman VS: 100/60, HR 150, RR 32 Lungs: bibasilar crackles 12 lead EKG: Afib with rapid ventricular response Interprofessional care: Continuous telemetry monitoring Discontinue Vasotec IV diltiazem (Cardizem) bolus and then IV gtt Digoxin 0.25mg daily Enoxaparin (lovenox) SQ q 12 hours Warfarin (coumadin) 5mg PO daily Discussion questions: What risk factors for afib does this patient have? What nursing interventions should be included in the initial emergency treatment management? Explain the pathophysiology of her symptoms on admission to the telemetry unit. Describe the characteristics of her EKG waveform. What is the immediate goal of the antidysrhythmic drug therapy? Explain the rationale for the drugs discontinued and ordered for her. What nondrug therapy can be used for her treatment?

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