A 71-year-old man is admitted to the

A 71-year-old man is admitted to the telemetry unit from the ED for treatment and monitoring of atrial fibrillation. The patient was at work when he suddenly experienced palpitations and lightheadedness. An ECG revealed that he was in atrial fibrillation with a rapid ventricular response (see rhythm below). The patient’s history reveals alcohol intake of two to three beers per day, coronary artery bypass graft (CABG) 6 months ago, and hypertension. Further assessment indicates that the patient is alert and oriented to person, place, and time. His Glasgow coma scale rating is 15. He appears anxious and asks how long he will be in the hospital and whether he can call his wife. He has bilateral trace edema of the lower extremities. Pulses are palpated bilaterally at 2+ radial and 1+ pedal. Auscultation of heart tones reveals that S1 and S2 are irregular. Auscultation of the lungs reveals the upper lobes, anterior and posterior, are clear, and bases of the posterior lobes have fine crackles bilaterally. The patient has a nonproductive cough. The abdomen is soft and nontender to light palpation with bowel sounds auscultated in all four quadrants. Vital signs are temperature 36.7ï‚° C (98.0ï‚° F); heart rate/rhythm 139 to 147/min, atrial fibrillation with rapid ventricular response; respirations 29/min; and blood pressure 111/67 mm Hg. Pulse oximetry is 94% on 2 L of oxygen per nasal cannula at rest. Interpret the patient’s rhythm strip above: RATE __________________________RHYTHM ___________________________________ P WAVES ___________________________________ PR INTERVAL _____________________ QRS DURATION _________________________ INTERPRETATION ___________________________________________________________ What is the initial treatment for this patient? What is a potential risk for this cardiac dysrhythmia? What are the preventive measures? Later that evening, the patient calls the nurse because he feels “like something terrible is going to happen.” He reports chest pain, has increased shortness of breath, and has coughed up blood-tinged sputum. What should the nurse suspect? What is the first thing the nurse should do, and what further assessments should be performed at this time? What are additional treatments for this patient if medication does adequately treat this dysrhythmia? SCIENCE HEALTH SCIENCE NURSING

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