A-Fib

[tiffanymarie25]

Can anyone please help me try to comprehend the pathophysiology of a patient who is in A-Fib? I can't seem to grasp pathophys.

[emtb2rn, BSN, RN, EMT-B]

Whatcha have is pacemakers besides the SA node firing in the R atria (aka multiple ectopic foci). This generally (usually) happens rapidly with an atrial rate that can reach 350, so the atria doesn't completely contract. This also impact the ventricles. The biggest problem is the failure of the atria to contract results in loss of atrial kick (the contraction that forces the last 20% of blood out of the atria). This in turn leads to potential of that remaining blood clotting. Those clots can wind up in systemic circulation which increases the risk of a an emboli winding up someplace it shouldn't, i.e., lungs or brain.

Treatment depends on when the a-fib started - 48 hours duration. First, control the rate (dig, cardizem or amiodarone). Then, if 48 hours, then anticoagulation with heparin, d/t risk of clots as mentioned above, followed by cardioversion.

Hope this helps. Anyone want to jump in with corrections if necessary?

[wtbcrna, MSN, DNP, CRNA]

Nothing else really to add, but check out the wikipedia entry/picture at the bottom of the page of this link http://en.wikipedia.org/wiki/Atrial_fibrillation.

[Daytonite, BSN, RN]

normally, the sa node (which is commonly referred to as the pacemaker of the heart) in the right atrium is the only group of cells that emits the electrical impulse that starts the process to initiate a heartbeat. the electrical pulse it emits spreads rhythmically and efficiently through the two atria causing both atria to contract as it moves on to the sa node where it pauses momentarily before it moves onward and down to the ventricles causing them to contract.

in atrial fibrillation rebel cells, or ectopic cells, in the atria begin emitting these electrical impulses in an irregular and sometimes very rapid and chaotic manner. these electrical discharges/impulses come from many different atrial cells other than the sa node. the electrical pulses of these ectopic cells do not spread throughout the atria in an organized rhythmical way like the ones coming from the sa node. in fact, they spread in a disorganized and chaotic way which results in the fibrillation, or quivering, of the atria. the patient may feel a fluttering sensation in their chest as a result of this. many of these electrical impulses never make it to the av node or they end up bottlenecked, much like a traffic jam, at the av node because there are so many of them. many are unable to make it through the av node because the av node just cannot accommodate them. the av node, which is like a switching station, can only let one electrical impulse through at a time. many of the jammed up impulses eventually lose their electrical charge and just fade away while some others will be successful in getting through the av node and completing the electrical cycle resulting in a ventricular contraction.

the rebel atrial discharges can be seen on ekgs as very different appearing p waves. this is because of the weird, unorganized and chaotic routes their electrical impulses take as they travel through the atrial tissue. in fact, often the actual p wave generated by the sa node is not even recognizable because of the many rebel discharges that are present on the ekg tracing.

the result of all this is often a very irregular heart rate because of the randomness of the impulses that actually make it through the av node and are able to complete the electrical cycle resulting in the contraction of the ventricles. the problem of the quivering of the atria is that if the atria are quivering and not beating, then blood is just sitting around in the cardiovascular system. sitting, or stationary, blood is a problem since blood clots can form. and, this is a problem in people who have chronic atrial fibrillation. you will sometimes find they have been placed on blood thinners as a prophylactic measure. strokes are a common complication of people with chronic atrial fibrillation. often doctors will not cardiovert people in chronic atrial fibrillation until they have been placed on blood thinners and given a few weeks for any blood clots that might have formed to dissolve because once they are cardioverted back into a sinus rhythm, any blood clots that might have formed while they were in atrial fib will become emboli with their new and efficient sinus rhythm and result in a stroke or an embolic event in another organ.

atrial fib can occur when there is hypoxia, hypercapnia and in patients with rheumatic heart disease, mitral valve disease, hypertension, congestive heart failure, pericarditis or thyrotoxicosis. the treatment is calcium channel blockers or beta adrenergic blockers. if they are ineffective, cardioversion may be tried to shock the heart back into a normal sinus rhythm.

http://www.emedicine.com/med/topic184.htm - atrial fibrillation

https://health.live.com/article.aspx?id=articles%2fmc%2fpages%2f1%2fds00291.html&qu=atrial+fibrillation

http://www.nlm.nih.gov/medlineplus/ency/article/000184.htm

[nursing235]

Can someone help me with a teaching plan for someone with sickle cell and afib? Help!

[rachelgeorgina]

Not everyone with AF has a pacemaker.

My great-aunt (basically my third gran) lives in constant, stable AF at 84 years of age, complicated by COPD and heart failure. She simply takes her meds (digoxin, lasix, lipex, aspirin) and doesn't exert herself and her AF doesn't tend to flare up to much.

RE: the teaching plan, what are you wanting to teach them? What do they need to know? What do they already know? What do they need to learn?

[nursing235]

Thanks everyone!

[Daytonite, BSN, RN]

can someone help me with a teaching plan for someone with sickle cell and afib? help!

a written teaching plan goes something like this:

1. overview: a synopsis about what is going to be taught in the course
   
2. goal(s): the aim(s) or outcome(s) that you want your learner to achieve as a result of the lesson you plan
   
3. objectives: the more specific information that the learner will come away from the course knowing that will achieve the goal(s) you have determined.
   
4. content: a play-by-play of the specific content that is going to be taught and in the sequence it will happen. your content should address and cover all the objectives. this part of the written lesson plan is presented in an outline format.
   
5. procedures and materials: how all the above will be achieved, i.e. lecture, demonstration, discussion, etc. materials that can be used and resources that can be needed for the lesson to be successful and essential to teaching your lesson plan are listed and may include demonstrations, audio-visuals, handouts, experiments, stories, game playing and any number of other creative items.
   
6. evaluation: determining if you met the goals of the teaching plan. this can be done through a return demonstration, short post test, short question and return answer session with the client to verify they understand the information correctly or a task the participant needs to perform.
   

if you look at it, it has some of the elements of a care plan (goals, interventions, execution and evaluation). what is different is that you actually lay out how a list of how you are going to do the teaching, kind of like a nursing procedure is laid out step-by-step for you.

you will need to learn as much about sickle cell anemia and atrial fibrillation as you can. the online merck manual (http://www.merck.com/mrkshared/mmanual/sections.jsp) is a good place to start. evaluate the patient and what the patient's/learner's learning needs are. don't bite off too big of a teaching subject (don't try to teach a whole textbook). you might try looking in the websites of the various national institutes of health (http://www.nih.gov/) that cover these two diseases or the center for disease control and prevention (http://cdc.gov/) because they often already have printable teaching pamphlets and handouts that you can merely download, copy and incorporate into your teaching projects.

[sweetandspecial]

I too have to do a nursing diagnosis poject, my patient is a diabetic type 2, who first came into the hospital with an ischemic left foot requiring BKA. Bilateral leg ambutation, end stage renal failure on hemodialysis, coronary artery disease, A-fib, CVA-stroke, cardiomyopathy - alcohol related. Fistula L arm, chronic pancreatitis / chronic adominal pain, hyperlipidemia, and an active smoker.

I need help to tie this all together please

Meds:

Acetaminophen

ASA

Atorvastation

Bisoprolol

Calcium Carbonate

Docusate Sodium

Herpain

Novorapid insulin

Pantoloc

Plavix

Replavite (folic acid)

Lynica

Coversyl

[tnbutterfly - Mary, BSN]

Moved to Nursing Student Assistance.

sweetandspecial, if you don't get responses here, you might want to start a new thread in this forum. Members may just think this is an old post since the thread was started in 2008.

Welcome to the site!!