Echocardiogram is another important non-invasive diagnostic tool for AF. This test uses sound waves to produces an image of the heart and helps the cardiologist observe the different regions of the heart and assess their performance. [NIH]
Treatment for AF involves different approaches and may also be decided by the cardiologist depending on the nature of the AF. Paroxysmal AF, which lasts for a short duration (maximum few days) is usually treated with drugs that aim to control the sinus arrhythmia while cases of persistent AF maybe treated either for rhythm control or ventricular rate control. Drugs such as digoxin, (increases contraction and reduces rate) beta-blockers such as atenolol, metoprolol and calcium channel blockers such as verapamil are some of the avilable medications that try to improve the atrial refractory period to control AF. [Josephson, 2003]

Restoration of cardiac rhythm by means of electrical cardioversion is the most common intervention for…...

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Bibliography

1) Maurits a. Allessie, MD, PhD & Penelope a. Boyden et.al (2001), 'Pathophysiology and Prevention of Atrial Fibrillation', Circulation. 2001;103:769, Available Online at, http://www.circ.ahajournals.org/cgi/content/full/103/5/769

2) NIH, 'Atrial Fibrillation', retrieved Sept 10th 2009, from  http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html 

3) Vias Markides & Richard J. Schilling, (2003), 'Atrial Fibrillation, Classification, Pathophysiology, Mechanisms and Drug Treatment', Heart. 2003 August; 89(8): 939 -- 943

4) Josephson Linda & McMullen Maureen, (2003), 'Atrial Fibrillation: Beyond Irregularly irregular', Nursing 2003, Available online at,  http://findarticles.com/p/articles/mi_qa3689/is_200301/ai_n9182958/

After ICI discharge daily ECG or predischarge (Jansen et al., 1986; Evrard et al., 2000) Holter monitoring was used to detect arrhythmias. In some cases the monitoring may be continued beyond the hospital stay for 30 (Guarnieri et al., 1999) up to 90 days (eber et al., 1990). The use of the Holter monitor makes extended monitoring more feasible than when ECG was the only option.
Several anomalies have been found to act as indicators that AF may occur. For instance, prolonged P-wave duration was found to be an indicator of reoccurring AF (Gialiafos, 1999; Steinberg et al., 1993). Patients with a clinical history of AF were found to have a significantly longer intra-atrial and inter-atrial conduction time of sinus impulses (Centurion et al., 2002). The presence of preoperative supraventricular arrhythmias and fluctuations in autonomic balance were identified in some, but not all studies as a risk factor for post…...

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Works Cited

Allessie MA, Wijffels MC, Dorland R. Mechanisms of pharmacologic cardioversion of atrial fibrillation by Class I drugs. J Cardiovasc Electrophysiol.

1998;9(suppl):S69-77.

Akdemir R, Ozhan H, Gunduz H, et al.2005. Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocardial infarction: primary angioplasty vs. thrombolytic therapy. Ann Noninvasive Electrocardiol. 2005;10:35-40.

Benjamin E., et al. 1994. Risk Factors for Atrial Fibrillation. The Framingham Heart

Atrial Fibrillation
Simply stated, atrial fibrillation describes a condition in which the human heart beats at an excessively rapid rate that can result in diminished blood flow to the body. While the condition is not typically life-threatening, atrial fibrillation still requires immediate medical care because left untreated, the condition can result in adverse, long-term complications. To determine the facts, this paper reviews the relevant literature concerning the etiology and pathogenesis of atrial fibrillation, why it occurs, what happens in electrophysiology terms when atrial fibrillation is present, and prominent risk factors for the condition. In addition, a discussion concerning the prevalence of the condition is followed by an analysis of corresponding clinical signs and symptoms. A description of the diagnostic pathways used to diagnose the condition is followed by a discussion concerning short- versus long-term therapeutic interventions for atrial fibrillation. Finally, a summary of the research and important findings concerning these…...

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References

Dowling, Renee. Clinical Economics: Atrial Fibrillation, 2015, May 1. Medical Economics 92(9): 23-25.

EB Medicine.[internet] AF etiology, 2015 [cited December 4, 2015]. Available from  https://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=53&seg_id=972 .

Gutierrez, Cecilia and Blanchard, Daniel G. Atrial fibrillation: Diagnosis and treatment. 2011, American Family Physician, 83(1): 61-68.

Hearth Rhythm Society. Types of atrial fibrillation, 2015 [cited December 4, 2015]. Available from  http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Fibrillation-AFib/Types-of-AFib .

Lessening the Incidence of Postoperative Atrial Fibrillation The issue of reducing or preventing atrial fibrillation (AF) after cardiac surgery has been the subject of numerous studies. Existing studies sought to establish which agents are effective in this process since multiple agents are used to prevent AF. Reduction of incidence of postoperative atrial fibrillation is critical in order to promote the outcomes of patients undergoing cardiac surgery. In addition to flutter, atrial fibrillation is usually observed in the immediate aftermath of cardiac surgery. While clinical studies have shown that medications have positive impacts in preventing atrial fibrillation, they can be cause of these kinds of arrhythmias. Therefore, clinicians are faced with the need to identify suitable interventions for lessening the incidence of postoperative atrial fibrillation in the aftermath of cardiac surgery, which is the subject of this research.
Clinical Question and Importance to Nursing
The incidence rates of postoperative arrhythmias such as flutter and…...

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References

Abbaszadeh, M., Khan, Z.H., Mehrani, F. & Jahanmehr, H. (2012, Jan/March). Perioperative Intravenous Corticosteroids Reduce Incidence of Atrial Fibrillation Following Cardiac Surgery: A Randomized Study. Brazilian Journal of Cardiovascular Surgery, 27(1), 18-23.

Halonen et al. (2010, December 7). Metoprolol Versus Amiodarone in the Prevention of Atrial Fibrillation After Cardiac Surgery: A Randomized Trial. Annals of Internal Medicine, 153(11), 703-709.

Halonen et al. (2006, July 4). Intravenous Administration of Metoprolol is More Effective than Oral Administration in the Prevention of Atrial Fibrillation After Cardiac Surgery. Circulation, 114(1), 1-4.

Hjalmarson et al. (2000, March 8). Effects of Controlled-release Metoprolol on Total Mortality, Hospitalizations, and Well-being in Patients with Heart Failure: the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). MERIT-HF Study Group. JAMA, 283(10), 1295-1302.

Lucio, E.A., Flores, A., Blacher, C., Leaes, P.E., Lucchese, F.A. & Ribeiro, J.P. (2004, January). Effectiveness of Metoprolol in Preventing Atrial Fibrillation and Flutter in the Postoperative Period of Coronary Artery Bypass Graft Surgery. Arquivos Brasileiros de Cardiologia, 82(1), 42-46.

Onk, O.A. & Erkut, B. (2015, October). Is the Preoperative Administration of Amiodarone or Metoprolol More Effective in Reducing Atrial Fibrillation. Medicine, 94(41). doi: 10.1097/MD.0000000000001576

Skiba et al. (2013, August). Prophylaxis Against Atrial Fibrillation after Cardiac Surgery: Beneficial Effect of Perioperative Metoprolol. Heart, Lung and Circulation, 22(8), 627-633.

Valtola, A., Kokki, H., Gergov, M., Ojanpera, I, Ranta, V.P. & Hakala, T. (2007, May). Does Coronary Artery Bypass Surgery Affect Metoprolol Bioavailability. European Journal of Clinical Pharmacology, 63(5), 471-478.

Efficacy and Safety of Dabigatran vs. Warfarin for Stroke
After more than five decades as the preferred anticoagulant worldwide, warfarin is being challenged by a new rival that doesn't require careful dosage monitoring. Pradaxa (dabigatran) was unanimously approved by the FDA on October 19, 2010 for treating atrial fibrillation (AF) patients, who are at an increased risk for suffering stroke and systemic embolisms (.S. Food and Drug Administration). Dabigatran acts by binding directly to thrombin. Warfarin (Coumadin) is an anticoagulant that functions by inhibiting the synthesis of vitamin K-dependent clotting factors (Lemos et al., 770-771). Variations in the levels of vitamin K in the diet can influence how effective a given dose of warfarin is for a patient, so appropriate therapeutic dosages are determined on an individual basis periodically through a standardized clotting test (international normalized ratio [INR]). Even though warfarin can reduce the risk of stroke in AF patients by…...

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U.S. Food and Drug Administration. "FDA News Release: FDA approves Pradaxa to prevent stroke in people with atrial fibrillation." U.S. Food and Drug Administration, 19 Oct. 2010. Web. 22 Jan. 2011.

Schulman, Sam, Kearon, Clive, Kakkar, Ajay K., Mismetti, Patrick, Schellong, Sebastian, Eriksson, Hentry, Baanstra, David, Schnee, Janet, and Goldhaber, Samuel Z. "Dabigatran vs. warfarin in the treatment of acute venous thromboembolism." New England Journal of Medicine 361 (2009): 2342-2352. Web.

Wallentin, Lars, Yusuf, Salim, Ezekowitz, Michael D., Alings, Marco, Flather, Marcus, Franzosi, Maria Grazia, Pais, Prem, Dans, Antonio, Eikelboom, John, Oldgren, Jonas, Pogue, Janice, Reilly, Paul A., Yang, Sean, Connolly, and Stuart J., on behalf of the RE-LY investigators. "Efficacy and safety of dabigatran compared with warfarin at different levels of international normalized ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial." Lancet 376 (2010): 975-983. Web.

Neuman Health Care Systems Model:
Preventative Care for Mr. H

The Neuman Health Care Systems Model was created by Betty M. Neuman in an effort to help nursing students focus on wellness for the client system (McHolm & Geib, 1998). In order to create wellness for a client system, the nursing students use an Assessment and Analysis Tool, which will help in identifying Mr. H's problems (McHolm & Geib, 1998).

First, a nurse must find out Mr. H's profile and define his stressors. This must be done by the nurse and by the concerns expressed by the client (NeumanSystemsModel.org, 2011). It is clear that stressors in this 72-year-old widower's life are affecting his overall health. ecent changes in his life, such as the loss of his wife of 45 years, are a factor in his health changes. It is good that Mr. H is still trying to maintain his normal activity before…...

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References

A.D.A.M. (2011). Hypotension. Retrieved January 21, 2011 from  https://health.google.com/health/ref/Hypotension .

McHolm, F.A. & Geib, K.M. (1998, January-March). Nursing diagnosis: Application of the Neuman systems model of teaching health assessment and nursing process. Retrieved January 21, 2011 from  http://findarticles.com/p/articles/mi_qa3836/is_199801/ai_n8792656/?tag=content;col1 

NCBI. (2010, July 1). Pubmed health - Atorvastatin. Retrieved January 20, 2010 from  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH 

NCBI. (2008, September 1). Pubmed health -- Furosemide. Retrieved January 20, 2010 from

Interventions
Home health visits can be a useful method of identifying potential and actual health issues. Visiting the patient's home may provide the opportunity to identify issues which may not be readily apparent at a medical office. The home health visit is meant to assist in the promotion of the patient's health maintenance; limit further disability, and increase baseline health.

The visiting nurse will gain the ability to build a caring, professional, trusting, patient focused relationship. The home health nurse will be able to assist the patient by identifying, procuring and providing education for interventional items. The nurse will also know how to facilitate the communication of identified patient needs, in the home, to interdisciplinary members of the health care team (Liebel, Powers, Friedman, & Watson, 2012, p. 80).

Problem #1

The patient has been prescribed oxygen for home use by her physician. The patient states the she has not arranged oxygen in…...

Sallie Mae Fisher
Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. With her age, and such an acute medical condition, she may undergo substantial changes in function and living standards.

Ms. Fisher has been hospitalized four times for exacerbation of her CHF in the last 6 months. One of her primary problems is most likely to be decline in function in activities of daily living (ADLs). During Post hospitalization, older patients experience changes in functional status, Mary seems not to recover well after hospitalization revealed by her frequent hospitalizations.

In addition, Ms. Fisher seems to gain weight fast an indication that her body is retaining extra fluid. This is a common complication associated with CHF. It appears that Ms. Fisher is not strict with her diet or in not monitoring her diet well to eliminate salt (De Lorgeril, Salen, & Defaye,…...

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References

De Lorgeril, M., Salen, P., & Defaye, P. (2005). Importance of nutrition in chronic heart failure patients. European Heart Journal, 2215-2217.

Mahoney, J.E., Eisner, J., Havighurst, T., Gray, S., & Palta, M. (2000). Problems of Older Adults Living Alone After Hospitalization. Journal Gen Intern Med, 611 -- 619.

Secondary Assessment
Tracy Folsom is a 28-year-old female who was brought to the Emergency Department by her neighbor. The neighbor stated that Miss Folsom was found lying semi-conscious in the shower. The patient was received in the ED by the on call nurse. The nurse's performance with Miss Folsom's management is reviewed in this article.

Emergency evaluation of a patient is supposed be in a systematic manner. A systemic approach prevents the examiner from missing out important clues that may point to a patient's diagnosis. This approach is divided into primary and secondary.

As part of the Primary Assessment, the patient's Airway, Breathing, Circulation and degree of Disability was evaluated, as per protocol. Miss. Folsom's airway was patent, breathing was shallow, and her skin color was pink, indicating good perfusion. She was obeying commands and pupils were equal in size and reactive to light. It is also helpful to state the capillary…...

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REFERENCES

Canadian Medical Association. (2007, July). Putting patients first ®: patient-centred collaborative care a discussion paper. Retrieved from http://fhs.mcmaster.ca/surgery/documents/CollaborativeCareBackgrounderRevised.pdf

Dean, R & Mulligan, J, 2009, 'Initial management of patients in an emergency situation', Nursing Standard, vol. 24, no. 5, pp. 35-41, (Academic Search Complete).

Gilbert, G., Souza, P., & Pletz, B. (2009). Patient assessment routine medical care primary and secondary survey. San Mateo County EMS Agency, 1-5. Retrieved from  http://smchealth.org/sites/default/files/docs/243322118Patient_Assessment.pdf 

Institute of Medicine. (2001) Crossing the quality chasm. Washington, DC: National Academy Press.

Does taking Metoprolol before cardiac surgery reduce the incidence of post-op atrial fibrillation Abstract
Postoperative atrial fibrillation (POAF) remains a prevalent supraventricular arrhythmia. PoAF has associated effects such as deteriorating hemodynamic, increased risk of stroke and increased probability of death. Beta-blockers have been recommended as effective intervention mechanism of preventing PoAF. Metoprolol is one such beta-blocker that is commonly administered to prevent the incidence of PoAF. The systematic review below entails an analysis of six clinical trials that explore the effectiveness of metoprolol. The analysis identifies reduced hospitalization length, reduced mortality and reduced financial burden as the beneficial impact associated with the administration of prophylactic. The small number of studies reviewed limits the validity of the conclusion warranting future large sample size research.
Introduction
Annually, approximately 750,000 cardiac surgery are performed globally with postoperative atrial fibrillation (PoAF) being the prevalent complications (George, et al., 2018). With the increasing proportion of elderly population globally, it’s expected that…...

Compendium to Research in Cardiology and elemetry
Cotiga, D., et al. (2007). Acute Conversion of Persistent Atrial Fibrillation During Dofetilide Initiation. Pacing & Clinical Electrophysiology, 30(12), 1527-1530. doi:10.1111/j.1540-8159.2007.00902.x.

he researchers look at the role of Dofetilide (D) as "a highly selective blocker of the rapid component of the delayed rectifier potassium current;" approved for the treatment of atrial fibrillation (AF). he study is a replication of clinical trials that concluded in a satisfactory safety/efficacy profile in patients with left ventricle (LV) dysfunction or heart failure. he participants to the investigation all received at least 6 dosing intervals D. while admitted in the elemetry unit. Seventy seven percent (77%) of the patients converted to sinus rhythm (SR) after the first 2.2 ± 1.2 doses. Findings to the investigation revealed that: 1) D. had an unusually high pharmacological conversion rate; 2) demonstrated response with incremental dosage; and 3) correlated with a high tolerance which…...

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The stent-based antenna can be used in monitoring of blood pressure from a minimally invasive device inserted for tracking the pulmonary artery in diagnostic and early warning system for cardiac health. In cardiac diagnostics, the foremost challenge in using a like device is the wireless transfer of data and power from within the blood vessel to external devices; whilst maintaining unrestricted blood flow through the artery.

Paoletti, R., Suess, T., Lesko, M., Feroli, A., Kennel, J., Mahler, J., et al. (2007). Using bar-code technology and medication observation methodology for safer medication administration. American Journal of Health-System Pharmacy, 64(5), 536-543. doi:10.2146/ajhp060140.

A three (3) inpatient nursing unit study on the implementation of a multidisciplinary approach to systematically decrease medication errors through the use of observation methodology and the deployment of electronic medication administration records (EMARs) and bar-coded-medication administration (BCMA) is discussed. Testing of two (2) intervention groups: 1) 20-bed cardiac control group in the telemetry unit; 2) a 36-bed medical-surgical unit. Testing was conducted utilizing a direct observation technique for data collection, the measurement of medication errors used the observation process was conducted in two (2) phases: 1) reimplementation; and 2) postimplementation. In the first phase of the study evaluating the medication administration process associated with a manual five (5) day medication administration record (MAR), a total of 188 errors were reported. During the second phase of the study, evaluation of the MAR process using EMAR and BCMA technology implemented under direct-observation. Accuracy rate in reporting before BCMA concluded at (86.5%); after BCMA, the rate rose to (97%). A (54%) reduction of errors to the MAR was observed following implementation the group's approach to medication safety.

Mrs. J CaseClinical Manifestations in Mrs. JSubjectively, Mrs. J presented with anxiety (she is worried her health is so bad she is going to die), difficulty breathing, exhaustion, and lack of strength to eat or drink. Objectively, she had an irregular heartbeat, elevated heart rate, low blood pressure, crackles in her lungs, hepatomegaly, and blood-tinged sputum. She also had fever and malaise, which could be symptoms of an acute infection which might have led to the acute decompensation of her chronic conditions (Caterino et al., 2019).Four Cardiovascular Conditions and InterventionThe cardiovascular conditions Mrs. J is at risk for include hypertension, atrial fibrillation, coronary artery disease, and chronic kidney disease.Uncontrolled hypertension can lead to left ventricular hypertrophy and ultimately heart failure (Slivnick & Lampert, 2019). Antihypertensive drugs such as enalapril can be administered, along with lifestyle modifications like diet and exercise.Atrial fibrillation can cause heart failure due to rapid heart rate…...

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ReferencesCaterino, J. M., Kline, D. M., Leininger, R., Southerland, L. T., Carpenter, C. R., Baugh, C. W., ... & Stevenson, K. B. (2019). Nonspecific symptoms lack diagnostic accuracy for infection in older patients in the emergency department. Journal of the American Geriatrics Society, 67(3), 484-492.Cerón-Pisa, N., Shafiek, H., Martín-Medina, A., Verdú, J., Jordana-Lluch, E., Escobar-Salom, M., ... & Cosío, B. G. (2022). Effects of Inhaled Corticosteroids on the Innate Immunological Response to Pseudomonas aeruginosa Infection in Patients with COPD. International journal of molecular sciences, 23(15), 8127.Seo, Y., Lee, H. J., Ha, E. J., & Ha, T. S. (2022). 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute and Critical Care, 37(1), 1-25.Slivnick, J., & Lampert, B. C. (2019). Hypertension and heart failure. Heart failure clinics, 15(4), 531-541.Watson, M. P., Bennett, M., Hamilton, C., Hill, L., & McNally, O. (2022). Rate vs rhythm: beta blockers and antiarrhythmics as pharmacological options for the treatment of postoperative atrial fibrillation. British Journal of Cardiac Nursing, 17(11), 1-7.Yang, T., Mei, X., Tackie-Yarboi, E., Akere, M. T., Kyoung, J., Mell, B., ... & Joe, B. (2022). Identification of a gut commensal that compromises the blood pressure-lowering effect of ester angiotensin-converting enzyme inhibitors. Hypertension, 79(8), 1591-1601.

Staffing shortages in nursing are a consequence of poor nurse retention and nurse satisfaction. Being a nurse requires a lot of dedication, patience, and ability to keep updated in a constantly evolving world. When hospitals and other medical facilities have staffing shortages or shortages in qualified nurses, the healthcare delivery of that particular place dwindles. Nurses are the backbone of any healthcare facility.
Especially in recent times, nurses provide prescriptions, treatment protocols, and diagnosis when doctors are away or busy. This literature review is meant to explain such a phenomena and how it relates directly to nurse satisfaction and nursing retention. From here, the connection crosses over to nursing care and healthcare delivery as standards of practice. Things like arrhythmias will be viewed to understand how nursing shortages attribute to lower quality of care. Utilizing Polk's theory of esilience, this review will allow a look into performance improvement concerns and practice…...

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References

Bosch, R., Kirch, W., Theuer, J., Pittrow, D., Kohlhaussen, A., Willich, S., & Bonnemeier, H. (2013). Atrial fibrillation management, outcomes and predictors of stable disease in daily practice: Prospective non-interventional study. International Journal Of Cardiology, 167(3), 750-756. doi:10.1016/j.ijcard.2012.03.053

GIANFERMI, R., & BUCHHOLZ, S. (2011). Exploring the relationship between job satisfaction and nursing group outcome attainment capability in nurse administrators. Journal Of Nursing Management, 19(8), 1012-1019. doi:10.1111/j.1365-2834.2011.01328.x

Hudgins, T. (2015). Resilience, job satisfaction and anticipated turnover in nurse leaders. Journal Of Nursing Management, n/a-n/a. doi:10.1111/jonm.12289

Minhas, R., Vogelaar, G., Wang, D., Almansoori, W., Lang, E., & Blanchard, I. et al. (2015). A prehospital treat-and-release protocol for supraventricular tachycardia. CJEM, 1-8. doi:10.1017/cem.2014.53

Care Plan
Morbidity and Mortality Statistics:

Hypertension affects around 1 in 3 Americans and according to the CDC only 52% of people have this condition under control (CDC.gov, 2016). In older men, two-thirds have hypertension, and one-third of white men have hypertension. There are nearly 1000 deaths from hypertension daily in the United States, around 360,000 per year. Hypertension is related to first heart attacks, strokes and chronic heart failure.

The patient also suffers from orthostatic hypotension, which is when blood pressure drops when going from a lying or sitting position to standing. The largest risk for elderly people is the increased risk of falling that this brings. The patient may have fallen because of this condition. It is caused by, or linked to, high blood pressure and prolonged bed rest, as well as other conditions not faced by this patient. Anemia or vitamin B12 deficiency is another potential contributor to this (CDC.gov,…...