Now I see why I didn’t work last year.
Balancing School and work and family and friends is starting to get to me. It’s starting to get to nearly all of us, and we’ve already had one dropout due to it. The wind sings outside with the huge temptation to just sit and look at all of the beauty, and we put in earplugs or ear-buds to tune it out. Oh well. It’s only till May, right?
On a slightly different note, I have a question for both patient and nurse(ing student). In my last post, I mentioned a cardiac case study that I needed to have completed, and now’s the time people are required to post “peer responses” to them on the class discussion board.
Here’s the case with the specific question I’d like your input on:
You are the charge nurse working in a long term care center. Mabel is an 85 year old resident with a long history of congestive heart failure, a myocardial infarction 3 years ago, COPD, hypertension, and degenerative joint disease. Her medications include: furosemide 20 mg QD, enalapril maleate (Vasotec) 5 mg QD, digoxin 0.125 mg QD, KCL (potassium chloride) 40 mEq QD, and ibuprofen (Motrin) 200 mg QID.
Today, Mabel (who is consistently alert and oriented x3) complains that she “just doesn’t feel right.” The nursing assistant reports that Mabel’s pulse is weak and irregular at 116 bpm and her skin feels cooler than usual. You go to her room for further assessment.
After reviewing the ECG, the physician decides that Mable is in atrial fibrillation. Mabel is again alert and oriented and her daughter is with her.
6) How would you explain atrial fibrillation to Mabel and her daughter?
Because the condition is being explained to those outside the medical field that are most likely frightened at this diagnosis, it is important to bring the explanation to their level of their understanding. An important thing to make sure of before explaining what afib is is to provide any education (if needed) on how the heart works – its parts, what they do, etc..
Atrial fibrillation is the fibrillation of the atria of the heart. Fibrillation resembles a sort of quivering. The heart rate is quick and irregular. This means that instead of moving all of the blood from the atria, the atria will have some significant pooling. The ventricals of the heart can beat more rapidly, causing the ventricals to have decreased filling. Because of this, there is a decreased cardiac output. (Iggy, 745)
Atrial fibrillation can be caused by many different things:
- High blood pressure (hypertension)
- Congestive heart failure
- Valvular disease
- Male gender
We can assume that Mabel’s atrial fibrillation is due to her congestive heart failure.
Another important thing would be to discuss the treatment for atrial fibrillation. But this education would probably be best provided when the doctor orders the treatment(s).
There is no offense implied in “bringing the explanation to their level.” I know that it would be difficult to have an explanation of something I didn’t understand in the most complicated unfamiliar jargon presented to me. I’m hoping that this part isn’t insulting anyone’s intelligence.
Now, some of the peer responses I’ve gotten back are saying that I should include things like how atrial fibrillation can increase Mabel’s chance of death, and stroke (she already has CHF). I didn’t add this at this time, quite frankly, because this was what I believed was the initial explanation.
But what do you think? Is this an explanation that is easy to understand or no? And, what should I add or take away from it to make it more beneficial for Mabel and her daughter?
(P.S. Don’t read into any incorrect form of grammar here . . . I didn’t exactly take the time to iron out all of the wrinkles.)