E. W., a 76-year-old white man, comes to the emergency department after a syncopal episode at a local restaurant. He is accompanied by two friends. Subjective Data
Has been feeling weak for a few days
Became dizzy and fainted while awaiting his dinner
Takes one medication, a "water pill" for high blood pressure
Objective Data
Physical Examination
Blood pressure 92/50, pulse 125 and irregular, respirations 24, temperature 97° F
Alert and oriented
Lung sounds clear in all fields
Diagnostic Studies
ECG monitor shows atrial fibrillation
Discussion Questions
What is atrial fibrillation?
What are your priority actions at this time?
What additional history should you obtain from E. W.?
Describe the risks associated with atrial fibrillation.
W. is placed on diltiazem, warfarin, and dronedarone. What is the purpose of each of these medications in treating E. W.’s atrial fibrillation?
Case Study Progress
E. W. is admitted with a diagnosis of new onset of atrial fibrillation. Despite medical therapy, 12 hours later, he is still experiencing dizziness, and his systolic blood pressure remains below 100. A transesophageal echocardiogram is done, showing E. W. does not have any blood clots, so the provider elects to perform a cardioversion.
What instructions should you give E. W. to prepare for a cardioversion? What do you tell him to expect during the procedure and what nursing assessments will you be performing?