Question

A client is admitted to the ER with new onset atrial fibrillation with a ventricular response of \(110 / \mathrm{min}\). The nurse would anticipate which of the following treatment options to be ordered. (Select all that apply.) a. Defibrillation b. Start oxygen at 2-4 lpm c. Anticoagulant therapy d. Medicate with beta blocker e. Start Lidocaine drip f. Atrial pacing

Short answer

b, c, d

Step-by-step solution

- Understand the Condition

Atrial fibrillation (AFib) is an irregular, often rapid heart rate that can lead to poor blood flow. When associated with a ventricular response of 110/min, it signifies that the heart rate is elevated and requires intervention.

- Evaluate the Options

Analyze each treatment option provided: a. Defibrillation - Typically used in life-threatening arrhythmias and not the first choice for new onset AFib with moderate symptoms. b. Start oxygen at 2-4 lpm - Oxygen is often given to ensure adequate oxygenation. c. Anticoagulant therapy - This helps prevent clot formation due to irregular heartbeats. d. Medicate with beta blocker - Beta blockers help control the heart rate. e. Start Lidocaine drip - Primarily used for ventricular arrhythmias and not standard for AFib. f. Atrial pacing - More related to bradyarrhythmias and not typically used for AFib.

- Select the Appropriate Treatments

Based on the evaluation: b. Start oxygen at 2-4 lpm to maintain oxygenation. c. Anticoagulant therapy to prevent thromboembolic events associated with AFib. d. Medicate with beta blocker to control the ventricular rate.

Key concepts

Atrial fibrillation

Atrial fibrillation, or AFib for short, is a heart condition characterized by an irregular and often rapid heart rate. This condition happens when the heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles). AFib can cause poor blood flow and increase the risk of stroke, heart failure, and other heart-related complications. Symptoms may include heart palpitations, shortness of breath, and fatigue. In the case of new onset AFib, immediate treatment is crucial to stabilize the patient's condition and prevent complications.
Common symptoms of AFib include:

• Heart palpitations
• Shortness of breath
• Fatigue

Anticoagulant therapy

Anticoagulant therapy is often used in the management of AFib to prevent stroke and other complications. Due to the irregular heartbeats in AFib, blood can pool in the atria and form clots. These clots can travel to the brain and cause a stroke. Anticoagulants, commonly referred to as blood thinners, help reduce the risk of clot formation. Some commonly used anticoagulants include:

• Warfarin
• Heparin
• Direct oral anticoagulants (DOACs) like rivaroxaban and apixaban

It's important for patients on anticoagulants to have regular blood tests to monitor their blood's clotting ability and adjust medication dosages as necessary.

Beta blockers

Beta blockers are medications that help manage heart rate and blood pressure. They work by blocking the effects of adrenaline on the heart, which slows the heart rate and reduces the force of heart contractions. In the context of AFib, beta blockers are used to control the ventricular rate, ensuring the heart doesn't beat too quickly. This helps alleviate symptoms and prevents complications.
Common beta blockers include:

• Metoprolol
• Atenolol
• Propranolol

These medications can be especially useful when the heart rate is significantly elevated, as in the case of a ventricular response of 110 beats per minute.

Oxygen therapy during AFib

Oxygen therapy involves providing extra oxygen to a patient who is experiencing difficulty in breathing or maintaining adequate oxygen levels. During an episode of AFib, the body's oxygen demand can increase due to the faster heart rate and decreased efficiency of blood flow. Starting oxygen therapy at 2-4 liters per minute can help ensure that the body's tissues receive enough oxygen. This treatment is relatively straightforward and can provide immediate relief from symptoms such as shortness of breath and fatigue.
Key points about oxygen therapy:

• Helps maintain adequate oxygenation
• Can be easily administered via nasal cannula or face mask
• Often used in combination with other treatments for AFib