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Running head: COMPLEX CARE NURSING 1

Complex Care Nursing

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COMPLEX CARE NURSING 2

Complex Care Nursing

Lisa is a fit mother of two who competes in triathlons and now presents with

complications post laparotomy. She has been diagnosed with the problem of atrial fibrillation

where episodes lasted 10 minutes. To illustrate, atrial fibrillation occurs when the SA nodes

chaotically fire and cause the heart to lose sinus rhythm and quiver ineffectively (Koweym &

Naccarelli, 2015). This occurrence causes the two upper chambers of the heart, the atria, to beat

irregularly and chaotically, out of harmonization with the ventricles (two lower chambers) of the

heart. It is often dangerous and has now placed Lisa at a high risk of developing blood clots due

to the amount of time her heart has been in Atrial Fibrillation as well as because of the fact that

she has not received her recommended dose of heparin as evidenced by the drug chart error.

The atrial fibrillation problem is manifested by the differences in heart rate and BP drops.

This is actually what causes the blood to pool in heart and lead to clots (Milner-Fenwick, 2014).

There is a drug order mistake on the medication chart. Lisa is not getting her full dose of

warfarin, which helps thin blood to prevent clots that could lead to pulmonary embolisms and

deep vein thrombosis. As she is in so much pain, she is unable to move around as required to

prevent clots post-surgery. Such increases risk of blockages, causing further complications and

longer hospital stay. She is not tolerating the pain medication and seems to be having adverse

reactions during the administration of Ropivacaine, with respiratory depression low blood

pressure, HR (Hazard Ratio) and dyspnea.

The goal will be to decrease/manage symptoms caused by pooling of the blood from

atrial fibrillation. Besides, the interventions that would be applied to Lisa would include cardiac

assessments and monitoring with Electrocardiogram (ECG/EKG). This would make sure that any

sudden changes in heart function could be picked ensuring proper management (Thakur &

COMPLEX CARE NURSING 3

Natale, 2018). In addition, the interventions would include the review of medication chart to fix

errors and prescribe appropriate analgesia and proper dose. The reason for this review is to

ensure warfarin is ordered stat order via IV infusion to help dissolve any clots caused by atrial

fibrillation. Besides, application of TED stockings would be necessary to prevent clots, deep vein

thrombosis, embolisms, stroke, and atrial fibrillation. As noted by Peacock & Clark (2016), the

TED stocking enable the return of blood. The medication to treat atrial fibrillation, low BP and

HR enables an increase in blood pressure to perfuse kidneys and operation site.

Apparently, Lisa has a low output of urine output because her kidneys are not getting

perfused properly due to atrial fibrillation and pooling of blood (Dieter, 2016). In this regard, the

doctor needs to do blood tests in order to check kidney function and electrolyte, as well as the

full blood count and full blood examination for possible infection (Chazov, Saks, & Rona, 2017).

Urinary catheterization would also be important to help drain urine owing to the possibility of

non-excreted toxin urea creatinine. Poor kidney function, which brings about the inability to

excrete medication and cause buildup of doses (toxicity), as well as the strain on the heart

causing atrial fibrillation, would require admission to the intensive care unit for 1:1 monitoring

with the aim of preventing further major organ damage and failure (Chazov, Saks, & Rona,

2017).

To achieve the goal, evaluation needed to help Lisa should include the assessment of

cardiac rhythms #1 EKG to see what the heart is doing. As well, it should review the heart

medication no beta agonists since this often lowers BP further. Since Lisa is on IV fluids but

with no urine output, the evaluation ought to consider the assessment of urinary retention post-

surgery. There is need to insert IDC and conduct respiratory assessments auscultation. Since

there is no sound in Lisa’s lung base, fixing is necessary because this indicates lack of gas

COMPLEX CARE NURSING 4

exchange; hence, oxygen sits low even on 40 percent ventilation (De & Canadian Agency for

Drugs and Technologies in Health, 2016).

COMPLEX CARE NURSING 5

References

Ande, J. P., Pinto, F. J., & Arnett, D. K. (2015). Prevention of cardiovascular diseases: From

current evidence to clinical practice.

Chazov, E. I., Saks, V. A., & Rona, G. (2017). Advances in myocardiology: Volume 4.

Chopra, H. K., Wander, G. S., Chandra, P., & Kumar, V. (2017). Atrial fibrillation update: A

textbook of cardiology.

De, A. G., & Canadian Agency for Drugs and Technologies in Health,. (2016). Monitoring for

atrial fibrillation in discharged stroke and transient ischemic attack patients.

Dieter, R. S,. (2016). Endovascular interventions: A case-based approach.

Kerr, E. A. (2000). Quality of care for cardiopulmonary conditions: A review of the literature

and quality indicators. Santa Monica, CA: Rand.

Kowey, P. R., & Naccarelli, G. V. (2015). Atrial fibrillation. Boca Raton, FL: Marcel Dekker.

Milner-Fenwick, inc. (2014). Atrial fibrillation. Hunt Valley, MD: Milner-Fenwick.

Peacock, W. F., & Clark, C. L. (2016). Short Stay Management of Atrial Fibrillation. Cham:

Springer International Publishing.

Thakur, R. K., & Natale, A. (2018). Atrial fibrillation. Philadelphia, Pa: Saunders.

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