Managing Atrial Fibrillation With Asthma And Hypertension: A Case Study

Drug Treatment and Pathophysiology

Case management studies in health care practice are paramount in diseases management and in-depth understanding of the patient medical history. Effective case study offer good opportunity to practice effective nursing strategies for a patient. In this review, we will analyse patient history medical status suffering from atrial fibrillation with previous history of asthma and hypertension and document a management plan towards his care

Atrial fibrillation is a medical which is characterized by irregular heartbeats that are too quick or skips the beats. It usually start slowly but can be persistent over time, (Zion, Lercari,Carzza & Domencucci, 2014). The heart can encounter symptoms such as palpitations, fainting, chest pain or shortness of breath. Increased risks have been observed with occurrence of dementia, heart failure and stroke in extreme cases, (Munger, Wu & Shen, 2014). For these reason the prescription of aspirin is majorly due to tits properties of being blood thinner, it prevents clots in the blood vessels, in the cases of heart attack and stroke, the characteristic feature of atrial fibrillation, (Lip, 2011).

Cardiprin drug is pain medication drug and used often as analgesic, antipyretic effects and anticoagulation properties. Drug effect takes 30 minutes, it is anti-inflammatory drug, which function as a suppressor to the normal functioning of white blood cells, thus will work with, it reduces the risks for the patient for conditions such as stroke and heart attack thus proofing beneficial. Observed negative effects of the drug are that, they affect the digestive tract by causing episodes of vomits and ulcerative disorders.  Stomach bleeding, urinary system disorder such as renal dysfunction or acute failure in critical cases, allergic reactions and long term usage increases chronic heart failure symptoms.

This drug regime is appropriate for patient Jones due to his previous medical history of asthma, observation  of eruption occurring cutenoulsy, care should be aimed at maintaining  low doses for the patient is efficient, (Jowsey, et al., 2016).

Atrial fibrillation is characterised by the irregular heartbeats which can pose danger to the patient. The irregular electrical impulses from the heart are counteracted excessively by the impulses originating from the pulmonary veins, which leads to abnormal signal relaying of ventricular impulses that initiate the heart beats. The common change in the pathology is the fibrosis of the aorta blood vessel. It occurs due to dilation of the atrial, which is often caused by the abnormal structure of the heart that elevates the pressure in the heart. Also inflammations occur in cases the aorta fibrosis. The effect of sarcoidosis can cause this inflammation and also it can be caused by any immune disorders which are responsible for myosin heavy chains.

Question 1 on drug treatment

The initiation of atrial, progresses to chain of activities which facilitates the rennin aldosterone angio stensin system and the increases metalloproteinase functionality, which brings atrial remodelling and fibrosis into action, the end result is further muscle mass loss. This process is not initiated from a short duration of time but rather long term development.  Fibrosis occurs in many sites which include muscle mass and sinus node. There has been an association of fibrillation prolonging which have been shown to correlate with the sinus recovery process. Normal electoral conduction system of the earth is initiated by the Sino atrial node to propagate and stimulate the myocardium. Patients being positive of this have shown to have decreased levels of exercise and heart failure cases. Atrial function decline can eventually lead to stasis in the left atrium which shapes the thrombus formation and raises the stroke and thrombi embolism in the heart.

Amiodarone is a widely recognised drug for the change reversal of atrial fibrillation to sinus system hence it is appropriate for this case stufy of patient Jones. It as a drug indicator for the initiation treatment and the common prophylaxis for ventricular fibrillation for patients who have refractory effects. It is widely used to treat patients for acute treatments. It used till the ventricular arrythmiasis are made to be stable. Is a safe drug and can be used for long duration of time. The effect of this drug is it affects the rhythm of the heart, it is used to ventricular tachycardia or the fibrillation thus suitable for the patient.

The action plan of the drug is that a treatment dose of 1000 mg in the last 24 hours should be given in a regimen. Initial loading of 800-1600 mg per day are required as the first phase for a period of 1-3 weeks. It usually occurs that once the effect has been felt that is arrhythmia has been controlled; the dose shall be reduced to 600-800 mg /day. The side effects associated with the diseases are that they occur for a long time after completion of the drugs. They include, wheezing, cough, blurred vision, liver associated problems, overactive thyroid and underactive thyroid, abnormal liver function test, loss of coordination and tremors. The patient should avoid intake of grapefruit and its juice and voidance of exposure to sunlight, the effect it has on sunlight is that it makes you sun burn easily and that the patient should wear sun glasses for outdoor exposure. Finally patient Jones is expected to be taking frequent medical tests and x-rays pictures to monitor thyroid, vision, lung functionality and liver function tests. In essence following the doctor’s prescription is of essence to the patients.

Question 2 Pathphysiology

Anticoagulant regiment is necessary for the patient so as to prevent blood clothing in the vessels. Blood anticoagulation is important when dealing with blood clothing especially in atrial fibrillation. Warfarin is used as a blood thinner for blood clots such as thrombosis and embolism of the pulmonary veins, (anonymous, 2017). It decreases blood clotting by enabling the enzyme K oxide that reactivates vitamin k. It is an injectable drug and has long effect on the body and used combine with heparin to reduce an effect called thrombosis, and their effect lasts long duration for effect to be felt. The side effects experienced include bleeding, pain on the jab site and decreased side effects. To achieve full therapist effect of the drug, it takes between 0-5 days, (Ageno et al., 2012).

Dabigatran on the other end is an anticoagulant factor which is taken orally and has the same mechanism as warfarin. The uniqueness about this drug is that there are no tests required to be performed through blood tests, however it has the same functionality as warfarin. It has an antidote for bleeding encase patient develops excessive bleeding. This drug has been widely used as a preventive measure for strokes associate with atrial fibrillation and prevents deep pain vein thrombosis and embolism of the pulmonary. Dabigatran has same functional properties as warfarin in the prevention of strokes and embolism sin patients such as Jones who have atrial fibrillation, (Gomez et al.,2013). The contraindication of the drug is that it can cause excessive bleeding with patients who have excessive bleeding; in this case Jones doesn’t have a history of bleeding. The most noticeable side effects of the drug is that it has side effects on the gastrointestinal upset when compared to warfarin.

 For patient Jones, the appropriate drug that i can recommend and is comfortable with regarding his age and medical history is Dabigatran, it helps less side effects and produce efficient results for management of blood clotting, in this situation.

Salbutamol is a drug regimen that offers opening of the large air media in the lungs. It is a common drug to treat asthma just as this case, whom you have asthma in addition to atrial fibrillation. To aid its usage, a puffer or nebular is used, however pills are also available and intravenous entry, (Starkey Mulla, Sammons & Pandya, 2014).

Side effects that you may encounter include shakiness of the body, headaches, dizziness and the feeling of anxiousness and in extreme cases you may encounter irregular heartbeats and low potassium levels which is observed with low blood pressure. The drug functions in a way that it relaxes the smooth muscles in the air pathway and when inhaled it takes effect within the first fifteen minutes and last for longer durations of 2- 6 hours.

The drug is inhaled using aerosol inhaler and the recommendations are two puffs taken 4 times in a day in taking this medication follow strictly the doctor’s prescription, as it important not to exceed the set limits or you, and any noticeable change should be made to the doctor immediately. The dose given should not be missed and in case kip occurs, just don’t take more to compensate as it can have more harm to your body.

Conclusion

With effective case study management above, a well medical plan is achieved which gives you the standard of care for the patients. In this case patient Jones assessment will assist in achieving optimal care for both the patient and the patient attendant available for the patient.

References

Zoni-Berisso, M; Lercari, F; Carazza, T; Domenicucci, S (2014). “Epidemiology of atrial fibrillation: European perspective.”. Clinical epidemiology. 6: 213–20. doi:10.2147/CLEP.S47385. PMC 4064952?. PMID 24966695.

Munger, TM; Wu, LQ; Shen, WK (January 2014). “Atrial fibrillation.”. Journal of biomedical research. 28 (1): 1–17. doi:10.7555/JBR.28.20130191. PMC 3904170?. PMID 24474959.

Lip, GY (26 July 2011). “The role of aspirin for stroke prevention in atrial fibrillation.”. Nature Reviews. Cardiology. 8 (10): 602–06. doi:10.1038/nrcardio.2011.112. PMID 21788962.

Anonymus, (2013). “Myocardial infarction with ST-segment elevation: the acute management of myocardial infarction with ST-segment elevation [Internet]”. NICE Clinical Guidelines (167). 17.2 Asprin. July 2013. PMID 25340241.

Jowsey, T., Dennis, S., Yen, L., Mofizul Islam, M., Parkinson, A., & Dawda, P. (2016). Time to manage: patient strategies for coping with an absence of care coordination and continuity. Sociology of health & illness, 38(6), 854-873.

“Warfarin Sodium”. The American Society of Health-System Pharmacists. Retrieved 8 January 2017.

Ageno, W; Gallus, AS; Wittkowsky, A; Crowther, M; Hylek, EM; Palareti, G; American College of Chest, Physicians. (February 2012). “Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.”. Chest. 141 (2 Suppl): e44S–88S. doi:10.1378/chest.11-2292. PMC 3278051? PMID 22315269.

Gómez-Outes, A; Terleira-Fernández, AI; Calvo-Rojas, G; Suárez-Gea, ML; Vargas-Castrillón, E (2013). “Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups”. Thrombosis. 2013: 640723. doi:10.1155/2013/640723. PMC 3885278?. PMID 24455237.

Starkey, ES; Mulla, H; Sammons, HM; Pandya, HC (September 2014). “Intravenous salbutamol for childhood asthma: evidence-based medicine?”. Archives of Disease in Childhood. 99 (9): 873–7. doi:10.1136/archdischild-2013-304467. PMID 24938536.