A 78-year old woman is admitted to a Medical unit directly from her physician’s office for evaluation and management of congestive heart failure. She has a history of systemic hypertension.

The initial assessment completed by the RN of the assigned patient reveals a pulse rate that is rapid and very irregular. The patient is restless, her skin is pale and cool, she states she is dizzy when she stands up and she is slightly short of breath and anxious. Her BP is 106/88. Her ECG monitor pattern shows uncontrolled atrial fibrillation with a heart rate ranging from 150 -170 beats/min. Her respirations are 20/min and her O2 saturation is 90%.

1. Given the findings, what should be the first action of      the practical nurse?
2. What additional data would the practical nurse collect?
3. Discuss the potential complications of cardioversion  and patient preparation for an elective cardioversion. Because the length      of time the patient has been in atrial fibrillation is unknown, what      adverse reaction may occur?

Later that evening the patient calls the nurse because she feels “like something terrible is going to happen.” She reports chest pain, has increased shortness of breath, and has coughed up blood-tinged sputum.

1. Based on these symptoms, what might you suspect is      happening?
2. What is the first thing the practical nurse should do      and what further information would you expect to be collected?

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