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Case Study on permanent pacemaker Assignment PDF

   

Added on  2021-02-19

11 Pages2806 Words90 Views
Caring the pt who will needpermanent pacemaker

TABLE OF CONTENTSINTRODUCTION..........................................................................................3ESSAY ...........................................................................................................3Reflections.................................................................................................7REFERENCES.............................................................................................10

INTRODUCTIONThe case was based on Mrs Jennette 85 years old who came to thehospital with the dizziness and shortness of breath indicating the symptomsof bradycardia. The case highlights the symptoms of slow Atrial Fibrillation(AF) causing bradycardia. The report will cover about my understanding onthe case which will include about symptoms of bradycardia, normal heartrate, in the form of case summary. The report will also present reflectionwriting in which I will discuss my personal experience and learning which Ihas gained by this case study as well as the research which I have performed(Reflective writing, 2018). ESSAY An 83 years old lady, who will be referred as Mrs Jenette to protecther identity came with shortness of breath, slow heart rate, dizziness etc.,which are the symptoms of bradycardia. On admission vital signs taken asit will be key for the initial evaluation. 12 lead ECG performed as itsimportant and most diagnostic value to analyses rhythm and identifypotential ischemic changes which in case of Mrs Jennette showed slow AF.Physical examination also performed as it will help with the signs ofhypoperfusion such as cyanosis, diaphoresis, altered mentation, pallor andweak pulses. Assessed heart sound and lungs for the signs of pulmonarycongestion. Blood investigations also taken including serum electrolytelevels, Blood Urea Nitrogen (BUN) and creatine to assess the renal functionand kidney injury including creatine kinase, troponin, thyroid function testand B -type natriuretic peptide (BNP) will help in assessing ischemia, heartfailure and myocardial injury (Murano & Stark, 2017). In addition, serumdrug levels for medications is also measured as Mrs Jennette was onmedication digoxin regularly, which the results showed all reports wereunder normal levels. Cardiologist reviewed all her past medications andincluding present. Chest radiograph performed to assess pulmonary vascularcongestion as in Mrs Jenette was normal. By analysis it was found that theMrs Jenette has a past history of AF and 2:1 Heart Block (HB). HB is a

disease of electrical conduction system of heart. It can occur any part of theconduction system and can be transient or permanent (Olson, 2014). MrsJennette has a history of Tricuspid Regurgitation (TR), Atrial Regurgitation(AR), DVT and pericarditis. She also had a problem of right bundle branchblock which is resolved in 2018. As Mrs Jennette came on admission with slow AF which is a sign ofbradycardia. A bradycardia is defined as slow heart rate which is less than60 beats per minute (Murano & Stark, 2017). As a normal heart rate of aperson is between 60 and 100 per minute. While the heart rate which isnoted in Mrs Jenette was 35/44 beats per minute which is quite low thannormal heart rate. Therefore, in order to provide treatment to the patient shewas kept in observation and it was noted that the body temperature of MrsJennette was 36.5, Pulse was about 35-44/min, and blood pressure recordedis 140/85. However, AF is not alone is the sign of bradycardia, some othersymptoms such as dizziness and shortness of breath can be seen in patientwhich indicates that it might be possible that she is suffering frombradycardia (Bonikowske et.al., 2019). Mrs Jenette showing symptoms of bardycardia with slow AF uponmonitoring. She was seen by the cardiologist and kept for observation. Theinitial management for bradycardia is stabilization of ventricular rate byboth pharmacological and nonpharmacological intervention. She wasadmitted in Coronary Care Unit (CCU) for cardiac monitoring, and kept inCCU for 4 days by withholding her regular medications with a metoprololas being betablockers and digoxin is an inhibitor of ATPase enzyme whichboth medications can decrease the heart rate (Cardiovascular Expert Group).Joanne states (Discussion Group) by withholding or reducing thosemedication can obtain increased heart rate (Olson, 2014). Barrett et al(2012), states bradycardia is a sign of general conduction system disease oriatrogenic due to the medication used for AF control. After observation of 4days she was prepared for procedure permanent pacing insertion. The reason

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