Care Plan for Elderly Patient with Atrial Fibrillation: A Case Study

Desklib provides past papers and solved assignments for students. This report details a care plan for an elderly patient with atrial fibrillation.

Contents
INTRODUCTION..............................................................................................................1
BODY............................................................................................................................... 2
CONCLUSION................................................................................................................. 7
REFERENCES.................................................................................................................8
1

INTRODUCTION
Mrs Mary Tonin is a 77 years old female living alone in a suburb near Adelaide. She is
living alone in her house for the past 10 years when her husband died. She has three
sons from which two lives in Queensland and one son lives nearby her with his wife and
three grandsons. The patient has a history of a heart attack I 2016 with recent recovery
from a right-sided vascular accident in 2018. Her overall health is deteriorating with
recent incidents of dementia-like symptoms where she forgets important things and is
unable to do routine work on her own due to breathlessness. She spent her last is days
recovering from atrial fibrillation in a hospital and is very adamant of not going to care
home or aged care for her remaining life and wants to stay at her own house only. Her
2

son Sam received the caring authorization for her and is eligible to care for her now but
his responsibility towards his wife and children is forcing him to place her mother in an
aged care home and he is aware of his mother's wishes to not to go there. This
assignment is a written report that will highlight the care needs of Mary as well as plan
appropriate nursing interventions for the patient. It will also focus on explaining the role
of a nurse in the scenario and how the patient can be provided patient-centred care
without violation of her wishes and human rights.
BODY
Mary is 77 years old that makes her in the age group that has various limitations and
health issues associated with it. Old age brings together a variety of issues and health
concerns and as the patient has a history of Trans ischemic attack and cerebral
accident the vulnerability of the patient to get ill is higher in such an age (Cherry and
Jacob., 2016). Various care needs are identified in this particular patient involving
assessment of her care requirement with the help of different assessment aids. The
patient recovering from atrial fibrillation is identified to have following care requirements
that include routine screening from further disease progress, a specialized
multispecialty team including a cardiologist, stroke neurologist, subspecialist and
registered nurse (Hendriks et al., 2015). Atrial fibrillation deteriorates the health and
wellbeing of an individual and risks the patient to morbidity; the care that a patient
requires involves the personalized education and care package for self-management as
well proper interventions for control of heart rate and rhythm (Kirchhof et al., 2016).
According to NICE guidelines, the control of heart rate is an essential aspect of care
requirements for a patient with atrial fibrillation or history of Trans ischemic episode
(Mazurek et al., 2017). Another need identified is interventions to prevent stroke or
acute atrial fibrillation in this patient. The care plan should also cover the need for
providing appropriate pharmacological interventions to restrict the progress of the
disease and maintain normal heart conditions. The patient is not willing to spend her
remaining life in aged care home rather wants to live in her own house and this
requirement puts her at higher risk of falls, improper care due to dementia, lack of
resources and overall risk of death. Placing her in an aged care home will be violating
3

her human rights and can be done on unethical grounds (Lip et al., 2017). The best
suitable solution for this dilemma can be providing her community care at home with the
help of a registered nurse caring for her round the clock. This requirement is essential to
be identified as part of her care assessment and planning as this provides a sense of
empowerment and control to the patient while getting involved in own care planning
(Hendriks et al., 2015).
Different resources and procedures will be involved in promoting these requirements to
the patient in this case. Use of appropriate referrals and multitasking team containing all
the professionals listed above who would visit her once a month for routine checks and
follow up (Gough., 2017). As per NICE guidelines, the multispecialty team will be
delivering services that involve routine screening and follow up of the heart condition
and care of the patient (Mazurek et al., 2017). Use of appropriate choice of
anticoagulant therapy is also required to monitor and maintain the risk associated with
the stroke after atrial fibrillation but as the patient, in this case, is hypertensive the
anticoagulant therapy can be harmful to this factor, so the hypertensive state of the
individual needs to be modified with appropriate interventions before the therapy is
provided. According to Dutcher and Kathryn (2014), there is an increased associated
risk of anticoagulant therapy in older adults with hypertension. Rhythm control therapy
includes the use of catheterization in pulmonary veins that will provide a reduced risk of
stroke due to arrhythmias as well as the anti-arrhythmic medications can also be
provided in order to control the condition (Lip et al., 2017). Digoxin in a given case is
being prescribed it is essential to be delivered on a routine basis.
Other than ensuring pharmacological therapy and care to the patient to control the heart
disease and its progression the other aspects of care identified were to provide
community care at home services with help of a registered nurse (Ferguson et al.,
2015). Registered care nurse providing care at home has a duty to provide health and
social care to the patient in a community home setting. The duties of a registered nurse
involve providing hands-on care by administrating medication, observing and monitoring
the patient's health parameters, and maintain records and communicating the essential
information and follow-ups with the multispecialty team.
4

These duties of a registered nurse are to be followed under the NMC code of ethical
conduct that enables the nurse to promote dignity and respect while caring as well as
provide care including empathy and patient-centred principles. Here the nurse will be
taking care of Mary’s routine as well as her daily dose of medication and follow up for
recording her progress and recovery. Other than this the patient-centred care concept
includes nurse to provide care including the spiritual and ethical requirements of the
patient as well. As seen Mary is in her late 70s and old age is a risk factor associated
with falls as she recently has a history of fracture due to a fall (Ferguson et al., 2015).
Having a registered home nurse caring for her will empower her with control over her
decisions of staying at her house as well as provide better opportunities and quality of
life for remaining life. Dutcher and Kathryn (2014) examined in their study the transition
of the patient from a community setting to hospitals after atrial fibrillation was
somewhere correlated with the pharmacological therapy provided to them. The findings
revealed that transition planning involving high-quality pharmacotherapeutic care is
supported by the majority of the health care professionals as it promotes better health
and care to the individual (Gough., 2017). It is also beneficial to place the patient in this
case in their own home setting with a registered nurse that will provide the patient with
the basic requirements of her care plan and promote better recovery. According to the
study by Shepperd et al (2016) that was aimed at examining the quality of life and
recovery of patient transited to home care health setting. The research showed that the
end of life care at home can provide patient satisfaction as well as better health
outcomes during the follow up as well the immense pressure and burden on health care
is reduces slightly by such transitions of the patient at home (Seow et al., 2016).
Some of the main nursing interventions identified in this scenario are as follows. To
maintain adequate cardiac output and tissue perfusion, to achieve this nurse should
have proper education and knowledge regarding the signs and monitor it regularly and
in case inform the medical team immediately (Gough., 2017). In case of any emergency
treatment consent and proper documentation should be done by the nurse ensuring the
criticality of the emergency kept in consideration. To deliver appropriate medication as
prescribed so that the pharmacotherapy will help in monitoring the progress of disease
and aid in recovery. Patient education as well as the promotion of activities of daily
5

living like bathing, cooking, eating, involvement with social circle etc. should be involved
during caring for the patient at home setting.
CONCLUSION
Atrial fibrillation is becoming a rising cause of morbidity and mortality worldwide. The
major reason for this is the post care after the episode is not appropriately done in the
care setting and this leads to the non-compliances of pharmacotherapy with the care
transitions. In given case the care plan should involve the transition of the patient to her
own house with the appointment of a registered nurse at the home care setting that will
empower her wishes and provide patient-centered care as well the multispecialty team
has to be appointed to be following her up monthly to provide better quality care and
services. Hence it can be concluded that the role of a registered nurse, in this case, is
crucial and it will help in the achievement of better health outcomes for the patient.
6

REFERENCES
Cherry, B. and Jacob, S.R., 2016. Contemporary nursing: Issues, trends, &
management. Elsevier Health Sciences.
Dutcher, Sarah Kathryn ., 2014. Atrial Fibrillation Management and Care Transitions
among Nursing Home Residents. Published by Shen, Xian; Dutcher, Sarah K; Palmer,
Jacqueline et al. (2015) A Systematic Review of the Benefits and Risks of
Anticoagulation Following Traumatic Brain Injury. J Head Trauma Rehabil 30:E29-37.
Retrieved from (http://grantome.com/grant/NIH/F31-AG044091-01A1) last accessed on
1/04/2019.
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. and Davidson,
P.M., 2015. The caregiver role in thromboprophylaxis management in atrial fibrillation: A
literature review. European Journal of Cardiovascular Nursing, 14(2), pp.98-107.
Gough, H., 2017. Community nursing assessment. In A Textbook of Community
Nursing (pp. 132-146). Routledge.
7

Hendriks, J.M., Crijns, H.J. and Vrijhoef, H.J., 2015. Integrated chronic care
management for patients with atrial fibrillation–a rationale for redesigning atrial
fibrillation care. Journal of atrial fibrillation, 7(5).
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M.,
Diener, H.C., Heidbuchel, H., Hendriks, J. and Hindricks, G., 2016. 2016 ESC
Guidelines for the management of atrial fibrillation developed in collaboration with
EACTS. European heart journal, 37(38), pp.2893-2962.
Lip, G.Y., Freedman, B., De Caterina, R. and Potpara, T.S., 2017. Stroke prevention in
atrial fibrillation: Past, present and future. Thrombosis and haemostasis, 117(07),
pp.1230-1239.
Mazurek, M., Shantsila, E., Lane, D.A., Wolff, A., Proietti, M. and Lip, G.Y., 2017,
August. Guideline-adherent antithrombotic treatment improves outcomes in patients
with atrial fibrillation: insights from the community-based Darlington atrial fibrillation
registry. In Mayo Clinic Proceedings (Vol. 92, No. 8, pp. 1203-1213). Elsevier.
Seow, H., Barbera, L., Pataky, R., Lawson, B., O'Leary, E., Fassbender, K., McGrail, K.,
Burge, F., Brouwers, M. and Sutradhar, R., 2016. Does increasing home care nursing
reduce emergency department visits at the end of life? A population-based cohort study
of cancer decedents. Journal of pain and symptom management, 51(2), pp.204-212.
Shepperd, S., Gonçalves‐Bradley, D.C., Straus, S.E. and Wee, B., 2016. Hospital at
home: home‐based end‐of‐life care. Cochrane Database of Systematic Reviews, (2).
8