M.H. is a 70-year-old man who comes

M.H. is a 70-year-old man who comes to your clinic requesting a routine blood pressure check. When you palpate his radial pulse you notice that it is irregular. 1. What should you do next? 2. M.H. reports that he has been feeling fine. After reviewing the ECG, his provider determines that he is in A-fib (atrial fibrillation). How would you explain A-fib to the patient? 3. Why is the provider concerned about M.H. having A-fib? 4. The provider orders the following studies to further evaluate the A-fib: echocardiogram, Holter monitor, chest x-ray, CBC (complete blood count), thyroid function, and chemistry panel. How would you explain these procedures and why they were ordered for the patient? The studies showed that M.H. has atrial fibrillation not caused by any identifiable factors. The provider decided to anticoagulant M.H. with warfarin for 3 weeks prior to cardioversion. M.H. has many questions about anticoagulation and cardioversion. 5. Explain the terms anticoagulation and cardioversion to M.H. 6. M.H. is cardioversion successful and 4 weeks later his warfarin is stopped. You understand that cardioversion is not always successful long term. What patient education should M.H. know regarding atrial fibrillation? 7. M.H. eventually develops chronic A-fib and is placed on lifelong warfarin therapy. You instruct him to monitor and report complications of warfarin therapy. Identify two main areas of concern and list four signs or symptoms for each. 8. What should an anticoagulated patient do if he or she notes any of these signs or symptoms? 9. M.H. asks what he should do if he forgets to take his medication. 10. What can you suggest to help him remember to take his medication? 11. What other factors may influence medication complication?

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