A client has developed atrial fibrillation, which has a ventricular rate of 150 beats per minute. A nurse assesses the client for:
A. Hypotension and dizziness
B. Nausea and vomiting
C. Hypertension and headache
D. Flat neck veins
Correct Answer: A. Hypotension and dizziness
The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. A physical exam should always begin with the assessment of airway breathing and circulation as it is going to affect the decision making regarding management. On general physical examination, patients may have tachycardia with an irregularly irregular pulse.
Option B: The presentation of AF can range from asymptomatic to devastating complications such as cardiogenic shock and ischemic stroke. A complete history should focus on symptoms such as palpitations, chest pain, shortness of breath, increased lower extremity swelling, dyspnea on exertion, and dizziness.
Option C: In addition, history is imperative in identifying risk factors such as hypertension, history of valvular, structural, or ischemic heart disease, obstructive sleep apnea, obesity hypoventilation syndrome, smoking, alcohol intake, illicit drug use, history of rheumatic fever/heart disease, history of pericarditis, and hyperlipidemia.
Option D: The physical exam should focus on identifying the cause of AF. For instance, examining the neck of the patient may give some clues regarding carotid artery disease or thyroid problems. The pulmonary examination may reveal signs of heart failure in the form of rales, and the presence of wheeze may indicate antecedent pulmonary diseases such as asthma and chronic obstructive pulmonary disease (COPD).
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