Branching Exercise: Cardiac Case 1: 63 Year Old Female

Branching Exercise: Cardiac Case 1: 63 Year Old Female

Week 2: 12-lead EKG Interpretation and Diagnostic Evaluation of Arrhythmias

Much like problems with a home’s heating and cooling system, arrhythmias begin with symptoms that often require expertise to diagnose. The symptoms of arrhythmias are routinely among the leading reasons for emergency room visits. Palpitations, racing hearts, anxiety, irregular heartbeats, and chest pain often alert sufferers to the potential for bigger problems. This puts cardiology squarely in the spotlight as the branch of medicine responsible for addressing not only arrythmias but the many cardiac and circulatory disorders that afflict so many each year.

As an advanced practice nurse, you must be prepared to effectively recognize, respond, diagnose, and treat these symptoms. Hence, it is important for nurses at every level of care to demonstrate expertise in heart arrhythmias as a component of cardiovascular care.

This week, you examine issues pertinent to arrhythmias. You examine diagnosis and management approaches to heart rhythm issues and the health problems that may trigger them. You also examine the tools used to help recognize and respond to these issues. 

Learning Objectives

Students will:

  • Interpret 12-lead EKGs
  • Discern arrhythmias within 12-lead EKGs
  • Develop appropriate treatment plans, including diagnostics and laboratory orders for patients with identified arrhythmias

Learning Resources – Branching Exercise: Cardiac Case 1: 63 Year Old Female

Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

  • Chapter 21, “Arrhythmias” (pp. 263–290)

Document: Admission Orders Template (Word document)

Required Media (click to expand/reduce)

MedCram. (2019, June 9). ECG interpretation explained clearly and succinctly – arrhythmias, blocks, hypertrophy [Video file]. Retrieved from https://www.youtube.com/watch?v=Rv6l0ViRJDQ

MedCram. (2018, July 15). ST elevation – EKG/ECG interpretation case 12 (STEMI, MI, ACS) [Video file]. Retrieved from https://www.youtube.com/watch?v=8ajWCLqz3VQ

MedCram. (2017, July 23). EKG/ECG practice strip interpretation explained clearly – case 10 [Video file]. Retrieved from https://www.youtube.com/watch?v=zA1Dpwnzrxg

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1 [Interactive media file]. Minneapolis, MN: Author.

Antiarrhythmic Drugs for the AGACNP

Dr. Tony Anno, core faculty for the AGACNP program at Walden University reviews that cardiac cycle and arrythmia pathophysiology. A review and discussion on the use of antiarrhythmic drugs that the AGACNP may encounter in practice is also provided. (18m)

 

ECG Review for the AGACNP

Dr. Tony Anno reviews important concepts and skills needed in understanding and interpreting ECGs for the AGACNP in practice. This review will also build upon you previous knowledge and expertise in diagnosing and treating cardiac disorders. (14m)

 

Assignment: Branching Exercise: Cardiac Case 1

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

Branching Exercise: Cardiac Case 1: 63 Year Old Female

Photo Credit: [IMAGEMORE Co., Ltd.]/[none]/Getty Images

To prepare:

  • Review the interactive media piece/branching exercise provided in the Learning Resources.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
  • You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

  • Be sure to address each aspect of the order template
  • Write the orders as you would in the patient’s chart
  • Make sure the order is complete and applicable to the patient
  • Any rationale you feel the need to supply should be done at the end of the order set – not included with the order
  • Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.
  • A minimum of three current, evidenced based references are required.
By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Scenario #1 63 year old female (Branching Exercise: Cardiac Case 1: 63 Year Old Female)

63 year old female

Decision Point One

Branching Exercise: Cardiac Case 1: 63 Year Old FemaleAtrial Fibrillation with Rapid Ventricular Response

RESULTS OF DECISION POINT ONE

  • Correct!

Decision Point Two

Branching Exercise: Cardiac Case 1: 63 Year Old Female12 lead EKG, TSH, CBC CMP

RESULTS OF DECISION POINT TWO

  •  Correct!
  • These tests are all indicated to evaluate this rhythm and the potential pathophysiology related to this rhythm.

Decision Point Three

Branching Exercise: Cardiac Case 1: 63 Year Old FemaleMetoprolol tartrate 2.5 mg IV bolus over 2 minutes

Guidance to Student

Correct.

Rate control in this patient is the first priority in order to enable ventricular filling and cardiac output. This would treat the initial symptoms and then medications for rhythm control can be considered.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “MD2Assgn1+last name+first initial.(extension)” as the name.
  • Click the Module 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
  • Click the Module 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD2Assgn1+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Module 2 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Module 2 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Module 2 Assignment 1

Rubric Detail – Branching Exercise: Cardiac Case 1: 63 Year Old Female

Select Grid View or List View to change the rubric’s layout.

Name: NRNP_6566_Module2_Assignment1_Rubric

ExcellentPoint range: 90–100 GoodPoint range: 80–89 FairPoint range: 70–79 PoorPoint range: 0–69
Using the Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. Be sure to address the following:
· Identify the Correct Diagnosis.
5 (5%) – 5 (5%)
The order set includes an accurate and correct diagnosis.
4 (4%) – 4 (4%)
The order set includes a diagnosis that is an appropriate differential diagnosis.
3 (3%) – 3 (3%)
The order set includes a diagnosis that is incorrect and not supported by patient data.
0 (0%) – 2 (2%)
The order set includes and inaccurate / dangerous diagnosis.
· Identify the ‘Status/Condition’, ‘Code Status’, ‘Admit to Unit’
for the patient in the presenting case.
5 (5%) – 5 (5%)
The order set includes an accurate description / plan for condition, code status, and admission location.
4 (4%) – 4 (4%)
The order set includes an accurate description for 2 of the 3 variables.
3 (3%) – 3 (3%)
The order set includes an accurate description for 1 of the 3 variables.
0 (0%) – 2 (2%)
The order set includes inaccurate, missing, or dangerous descriptions for these variables.
· Describe the “Allergies’, ‘Activity Level’ and “Diet” for the patient in the presenting case.
5 (5%) – 5 (5%)
The order set includes an accurate description / plan for allergies, activity level, and diet.
4 (4%) – 4 (4%)
The order set includes an accurate description for 2 of the 3 variables.
3 (3%) – 3 (3%)
The order set includes an accurate description for 1 of the 3 variables.
0 (0%) – 2 (2%)
The order set includes inaccurate, missing, or dangerous descriptions for these variables.
· Identify any ‘IV Fluids’ needed for the patient in the presenting case.
9 (9%) – 10 (10%)
The order set clearly and accurately identifies a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
7 (7%) – 8 (8%)
The order set is missing 1 element of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
5 (5%) – 6 (6%)
The order set is missing 2 elements of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
0 (0%) – 4 (4%)
The order set is incomplete, includes wrong / dangerous fluids or flow rate, incorrect parameters for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
· Identify any ‘Respiratory’ needs for the patient in the presenting case. Be specific about oxygen (if ordered, include type and rate), pulmonary toilet needs, and ventilator settings.
5 (5%) – 5 (5%)
The order set clearly and accurately identifies a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
4 (4%) – 4 (4%)
The order set is missing 1 element of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
3 (3%) – 3 (3%)
The order set is missing 2 elements of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
0 (0%) – 2 (2%)
The order set is incomplete, includes wrong / dangerous orders, or incomplete parameters for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
· Describe the ‘Medications’ including any IV drips for the patient in the presenting case.Be specific about medications related to the reason for admission and any chronic medications the patient may be taking (ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc.). Be sure to include name, dose, route of administration, and frequency of each medication.
13 (13%) – 15 (15%)
The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. Orders are complete, account for all conditions, and are appropriate to treat the patient.
10 (10%) – 12 (12%)
The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. There are incomplete orders, missing medications, or missing elements in the orders.
5 (5%) – 9 (9%)
The order set is missing essential elements of a medication order, missing medications, or are inappropriate to treat the patient in the presenting case.
0 (0%) – 4 (4%)
The order set is incomplete, includes wrong / dangerous orders, or inappropriate medications to treat the patient in the presenting case.
· Explain any ‘Nursing Orders’ for the patient in the presenting case. Be specific about vital signs, skin care, toileting, and ambulation.
9 (9%) – 10 (10%)
The order set includes a full set of nursing orders that provide essential direction to provide care, monitor, assess, ensure safety, prevent complications and promote healing.
7 (7%) – 8 (8%)
The order set include inaccurate or is missing 1 or 2 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
5 (5%) – 6 (6%)
The order set include inaccurate or is missing 3 or 4 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
0 (0%) – 4 (4%)
The order set include inaccurate, missing, or provides dangerous nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
· Explain the ‘Follow-Up Lab’ tests for the patient in the presenting case. Be specific about diagnostic testing (e.g., CXR, US, 2D Echo, etc.).
9 (9%) – 10 (10%)
The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
7 (7%) – 8 (8%)
The order set includes most (missing 1 or 2) laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
5 (5%) – 6 (6%)
The order set includes some (missing 3 or 4) complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
0 (0%) – 4 (4%)
The order set is missing essential laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
· Explain the ‘Consults’ for the patient in the presenting case. Be specific about how you, as an ACNP, would manage the patient’s acute needs for at least a 24-hour period. Include indication for consult (e.g., “Cardiology consult for evaluation of new-onset atrial fibrillation,” “Nutrition consult for TPN recommendations”).
5 (5%) – 5 (5%)
The order set includes clear, accurate, and essential consults for the patient in the presenting case including complete rationale for the consult.
4 (4%) – 4 (4%)
The order set is missing one of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.
3 (3%) – 3 (3%)
The order set is missing 2 or more of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.
0 (0%) – 2 (2%)
The order set is missing multiple consults, rations, or accurate descriptions for consults needed to manage the presenting patient.
· Explain the ‘Patient Education and Health Promotion’ for the patient in the presenting case. Be sure to address age-appropriate patient education, if applicable.
9 (9%) – 10 (10%)
The order set provides clear, accurate, and complete patient education and health promotion recommendations for the patient in the presenting case.
7 (7%) – 8 (8%)
The order set is missing 1 or 2 essential elements of patient education and health promotion for the patient in the presenting case.
5 (5%) – 6 (6%)
The order set is missing 3 or 4 essential elements of patient education and health promotion for the patient in the presenting case.
0 (0%) – 4 (4%)
The order set is missing multiple essential elements of patient education and health promotion for the patient in the presenting case.
·(5%) – 5 (5%)
The order set provides clear, accurate, and complete discharge planning and necessary follow up care for the patient in the presenting case.
4 (4%) – 4 (4%)
The order set is missing 1 or 2 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
3 (3%) – 3 (3%)
The order set is missing 3 or 4 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
0 (0%) – 2 (2%)
The order set is missing multiple essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
· Identify a minimum of three ‘References.’ Be sure that they are timely and support the admission order in following current standards of care.
9 (9%) – 10 (10%)
The order set includes a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. References are formatted in APA format.
7 (7%) – 8 (8%)
The order set does not include a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. APA format is incorrect.
5 (5%) – 6 (6%)
The order set does not include a minimum of three references or includes non-professional level resources to support their admission order set. APA format is incorrect.
0 (0%) – 4 (4%)
The order set is missing minimum number of references or includes poor sources that do not reflect professional writing or current standard of care information. APA format is not followed.
Written orders include all elements, address all the needs of the patient, are complete, logical, and meets the complete needs of the patient.
5 (5%) – 5 (5%)
Written order set is complete, addresses all the needs of the patient, and are based on current literature.
4 (4%) – 4 (4%)
Written orders are mostly complete only missing 2 essential elements in addressing the needs of the patient.
3 (3%) – 3 (3%)
Written orders are missing 3 to 4 essential elements are reflect an incorrect standard of care.
0 (0%) – 2 (2%)
Written orders are incomplete, do not address the needs of the patient, or reflect an outdated standard of patient care.
Total Points: 100

Name: NRNP_6566_Module2_Assignment1_Rubric