Nursing Discussion Post – CPGs Related to Cardiac Conditions

Nursing Discussion Post: CPGs Related to Cardiac Conditions
TOTAL POINTS POSSIBLE: 50 POINTS

PREPARING THE ASSIGNMENT
Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.

General Instructions

Step 1: Identify your assigned client from the Week 2 Explore lesson. Your assignment is based on the first letter of your last name in the chart below. Review your assigned clinical application activity from the lesson. The client case link will take you to the page in the lesson where the respective case is located. Scroll to the bottom of the page to locate the client case.

Last Name Client from Week 2 Lesson
A – E Malia Mowry
F – J Raymond Collins
K – N Gertrude Green
O – R Arthur King
S – V Peter Xi
W – Z Tyrone Ball
Step 2: Assess the client’s case, the applicable clinical practice guideline (CPG), and the prescription writing activity for that client within the lesson.

Step 3: Answer the discussion prompts below with explanation and detail, providing complete references for all citations. Refer to the lesson for client information.

Step 4: Reply to peers with a different assigned client.

Include the following sections:

Application of Course Knowledge: Answer all questions/criteria with explanations and detail.

Describe your assigned client’s situation. Why are they presenting to the clinic? What medications are they currently taking?

Assess the applicable clinical practice guideline (CPG) for your assigned client linked on the same page in the lesson where the client case is located. What treatment is recommended by the CPG for your client’s situation?

Discuss your personal professional assessment of the client’s situation provided in the scenario. What pharmacological treatment is necessary and why?

Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?

NR565.

Arthur King, a 65-year-old male (DOB: 10/5/1959), presents to the clinic today one day after discharge from the hospital with a new diagnosis of atrial fibrillation in need of medication for anticoagulation while waiting for an ablation. His labs indicate normal renal function, stable blood sugar, and an INR of 1. His physical exam is unremarkable.

Allergies: Aspirin
Past Medical History: Type 2 Diabetes, Hypertension, Heart Failure with preserved ejection fraction (HFpEF)
Medications: Hydrochlorothiazide (HCTZ) 25mg PO daily, glucophage (Metformin) 500mg PO BID, captopril (Capoten) 25mg PO q12hr, and verapamil (Calan) 120mg PO TID
Social History: The client drinks 4-5 drinks per week and quit smoking 5 years ago.
Physical Exam:

HEIGHT: 5’10”

BP: 126/79

O2 Sat: 95% on RA

WEIGHT: 250 lbs

HR: 84 (Afib)

TEMP: 98.5 oral

BMI: 35.9

RR: 16

References:

January, C. T., et al. (2019). 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 74(1), 104-132.

Lip, G. Y. H., et al. (2018). Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report. Chest, 154(5), 1121-1201.

Hindricks, G., et al. (2020). 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the EACTS. European Heart Journal, 42(5), 373-498.

Topics.

“Clinical Practice Guidelines for Managing Atrial Fibrillation in High-Risk Patients”

“Anticoagulation Therapy in Atrial Fibrillation: A Case Study Approach”

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Nursing Discussion: Clinical Practice Guidelines (CPGs) for Atrial Fibrillation
Application of Course Knowledge
Client Situation
Arthur King, a 65-year-old male, presents to the clinic one day after hospital discharge with a new diagnosis of atrial fibrillation (AF). He requires anticoagulation therapy while awaiting an ablation. His medical history includes type 2 diabetes, hypertension, and heart failure with preserved ejection fraction (HFpEF). His current medications include hydrochlorothiazide, metformin, captopril, and verapamil. He is allergic to aspirin, drinks 4-5 alcoholic beverages per week, and has a BMI of 35.9, indicating obesity. His renal function is normal, blood sugar is stable, and INR is 1.

Applicable Clinical Practice Guideline (CPG) Recommendations
The 2023 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend oral anticoagulation for AF patients at risk of stroke. Given Mr. King’s age, history of hypertension, and diabetes, the CHA₂DS₂-VASc score likely indicates a need for anticoagulation therapy. The preferred first-line anticoagulants are direct oral anticoagulants (DOACs), such as apixaban (Eliquis) or rivaroxaban (Xarelto), due to their lower bleeding risk and ease of use compared to warfarin. Warfarin may be considered if DOACs are contraindicated, but it requires frequent INR monitoring, which may not be ideal given his stable renal function and preference for convenience.

Professional Assessment and Pharmacological Treatment
Given Mr. King’s medical profile and aspirin allergy, a DOAC such as apixaban 5 mg PO BID or rivaroxaban 20 mg PO daily is appropriate. These agents reduce stroke risk while minimizing bleeding complications. Warfarin would require close INR monitoring, which is unnecessary with DOACs. Verapamil, a calcium channel blocker, may interact with DOACs by increasing their plasma concentration. Dose adjustments or alternative anticoagulants might be needed if verapamil is continued.

Additional Considerations and Follow-Up
Further assessment is required to confirm adherence and monitor potential drug interactions. Additional considerations include:

Renal Function Tests: Although currently normal, ongoing monitoring is essential due to potential nephrotoxic effects.
Liver Function Tests: Needed to assess metabolism and safety of DOACs.
Alcohol Consumption: Education on reducing alcohol intake to prevent bleeding risks.
Weight Management: Addressing obesity may improve cardiovascular outcomes.
Blood Pressure Control: Ensuring antihypertensive therapy remains optimal while preventing hypotension.
Close follow-up is required to evaluate bleeding risks, medication adherence, and the timing of ablation.

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