PathosynthesisOur patient came to the hospital for a TURP procedure. Following the procedure our patient’s vital signs drastically decreased which concerned the medical staff. The patient’s overall trajectory of care was altered due to the new diagnosis.Patient PresentationOur patient was originally admitted for a transurethral resection of the prostate procedure (TURP procedure). The procedure is mainly done because of an enlarged prostate due to benign prostate hyperplasia. It relieves a patient suffering from moderate to severe urinary problems most commonly used when medicine isn’t working properly or as hoped. It is a simple, minimally invasive procedure that doesn’t involve any surgical incisions. The doctor goes in through the penis and into the urethra with a visual and surgical tool so he is able to see what he or she is doing when they start trimming away the excess prostate tissue that is causing the main issue. Following the procedure right before our patient was able to be discharged, his vital signs rapidly decreased. His readings were as followed:”Radial pulse: irregular, apical pulse: 122 and irregular, blood pressure: 102/60 and his cardiac rhythm was interpreted as Atrial Fibrillation.” Considering our patient was soon to be discharged, his vital signs would not have been irregular or they would not have had the plan to be send him home. His other symptoms were he complained of not being able to catch his breath, extreme heart palpitations and diaphoretic. We came to the conclusion that these symptoms are all results of his atrial fibrillation which put him at a huge risk for blood clotting that can lead to a stroke. Atrial fibrillation is when the atria’s of the heart are not pumping effectively, they quiver rather than pump which leaves an excess of blood behind causing there to be a smaller amount of blood distributed to the rest of the body. The residual blood does not leave the heart therefore can lead to blood clots throughout your body. The most severe case of blood clots are a pulmonary embolism, deep vein thrombosis and a stroke. Atrial FibrillationAtrial fibrillation is an abnormal condition of the heart where the atria’s of the heart quiver rather than pump. As a result of the quivering, the heart is unable to pump out all of the blood that is pumped into the heart. In the end, there is a residual amount of blood left in the heart. When the residual blood is in the heart, it is not moving, therefore the formation of clots can occur. Atrial fibrillation causes a decreased cardiac output of 66% along with a decreased oxygen capacity. Due to the atrial fibrillation, the heart is working overtime which explains the patient’s irregular heartbeat, irregular blood pressure, the feeling where his heart is pounding out of his chest and lightheadedness. Overall, atrial fibrillation is detrimental on our patient and can cause numerous health problems.GapsThrough the provided data, it is evident that our patient has atrial fibrillation. However, there are other tests that could and should be done to confirm the diagnosis. Key tools used to detect atrial fibrillation are a holter monitor and an event reporter. This tool records the patient’s heart as electrical signals travel through. The one major difference between the holter monitor and the event reporter is that the holter monitor records the patient’s heart over a 24 hour period where the event reporter records the patient’s heart over a course of weeks to months. Another test that can be done is an echocardiogram. Through the use of the electrocardiograph, the heart is monitored with the use of sound waves to have a video image of the patient’s heart. Stress tests are also an effective method to monitor the heart during multiple situations to see how the heart works under the stress and pressure the patient is enduring. The final way to test our patient would be running multiple blood tests showing the levels of a few different things that are indications of his atrial fibrillation. Some of the lab values that we would want to monitor are his troponin levels, which can be the key indication for us to see if our patient has had a myocardial infarction which is a possibility because of his atrial fibrillation. A complete blood count test should be ran so we could monitor his platelet count for a blood clots, his red blood cell count and hematocrit and hemoglobin levels should also be monitored to keep an eye on his circulation and his oxygenation levels. Complications, Laboratory, and Diagnostic StudiesAtrial fibrillation can cause severe complications due to our patient’s lack of circulation. Because of the abnormal cardiac rhythm causing the heart to inadequately pump out blood, complications can arise and increase the chances of forming blood clots which can lead to strokes, heart failure, and unfortunately even death. To reduce these risks, it is vital that we reset the heart to get back to a healthy sinus rhythm and keep it under control in our patient at all times. Two different routes we could use to restore the sinus rhythm include electrical cardioversion and cardioversion using drugs. Electrical cardioversion is performed by placing paddles on the patients chest and then using an electrical shock in hopes to start it back on track. If that route is unsuccessful, we should look into using drugs to reverse the rhythm back to normal. The medications that could potentially work would be antiarrhythmics which aid in restoring a person’s normal sinus rhythm. Trajectory of Care After researching and learning more about our patient’s main issue planning the care and discharge plans he would need seemed to fall into place. The main goal of caring for someone living with atrial fibrillation is to reset the heart immediately, maintain a sinus rhythm and prevent possible complications that can lead to ultimately larger problems for the patient. There are many ways to successfully do those things, starting with your doctor prescribing the antiarrhythmic medications to prevent any future atrial fibrillation episodes and heart rate control medications that only maintain a normal heart rate at rest so additional medications such as calcium channel blockers and beta blockers for times of activity. There are four procedures that can be considered for the chance that medications and cardioversion wasn’t successful. They are, catheter ablation, surgical maze procedure, atrioventricular node ablation and left atrial appendage procedure. Each procedure is done as a last resort after the least invasive interventions weren’t successful. Last but not least, the most important preventative action to be known by the patient would be taking their prescribed anticoagulant medicine to prevent the blood clots. The patient being aware of what to do when he notices his heart rhythm going irregular is important because all the severe complications can be prevented if the atrial fibrillation is reversed early enough.