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Atrial fibrillation etiologypathophysiology
Atrial fibrillation etiologypathophysiology
Atrial dysrhythmias
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In today days Atrial Fibrillation (AF) is the most common cardiac dysrhythmia that is often seen in clinical practice. There are 700,000 strokes in the USA each year and 15% of it caused by Atrial Fibrillation. For a long period of time warfarin was the only oral anticoagulant available in the US for patients with atrial fibrillation to prevent stroke events. Recently a new oral anticoagulants, including apixaban, dabigatran, and rivaroxaban have been developed and became available in the US for the stoke prevention and systemic embolism for patients with atrial fibrillation. Now, when all three new anticoagulants are available as an alternative to warfarin for the same indication, they make the health care providers question which agent is the best and for which patients. New agents have practical advantages over warfarin that has many limitations such as need for monitoring, regular dose adjustment, food and drug interaction and side effects. The major goal of the health care providers is to prescribe the safest and the most effective alternative drug and dose to each individual patient with AF. However, the approval for clinical use by the Food and Drug Administration (FDA) and the European Medicine Agency differ for anticoagulants and their dosages, and for the individual indication (Harenberg & Kraemer, 2012). Thus, more research needs to be done regarding the monitoring tools for new anticoagulant agents, and extend the use of these agents to other patient population. Keywords: anticoagulants, apixaban, dabigatran, rivaroxaban, warfarin, atrial fibrillation, stroke. Warfarin or New Anticoagulant for Stroke Prevention in Patients with Atrial Fibrillation Atrial Fibrillation (AF) is one of the most common arrhythmias that ... ... middle of paper ... ...s and may not fully understand the importance of their medication, therefor, Advanced Practical Nurse should take every opportunity to reinforce the need of the patients to adhere to anticoagulant therapy and may play an important role in patient’s adherence by providing constant education about their health condition and the importance of their medication. More research should be done on new oral anticoagulants with different study population and similar patients that are seen in everyday clinical practice as well as attempt to define the best pharmacodynamic monitoring tools. Research should be conducted to outline monitoring protocol including timing relative to dosing and frequency as well as therapeutic targets. Using these strategies, future trials could enhance further the efficacy and safety of these new agents and could extend their use to new indications.
...estions if not 100% sure of something or use a double checking system. When a nurse is administrating medication, they should use the ten rights of medication administration (right patient, right drug, right route, right time, right dose, right documentation, right action, right form, right response, and right to refuse). Nurses should always keep good hand hygiene and always wear appropriate clothing to prevent from the spread of disease. Good communication with patients and healthcare team members is also key to success. Keeping on the eye on the patient within an appropriate time is important. If the patient ever seems to be looking different than their usual self vitals should be taken immediately. Encouraging patients to ask questions if they are unaware of something can prevent errors as well. Nurses should make sure the patient is on the same page as they are.
27-Ussia GP, Scarabelli M, Mulè M, et al. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.Am J Cardiol 2011;108:1772–6.
(14) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD.. (2009). Dabigatran versus warfarin in patients with atrial fibrillation.. New England Journal Of Medicine. 361 (12), 1139-51.
“Chronic diseases and illnesses are the leading causes of death and disability in the United States” (CDC.gov, 2014). These types of illnesses are the most common health problems that people in this country face today and they are also the most preventable (CDC.gov, 2014). Every year the cost to help care for and manage people with these types of illnesses increases and there is less being done about educating people about prevention. Venous Thromboembolism is one such chronic disease that is very deadly but also very preventable if the right precautions are taken. This paper will aim to educate about the disease, courses and costs of treatment, clinical microsystems that are involved and what barriers if any exist to achieving generative relationships among the various clinical microsystems involved.
nurse becomes the patient advocate letting the physician know the effect of the medication the
It is important to evaluate which learning style your patients prefer in order for them to best understand what needs to be done for the maximum appropriate outcome. Licensed practical nurses are advocates and that’s someone who supports and supplies information to their patients. Advocacy often involves standing up in support of a patient and their rights. This is especially true when patients are not able to protect their own rights. When filling the role of counselor, Licensed Practical Nurses can help patients and families explore ideas and feelings towards healthcare and illness (8 Roles of the LPN). Some patients have a difficult time accepting a disease or its treatment options. As a practical nurse you consult with RN supervisors regarding patient care and assessments. In some settings LPN 's communicate directly to physicians. Communicating information to the proper people assists in increasing the effectiveness of care plans (Role). As practical nurses we are only one part of a patient care team. Other important members include RN 's, CNA 's, physicians, physical/occupational/speech therapists, dietitians, volunteers, and more (8 Roles of the LPN). With such a large team, every member has their own scope of
The American Nurses Association (2008) has defined the FNP, under the broader title of Advanced Practice Registered Nurse (APRN), as one “who is educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic i...
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
Warfarin is the main anticoagulant used in the UK and it works by intervening with the production of vitamin K. This essential vitamin is used in the clotting process and it works by acting on the proteins that form part of the clotting process in your body. Warfarin has a narrow therapeutic window so a lot of dosages of warfarin are needed and this makes dosing problematic. So usually half a milligram at a time is g...
Recently stroke in young people who had been considered to have a lower risk of stroke has been reported and the number is increasing. Atrial fibrillation (AF) is known as a major risk of stroke and anticoagulation therapy is recommended. Particularly non-valvular AF (NVAF) patients can be treated with direct oral anticoagulants (DOACs) recently approved. It is reported that clinical introduction of DOACs were advancing, and factors affected on DOACs prescription were studied using everyday practice data in other countries. Although several registry are beginning to be conducted, there is no study focused on anticoagulant therapy in everyday clinical practice which consisted with physician office in Japan. Furthermore, there
Decision making in RN’s practice starts with the beginning of a nurse’s day. The nurse must prioritize which patient to access first and which patient to administer medications first, especially in light of upcoming surgeries and procedures. The nurse must also consider patient’s current blood and other test results in order to decide whether it might be necessary to contact the healthcare provider and report any abnormalities. Since the nurse is the person that is the most with the patient during his hospital stay, she is the one that is the most familiar with that patient and his condition. Therefore even a subtle change she notices in her patient’s condition on assessment, can lead to change of treatment which in some cases might save that patient’s life or greatly contribute to the positive o...
Anticoagulants agents are medicines used to reduce clotting in an artery, a vein, or the heart. These clots can block the blood flow to your heart muscle and could cause the patient to have a heart attack. This blockage can also block blood flow to your brain, causing a patient to have a stroke. There are several types of anticoagulants like warfarin and heparin. Certain labs such as INR and PT have to be done before warfarin is given and the PTT must be checked also before giving heparin. It’s important to know this because if a patient is already bleeding, you should not give anticoagulants because the patient will further bleed out. In addition to this statement, patients with a hemorrhagic stroke; anticoagulants and antiplatelets are contraindicated.
In patients with a drug eluding stent dual antiplatelet therapy of aspirin and a P2y12 inhibitor is recommended. The dual antiplatelet therapy will reduce the chances of stenosis, heart attacks and sequentially death. Aspirin and one of the P2y12 inhibitors of which include Clopidogrel, Prasugrel or Ticagrelor has been shown to be most effective. The American College of Chest Physicians Evidence Based Clinical Practice Guidelines recommends that patients who have received percutaneous coronary interventions with drug eluding stents should receive 3 to 6 months of dual antiplatelet therapy. The minimum of 3 months is recommended for limus stents and 6 months is recommended for taxel stents. This recommendation is made with Grade 1A evidence. The shorter duration of dual antiplatelet therapy will reduce the risk of bleeding, however chances of early discontinuation will increase chances of stent thrombosis.
Care planning is one of these tasks, as expressed by, RNCentral (2017) in “What Is a Nursing Care Plan and Why is it Needed?” it says, “Care plans provide direction for individualized care of the client.” A care plan is for an individual patient and unique for the patient’s diagnosis. It is a nurse’s responsibility to safely administer a patient’s medication prescribed by the doctor. Colleran Michelle Cook (2017) in “Nurses’ Six Rights for Safe Medication Administration,” she says, “The right patient, the right drug, the right dose, the right route and the right time form the foundation from which nurses practice safely when administrating medications to our patients in all health care settings.” Nurses must be safe when dealing with medications, and making sure they have the right patient. Nurses document the care that is given to their patient, as said by, Medcom Trainex (2017) in “Medical Errors in Nursing: Preventing Documentation Errors,” it states, “Nurses are on the front lines of patient care. Their written accounts are critical for planning and evaluation of medical interventions and ongoing patient care.” Nurses must provide an exact, complete, and honest accounts of everything that happens with a patient. Doing this allows for the proper evaluation, and medical interventions for the patient. The typical tasks a nurse involves care planning, administration of treatments and medication, and documenting the care given to a
Emphasizing the Value of the Regimen and the positive effect of adherence. Nurses have the right to emphasize the value of the medication regimen and explain the effect of compliance and noncompliance to their patients. Though patients have the right to refuse their medications, its adherence or compliance benefits the patients more. Nurses are to educate patients who are weighing the medication's costs and benefits, adverse reactions, and perceived efficacy on the need to take their medications that help reduce side effect. In this regard the patients feel safe.