Heart Education Awareness Resource and Training through eLearning (HEARTe)
The nurse calls Sally in
The nurse calls Sally in to discuss her results. The nurse refers to the 1,2,3 of management of AF to help structure her conversation. Consider the additional information box in relation to other challenges relating to other medications.
The nurse calls Sally in to discuss the results of her test.
Scene 1. Exclude or treat underlying cause
Nurse: Hi Sally. We now have all the results back. The reason you”ve been feeling unwell is that you have Atrial Fibrillation. This means your heart beat is irregular. This often happens as people get older. The ECHO suggests this has been going on for a wee while.
Scene 2. Cardiac Stability
Nurse: Your heart rate is a little fast. If we slow this down with tablets, it will improve how you feel and also improve the function of your heart. The decision was made to aim for good heart rate control with Sally. The first line drug in her area was a beta-blocker. The GP decided on bisoprolol as it is a once a day preparation. If Sally had been asthmatic, had a history of intolerance of beta-blockers, or any other contraindications for beta-blockers, a rate limiting calcium channel blocker would have been used instead.
Scene 3. Stroke risk
Nurse: Atrial Fibrillation increases your risk of stroke and as a result it’s recommended that you start on a tablet to thin the blood called an “anticoagulant”.
Scene 4. Patient engagement in their ongoing care
Nurse: I realise I”ve given you a lot of information, Sally. How do you feel about that? Here are some booklets about the condition. Sally: Thanks, I should have brought my daughter with me… Two heads are better than one! I”ll take my daughter with me when I go to the pharmacist.
Additional Information
Other or further medication considerations
Rate control medicine
Pros
Cons
Beta-blockers e.g Bisoprolol
Rate control at rest and exercise.
May cause fatigue, especially at the start of treatment and when dose increased. Contra-indicted in asthma.
Calcium channel blockers e.g. Verapamil
Rate control at rest and exercise.
May cause constipation. Contra-indicted in heart failure.
Digoxin
Useful in frail patients. Doesn’t reduce blood pressure.
Only controls heart rate at rest. Poor rate control in active patients.
Pulse point
Using a methodical focussed approach when taking the patient history helps to determine the most likely cause and helps to avoid jumping to early conclusions that may be wrong. It is important to engage the patient in a variety of communication methods as it is often difficult to articulate symptoms.
Consider your own area of practice and refer to: Bickley, L.,S.(2013) Bates Guide to Physical Examination and History Taking. Philadelphia. Wolters Kluwer Health/Lippincott & Wilkins for further reading. Other common mnemonic acronyms which help to focus the history include: SOCRATES OLDCART You can learn more about applying these in practice scenarios within Modules 3, 4 and 5 of HEARTe.
