NR 603 Week 3 Assignment_Grand Rounds Complex Case Presentation on Atrial Fibrillation

NR603 Week 3 Assignment Client Information • Primary diagnosis/Reason for clinic visit: Atrial Fibrillation • Client name: Robert Harrison • Date of Birth: 03/14/1954 • Allergies and Typical Reaction: • Penicillin-rash • Shellfish-nausea/vomiting Physical Exam Height Weight BMI Blood Pressure 178 cm 96 kg 30.3 kg/m² 148/92 mmHg Heart Rate Respiratory Rate Oxygen Saturation Temperature 128 bpm irregularly 22/min 94% 98.4°F irregular Concerning Physical Exam Findings: irregular cardiac rhythm, tachycardia, bilateral lower-extremity edema Differential Diagnosis Diagnosis 1 Diagnosis 2 Diagnosis 3 Diagnosis 4 Diagnosis: Atrial flutter Diagnosis: Acute coronary Diagnosis: Pulmonary Diagnosis: Heart failure syndrome embolism exacerbation Rationale: The patient’s persistent tachycardia and Rationale: Although chest Rationale: Acute shortness Rationale: Lower- symptomatic palpitations pain is denied, advanced of breath combined with extremity edema and raise concern for an age and multiple tachycardia necessitates exertional intolerance organized atrial arrhythmia cardiovascular risk factors evaluation for suggest possible volume that can clinically resemble warrant consideration of thromboembolic disease, overload contributing to atrial fibrillation but often ischemia as a contributor particularly in a patient with symptom progression requires different rhythm to new-onset dyspnea and limited mobility and chronic and cardiac strain (Joglar interpretation on ECG. arrhythmia. comorbid conditions (Joglar et al., 2024). et al., 2024). © 2023. Chamberlain University LLC. All rights reserved. 6 Priority Non-Pharmacologic Interventions: Priority Pharmacologic Interventions: • Activity pacing and rate- • Metoprolol tartrate 25 mg orally control education twice daily • Sodium restriction and daily weights • Apixaban 5 mg orally twice daily Priority Referrals: Recommended Follow-up with Provider: • Cardiology (telehealth) • Timeline: 2 weeks • Rationale: To assess symptom • Social work control and medication tolerance How does the rural setng with limited resources How can the FNP practically incorporate impact the diagnosis and management of the cultural preferences, values, health beliefs, complex client’s primary and secondary health and behaviors into the care of this complex concerns? client? • Limited access to advanced diagnostics and • Incorporating patient preferences, financial specialty care requires reliance on focused limitations, and health beliefs through clinical assessment, basic diagnostic tools, and shared decision-making improves evidence-informed management strategies treatment adherence and supports appropriate for primary care. sustainable long- term management.