J. D. is a 67 year old female with a history of CHF. She is an ex-smoker and has committed to living a healthy lifestyle. She is careful with her diet and exercise and her goal is to be able t

J. D. is a 67 year old female with a history of CHF. She is an ex-smoker and has committed to living a healthy lifestyle. She is careful with her diet and exercise and her goal is to be able to discontinue her cardiac medications. J. D. believes that if she can get back into shape, her body will no longer require medical intervention.

J. D. has been noticing an increase in shortness of breath when doing simple tasks around the house and also noticied some “heart skipping.” She comes to the clinic for a check-up.

Physical Assessment:

Neuro: AAOx3, moves all extremities to command, and exhibits equal strength

Pulmonary: Exhibits shortness of breath when walking; lung auscultation reveals bilateral crackles in the bases

GI: Bowel sounds normal; abdomen is non-tender to palpation

GU: Clear yellow urine, no abnormalities

CV: Pulse irregular, nailbeds pink, peripheral pulses strong. 2+ edema in lower extremities

Vital signs: HR 90-95, Respiratory rate 30, BP 156/88, Temp 98.4 F, Weight 165 (note: her weight has increased by 15 lbs. since her last check-up 1 month ago)

History: J.D. states that she discontinued her digoxin and her lasix last week because she felt like she didn’t need them any more.

Medications: Digoxin 0.125 mg PO qd

Lasix 40 mg PO qd

KCL 20 meq PO qd

Multivitamin PO qd

ASA 81mg PO qd

Diagnostic Studies:

CXR: reveals a right lower lobe pleural effusion

Labs: NA 137, K 3.8, BUN and Creatinine normal

1. Identify this dysrhythmia. Atrial flutter

2. What might be appropriate treatment for J.D.? cardioversion, pacing

3. What are appropriate nursing interventions?

4. What is the “Hallmark” of the dysrhythmia?

5. What is the PR interval in the dysrhythmia?