A week has passed. L.J. responded to heparin therapy and was ...

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A week has passed. L.J. responded to heparin therapy and was bridged to oral warfarin therapy. His heart dysrhythmia converted to sinus rhythm after he started taking cardiac medications, and he is being discharged to home with home care follow-up.
 
  Good, he says, just in time to fly out west for my grandson's
  wedding. His wife, who has come to pick him up, rolls her eyes and looks at the ceiling.
 
  Although you are surprised at his comment, you realize he is serious about going to the
  wedding. What are you going to tell him?

Question 2

You evaluate L.J.'s electrocardiogram (ECG) strip.
 
  Name this rhythm, and explain what consequences it could have for L.J.

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Answer to Question 1

You observe that L.J. doesn't seem to have realistic expectations associated with his recovery, so you
explain the following:
 He is going to require daily follow-up visits to monitor his status.
 Sitting on a plane for several hours, along with the vigorous activity required to make plane
changes, is not safe for him at this time. He is likely to have another DVT develop from sitting on
the plane (not to mention sitting at the wedding and reception). He is going to continue to receive
warfarin for life and will be at risk for bleeding and bruising; in addition, after his hospitalization
and bed rest, it will take him weeks or even months to adapt to the rigors of everyday life.
 Explore with him the possibility of sending an audiotaped or videotaped message from him to the
newlyweds. Ask whether anyone can video-record the ceremony and parts of the reception for him
to view at home so that he won't feel so isolated.

Answer to Question 2

The rhythm is atrial flutter. You can see flutter waves with varying numbers between the QRS
intervals. The problem with atrial flutter is that the atria are quivering, or not contracting correctly.
Blood can pool inside the atria, and clot formation might occur.