Atrial fibrillation is one of the most common heart arrhythmias. It may be abbreviated as AFib or AF. AFib causes an irregular and often rapid heart rhythm. This can lead to abnormal blood flow and the development of clots. AFib increases the risk of events such as stroke, heart failure, and myocardial ischemia or heart attack.
Most of the signs, symptoms and long term risks from AFib are linked to how quickly the heart beats and how frequently rhythm abnormalities take place. AFib symptoms may only last a short while. There is a chance that an atrial fibrillation episode will go away on its own. Alternatively, the condition can persist and require treatment. Treatment options include:
- Medications to control the heart rate and rhythm
- Anticoagulants to prevent clot formation
- Interventions such as cardiac ablation
- Pacemaker placement for rate control
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Anticipated Treatments
- Nursing Care Plans
- Deficient Knowledge
- Ineffective Tissue Perfusion
- Risk for Activity Intolerance
- Risk for Ineffective Cerebral Tissue Perfusion
Nursing Process
In an inpatient setting, the nurse may care for patients with AFib. Monitoring may be the only required action, while sustained AFib will require further intervention. The nurse can educate the patient on medication compliance for hypertension and cardiovascular disease, depending on the underlying cause of the Afib. The patient should also be informed about the signs of a stroke and other possible complications as well as when to contact a healthcare provider.
Nursing Assessment
The first step of nursing care is the nursing assessment.
Review of Health History
1. Ask about the patient’s general signs and symptoms.
Assess the patient’s complaints and symptoms, such as:
- Palpitations
- Chest discomfort
- Shortness of breath
- Increased edema of the lower extremities
- Difficulty breathing with exertion
- Disorientation
- Fatigue
- Weakness
2. Let the patient describe further details of symptoms.
Note onset, duration, frequency, triggers, and relieving methods of any symptoms related to atrial fibrillation.
3. Determine the risk.
Look for the following relevant conditions and risk factors:
- Hypertension
- Obstructive sleep apnea
- Obesity
- Valvular and structural heart defects
- Coronary artery disease
- Myocardial infarction
- Rheumatic fever
- Myocarditis
- Pericarditis
- Hyperlipidemia
- Endocrine disorders (such as diabetes and hyperthyroidism)
- Stroke
- Family history
- Advanced age
- History of heart disease
- Congenital heart disease
- High alcohol consumption
- Smoking
4. Review treatment records.
List the medications, procedures, surgeries, approaches, and referrals made for the patient. Although atrial fibrillation may be a chronic condition, many therapies, and risk-reduction measures have been developed to help people still in atrial fibrillation lower their risk of stroke (the most common and serious outcome of atrial fibrillation).
5. Investigate the patient’s health behaviors and lifestyle factors.
Interview and note concerns or areas for improvement in the patient’s health and lifestyle practices.
Physical Assessment
Note: Finding the cause of AFib should be the primary goal of the physical examination.
1. Prioritize ABC.
The airway, breathing, and circulation evaluation should always come first in a physical examination since it will influence the priorities and treatment choices.
2. Assess vital signs.
Atrial fibrillation is the most common form of heart arrhythmia. Patients exhibiting symptoms should have their blood pressure, pulse, respiratory rate, and Spo2 measured at the initial assessment.
3. Systemic assessment approach:
- Neck: swelling of the neck (signs of thyroid disease), distended jugular veins (signs of heart failure)
- CNS: changes in mentation, speech, pupils, motor response (signs of transient ischemic attack or cerebrovascular accident), fatigue
- Cardiovascular: chaotic irregular pulse, tachycardia, chest pain, adventitious sounds (murmur) upon auscultation
- Respiratory: adventitious sounds (rales may be a sign of heart failure; wheezing may be a sign of a lung disorder) upon auscultation
- Abdomen: abdominal bruits on auscultation, enlarged liver (hepatomegaly), and abdominal distension (signs of heart failure)
- Circulatory: irregular, fluttering in peripheral pulses
- Lymphatic: edema
- Integumentary: hair loss and skin color and temperature changes in the extremities (signs of vascular disease)
Diagnostic Procedures
1. Obtain ECG.
A distinctive narrow complex “irregularly irregular” or chaotic pattern without p-waves characterizes atrial fibrillation on ECG. Fibrillary waves may be present. The ventricular rate ranges from 80 to 180 beats per minute.
2. Send samples for laboratory tests.
Explain the purpose of the following laboratory tests:
- Complete blood count (CBC) to test for infections and anemia
- Basic metabolic panel (BMP) to look for electrolyte abnormalities
- Thyroid function tests to check for hyperthyroidism
- Kidney function to assess for kidney injury
- Cardiac biomarkers and B-type natriuretic peptide (BNP) assess for underlying heart disease
- D-dimer tests assess the breakdown of fibrin in the presence of blood clots
3. Review chest X-ray results.
Review the results of the chest x-ray for any abnormalities in the thorax or lungs. A chest X-ray can highlight any factors contributing to AF, such as fluid buildup or infection.
4. Prepare for TEE.
Transesophageal echocardiography assesses the heart’s anatomy and any atrial thrombus caused by atrial fibrillation. TEE should always be performed before cardioversion.
5. Further investigations.
- Holter or event monitor records the patient’s heart activities. It records AFib that happens intermittently or is asymptomatic.
- During a stress or exercise test, the patient engages in physical activity, such as treadmill running, while ECG is recording. It can demonstrate how the patient’s physical capabilities may be affected by AFib.
- Echocardiography creates a moving image of the heart using sound waves. It can identify structural abnormalities and ejection fraction.
- Tilt-table test is carried out if an ECG or Holter monitor does not detect cardiac arrhythmia, but the patient still exhibits symptoms like fainting or dizziness. While the patient is lying on a table that elevates them from a prone to an upright posture, it displays heart function and blood pressure.
- Electrophysiologic examination involves inserting a catheter into the heart’s chambers through an artery. The catheter then stimulates the heart while observing irregular impulses and noting their speed and starting point.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section you’ll learn more about possible nursing interventions for a patient with atrial fibrillation.
1. Assess risk.
Hemodynamic stability and risk reduction are vital components of AFib care. It’s important to assess the patient for hemodynamic stability including vital signs, a focused cardiovascular assessment and assessment of level of consciousness. Urgent cardioversion may be needed if the patient is unstable.
2. Provide safety education about anticoagulants.
The most significant complication of anticoagulants is bleeding, which can lead to hemorrhage and shock. It’s important to educate the patient about how they can reduce their risk of significant bleeds such as avoiding contact sports and using caution with sharp objects.
3. Support rehabilitation and lifestyle modifications.
Cardiac rehabilitation (cardiac rehab) is a support, exercise, and education program tailored to the patient’s needs and directed by healthcare professionals. It aids the patient and family in making long-term lifestyle adjustments. It also lessens their risk of developing complications and reduces hospital readmissions. Cardiac rehab aims to help the patient regain strength, lower the chance of developing AFib complications, and generally enhance the patient’s health and quality of life. Cardiac rehabilitation programs may include:
- Exercise training
- Emotional support
- Patient education about lifestyle changes
- Lowering the risk of heart disease
- Emphasizing a heart-healthy diet, weight maintenance, and smoking cessation
Patient Education
1. Discuss the importance of exercise.
Regular exercise can lower blood pressure, slow the resting heart rate, and minimize the severity and frequency of AFib episodes.
2. Maintain an ideal weight.
AFib progresses more rapidly in those who are obese. Encourage and instruct on weight loss measures. Atrial fibrillation is less likely in patients who reduced at least 10% of their body weight.
3. Manage stress.
Psychological stress triggers and worsens atrial fibrillation. AFib is linked to anxiety and depression so nurses should educate the patients about the importance of mental health.
4. Educate the patient on lifelong blood monitoring if necessary.
If prescribed warfarin, the INR should be kept within the therapeutic range. The nurse informs the patient about continuous monitoring of the anticoagulation profile while on blood thinners.
5. Teach when to seek medical attention.
The patient and family members should know when to alert the healthcare team and seek medical attention. Describe the signs and symptoms of possible AFib complications (such as stroke). Highlight to the patient to immediately report when a change in health status has occurred.
6. Maintain cardiology follow-up.
Lifelong follow-up with a cardiologist and routine testing such as ECG and echocardiogram will be necessary for long-term management.
Anticipated Treatments
In the following section you’ll learn more about possible treatments for a patient with atrial fibrillation.
1. Reset the heart rhythm.
Cardioversion restores the normal sinus rhythm of the heart. There are two ways to correct the heart rhythm:
- Electrical cardioversion applies electric shocks to the heart through electrodes on the chest.
- Drug cardioversion administers medication orally or intravenously to revamp the heart’s rhythm.
2. Control the rate.
These medications will slow the heart’s pumping action:
- Beta-blockers lower the rate when the heart is at rest and during exercise.
- Calcium channel blockers reduce heart rate. However, they should be avoided in patients with heart failure or low blood pressure.
- Digoxin regulates the heart rate while at rest but not during strenuous activity. It is not a first-line treatment and is combined with beta-blockers or calcium channel blockers.
- Antiarrhythmic medications maintain a regular heart rhythm and heart rate. They are not recommended for patients with heart failure due to their side effects.
3. Anticoagulation therapy.
For symptomatic patients, rate control, anticoagulation, and rhythm control are the cornerstones of atrial fibrillation therapy. For lowering the risk of stroke associated with atrial fibrillation, non-vitamin K oral anticoagulants (NOACs) are now recommended as the preferred option for warfarin in AFib, except for patients with mitral stenosis or mechanical heart valve. Before starting oral anticoagulants that do not contain vitamin K, check the liver and kidney function.
4. DOACs for patients with heart valve replacement.
Direct-acting oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, and apixaban, are given to patients with mechanical and bioprosthetic heart valves. DOACs are recommended for patients with atrial fibrillation to prevent ischemic stroke.
Cardiac Ablation
1. Consider cardiac ablation.
Cardiac ablation is recommended if medication or other treatments are ineffective for treating AFib. Patients with a low ejection fraction have the option of catheter ablation. Cardiac ablation involves heat (radiofrequency energy) or extremely cold (cryoablation) to create scars in the heart to prevent abnormal electrical signals and reset the irregular heartbeat.
2. AV pacemaker placement after ablation.
Ablation of the atrioventricular node results in permanent AV block, requiring a ventricular pacemaker for rate control.
3. Prepare for possible open-heart surgery.
A surgical maze procedure requires open-heart surgery if it is done with a scalpel. It is the preferred treatment for AFib in patients with a history of heart surgery (such as coronary artery bypass surgery or heart valve repair).
4. Atrial fibrillation may recur after ablation.
After cardiac ablation, recurrence of AFib is possible. Repeated cardiac ablation or another treatment is recommended. Lifelong blood thinners may be required to prevent strokes following cardiac ablation.
Nursing Care Plans
In the following section you will find sample nursing care plans related to atrial fibrillation.
Decreased Cardiac Output
Decreased cardiac output associated with atrial fibrillation can be caused by impaired (chaotic) atria contraction resulting in inadequate blood flow to the heart’s lower chambers (ventricles) and increased pulmonary venous pressure.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Impaired cardiac muscle contraction
- Ineffective atrial contraction
- Decreased oxygenated blood flow to ventricles
- Increased cardiac afterload
- Imbalanced ventricular filling (cardiac preload)
- Increased pulmonary venous pressure
- Failure of the heart to pump adequate blood to the rest of the body
As evidenced by:
- Decreased cardiac output
- Hypotension
- Decreased peripheral pulses
- Increased central venous pressure (CVP)
- Increased pulmonary artery pressure (PAP)
- Tachycardia
- Dysrhythmias
- Ejection fraction less than 40%
- Decreased oxygen saturation
- Presence of abnormal heart sound S3 and S4 upon auscultation
- Chest pain (angina)
- Presence of adventitious lung sounds upon auscultation
- Difficulty breathing (dyspnea)
- Difficulty breathing when lying down and relieved by upright position (orthopnea)
- Rapid breathing (tachypnea)
- Alteration in the level of consciousness
- Restlessness
- Fatigue
- Intolerance in activities
- Cold and clammy skin
- Prolonged capillary refill time
- Significant weight gain
- Edema
- Decreased urine output
Expected outcomes:
- Patient will manifest blood pressure and pulse rate within normal limits.
- Patient will be able to tolerate activities without chest pain, dyspnea, or changes in the level of consciousness.
- Patient will display normal sinus rhythm on EKG.
Assessment:
1. Assess for cardiovascular status.
The most prevalent cardiac arrhythmia is atrial fibrillation. AFib places the patient at risk for stroke or heart attack. Assess for a potential causes of atrial fibrillation by taking a detailed patient history.
2. Monitor the patient’s blood pressure and pulse.
If the patient is hemodynamically unstable related to decreased cardiac output they will likely be hypotensive. Monitor the patient for changes in their blood pressure and pulse.
3. Auscultate heart and lung sounds.
Atrial fibrillation over the long term can cause heart failure, which may manifest as gallop heart rhythm (S3 and S4), dyspnea, and coarse crackles. The S3 heart sound indicates left ventricular failure and denotes diminished left ventricular ejection, while the S4 heart sound coincides with diastolic filling.
4. Obtain ECG.
Atrial fibrillation in ECG shows a chaotic pattern with no discernible p-waves. Fibrillary waves may be present. The ventricular rate usually lies between 80 and 160 beats per minute.
5. Determine the cause of atrial fibrillation.
The following laboratory work and diagnostic scans evaluate for potential causes of atrial fibrillation:
- Complete blood count (CBC) for infection
- Basic metabolic panel (BMP) for electrolyte abnormalities
- Thyroid function tests for hyperthyroidism
- Chest x-ray for any abnormality in the thorax
- Cardiac biomarkers and B-type natriuretic peptide (BNP) to rule out or identify underlying cardiac disorders like congestive heart failure or myocardial infarction
- D-dimer test for pulmonary embolism
- Transesophageal echocardiogram for atrial thrombus secondary to atrial fibrillation
6. Monitor for possible development of atrial fibrillation complications.
Inadequate blood flow to the heart, which can reduce cardiac output, is usually indicated by chest pain or discomfort. Edema is a distinctive symptom of heart failure, a complication of atrial fibrillation over the long term. Various atrial pressures cause peripheral edema and hepatojugular reflux.
Interventions:
1. Intervene with cardioversion.
For patients with atrial fibrillation who are unstable, cardioversion with anticoagulant therapy is recommended. Cardioversion may be indicated without prior TEE during emergency cases.
2. Administer beta-blocker or calcium-channel blocker as prescribed.
Beta-blockers and calcium channel blockers offer quick heart rate control at rest and during activity. They can be administered intravenously (IV) or orally.
3. Cautiously give digoxin.
Digoxin reduces the heart rate to treat atrial fibrillation. The goal is to lessen the pressure on the heart. Over time, atrial fibrillation can induce heart failure by weakening the heart muscle. Digoxin is given in conjunction with other medications.
4. Place the patient in an upright position.
High- or semi-Fowler’s position lessens preload and ventricular filling. This also allows the patient to breathe easier.
5. Prepare for possible ablation therapy.
Atrial fibrillation ablation treats the chaotic and erratic heart rhythm and is used when medications or cardioversion fail. The malfunctioning electrical signals are blocked by tiny scars formed in the heart using heat or cold energy. It results in the return of the normal heart rate and rhythm.
6. Consider a pacemaker.
A pacemaker implant is considered in severe cases of atrial fibrillation leading to heart failure. A pacemaker is not a treatment for atrial fibrillation but may help ensure the heart does not beat too slowly when in atrial fibrillation.
7. Refer the patient to cardiac rehabilitation.
Exercise, support, counseling, and diet education are all part of cardiac rehabilitation. Patients with atrial fibrillation or who have undergone a cardiac procedure may benefit from cardiac rehabilitation.
Deficient Knowledge
Deficient knowledge associated with atrial fibrillation can lead to a lack of adherence to the treatment plan and poor health outcomes. The risk of stroke and heart failure associated with atrial fibrillation can be considerably reduced with appropriate risk factor assessment and medical/surgical treatment. This can be achieved by accurate health education.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Insufficient knowledge of atrial fibrillation and its treatment
- Lack of interest in learning
- Poor recall of information
As evidenced by:
- Verbalization of confusion
- Nonadherence with the treatment regimen
- Development of chronic health conditions
Expected outcomes:
- Patient will be able to verbalize understanding of atrial fibrillation, treatment plan, any potential drug adverse effects, and when to contact a healthcare provider.
- Patient will be able to demonstrate two behavior and lifestyle modifications to prevent complications.
Assessment:
1. Determine knowledge level and capabilities.
To encourage informed decision-making, patients’ awareness of the risks, advantages, and characteristics of medical interventions must be understood.
2. Establish the client’s capacity, readiness, and learning obstacles.
The patient may not be psychologically, emotionally, or physically capable of understanding the treatment plan. Provide education resources to best meet their learning needs. Involvement of a support system may be necessary.
3. Recognize avoidance cues.
A patient who is avoidant or nonadherent to the treatment plan requires further assessment. The nurse can listen and may uncover concerns that can be remedied.
Interventions:
1. Identify the person’s motivating elements.
Motivating factors can be either positive or negative. Identifying goals helps the client understand exactly what they are aiming for.
2. Provide facts pertinent to the situation.
Having only necessary information at any given time helps the client stay focused and avoid feeling overloaded.
3. Encourage using positive reinforcement.
Reinforcement can be utilized to promote on-task behavior, teach new skills, or promote behavior modification. This might inspire continued attempts. Avoid using punishment as reinforcement (e.g., criticism, threats).
4. Involve support systems.
Family or other support system involvement may be necessary to ensure thorough understanding, follow-through, and optimal health outcomes.
Ineffective Tissue Perfusion
Ineffective tissue perfusion associated with atrial fibrillation can be caused by a reduction in cardiac output due to the loss of the “atrial kick.” Depending on the rate of the ventricular contractions the heart rate may either be too fast or two slow, which can lead to inadequate tissue perfusion. Atrial fibrillation also predisposes patients to pulmonary congestion which over time can cause heart failure. This also causes reduced blood flow and perfusion.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Interruption of blood flow
- Loss of atrial contraction
- Unstable heart rate
- Decreased cardiac output
As evidenced by:
- Report of a pounding, fluttering, or rapid heartbeat (palpitations)
- Chest pain or tightness
- Altered mental status
- Lightheadedness
- Dyspnea
- Syncope
Expected outcomes:
- Patient will demonstrate increased perfusion as evidenced by vitals signs within parameters and intact mentation.
Assessment:
1. Assess mental status, level of consciousness, speech, and behavior.
Consciousness level, changes in behavior, speech, motor response, and pupillary response should all be evaluated. Alteration in consciousness and cognitive function are clinical signs of reduced cerebral perfusion. The nurse can assess mental status by performing a neurological examination.
2. Monitor blood pressure
A lack of appropriate brain perfusion is caused by severe hypotension. The nurse can monitor the blood pressure carefully at regular intervals. If perfusion is sufficiently impacted, the patient will have alterations in level of consciousness. Less severe impacts of ineffective tissue perfusion include reductions in exercise capacity and fatigue.
3. Assess the client’s treatment plan
Determine the client’s treatment plan and adherence. People may quit taking medications due to lack of symptoms, the development of unwanted side effects, the cost of the treatment, or forgetfulness. Medications that may impact tissue perfusion include medications to control heart rate and rhythm. Chronic conditions like stroke and heart attack can develop if medications are not taken as prescribed.
Interventions:
1. Collaborate with the interdisciplinary team.
Collaboration of an interdisciplinary team allows for treatment from different disciplines to create an appropriate and suitable treatment plan that will improve systemic perfusion and organ function of the client.
2. Administer medications.
Dysrhythmias can lead to impairments of the heart, brain, or other organs if they are not addressed. Administration of antihypertensives, antidysrhythmics, anticoagulants, and more may be utilized. Vasoactive medications enhance systemic hemodynamics but also lessen abnormalities in organ perfusion and oxygenation during shock. This is to increase cardiac output and/or adequate arterial blood pressure and maintain cerebral perfusion.
3. Closely monitor lab values and tests.
Hemoglobin, ABGs, electrolytes, cardiac enzymes, and kidney function labs provide information on organ perfusion. CT scans and ultrasounds can assess for stroke or emboli.
4. Prepare for cardioversion.
Cardioversion is a medical procedure that shocks the heart from AFib into a normal heart rhythm. This is often completed at the bedside and the nurse may administer a medication prior to the procedure and assist the provider as necessary.
Risk for Activity Intolerance
Risk for activity intolerance associated with atrial fibrillation can be caused by the atria, or upper chambers of the heart, contracting erratically that the cardiac muscle is unable to appropriately relax in between contractions. This lessens the effectiveness and performance of the heart, limiting exercise capacity.
Nursing Diagnosis: Risk for Activity Intolerance
Related to:
- Imbalanced oxygen supply and demand
- Condition of circulatory problems (dizziness, presyncope, or syncopal episodes)
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention.
Expected outcomes:
- Patient will be able to engage in a conditioning or rehabilitation program to improve performance.
- Patient will be able to recognize two symptoms or indications that necessitate medical evaluation.
Assessment:
1. Assess for the presence of symptoms of atrial fibrillation.
Numerous variables may contribute to or be the cause of symptoms, which may impair a client’s capacity to function at a desirable level of activity. The nurse should perform a baseline assessment to determine the patient’s normal condition from the abnormal and identify specific conditions that may have precipitated the symptoms.
2. Assess the patient’s perceived and actual restrictions as well as the severity.
This offers a comparative baseline and details on the education or treatments that are necessary to improve quality of life. The nurse can directly observe the patient’s activity level to determine actual from perceived limitations.
3. Assess the cardiopulmonary response to activity.
Before, during, and after physical activity, evaluate the cardiopulmonary response, including vital signs. Observe for increasing fatigue and dyspnea. An imbalance of oxygen supply and demand causes abrupt fluctuations in blood pressure, heart rate and rhythm, and dyspnea on exertion.
4. Assess the patient’s cardiovascular history.
The nurse can assess the client’s cardiovascular and peripheral vascular system which includes gathering subjective information about the patient’s diet, exercise habits, stress levels, and family history of cardiovascular disease. The nurse can also inquire or assess for symptoms such as peripheral edema, dyspnea, and irregular heartbeat.
Interventions:
1. Monitor vital signs and mental status.
Monitor for discrepancies in the client’s heart, breathing, and blood pressure rates. The nurse can take note of any changes such as pallor, cyanosis, or confusion during exercise. Maintain patient safety by assisting with activity and preventing overexertion beyond limitations.
2. Administer medication and provide oxygen as needed.
Assess the patient’s response to medications and oxygen or the need for increasing supplemental oxygen with activity. The nurse can collaborate with the healthcare team to create an appropriate care plan for the client.
3. Balance rest periods with activity.
Gradually increase exercise and activity levels. Teach energy-saving techniques like taking a 3-minute break midway through a 10-minute walk or sitting down to brush your hair rather than standing to prevent overexertion.
4. Coordinate with rehab or exercise programs.
Consider the need for cardiac rehab programs, physical therapy, or other exercise programs that instruct on limiting exertion and maintaining activity within the patient’s capabilities.
Risk for Ineffective Cerebral Tissue Perfusion
Risk for ineffective cerebral tissue perfusion associated with persistent atrial fibrillation can be caused by ineffective atrial contraction and risk of stroke development from blood clots formed in the atria leading to decreased oxygenated blood flow to the brain.
Nursing Diagnosis: Risk for Ineffective Cerebral Tissue Perfusion
Related to:
- Ineffective atrial contraction
- Decreased oxygenated blood flow to the brain
- Risk of stroke
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention.
Expected outcomes:
- Patient will verbalize how atrial fibrillation can cause ineffective cerebral tissue perfusion.
- Patient will adhere to lifestyle modifications to prevent the recurrence of atrial fibrillation.
- Patient will not experience altered mental status, confusion, or decreased consciousness related to atrial fibrillation.
Assessment:
1. Note any alterations in mentation.
Hypoxia related to atrial fibrillation can affect perfusion in the brain. Note for irritation, restlessness, confusion, or changes in alertness which indicate changes in mentation.
2. Determine neurovascular assessment.
Evaluate signs and symptoms indicating changes in the central and peripheral nervous systems. This includes cognitive and sensory perception function changes, headache, and dizziness.
3. Assess neuromuscular status.
Assess the movement in response to simple instructions. Note for voluntary and involuntary movement and symmetry of the right and left sides. Assess coordination and reflex responses.
4. Closely monitor the blood pressure.
Monitor BP measurements for changes in orthostatic pressure (a decrease of 20 mm Hg systolic or 10 mm Hg diastolic) with changes in position.
5. Watch out for signs and symptoms of a stroke.
A stroke is a severe complication of atrial fibrillation due to the high risk of blood clot formation. Changes in speech, vision, facial symmetry, and muscle weakness signal a stroke.
Interventions:
1. Begin prophylactic anticoagulant therapy.
Proper anticoagulation is essential for atrial fibrillation. Some common medications used for anticoagulation include dabigatran, rivaroxaban, apixaban, and edoxaban. Warfarin is still also sometimes used, although more monitoring is necessary.
2. Provide safety when dizziness occurs.
Provide advice on how to reduce dizziness caused by decreased oxygenated blood flow when a patient experiences it as a result of orthostatic hypotension when getting up, including the following:
- Staying in a sitting position for a few minutes before standing
- Repeatedly flexing the feet upward while seated
- Immediately sit down if dizziness occurs
- Have assistance when standing up
- Use an ambulation device for support
3. Teach early recognition tips.
Early symptom identification helps with the timely treatment of decreased cerebral tissue perfusion. Encourage patients to seek assistance with changes such as dizziness, trouble concentrating, or headache.
4. Manage stress.
Stress management programs and health education can improve outcomes related to atrial fibrillation, decreasing the risk of ineffective cerebral perfusion.
5. Emphasize treatment adherence.
The nurse must ensure follow-up at regular intervals and educate the patient on adherence to atrial fibrillation treatment. Teach the patient about the impending signs of a stroke and when to seek emergency care.
References
- American College of Cardiology. (2019, January 28). Updated AFib guidelines recommend NOACs to prevent stroke in AFib patients. Retrieved February 2023, from https://www.acc.org/latest-in-cardiology/articles/2019/01/28/12/56/updated-afib-guidelines-recommend-noacs
- American Heart Association. (2018, January 11). What is cardiac rehabilitation? www.heart.org. Retrieved February 2023, from https://www.heart.org/en/health-topics/cardiac-rehab/what-is-cardiac-rehabilitation
- American Heart Association. (2017, August 22). Why atrial fibrillation (AF or AFib) matters. https://www.heart.org/en/health-topics/atrial-fibrillation/why-atrial-fibrillation-af-or-afib-matters
- American Heart Association. (n.d.). Atrial fibrillation. www.heart.org. Retrieved February 2023, from https://www.heart.org/en/health-topics/atrial-fibrillation
- Centers for Disease Control and Prevention. (2022, July 12). Atrial fibrillation. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
- Cleveland Clinic. (2022, May 1). Atrial fibrillation (Afib): Causes, symptoms and treatment. Retrieved February 2023, from https://my.clevelandclinic.org/health/diseases/16765-atrial-fibrillation-afib
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Hinkle, J. L., & Cheever, K. H. (2018). Management of Patients with Dysrhythmias and Conduction Problems. In Brunner and Suddarth’s textbook of medical-surgical nursing (14th ed., pp. 1972-1985). Wolters Kluwer India Pvt.
- Mayo Clinic. (2021, October 19). Atrial fibrillation – Symptoms and causes. Retrieved February 2023, from https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
- National Center for Biotechnology Information. (2022, May 21). Atrial fibrillation – StatPearls – NCBI bookshelf. Retrieved February 2023, from https://www.ncbi.nlm.nih.gov/books/NBK526072/
- Silvestri, L. A., & CNE, A. E. (2019). Cardiovascular Problems. In Saunders comprehensive review for the NCLEX-RN examination (8th ed., p. 1685). Saunders.
