Atrial Fibrillation Nursing Diagnosis & Care Plan

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.

The majority of the dangers, signs, and symptoms 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
  • Surgical interventions such as cardiac ablation
  • Pacemaker placement for rate control

The 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. 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 Care Plans Related to Atrial Fibrillation

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)

Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Interventions are 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.

Risk for Activity Intolerance 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.

Risk for Activity Intolerance 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. 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.


Ineffective Tissue Perfusion

Ineffective tissue perfusion associated with atrial fibrillation can be caused by a reduction in cardiac output due to ineffective atrial systole and a rise in pulmonary venous pressure causing heart failure. This causes reduced blood flow and perfusion.

Nursing Diagnosis: Ineffective Tissue Perfusion

Related to:

  • Interruption of blood flow
  • Embolism
  • Thrombolytic therapy
  • Decreased cardiac output

As evidenced by:

  • Report of a pounding, fluttering, or rapid heartbeat (palpitations)
  • Chest tightness or pain
  • Altered mental status
  • Lightheadedness
  • Dyspnea
  • Syncope

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 demonstrate increased perfusion as evidenced by vitals signs within parameters and intact mentation.

Ineffective Tissue Perfusion 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
Strokes can be caused by either chronic or severe acute hypertension. A lack of appropriate brain perfusion is caused by severe hypotension. The nurse can monitor the blood pressure carefully at regular intervals. When a patient is taking antihypertensive medication, blood pressure is measured to evaluate the medication’s efficacy.

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. Chronic conditions like stroke and heart attack can develop if medications are not taken as prescribed.

Ineffective Tissue Perfusion 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, fibrinolytics, 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.


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.

Deficient Knowledge 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.

Deficient Knowledge 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.


References and Sources

  1. 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
  2. Centers for Disease Control and Prevention. (2022, July 12). Atrial fibrillation. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
  3. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
  4. 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.
  5. Silvestri, L. A., & CNE, A. E. (2019). Cardiovascular Problems. In Saunders comprehensive review for the NCLEX-RN examination (8th ed., p. 1685). Saunders.
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Kathleen Salvador, MSN, RN

Kathleen Salvador is a registered nurse and a nurse educator holding a Master’s degree. She has more than 10 years of clinical and teaching experience and worked as a licensed Nursing Specialist in JCI-accredited hospitals in the Middle East. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care.