Does your patient need an atrial fibrillation (AF or AFib) nursing care plan? AFib is the most common heart arrhythmia and the leading cause of stroke, and it may affect up to 5% of adults in the U.S. If you’re looking for what to include in your nursing care plan for AFib, use our guide below.
Nursing care plans are step-by-step approaches to giving care. They help standardize nursing workflows and are commonly taught in nursing schools. Every nursing care plan includes assessment, diagnosis, planning, intervention, and evaluation.
What Is AFib?
AFib is when the atria quiver or beat irregularly due to abnormal electrical activity. This can cause a fast heart rate, yet the atria cannot empty correctly, and blood flow becomes turbulent. This increases the chances of a blood clot forming and leading to a stroke.
AFib can be completely asymptomatic, but the patient may report chest pain, palpitations, a fast heart rate, nausea, shortness of breath, dizziness, severe sweating, and fatigue. Many patients can spontaneously convert out of it in less than seven days (paroxysmal AFib), but it can also last far longer (persistent AFib).
AFib risk factors include:
- Advanced age
- Hypertension
- Diabetes
- Heart disease
- Alcohol consumption
- Endocrine disorders
- Neurological disorders
- Valve disease
- Obstructive sleep apnea
- Cardiac inflammation
AFib with rapid ventricular rate (RVR) occurs when irregular signals travel down to the ventricles, affecting their rhythm as well. This leads to a heart rate of over 100 beats per minute, as well as more intense symptoms such as passing out and anxiety. Depending on the status of the patient, nursing diagnoses for atrial fibrillation with RVR are typically more focused on emergent care.
When is AFib an emergency? If your patient’s vital signs are far outside the norm, extremities are cold, or they experience a loss of consciousness, seek help from your code blue team or rapid response team (RRT).
AFib vs. Atrial Flutter
Atrial flutter also stems from electrical activity gone awry in the atrium of the heart, but it’s more predictable than AFib. Many patients will switch in and out of these rhythms. Flutters are also associated with a risk for stroke, but are more commonly treated with a cardiac ablation. Nursing interventions for atrial flutter may focus on preparing a patient for the cath lab.
Common Treatments for AFib
Treatments focus on preventing clots (thrombus) and maintaining a regular rhythm:
- Cardioversion: Used most commonly in patients who are unstable (such as AFib with RVR), cardioversion is an attempt to shock the heart back into a regular rhythm.
- Anticoagulation: Medications like heparin or enoxaparin attempt to lessen clotting in the blood and reduce the risk of a thrombus.
- Rate control medications: Calcium-channel blockers and beta-blockers can be used to lessen the heart rate, usually via intravenous infusion.
- Ablation therapy: A procedure creates small scars on the heart tissue, attempting to block abnormal signals.
- Pacemaker: In severe cases, an implanted pacemaker may be used to control heart rate.
Clinical Areas Where You’re Likely to Need an AFib Nursing Care Plan
AFib can be acute or chronic, so you might see it in a variety of clinical areas and settings. Learn more about the nursing specialties where AFib may be commonly seen:
- Cardiac nursing
- Emergency department (ED or ER)
- Intensive care (ICU)
- Cardiovascular intensive care (CVICU)
- Med-surg
- Outpatient medicine
- Community health
- Rehabilitation
- Long-term care
Sample Nursing Care Plan for a Patient with AFib
What does nursing care look like for a patient with non-emergent atrial fibrillation? Let’s explore an AFib nursing care plan in action.
1. Assessment
Warren is a 64-year-old male who presents to the emergency department after experiencing AFib for 3 days. He reports periods of atrial fibrillation for the last five years, but they have never lasted this long. He also has a history of diabetes and hypertension.
Below are essential elements in a nursing assessment for AFib:
- Check vital signs.
- Gather medical history and physical information, including drug and alcohol use.
- Auscultate the heart and lung sounds.
- Perform a thorough symptom assessment.
- Assess lower limbs for swelling.
- Examine the neck for signs of jugular venous distention (JVD).
- Assess peripheral pulses.
2. Diagnosis
AFib is medically diagnosed based on a patient examination and an electrocardiogram (ECG). Nursing diagnoses are separate but often related to medical diagnoses, so potential nursing diagnoses for Warren include:
Decreased cardiac output (CO): A heart that is quivering cannot pump blood effectively, leading to a decrease in output to the body despite a high heart rate. Patients may have a decreased ability to exercise or complete regular tasks. The good news is that many patients’ output will improve once their rhythms convert back to a normal sinus rhythm.
Potential nursing interventions for a decrease in CO include the following:
- Taking frequent vital signs
- Assessing for signs of heart failure
- Encouraging rest, limiting activity, and clustering care as much as possible
Risk for stroke: Patients with AFib are at high risk for a clot, which can travel into the brain. Anticoagulants like heparin are often used to prevent the blood from clotting. However, medications like this can also put patients at risk for bleeding and require further testing.
Here are some potential nursing interventions to decrease risk for thrombosis:
- Encouraging movement
- Administering anticoagulant medications as ordered
- Educating the patient on early stroke detection and noting the Last Known Well time
Anxiety: AFib can be very uncomfortable for patients, and learning about its risks can further add to anxiety. Nursing care focuses on keeping these patients comfortable and educating them on the current plan of care.
Nursing interventions for anxiety include the following:
- Reducing environmental stimuli
- Using a calm and relaxed demeanor
- Enquiring about anxiety and advocating for the patient as needed
3. Planning
Next, Warren’s nurse plans his care using the highest-priority nursing diagnoses and the interventions that best fit his needs. Planning also includes setting patient goals. Warren’s top care goals include:
- The patient will achieve a regular heart rate and rhythm.
- The patient will report a lessening of subjective symptoms.
- The patient will repeat back education on thrombus prevention and the signs of a stroke.
4. Intervention
The nurse carries out the plan of care, implementing the following atrial fibrillation nursing interventions for Warren:
- Obtaining a 12-lead ECG
- Taking frequent vital signs
- Implementing continuous cardiac monitoring
- Administering anticoagulants as prescribed
- Administering beta-blockers as prescribed
- Monitoring for worsening symptoms or signs of stroke
5. Evaluation
The final step in any care plan is evaluating outcomes to determine next steps. Four hours later, Warren converts to a normal sinus rhythm, as evidenced by a new ECG. He reports that his symptoms have decreased, and verbalizes relief at feeling better. Warren is referred to a cardiac clinic for further evaluation and management.
Ready to Use an AFib Nursing Care Plan?
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