Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)

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Electrical Conduction of The Heart (Cheat Sheet)
10 Common EKG Heart Rhythms (Cheat Sheet)
Atrial Fibrillation Cheatsheet (Cheat Sheet)
ECG: Atrial Fibrillation (Picmonic)

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I am going to be showing you how to write a nursing care plan on atrial fibrillation also known as AFib. We're going to be formulating the care plan, but we're also going to talk about how to care for these patients, as well as how to educate them for care planning. 


We're always going to start with our assessment here. So, the patient comes in, they tell us that they are experiencing some dizziness, as well as their heart just feels like it's fluttering. They're probably not going to use this word, but what they're experiencing is palpitations and sometimes, patients will describe this as fluttering. Sometimes they'll describe it as a pounding. It feels like their heart's beating out of their chest. Sometimes they might not even notice. It might not feel like anything at all. That's all really common with AFib. We decide to check out their heart and we discover that they have a very irregular heartbeat. AFib is one of the most irregular heart rhythms you will ever see or experience, so that's a key that they're probably experiencing AFib as well as having tachycardia. This patient is having 164 beats per minute. The heart is freaking out. 


Let's look at some diagnoses. With the atria freaking out, sending all these signals, the ventricles don't really know what they're doing either, so that can cause problems with output. We're going to have decreased cardiac output. The heart is just a hot mess. It's not pumping the way it should. Now, whenever we don't have enough blood flowing out, it means that blood is going to be pooling somewhere, and that can cause the patient to develop blood clots. So, whenever you think of AFib, I want you to think okay, we're worried about blood clots. We're worried about decreased cardiac output. Those are both super, super important. 


Some goals that this patient can work on include wearing EKG leads. This is very important, so we can monitor the heart. They also need to receive some medications. We want to be able to control the heart rate, as well as the rhythm, and we want to prevent clots. There's quite a few different medications that this patient is going to be on in order to try to manage their AFib. We always want to move from the least invasive to the most invasive, right, so there are a lot of options that we can use to treat AFib, but let's go ahead and start with medications. 


Okay, we want them, of course, to have these medications work and we want to have an improved rate and improve rhythm. If that's not an issue, then hopefully they're not going to be forming the clots because there's no stagnant blood. They still might end up on a blood thinner when they go home, depending on what we figure out throughout their stay. Some ways that the nurse can support these goals is to continuously monitor the EKG, make sure that the leads are working, that the battery's working, as well as their cardiovascular status. Putting on a stethoscope, listening to that heart and seeing what they are doing online? Are they staying in AFib, or are they, you know, going back and forth. I say all night, because I'm a night shift nurse, but you know what I mean, all day, all night, however long we're monitoring for. We will be administering these here per the doctor's orders, as well as providing some education about how they should be working, and maybe some side effects that they will be experiencing. We also can educate about AFib in general, what things they need to report, how often they need to see a physician and monitoring their heart rate. 


It's actually really cool that we have so many more options that are very affordable for monitoring the heart rate at home? A lot of us have smart watches or watches that can track heart rate and steps and those are actually not a bad idea for these patients to do in their home, because they can monitor very easily and see if they're getting tachycardic. Let's evaluate our goals here. So, this one was met, the EKG was completed. It was red and determined that the patient is in AFib continuously, this goal was also met. The patient did receive the medications that were appropriate. This goal right here, unfortunately, was not met. The patient is still in AFib despite this medication attempt. So, what we have to do at this point is just reevaluate. We're going to go back here and we're going to work with the rest of our healthcare team and decide if we try different medications? Do we move forward with cardioversion or cardiac ablation? There's tons of different options that we can do, and we just want to make sure that we have the patient's best benefit in mind, and that we're doing again, something that is the least invasive that will work for this patient. 


Alright, we learned how to educate as well as care for these patients and you rocked it. We love you guys. Go out and be your best selves today and as always, happy nursing!

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