Last updated on December 28th, 2023
Here we’ll formulate a scenario-based sample AFib nursing care plan. It will include three sample nursing care plans with NANDA nursing diagnosis, nursing assessment, expected outcome, nursing interventions, and rationales.
What is AFib?
AFib or AF is a commonly used abbreviation for the heart condition known as Atrial Fibrillation. AFib is the most common type of heart arrhythmia.
AFib occurs when the atria and ventricles are not coordinated as they should, causing the heart to beat irregularly either too slowly or too quickly.
According to the CDC, approximately 12.1 million people in the United States will have AFib in 2030.
AFib Nursing Care Plan
Case Scenario
A 55-year old male presents to the ED with reports of dizziness, shortness of breath, and heart palpitations. The patient says that he was mowing the grass when the shortness of breath began. He took a break and drank some water, but when the symptoms persisted he decided to call an ambulance.
The patient has a history of heart failure, atrial fibrillation, and asthma. He was admitted 3 months ago for an episode of atrial fibrillation and was sent home on metoprolol and coumadin. The patient reports that he stopped taking both medications 2 weeks after discharge because he started feeling better.
Upon exam, the patient appears to be diaphoretic and anxious. His heart rate is 165 BPM, blood pressure is 93/62 (59) mmHg, and oxygen saturation is 96% on 2L nasal cannula. The patient’s pulses are weak and irregular, and extremities are cool. On the patient’s blood work, the troponin is 0.35 ng/mL, CK is 200 U/L and CK-MB is 15 IU/L. His PT is 12 seconds and INR is 1.0. A 12-lead EKG is performed and the patient is found to be in atrial fibrillation with RVR.
The patient is admitted to the hospital for Atrial Fibrillation
#1 Sample AFib Nursing Care Plan – Decreased Cardiac Output
Nursing Assessment
Subjective Data:
- The patient feels heart palpitations and is dizzy and short of breath
Objective Data:
- HR of 165 BPM
- 12-lead EKG shows a-fib with RVR
- Cardiac enzymes are elevated
Nursing Diagnosis
Decreased cardiac output related to altered heart rate and rhythm as evidenced by shortness of breath, palpitations, and elevated cardiac enzymes.
Goal/Desired Outcome
Short-term goal: The patient will remain normotensive and will convert to normal sinus rhythm by the end of the shift
Long-term goal: The patient will remain in normal sinus rhythm with no further episodes of dysrhythmia
Nursing interventions with rationale for AFib – decreased cardiac output
| Nursing Interventions | Rationales |
| Perform 12-lead EKG initially and as needed to confirm heart rhythm | Reliable rhythm diagnosis will dictate and guide treatment |
| Closely monitor for hypotension or worsening symptoms and evaluate the need for emergent cardioversion | If the patient is deemed to be unstable, cardioversion may be required to quickly convert to normal sinus rhythm. The voltage to cardiovert unstable atrial fibrillation is 120-200 J. Special care should be taken because thromboembolic events are possible after cardioversion. Risk vs. benefit must be weighed. |
| Administer medications for rate control | A-fib with RVR is very taxing on the heart, so efforts should be made to slow the heart rate. Common classes of medications include beta-blockers, calcium channel blockers, and cardiac glycosides |
| Monitor for medication side effects | Medication therapy may need to be terminated if serious side effects arise such as bradycardia or hypotension |
| Monitor cardiac enzymes such as troponin and CK-MB | Elevated cardiac enzymes are common with a-fib but should continue to be monitored to rule out a myocardial infarction |
#2 Sample AFib Nursing Care Plan – Risk for ineffective cerebral artery perfusion
Nursing Assessment
Subjective Data:
- The patient feels dizzy
Objective Data:
- The patient appears anxious
- HR of 165 BPM
- Blood pressure is 93/62 (59) mmHg
Nursing Diagnosis
Risk for ineffective cerebral artery perfusion related to rapid, irregular heart rhythm as evidenced by dizziness, anxiety, elevated heart rate, and hypotension.
Goal/Desired Outcome
Short-term goal: The patient will remain alert and oriented, and report a reduction in dizziness and anxiety by the end of the shift
Long-term goal: The patient will remain in normal sinus rhythm and suffer no adverse long-term neurological effects.
Nursing interventions with rationale for AFib- Risk for ineffective cerebral artery perfusion
| Nursing Interventions | Rationales |
| Monitor neurological status | Neurological changes can arise from poor perfusion due to rapid heart rate, or from blood clots due to a stroke |
| Educate the patient and their family about the FAST mnemonic to monitor for strokes: F – facial droop. A – arm weakness. S – slurred speech. T – time to call 911 | This mnemonic will help the family recognize a stroke and seek appropriate care |
| Administer anticoagulation | Anticoagulation can prevent the formation of clots, break up existing clots, and increase the blood flow |
| If the atrial fibrillation becomes chronic, long-term anticoagulation should be prescribed, and the associated lab work should be monitored | Certain anticoagulation (such as coumadin) requires frequent lab draws to ensure the proper level of anticoagulation is achieved |
| Educate the patient about the risk of falls | A fall can be deadly for patients on anticoagulation due to increased risk of bleeding. Special care needs to be taken to prevent falls |
#3 Sample AFib Nursing Care Plan – Lack of knowledge about AFib management
Nursing Assessment
Subjective Data:
- The patient reports medication non-compliance
Objective Data:
- PT 12 seconds
- INR 1.0
Nursing Diagnosis
Lack of knowledge about AFib management related to chronic irregular heart rhythm as evidenced by medication non-compliance
Goal/Desired Outcome
Short-term goal: The patient will verbalize the importance of home medication compliance by the end of the shift
Long-term goal: The patient will take his home medications as prescribed
Nursing interventions with rationale forAfib- Lack of knowledge about AFib management
| Nursing Interventions | Rationales |
| Familiarize the patient with the symptoms of a-fib with RVR | Symptom awareness can alert the patient to seek medical attention |
| Educate patient on the importance of taking prescribed medications | Medication noncompliance with atrial fibrillation can have serious, sometimes deadly, consequences |
| For chronic atrial fibrillation, consider an ablation | An ablation creates scar tissue in the heart which can prevent irregular rhythms |
| Educate the patient on the available technology to self-monitor their heart rhythm at home | A lot of noninvasive, inexpensive, and readily available technology is emerging that makes it easier for people to monitor their heart rhythms at home. Self-monitoring allows patients to take accountability and can alert them to seek help if needed |
Conclusion
To summarize, Afib is a common chronic condition. As a nurse, you should be able to detect abnormal heart rhythms from EKG and treat them accordingly. Since it could become life-threatening if not treated early.
Here, we’ve created a hypothetical case scenario for an elderly AFib patient. Then formulated three sample AFib nursing care plans using the nursing process.
Reference
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
