Atrial Fibrillation – Pathophysiology, Podcast, and Nursing Care Plan

Atrial Fibrillation drawing

Atrial Fibrillation

Atrial Fibrillation is described as a quivering or irregular and sometimes fast heart rate. Atrial Fibrillation (Afib) can lead to heart failure, stroke, blood clots, and other complications of the heart.

In Afib, the atria ( the hearts upper two chambers) beat irregularly and at a high rate. Afib may be sporadic (come and go) or may become permanent. Afib may become dangerous for the patient and may require urgent treatment.

Afib can also lead to clots that form in the heart and can travel to other parts of the body and cause ischemia (damage).

Signs and Symptoms

The heart can not pump blood efficiently throughout body in Afib. Some patients maybe asymptomatic with Afib, and have no idea that they have this condition until it is found through examination by healthcare provider.

If the patient is experiencing symptoms, they may complain of:

  • Chest Pain
  • Palpitations
  • Weakness
  • Confusion
  • Fatigue
  • Dizzy and Lightheadedness
  • Shortness of breath

 Types of Atrial Fibrillation

  • Paroxysmal: Afib will start and stop, usually without any intervention. Symptoms will also wax and wane.
  • Persistent: Afib will start and not convert back to sinus rhythm on its own.  Instead medications and/or cardioversion (shock) may be utilized.
  • Permanent: Afib is unable to be converted back to a sinus rhythm.  The A fib will be permanent. Medications will be needed to control the heart rate and prevention of blood clots.

Causes

To comprehend Atrial Fibrillation, we need to review the cardiac electrical system as this system controls the rate and rhythm of the heat rate.

In order for the heart to beat, an electrical signal starts at the top of the heart and spreads to the bottom of the heart. This “signal” begins in the sinoatrial node (SA node). This node is located at the top of the right atrium. After the SA node, an electrical impulse travels to the right and left atria.  This causes BOTH atria to contract and pump blood into the right and left ventricles.

The atrioventricular node (AV node), is situated between the atria and ventricles. This signal will slow down slightly which will allow the right and left ventricles to fill with blood.

The electrical signal will then leave the AV node and will travel to the ventricles causing them to contract and pump blood to the lungs and body. Once this occurs, the ventricles will then again relax.  The whole process will then repeat itself.

When a patient has Afib, the electrical signal of the heart does not start in the SA node as it should. The electrical impulse begin in another part of the atria or even in the pulmonary veins. The electrical signals do not travel normally. They can instead spread very chaotically through both atria. This is what causes the atria to fibrillate.

This chaotic signal overwhelms the AV node which can not send the appropriate signals to the ventricles since they are so rapid and disorganized. While the ventricles are beating faster than normal, they can not beat as fast as the atria. Since the atria and ventricles are not working together, the rhythm becomes fast and irregular. As a result, the amount of blood pumped to the ventricles is dependent on how much blood flows the the ventricles from the quivering atria.

Because the atria in Afib are not allowing blood to flow into the ventricles in an efficient way, the atria may have some blood pooling which can lead to the formation of blood clots.

The heart rate in Afib can range from 100-175 beats per minute or higher. Usually there are no P waves on the EKG strip, the rhythm is irregular.

Atrial Fibrillation

Some causes of Afib:

  • CAD (coronary artery disease)
  • HTN
  • Heart attack
  • Congenital heart defects
  • Abnormal heart valves
  • Lung disease
  • Heart surgery
  • Infections
  • Stress
  • Sleep apnea
  • Tobacco or alcohol (among other stimulants)
  • Obesity
  • Family history of Afib

Complications

Atrial fibrillation can lead to the following complications:

  • Stroke – the disorganized rhythm can cause blood to pool in the right and left atria.  This pooling can produce blood clots.  If the clots dislodges from the atria, it can travel to the brain and then block blood flow.
  • Heart Failure – This can occur if the Afib is not controlled.

Diagnosis

The following diagnostic exams may be ordered to diagnose Afib:

  • EKG
  • Echocardiogram – Cardiac ultrasound of the heart
  • Chest X-ray
  • Holter Monitor – This will record the cardiac rhythm for 24 hours or a longer duration.
  • Echocardiogram – Cardiac ultrasound of the heart
  • Lab tests – to rule out condition that may lead to Afib (i.e. thyroid problems)

Atrial Fibrillation drawing

 Medications and Treatments

Treatment and medications are aimed at preventing blood clots and attempting to control the rate and rhythm or the heart beat.

When the nurse is taking care of a hospitalized patient, the following treatments may be utilized:

    • Patient is placed in O2
    • Prescribed anticoagulants due to the risk on clot formation
    • Cardiac medication may be ordered to control ventricular response and cardiac output.
    • Anti-arrhythmic medication may be prescribed to help prevent Afib.
    • Beta Blockers and Calcium Channel blockers may be given to help control heart rate. Use with caution for patients with hypotension or heart failure.
    • Patient may need to be cardioverted, this can be done with medication or by electrical cardioversion.
    •  Patient needs to know and understand the importance of adhering to medication regime to control the dysrhythmia.
    • Catheter Ablation or AV node Ablation

Podcast for Atrial Fibrillation

Nursing Care Plan

Nursing Diagnosis

1. Decreased Cardiac Output related to alteration of rate, rhythm and conduction.

Desired outcomes:

Withing 30-60 minutes of intervention, the patient will have improved cardiac output as evidenced by heart rate of 60-100 beats per minute, blood pressure 90/60 or higher, and a NSR on the EKG.

InterventionsRationals
InterventionsRationals
Assess client q4h for increasing heart rate, increased blood pressure, fatigue or chest pressure/pain.one or all of these symptoms may indicate the beginning of cardiac failure or other complications.
Monitor pulse oximetry and report O2 saturation <92%.O2 sat of <92% indicates the need to supplement oxygen in the myocardium.
Assess patients heart rate and rhythm continuously on cardiac monitor.This will monitor cardiac dysrhythmias as they occur or if they are getting worse.
If patient is exhibiting signs and symptoms of decreased cardiac output, prepare to transfer patient to ICU.This will allow for more intensive monitoring and care.

2. Deficient Knowledge related to being unfamiliar with diagnosis, treatment and medication regime.

Desired outcomes:

Within 1 day of discharge, patient and family will verbalize knowledge of dysrhythmia condition and necessary lifestyle changes.

InterventionsRationals
InterventionsRationals
Assess the patients level of comprehension and language.This will ensure that the information given is at a level of comprehension that is tailored to the patient and their health education.
Determine the patients knowledge of medication regime.Patients who are more knowledgeable and educated on their medications are more likely to continue to take their medications as prescribed.
Explain in detail the importance of keeping regular physician and routine laboratory appointments. The patient will need to be monitored closely by physician who will need to adjust anticoagulants as needed depending on laboratory results.

 

 

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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