- Decreased Cardiac Output related to Ineffective atrial contraction, decreased oxygenated blood flow to ventricles and failure of the heart to pump adequate blood to the rest of the body as evidenced by dysrhythmias and ejection fraction less than 40%
- 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 and nonadherence with the treatment regimen
- Ineffective Tissue Perfusion related to Interruption of blood flow due to embolism and thrombolytic therapy as evidenced by Report of a pounding, fluttering, or rapid heartbeat and Chest pain or tightness
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalizes patient is unable to breathe properly Objective Data: -Presence of abnormal heart sound S3 and S4 upon auscultation -Chest pain (angina) -Presence of adventitious lung sounds upon auscultation -Difficulty breathing when lying down and relieved by upright position (orthopnea) -Rapid breathing (tachypnea) -Alteration in the level of consciousness | Decreased Cardiac Output related to Ineffective atrial contraction, Decreased oxygenated blood flow to ventricles and failure of the heart to pump adequate blood to the rest of the body as evidenced by dysrhythmias and ejection fraction less than 40% | Patient will manifest blood pressure and pulse rate within normal limits. Patient will be able to tolerate activities without chest pain, dyspnoea, or changes in the level of consciousness. Patient will display normal sinus rhythm on EKG. | 1. Intervene with cardioversion. For patients with atrial fibrillation who are unstable, cardioversion with anticoagulant therapy is recommended. Cardioversion may be indicated without prior TEE during emergency cases. 2. Administer beta-blocker or calcium-channel blocker as prescribed. Beta-blockers and calcium channel blockers offer quick heart rate control at rest and during activity. They can be administered intravenously (IV) or orally. 3. Cautiously give digoxin. Digoxin reduces the heart rate to treat atrial fibrillation. The goal is to lessen the pressure on the heart. Through time, this can induce heart failure by wearing out the heart muscle. Digoxin is given in conjunction with other medications. 4. Limit fluids. Fluid restriction lowers the heart’s preload and extracellular fluid volume, which reduces the heart’s workload. 5. Place the patient in an upright position. High- or semi-Fowler’s position lessens preload and ventricular filling. This also allows the patient to breathe easier. 6. Prepare for possible ablation therapy. Atrial fibrillation ablation treats the chaotic and erratic heart rhythm and is used when medications or cardioversion fail. 7. Consider a pacemaker. A pacemaker implant is considered in severe cases of atrial fibrillation leading to heart failure. A pacemaker is not a treatment for atrial fibrillation but treats bradycardia. 8. Refer the patient to cardiac rehabilitation. Exercise, support, counselling, and diet education are all part of cardiac rehabilitation. Patients with atrial fibrillation or who have undergone a cardiac procedure may benefit from cardiac rehabilitation. | Patient manifested blood pressure and pulse rate within normal limits. Patient tolerated activities without chest pain, dyspnoea, or changes in the level of consciousness. Patient displayed normal sinus rhythm on EKG. |
| Subjective Data: -Verbalizes poor understanding -Seeks additional information Objective Data: -Inaccurate demonstration or teach-back of instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment | 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 and nonadherence with the treatment regimen | 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. | 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. | Patient verbalized understanding of atrial fibrillation, treatment plan, any potential drug adverse effects, and when to contact a healthcare provider. Patient demonstrated two behavior and lifestyle modifications to prevent complications. |
| Subjective Data: Verbalizes that he can feel the heartbeat Objective Data: -Report of a pounding, fluttering, or rapid heartbeat -Chest pain or tightness -Altered mental status -Light-headedness -Dyspnea -Syncope | Ineffective Tissue Perfusion related to Interruption of blood flow due to embolism and thrombolytic therapy as evidenced by Report of a pounding, fluttering, or rapid heartbeat and Chest pain or tightness | 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 vital signs within parameters and intact mentation. | 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, antidysrhythmic, fibrinolytics, anticoagulants, and more may be utilized. Vasoactive medications enhance systemic hemodynamic 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. Haemoglobin, 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. | Patient verbalized understanding of atrial fibrillation, treatment plan, any potential drug adverse effects, and when to contact a healthcare provider. Patient demonstrated increased perfusion as evidenced by vital signs within parameters and intact mentation. |