Nursing Care for AF

Nursing care for AF encompasses the entire individual with a focus on preventing the possible risks related to the arrhythmia and patient understanding of their pathology. Once a treatment plan has been established, the nurse's role is to help maintain the course of therapy. As there are several possible routes of intervention for AF, the nursing interventions depend upon these. (1)

Below is a table to summarize the nursing care which would accompany the form of treatment.

References:
1. Crawford, A., & Harris, H. (2009, May 1). Atrial Fibrillation: Nurses' guide to this common arrhythmia (M. Raymond, Ed.). Retrieved February 18, 2015, from http://www.modernmedicine.com/modern-medicine/news/modernmedicine/modern-medicine-feature-articles/atrial-fibrillation-nurses-guid?id=&pageID=3

Treatment: Medication	Treatment: Cardioversion	Treatment: Ablation
·         Antihypertensives (keep blood pressure in a healthy range) ·         Anticoagulants (prevent blood clotting) ·         Antiarrhythmics (prevent irregular heart conduction)	·         Conduction therapy to return the hearts rhythm back to normal	·         Destruction of malfunctioning heart cells
·         Monitor EKG rhythm, heart sounds, apical pulse, and vital signs ·         Monitor for signs and symptoms of drug side effects (hypotension, dizziness, syncope) ·         Monitor lab values; PTT and PT/INR	·         Assess patient status and determine if patient condition is declining, notify physician if cardioversion seems necessary ·         Prepare for administering sedation medication prior to cardioversion ·         Monitor vital signs before and after cardioversion ·         Assess sites of cardioversion on chest after procedure, treat with warm compress and/or analgesics if needed	·         Monitor vital signs, heart sounds, and apical pulse ·         Assess femoral insertion site for bleeding and clot formation, keep compressed ·         Assess calf and foot for signs of clot; check pulses for perfusion, pain and swelling

Treating AF

Treatment options for AF, like many diseases, depend on the severity, available treatments, and the person's desire/goal. We know how AF effects the heart and body, so we can narrow down what kind of treatments will help manage the disease and prevent progression of complications.

Common treatments for managing AF and preventing clot formation include anticoagulant therapy. Because the blood may pool in the heart during atrial fibrillation, these medications prevent the blood from clotting and causing a stroke/heart attack/pulmonary embolism. Side effects of these medications include the risk for bleeding. People taking these must be cautious with their physical activities to avoid injury and internal bleeding.

More invasive treatment options include cardioversion and surgical ablation. Cardioversion is an acute treatment option used to reset the hearts rhythm. It is usually done when the heart has been in AF for less than 48 hours. Time is a factor as cardioverting the heart after a prolonged arrhythmia may force a clot out of the heart and cause a stroke. Cardioversion may also fail to restore the hearts rhythm and possibly induce a more life threatening rhythm.

Ablation is becoming a common treatment option which is the closest treatment to a cure at the current time. This procedure is performed by a surgeon, with a rather quick recovery time for being considered a surgery. A catheter is threaded into the atria and destroys the problem tissue in the heart which is causing the electrical malfunctioning. Like any surgery there are risk factors, especially when the location is in the heart. Risks include stroke, trauma to the heart tissue, and cardiac tamponade (a life threatening problem which occurs when fluid accumulates in between the heart muscle and the lining sac which surrounds it).

These treatments can be extremely beneficial to the patient but anticoagulant therapy is often continued for life.


The following table presents a model for identifying whether a problem exists and the recommended options to pursue.

Signs and Symptoms

Signs and symptoms may vary among individuals with AF, as with many other pathologies. Some people experience symptoms and exhibit signs while some do not. Signs are objective findings which those assessing the person are able to identify. Symptoms are subjective experiences which the patient is aware of and must share if others are to know. The following are typical signs and symptoms of AF. (1)

Palpitations - when the person is able to feel abnormal and/or fast heart contractions. Feeling your heart beat is usually not normal. 

Shortness of breath

Weakness/exercise intolerance 

Chest pain

Dizziness/fainting

Confusion 

Many of these are common to a variety of diseases. The palpitations and feel of a rapid heart rate are hallmark for AF. Experiencing these symptoms benefits the person because they are able to recognize a change and will hopefully seek medical attention. Unfortunately, not everyone experiences symptoms, this increases the risk for complications such as stroke or heart attack because the person may not be aware of the arrhythmia and wait too long to seek help. (2)

References: 

1.      What Are the Signs and Symptoms of Atrial Fibrillation? (2014, September 18). Retrieved February 4, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/af/signs

2.      Atrial fibrillation symptoms [Motion picture]. (2012). Heart and Stroke Foundation.