ATRIAL FIBRILLATION (A CONCEPT MAP)

Clinical Manifestations/Symptoms of AF

Etiology of Atrial Fibrillation

Information Obtained from:

• http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/basics/treatment/con-20027014
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767799/
• http://nursestudy.net/2015/03/28/atrial-fibrillation-pathophysiology-podcast-and-nursing-care-plan/
• http://www.registerednursern.com/nursing-care-plan-and-diagnosis-for-atrial-fibrillation-decreased-cardiac-output-a-fib-cardiac-arrhythmia-dysrhythmia-irregular-heart-rate-cardiac-dysrhythmia-risk-for-stroke-and-pulmonary-embolism/

Nursing Management

Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your heart (atria) experience chaotic electrical signals.

Some people with atrial fibrillation have no symptoms and are unaware of their condition until it's discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience signs and symptoms such as:

Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest

Weakness

Reduced ability to exercise

Fatigue

Lightheadedness

Dizziness

Confusion

Shortness of breath

Chest pain

• 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.

Nursing Diagnosis

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

• "as evidence by EKG showing Atrial Fibrillation, HR irregular 130-160s, and BP 108/73."

Risk for impaired gas exchange-related to alveolar/capillary changes

Abnormalities or damage to the heart's structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:

High blood pressure

Heart attacks

Coronary artery disease

Abnormal heart valves

Heart defects you're born with (congenital)

An overactive thyroid gland or other metabolic imbalance

Exposure to stimulants, such as medications, caffeine or tobacco, or to alcohol

Sick sinus syndrome — improper functioning of the heart's natural pacemaker

Lung diseases

Previous heart surgery

Viral infections

Stress due to pneumonia, surgery or other illnesses

Sleep apnea

Pharmacology

Pathogenesis of Atrial Fibrillation

Medications prescribed are specific to a patient's type (occasional, persistent, permanent) and duration of atrial fibrillation as well as symptoms. The doctor may order a blood thinner such as Coumadin which will allow regular blood flow and prevent blood clots. Some medications used for maintaining a regular heart rhythm are:

• Dofetilide (Tikosyn)
• Flecainide
• Propafenone (Rythmol)
• Amiodarone (Cordarone, Pacerone)

Hypertensive, valvar, ischemic, and other types of structural heart disease underlie most cases of persistent and permanent AF, whereas, lone AF accounts for approximately 15% of AF cases. Familial AF is well described, although at present considered rare.

Diagnostics & Lab Tests

A doctor may review a patient's family and medical history as well as current symptoms before ordering the following tests:

• EKG
• Holter Monitor
• Event Monitor
• Echocardiogram
• Various Blood Tests
• Chest X-Ray

ATRIAL FIBRILLATION (A CONCEPT MAP)