When your patient flips into atrial fibrillation suddenly, it can be a bit intimidating. These atrial fibrillation tips for nurses are exactly what you need to know, whether you are a new nurse or one with more experience, about how to handle this common clinical situation with confidence and care.
There are different levels of urgency related to atrial fibrillation. If their heart rate is less than 100 BPM and they have a history of this, it’s not nearly as urgent as a heart rate of 185 BPM and no previous history. For the purposes of this post, we will discuss how to speak to your patient while you address the high-urgency situation of atrial fibrillation with rapid ventricular response.
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Atrial Fibrillation Tips for Nurses
Let’s go over some atrial fibrillation tips for nurses and how you can talk to your patient so they can stay as calm as possible while you work quickly and diligently to get this urgent issue addressed.
Please note, we are talking about patient who
If you have a patient who just flipped into uncontrolled atrial fibrillation, even if they can’t feel it, they may be worried, especially if they can see their heart rate on the monitor or the vitals machine next to them.
The Most Important Thing You Can Do
The most important thing you, as their capable and confident nurse, can do is stay calm.
You need to have your Nurse Face on and act like you’ve got everything under control, even if it’s not. If your patient gets incredibly anxious, that can undermine your efforts.
The first pulse you take in this situation is your own. Take some deep belly breaths, bring your own heart rate down, and be a calming presence to them.
How to Explain it to Your Patient
How do you explain this to a patient going through it?
Here is my general explanation I give to patients when patients are newly in afib with a high heart rate requiring prompt intervention.
I speak with a very calm and reassuring voice because this is really scary to experience.
Right now your heart isn’t beating normally. You have four chambers of your heart. Normally, they have strong and smooth contractions that move blood through the heart. But right now, the top two chambers of your heart aren’t doing that. Instead of a strong and smooth contraction, they’re just quivering… or fibrillating.
In addition to that, your heart rate is much higher than we would like it. Our goal is to get your heart back to contracting normally and at the right speed. We will try some medications to try to get that to happen. They will go through your IV. We’re going to watch you closely to see how you respond to them.
The reason this is so important for us to do as fast as possible is that when your heart doesn’t contract properly, blood can pool in your heart and cause clots. These can form and then travel from your heart to other areas of your body, like your brain, and cause major problems… like a stroke. That’s why you’re going to see me working quickly to get your heart back into that normal rhythm.
(Are you reading that to yourself with a calm, reassuring voice? Good. Patients love that voice. I love that voice. I feel so safe!)
Remind Them You See it Frequently And It’s Under Control
Continue to explain that we have a lot of different and extremely effective ways to handle this. We see this frequently and know how to deal with it. Use this time to tell them it’s important they are not exerting any additional energy while we’re trying to get their heart rate and rhythm controlled.
They won’t be working with therapy today and they need to stay in bed for the time being.
Tell Them You’ll Be Taking Blood Pressures Frequently
Also, let them know that we’re going to be taking blood pressures frequently. This is because sometimes the blood pressure can drop a little bit due to this rhythm and because of some of the medications we give.
Reassure the Patients With A Calm Voice
Reassure them. Let them know that yes, this is scary but we’ve got it all under control. The doctor is aware, and we’ve got orders we are working on to get that heart back into shape.
Stay calm, confident, cool, and collected.
Try Your Best Not to Overwhelm Them
Don’t explain every possible aspect and complication possibility right away. This may scare and overwhelm them, and we need to be cognizant of that. We also don’t want to confuse them with information that might not be applicable yet.
Therefore, I tend to not bring up things like anticoagulation unless it’s looking like we will need it.
Take It One Step At A Time
Don’t explain the entire algorithm to them of all of the possibilities. As you encounter issues, explain what you’re doing and why in simple and concise terms. Reiterate and re-explain as needed.
It’s really hard to learn and absorb information when you’re scared and you’ve got your sympathetic nervous system (fight or flight) raging. Not only will your patient most likely be in that state, so will their loved ones. Chances are, a lot of what you explain to them in the heat of the moment will go in one ear and out the other.
Ask Them For Any Questions
Something I like to ask frequently is, “What questions do you have for me?”
This is much more open ended than: “Do you have any questions?”
Even if you remain calm, explain along the way, and get them successfully converted back to normal sinus rhythm, make sure you go over everything that just happened with them once the dust settles. They will most likely be in a much better mental place to truly understand what the heck just happened.
Atrial Fibrillation Tips for Nurses: What to Say When You Need to Cardiovert
At times, cardioversion is a necessary measure. However, this is the most invasive and a very scary situation for patients and loved ones, especially if it’s urgent and done on the nursing unit. Sometimes, depending on the circumstance, this can be done down in a cardiac procedural center. However, that’s not always the case.
Whenever they are thinking about doing this, don’t give them anything to eat or drink until they’re done. (Sometimes they puke after they get shocked.) Typically, they give some conscious sedation and we don’t want anyone aspirating/choking on vomit.
What to Tell Them
We will let the patient know we’re going to give them something to relax and we’re going to shock their heart back into a normal rhythm. Ideally, the physician or advanced practice provider tells shares that information.
However, realistically, they’re going to want to know why you’re bringing the code cart into their room. If they need cardioversion, that means a lot of things are happening at once and you need to quickly and succinctly inform them while they’re seeing the team set up for the procedure. That usually scares people, so make sure you’re calm, comforting, and reassuring.
Tell Family/Visitors To Wait Outside
Have family/visitors go to the waiting room while you do your synchronized cardioversion – it’s very upsetting to see your loved one get shocked by 200 joules.
Do Not Do a Cardioversion Alone
You’ll never do cardioversion alone; a doctor and/or NP/PA should be with you as well as another nurse (preferably your charge nurse).
Here is a great video of cardioversion in an emergency department. They go through the entire process of sedating the patient and showing the monitor, but if you want to see the actual cardioversion it is right at the 5-minute mark.
Atrial Fibrillation Tips for Nurses: Emotional Considerations
I’ve had dozens and dozens of patients flip into afib with RVR over the years. It scares patients and families, especially if it’s after a huge heart surgery, like a CABG. They’re typically emotionally exhausted at that point. The best thing you can do for these patients and families is to be confident, remain calm, and try to make them feel as safe as possible.
(Have I said that enough yet?)
Explain things to them in a reassuring voice and don’t freak out (even if you’re freaking out on the inside). If you get concerned, ask a fellow nurse, but don’t do it in front of them.
This can also be discouraging to a patient and/or family. Let them know it’s a bump in the road to recovery, but we’re still getting there. Be positive, confident, and hopeful with them. Even if they don’t act down, they may be good at hiding it. Be encouraging to them and their family.
Please use your judgment. If it is a case of someone with a very poor prognosis, don’t change the tone that’s already been set by the medical team.
I hope these atrial fibrillation tips for nurses were helpful to you! See below for some additional cardiac resources.