Atrial fibrillation (AFib), often abbreviated as AF, stands as a prevalent cardiac arrhythmia characterized by an irregular and frequently rapid heart rhythm. This erratic rhythm disrupts normal blood flow, fostering the potential for clot formation. Consequently, AFib significantly elevates the risk of serious health events including stroke, heart failure, and myocardial ischemia or heart attack.
The dangers, signs, and symptoms associated with AFib are largely determined by the heart’s rate and the frequency of rhythm disturbances. AFib episodes can be transient, resolving spontaneously, or they may persist, necessitating medical intervention. Treatment strategies for atrial fibrillation encompass:
- Medications aimed at regulating heart rate and rhythm.
- Anticoagulants to mitigate the risk of blood clot formation.
- Surgical procedures like cardiac ablation.
- Pacemaker implantation for heart rate management.
In the realm of inpatient care, nurses play a pivotal role in managing patients with AFib. Their responsibilities range from vigilant monitoring to implementing comprehensive interventions for persistent AFib. Nurses are crucial in educating patients on the importance of medication adherence, especially for those managing hypertension and cardiovascular disease. Furthermore, patient education extends to recognizing stroke symptoms and other potential complications, empowering them to promptly seek medical attention when necessary.
Nursing Assessment for Atrial Fibrillation
The cornerstone of effective nursing care begins with a thorough nursing assessment.
Reviewing the Patient’s Health History
1. Inquiry into General Symptoms: Begin by exploring the patient’s presenting complaints and symptoms. Key symptoms to assess include:
- Palpitations: Awareness of heartbeats that are rapid, strong, or irregular.
- Chest Discomfort: Pain, pressure, or tightness in the chest region.
- Shortness of Breath (Dyspnea): Difficulty or labored breathing.
- Increased Edema of Lower Extremities: Swelling in ankles, feet, and legs.
- Exertional Dyspnea: Shortness of breath that worsens with physical activity.
- Disorientation: Confusion or lack of awareness of time, place, or person.
2. Detailed Symptom Description: Encourage the patient to provide a comprehensive account of their symptoms. Document the onset, duration, frequency, triggers, and any relieving factors associated with AFib-related symptoms.
3. Risk Factor Identification: Systematically investigate for conditions and risk factors that predispose individuals to atrial fibrillation:
- Hypertension: High blood pressure.
- Obstructive Sleep Apnea: Disordered breathing during sleep.
- Obesity: Excessive body weight.
- Valvular and Structural Heart Defects: Abnormalities in heart valves or heart structure.
- Coronary Artery Disease: Narrowing of arteries supplying blood to the heart.
- Myocardial Infarction: Heart attack.
- Rheumatic Fever: Inflammatory disease affecting the heart, joints, and brain.
- Myocarditis: Inflammation of the heart muscle.
- Pericarditis: Inflammation of the sac surrounding the heart.
- Hyperlipidemia: High cholesterol.
- Endocrine Disorders: Conditions like diabetes and hyperthyroidism.
- Stroke: Cerebrovascular accident.
- Family History of AFib: Genetic predisposition.
- Advanced Age: Increased risk with older age.
- History of Heart Disease: Pre-existing cardiac conditions.
- Congenital Heart Disease: Heart defects present at birth.
- High Alcohol Consumption: Excessive alcohol intake.
- Smoking: Tobacco use.
4. Treatment History Review: Compile a list of the patient’s current and past medications, procedures, surgeries, and referrals related to atrial fibrillation management. Recognize that while AFib may be chronic, significant advancements in therapies and risk reduction strategies exist to mitigate stroke risk.
5. Health Behaviors and Lifestyle Assessment: Conduct an interview to understand the patient’s health behaviors and lifestyle practices. Identify areas for potential improvement and address any concerns raised by the patient.
Physical Examination
Primary Goal: The primary objective of the physical examination is to identify the underlying cause of AFib.
1. Prioritize ABCs: Always begin with assessing Airway, Breathing, and Circulation (ABCs). This initial evaluation dictates immediate priorities and subsequent treatment decisions.
2. Vital Signs Assessment: For patients presenting with symptoms suggestive of atrial fibrillation, promptly measure blood pressure, pulse, respiratory rate, and oxygen saturation (SpO2). AFib is the most common arrhythmia, and vital signs provide critical baseline data.
3. Systemic Physical Assessment: Employ a systematic approach to assess various body systems:
- Neck: Observe for neck swelling (potential thyroid disease indicator) and jugular vein distention (possible heart failure sign).
- Central Nervous System (CNS): Evaluate for alterations in mentation, speech, pupillary response, and motor function (indicators of transient ischemic attack or stroke).
- Cardiovascular System: Note chaotic, irregular pulse, tachycardia, chest pain, and any abnormal heart sounds (murmurs) upon auscultation.
- Respiratory System: Auscultate for adventitious breath sounds. Rales (crackles) may suggest heart failure, while wheezing could indicate an underlying lung disorder.
- Abdomen: Auscultate for abdominal bruits, and palpate for an enlarged liver (hepatomegaly) and abdominal distension (potential heart failure signs).
- Peripheral Circulation: Assess for irregular, fluttering peripheral pulses.
- Lymphatic System: Observe for edema.
- Integumentary System: Examine hair loss, skin color changes, and temperature variations in the extremities (possible signs of vascular disease).
An ECG strip clearly showing the characteristic irregular rhythm of atrial fibrillation, a key diagnostic indicator in cardiac nursing.
Diagnostic Procedures for Atrial Fibrillation
1. Electrocardiogram (ECG): Obtain an ECG to confirm the diagnosis. Atrial fibrillation on ECG is characterized by a distinctive narrow complex “irregularly irregular” or chaotic pattern, lacking discernible P-waves. Fibrillatory waves may be present. The ventricular rate typically ranges from 80 to 180 beats per minute.
2. Laboratory Tests: Collect samples for the following laboratory evaluations and explain their purpose to the patient:
- Complete Blood Count (CBC): To assess for infection and anemia.
- Basic Metabolic Panel (BMP): To evaluate electrolyte imbalances.
- Thyroid Function Tests: To screen for hyperthyroidism.
- Kidney Function Tests: To assess renal function.
- Cardiac Biomarkers and B-type Natriuretic Peptide (BNP): To evaluate for underlying heart disease.
- D-dimer Test: To assess for the presence of blood clots.
3. Chest X-ray Review: Review chest X-ray results to identify any thoracic or pulmonary abnormalities. A chest X-ray can reveal contributing factors to AFib, such as fluid accumulation or infection.
4. Transesophageal Echocardiography (TEE) Preparation: Prepare the patient for a TEE, which provides detailed visualization of the heart’s anatomy and can detect atrial thrombi (blood clots) often associated with atrial fibrillation. TEE is typically performed before cardioversion.
5. Further Investigations: Consider the following additional diagnostic tools as indicated:
- Holter or Event Monitor: Ambulatory ECG monitoring to record heart activity over an extended period (24-48 hours for Holter, up to 30 days for event monitor). Useful for detecting intermittent or asymptomatic AFib.
- Stress or Exercise Test: Evaluates the heart’s response to physical exertion while ECG is monitored. Can demonstrate how AFib affects functional capacity.
- Echocardiography (Transthoracic Echocardiogram – TTE): Uses ultrasound to create moving images of the heart. Identifies structural heart abnormalities or blockages.
- Tilt-Table Test: Performed if ECG and Holter monitoring are non-diagnostic, but the patient experiences symptoms like syncope or dizziness. Assesses heart rate and blood pressure response to postural changes.
- Electrophysiologic Study (EPS): Invasive procedure involving catheter insertion into heart chambers via an artery. Catheter stimulates the heart to map electrical pathways and identify the origin and characteristics of arrhythmias.
Nursing Interventions for Atrial Fibrillation
Effective nursing interventions are crucial for patient recovery and management of atrial fibrillation.
Heart Rhythm Management Strategies
1. Stabilization and Risk Reduction: Prioritize hemodynamic stability and risk reduction in AFib care. In unstable patients, immediate cardioversion, coupled with anticoagulation therapy, is often necessary. A thorough patient history is vital to mitigate AFib risks and complications.
2. Heart Rhythm Restoration (Cardioversion): Cardioversion aims to restore normal sinus rhythm. Two primary methods are employed:
- Electrical Cardioversion: Delivers controlled electrical shocks to the heart via chest electrodes to reset the rhythm.
- Pharmacological Cardioversion: Utilizes antiarrhythmic medications, administered orally or intravenously, to convert the heart rhythm back to normal.
3. Heart Rhythm Control (Rate Control): Medications are used to slow down the heart rate:
- Beta-blockers: Reduce heart rate both at rest and during physical activity.
- Calcium Channel Blockers: Effective in lowering heart rate, but generally avoided in patients with heart failure or hypotension.
- Digoxin: Regulates heart rate primarily at rest, less effective during exertion. Typically used in combination with beta-blockers or calcium channel blockers, not as a first-line agent.
- Antiarrhythmic Medications: Maintain regular heart rhythm and rate. Use is often limited in patients with heart failure due to potential side effects.
A nurse carefully administering medication to a patient, highlighting the crucial role of medication management in atrial fibrillation care.
Stroke and Blood Clot Prevention
1. Initiate Anticoagulation Therapy: For symptomatic AFib patients, anticoagulation is a cornerstone of therapy, alongside rate and rhythm control.
2. Non-Vitamin K Oral Anticoagulants (NOACs): NOACs are now the preferred anticoagulants over warfarin for stroke risk reduction in AFib, except in patients with mitral stenosis or mechanical heart valves.
3. Liver and Kidney Function Assessment: Prior to initiating NOACs, assess liver and kidney function to guide appropriate dosing and minimize bleeding risk.
4. Direct-Acting Oral Anticoagulants (DOACs) for Valve Replacement: DOACs, including dabigatran, rivaroxaban, and apixaban, are used in patients with mechanical and bioprosthetic heart valves. DOACs are generally recommended for stroke prevention in AFib.
5. Safety Precautions with Anticoagulants: Bleeding is the most significant complication of anticoagulation therapy. Educate patients about bleeding risks and implement safety measures to prevent hemorrhage and shock.
6. Left Atrial Appendage Ligation: For AFib patients with contraindications to long-term anticoagulation, percutaneous left atrial appendage ligation may be considered to reduce stroke risk.
Cardiac Ablation Procedures
1. Cardiac Ablation Consideration: Cardiac ablation is recommended if medications or other treatments are ineffective in managing AFib. Catheter ablation is an option for patients with reduced ejection fraction.
Cardiac ablation involves creating scar tissue in the heart using heat (radiofrequency energy) or cold (cryoablation) to disrupt abnormal electrical signals and restore a regular heartbeat.
2. AV Node Ablation and Pacemaker Placement: Ablation of the atrioventricular (AV) node results in complete AV block, necessitating permanent pacemaker implantation for heart rate control.
3. Surgical Maze Procedure: Involves open-heart surgery when performed with a scalpel. The maze procedure is often the preferred AFib treatment in patients undergoing other cardiac surgeries like coronary artery bypass grafting or valve repair.
4. AFib Recurrence Post-Ablation: Recurrence of AFib is possible after cardiac ablation. Repeat ablation or alternative treatments may be necessary. Lifelong anticoagulation may still be required post-ablation to prevent stroke.
Cardiac Rehabilitation Programs
1. Program Adherence: Cardiac rehabilitation is a structured program encompassing exercise, education, and support, tailored to individual patient needs and supervised by healthcare professionals. It assists patients and families in adopting long-term lifestyle modifications.
2. Complication Reduction: Cardiac rehab aids in recovery from AFib, reduces the risk of complications, and lowers hospital readmission rates.
3. Home and Community Involvement: Cardiac rehabilitation typically begins in the hospital and continues post-discharge in home or community settings. Program duration often ranges from 6 to 10 weeks, depending on individual needs and program structure.
4. Goal Setting in Cardiac Rehab: Cardiac rehab aims to improve strength, reduce the likelihood of AFib complications, and enhance overall health and quality of life.
5. Program Component Emphasis: Adherence to cardiac rehabilitation interventions is associated with better outcomes. Key components include:
- Exercise Training
- Emotional Support
- Patient Education on Lifestyle Modifications
- Heart Disease Risk Factor Reduction
- Emphasis on Heart-Healthy Diet, Weight Management, and Smoking Cessation
Patient Education for Atrial Fibrillation Management
1. Prioritize Regular Exercise: Regular physical activity can lower blood pressure, reduce resting heart rate, and decrease the severity and frequency of AFib episodes.
2. Maintain Ideal Body Weight: Obesity accelerates AFib progression. Educate and encourage patients on weight loss strategies. Even modest weight reduction (e.g., 10% of body weight) can significantly reduce AFib burden.
3. Risk Factor Reduction: Adopting a heart-healthy lifestyle is the most effective approach to minimize AFib risk. Proper risk factor management reduces the likelihood of heart failure and stroke.
4. Stress Management: Psychological stress triggers can exacerbate atrial fibrillation. AFib is linked to anxiety, depression, distress, and increased suicide risk. Teach stress reduction techniques.
5. Lifelong Blood Monitoring Education: For patients on warfarin, emphasize the importance of maintaining INR within the therapeutic range. Educate on continuous monitoring of anticoagulation profiles when using blood thinners.
6. Recognize and Respond to Symptoms: Instruct patients and families on when to seek prompt medical attention. Detail the signs and symptoms of potential AFib complications, particularly stroke. Emphasize immediate reporting of any changes in health status.
7. Treatment Adherence Reinforcement: Provide ongoing education regarding prescribed medication regimens for AFib to ensure adherence.
8. Cardiology Follow-Up: Stress the necessity of lifelong follow-up with a cardiologist and routine testing, including ECG and echocardiogram, for long-term AFib management.
Nursing Care Plans for Atrial Fibrillation
The following are sample nursing care plans addressing common nursing diagnoses related to atrial fibrillation.
Decreased Cardiac Output related to Atrial Fibrillation
Nursing Diagnosis: Decreased Cardiac Output related to impaired atrial contraction secondary to atrial fibrillation.
Related Factors:
- Impaired cardiac muscle contraction
- Ineffective atrial contraction
- Decreased oxygenated blood flow to ventricles
- Increased cardiac afterload
- Imbalanced ventricular filling (cardiac preload)
- Increased pulmonary venous pressure
- Heart failure
As Evidenced By:
- Decreased cardiac output measurements
- Hypotension
- Decreased peripheral pulses
- Increased central venous pressure (CVP)
- Increased pulmonary artery pressure (PAP)
- Tachycardia
- Dysrhythmias (atrial fibrillation)
- Ejection fraction less than 40%
- Decreased oxygen saturation
- Presence of abnormal heart sounds (S3 and S4)
- Chest pain (angina)
- Adventitious lung sounds (rales/crackles)
- Difficulty breathing (dyspnea, orthopnea, tachypnea)
- Altered level of consciousness, restlessness
- Fatigue
- Activity intolerance
- Cold, clammy skin
- Prolonged capillary refill
- Weight gain, edema
- Decreased urine output
Expected Outcomes:
- Patient will maintain blood pressure and pulse rate within acceptable limits.
- Patient will demonstrate tolerance to activity without chest pain, dyspnea, or changes in level of consciousness.
- Patient will exhibit a stable cardiac rhythm, ideally sinus rhythm, on ECG.
Nursing Assessments:
1. Cardiovascular Status: Assess for history of coronary artery disease, as AFib increases risk of stroke and heart attack.
2. Blood Pressure and Pulse: Monitor for hypotension and tachycardia, compensatory responses to decreased cardiac output. Persistent tachycardia can be detrimental.
3. Heart and Lung Sounds: Auscultate for S3 and S4 heart sounds (gallop rhythm), crackles in lungs, indicating potential heart failure.
4. ECG Monitoring: Obtain and continuously monitor ECG for atrial fibrillation pattern (chaotic, no P-waves, fibrillatory waves).
5. Identify Underlying Cause: Review lab results (CBC, BMP, thyroid function, kidney function, cardiac biomarkers, BNP, D-dimer) and chest X-ray to identify potential causes of AFib.
6. Monitor for Complications: Assess for chest pain, edema, and other signs of reduced cardiac output and potential heart failure.
Nursing Interventions:
1. Cardioversion: Prepare for and assist with cardioversion (electrical or pharmacological) for unstable patients with AFib, often with concurrent anticoagulation.
2. Administer Medications: Administer beta-blockers or calcium channel blockers as prescribed for rapid heart rate control.
3. Digoxin Administration: Administer digoxin cautiously, often in combination with other rate control medications, to reduce heart rate.
4. Fluid Management: Implement fluid restriction as ordered to reduce preload and cardiac workload.
5. Positioning: Place patient in upright (high or semi-Fowler’s) position to ease breathing and reduce preload.
6. Prepare for Ablation: Prepare patient for possible cardiac ablation therapy if medications and cardioversion are ineffective.
7. Pacemaker Consideration: Consider pacemaker implantation for severe bradycardia related to AFib or AV node ablation.
8. Cardiac Rehabilitation Referral: Refer patient to cardiac rehabilitation program for exercise, education, and support.
Deficient Knowledge related to Atrial Fibrillation
Nursing Diagnosis: Deficient Knowledge related to atrial fibrillation and its management.
Related Factors:
- Lack of information about AFib and treatment
- Limited interest in learning
- Memory deficits
As Evidenced By:
- Expresses confusion about AFib
- Non-adherence to treatment plan
- Development of complications
Expected Outcomes:
- Patient will verbalize understanding of AFib, treatment plan, potential medication side effects, and when to seek medical care.
- Patient will demonstrate two lifestyle modifications to prevent complications.
Nursing Assessments:
1. Knowledge Level: Assess patient’s current understanding of AFib, risks, and treatment options.
2. Learning Readiness: Determine patient’s capacity, readiness, and barriers to learning. Consider emotional and physical state, and learning preferences.
3. Identify Avoidance Cues: Recognize cues of avoidance or non-adherence to treatment, and explore underlying concerns.
Nursing Interventions:
1. Identify Motivators: Determine patient’s motivating factors (positive or negative) to tailor education.
2. Provide Relevant Information: Provide concise, relevant information about AFib, treatment, and self-management.
3. Positive Reinforcement: Use positive reinforcement to encourage learning and adherence.
4. Involve Support Systems: Engage family or support system in education to enhance understanding and support adherence.
Ineffective Peripheral Tissue Perfusion related to Atrial Fibrillation
Nursing Diagnosis: Ineffective Tissue Perfusion related to decreased cardiac output and potential emboli associated with atrial fibrillation.
Related Factors:
- Disrupted blood flow due to arrhythmia
- Embolism formation
- Thrombolytic therapy (potential complication)
- Decreased cardiac output
As Evidenced By:
- Palpitations (reported pounding, fluttering, rapid heartbeat)
- Chest pain or tightness
- Altered mental status
- Lightheadedness, dizziness
- Dyspnea
- Syncope
Expected Outcomes:
- Patient will verbalize understanding of AFib, treatment plan, medication side effects, and when to contact healthcare provider.
- Patient will demonstrate improved tissue perfusion evidenced by stable vital signs and intact mentation.
Nursing Assessments:
1. Neurological Status: Assess mental status, level of consciousness, speech, and behavior for signs of decreased cerebral perfusion.
2. Blood Pressure Monitoring: Monitor blood pressure closely for hypotension or hypertension, both impacting tissue perfusion.
3. Treatment Plan Adherence: Assess patient’s understanding of and adherence to treatment plan, as non-adherence increases risk of complications.
Nursing Interventions:
1. Interdisciplinary Collaboration: Collaborate with physicians and other healthcare team members for comprehensive care planning.
2. Medication Administration: Administer prescribed medications (antihypertensives, antiarrhythmics, anticoagulants) to manage AFib and improve perfusion.
3. Monitor Lab Values and Tests: Closely monitor labs (hemoglobin, ABGs, electrolytes, cardiac enzymes, kidney function) and diagnostic tests (CT scans, ultrasounds) to assess perfusion and organ function.
4. Prepare for Cardioversion: Prepare patient for cardioversion to restore normal rhythm and improve cardiac output.
Risk for Activity Intolerance related to Atrial Fibrillation
Nursing Diagnosis: Risk for Activity Intolerance related to imbalanced oxygen supply and demand secondary to atrial fibrillation.
Related Factors:
- Imbalanced oxygen supply and demand due to arrhythmia
- Circulatory problems (dizziness, presyncope, syncope)
As Evidenced By:
(Risk diagnosis – no defining characteristics present)
Expected Outcomes:
- Patient will participate in a conditioning or rehabilitation program to improve activity tolerance.
- Patient will identify two symptoms indicating need for medical evaluation.
Nursing Assessments:
1. Symptom Assessment: Assess for symptoms of AFib that may limit activity (fatigue, dyspnea, palpitations).
2. Perceived and Actual Limitations: Assess patient’s perceived and actual activity restrictions to establish baseline and needs.
3. Cardiopulmonary Response to Activity: Monitor vital signs and symptoms (fatigue, dyspnea) before, during, and after activity.
4. Cardiovascular History: Assess cardiovascular history, lifestyle factors (diet, exercise, stress), and symptoms (edema, dyspnea, irregular heartbeat).
Nursing Interventions:
1. Monitor Vital Signs and Mental Status: Monitor vital signs and mental status during activity, ensuring patient safety and preventing overexertion.
2. Medications and Oxygen: Administer medications and oxygen as needed, monitoring patient response.
3. Balance Rest and Activity: Promote balanced rest periods and gradually increase activity levels, teaching energy-saving techniques.
4. Rehab Program Coordination: Coordinate with cardiac rehab, physical therapy, or exercise programs to guide activity progression.
Risk for Ineffective Cerebral Tissue Perfusion related to Atrial Fibrillation
Nursing Diagnosis: Risk for Ineffective Cerebral Tissue Perfusion related to ineffective atrial contraction and blood clot formation in atrial fibrillation.
Related Factors:
- Ineffective atrial contraction
- Decreased oxygenated blood flow to brain
- Blood clot formation and embolization
As Evidenced By:
(Risk diagnosis – no defining characteristics present)
Expected Outcomes:
- Patient will verbalize understanding of how AFib can cause ineffective cerebral tissue perfusion (stroke risk).
- Patient will adhere to lifestyle modifications to prevent AFib recurrence and stroke.
- Patient will not experience altered mental status, confusion, or decreased consciousness related to AFib complications.
Nursing Assessments:
1. Mentation Changes: Monitor for any alterations in mentation (restlessness, confusion, decreased alertness) indicating cerebral hypoperfusion.
2. Neurovascular Assessment: Perform neurovascular assessment for changes in cognitive, sensory, motor function, headache, dizziness.
3. Neuromuscular Status: Assess neuromuscular function, including movement, coordination, and reflexes.
4. Blood Pressure Monitoring: Monitor for orthostatic hypotension, which can reduce cerebral perfusion.
5. Stroke Symptom Recognition: Educate patient and family on stroke signs and symptoms (speech changes, vision changes, facial droop, weakness).
Nursing Interventions:
1. Prophylactic Anticoagulation: Administer prophylactic anticoagulation as prescribed to reduce stroke risk.
2. Safety for Dizziness: Provide safety measures and education for managing dizziness related to orthostatic hypotension.
3. Early Recognition Education: Teach patient early recognition of symptoms of decreased cerebral perfusion and stroke.
4. Stress Management: Implement stress management strategies to reduce AFib triggers.
5. Treatment Adherence Education: Emphasize adherence to AFib treatment plan and importance of follow-up.
References
Original Article Link 1 – NurseTogether – Stroke Nursing Diagnosis
Original Article Link 2 – NurseTogether – Heart Failure Nursing Diagnosis
Original Article Link 3 – NurseTogether – Myocardial Infarction Nursing Diagnosis
Original Article Link 4 – NurseTogether – Hypertension Nursing Diagnosis
Original Article Link 5 – NurseTogether – Shortness of Breath Nursing Diagnosis
Original Article Link 6 – NurseTogether – Edema Nursing Diagnosis
Original Article Link 7 – NurseTogether – Sleep Apnea Nursing Diagnosis
Original Article Link 8 – NurseTogether – Obesity Nursing Diagnosis
Original Article Link 9 – NurseTogether – Coronary Artery Disease Nursing Diagnosis
Original Article Link 10 – NurseTogether – Hyperlipidemia Nursing Diagnosis
Original Article Link 11 – NurseTogether – Diabetes Nursing Diagnosis
Original Article Link 12 – NurseTogether – Smoking Nursing Diagnosis
Original Article Link 13 – NurseTogether – Pulse Points
Original Article Link 14 – NurseTogether – Tachycardia Nursing Diagnosis
Original Article Link 15 – NurseTogether – Chest Pain Nursing Diagnosis
Original Article Link 16 – NurseTogether – Nursing Interventions
Original Article Link 17 – NurseTogether – Calculate IV Drip Rate
Original Article Link 18 – NurseTogether – Decreased Cardiac Output Nursing Diagnosis
Original Article Link 19 – NurseTogether – Hypotension Nursing Diagnosis
Original Article Link 20 – NurseTogether – Fatigue Nursing Diagnosis
Original Article Link 21 – NurseTogether – Knowledge Deficit Nursing Diagnosis
Original Article Link 22 – NurseTogether – Ineffective Tissue Perfusion Nursing Diagnosis
Original Article Link 23 – NurseTogether – Altered Mental Status Nursing Diagnosis
Original Article Link 24 – NurseTogether – Activity Intolerance Nursing Diagnosis
Original Article Link 25 – NurseTogether – Syncope Nursing Diagnosis
Original Article Link 26 – NurseTogether – Stress Overload Nursing Diagnosis
Original Article Link 27 – NurseTogether – Anxiety Nursing Diagnosis
Original Article Link 28 – NurseTogether – Major Depression Nursing Diagnosis
Original Article Link 29 – NurseTogether – Acute Confusion Nursing Diagnosis
Original Article Link 30 – NurseTogether – Safety Nursing Diagnosis
