Atrial Fibrillation

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia with uncoordinated atrial activation and ineffective atrial contraction. Irregular conduction through the atrioventricular node produces an irregular ventricular response, and atrial blood stasis contributes to thromboembolic risk. AF creates three related but separate clinical decisions. First, is the ventricular response causing hemodynamic compromise now? Second, should the care plan focus on rate control, rhythm restoration, or both? Third, what stroke-prevention strategy is required? A patient may need urgent cardioversion before a long-term plan is discussed, while another may be comfortable with rate control alone. A normal rate or restored sinus rhythm does not by itself remove embolic risk. For an RPN, the safest sequence is to assess perfusion, obtain or confirm ECG documentation, look for a reversible trigger, carry out ordered therapy within scope, and activate the rapid response team and notify the physician or nurse practitioner immediately for signs of instability.