Rhythm interpretation a fib

  1. i am new on a tele floor. I was taught that a fib is irregularly irregular. I notice a lot of nurses on the floor chart a fib as the rhythm when the rhythm is completely regular. Im wondering if they are not interpreting the stips correctly or if I am wrong. If the rhythm is regular, can you call it a fib? Im assuming the rhythm becomes regular with antiarrhythmics but if it becomes regular, i wouldnt call it a fib. What do you guys think ?
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  2. 18 Comments

  3. by   AJJKRN
    I'm in Med-Surg but crossed trained for cardiac tele monitoring at work when I was in nursing school. Everything depends on whether or not there is a consistent P wave. No P wave = afib or flutter (flutter's often regular with the QRS & flutter waves ratio).

    It is my experience that afib QRS' are generally always irregular w/o a consistent discernable P wave. Are these patients flipping back and forth from afib to sinus and the nurse is just charting afib? Are they throwing a lot of PAC's in sinus? Antiarrhythmics should either help keep the afib/flutter at a controlled HR (not a regular HR for afib) or help the rythm flip back to sinus. Hope this helps.

    Remember, as hard as it is can be sometimes when you're newer and the nurses around you are more seasoned, chart what you see/hear/feel! And get a rythm book, it will help. It may be daunting but it will help!
  4. by   turnforthenurse
    It could be that the nurse(s) just are not paying attention and happen to accidentally chart a-fib as being regular. We have computer charting at work and I have accidentally clicked "regular" along with documenting the patient's rhythm (in this case, a-fib)...only to catch it later and modify it.
  5. by   akulahawkRN
    A-fib is classically defined as an irregularly-irregular rhythm with no discernible P waves. Make sure you do your own interpretation and be certain that when you're looking at the rhythms that you actually see P waves and all the other criteria for NSR. While I'm not a nurse yet, I've done my own interpretation of EKG's and have seen more than a few A-Fib patients.

    Any time I see an A-Fib patient with a VERY regular rhythm, I look at them very, very closely to see if they're in a J Tach or V Tach (with pulses), or if they've got a pacer and my EKG machine is just filtering the spikes...
  6. by   hodgieRN
    Yes, if they are not in a-fib, then it is regular (or whatever the new rhythm is). A-fib is irregularly irregular. Nurses can chart regular on a-fib because they are used to filling in the same boxes each day and don't change the corresponding boxes. Like when nurses chart positive gag reflex on a pt that is awake and talking. They didn't check the gag reflex. They marked it because they want the neuro portion to indicate a good story or they always click it and don't think to mark "deferred."

    If they are still marking a-fib when the pt is not in a-fib, the usual explanation is they are filling in what the previous shift marked. Instead of actually looking at the rhythm, they just copy the whole assessment and move on. It happens. Or, the prior shift told them that the pt was in a-fib during report, so the nurse marks that down on the chart without properly assessing. Or, they don't want to be held accountable when the doctor asks if the pt converted and then end up being wrong. Or, they wait for the doctor to round and then fill in the rhythm after the doctor finished the progress note.

    Pts that are on antiarrhythmics convert all the time. Make sure you get a strip of when it happens. And when they convert, make sure your charting reflects that.
  7. by   martymoose
    You have to look at the whole strip- some 2:1 a- flutters look like NSR sometimes. If I am in doubt, I look at the the tele strip in other leads. Afib should not have discernible P waves,although I had a strip the other day that was regular as could be, but had no p waves( wasn't junctional either)

    Could be as stated above- prev. shift just copying.
  8. by   tiffanyleigh0212
    a fib is the absence of Pwaves, so it could actually be regular and still be a fib
  9. by   MendedHeart
    Actually its also categorized as grossly irregular or irregularly irregular with no p waves
  10. by   hodgieRN
    Quote from tiffanyleigh0212
    a fib is the absence of Pwaves, so it could actually be regular and still be a fib
    Afib is not defined as the absence of p waves. A-fib is an irregular rhythm. Irregularly irregular. If a pt is in a regular rhythm and has no p waves, that means the pt is in a junctional rhythm. That is one of the deciding factors for junctional. If there are no p waves, it's one of the two. If the rhythm is regular and marches out with no p waves, then it is not a-fib.
  11. by   SnowboardRN
    Quote from hodgieRN

    Afib is not defined as the absence of p waves. A-fib is an irregular rhythm. Irregularly irregular. If a pt is in a regular rhythm and has no p waves, that means the pt is in a junctional rhythm. That is one of the deciding factors for junctional. If there are no p waves, it's one of the two. If the rhythm is regular and marches out with no p waves, then it is not a-fib.
    A fib is defined as an irregular rhythm, narrow qrs, AND no p waves.
  12. by   SnowboardRN
    Sorry I quoted the wrong person.
  13. by   martymoose
    If I cant see the waves, then I slow down the speed to see if there's fibrillation. Or look at other leads. When I worked a short time in EP, saw a few AF ablations. Was quite fascinating to see the fibrillation on the fluoroscopy.
  14. by   BriGuyRN
    Irregular, without a distinguishable P wave. Don't trick yourself into "seeing a possible P wave".

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