Nursing Care for a Patient with Atrial fibrillation Receiving Warfarin Therapy with Comorbid Hypertension : Case Study
Abstract
Abstract
Background : Atrial fibrillation (AF) is a common cardiac arrhythmia among the elderly with an increasing prevalence. Patients with AF are at high risk of thromboembolism and therefore require Warfarin therapy for prevention. However, Warfarin use carries a risk of complications, necessitating careful monitoring and follow-up to prevent disability and mortality.
Objective : To examine the nursing care of a patient with atrial fibrillation (AF) receiving warfarin therapy in conjunction with hypertension.
Methods : A purposive case study was conducted with one patient diagnosed with atrial fibrillation (AF) and hypertension who was receiving Warfarin treatment at the Warfarin Clinic, Huai Thalaeng Hospital, Nakhon Ratchasima Province. Data collection tools included the patient’s medical records and interviews with the patient and family members using Gordon’s Functional Health Patterns. The nursing process was applied to assess the patient’s condition, identify nursing diagnoses, develop a care plan, implement nursing interventions, and evaluate outcomes. This approach ensured comprehensive nursing care that addressed the patient’s needs in all dimensions.
Results : The patient was a 73-year-old Thai female diagnosed with atrial fibrillation, referred from Maharaj Hospital to the Warfarin Clinic at Huai Thalaeng Hospital. She also had comorbid hypertension and presented with dyspnea and ecchymosis on the right thigh. Laboratory and clinical findings included an INR of 7.34 and blood pressure of 155/90 mmHg. Nursing assessment identified the following problems: (1) risk of bleeding complications due to warfarin therapy, (2) suboptimal therapeutic outcomes from warfarin, (3) risk of cerebrovascular complications from hypertension, (4) risk of injury from accidental falls, and (5) anxiety and insufficient knowledge regarding disease management and self-care. A holistic nursing care plan was implemented to promote knowledge, confidence, and active participation of the patient and her family in self-care, as well as to empower them in adhering to treatment guidelines. The patient was hospitalized for four days, during which her condition improved. She was discharged with continued follow-up and demonstrated effective self-care without complications or adverse effects related to her illness or warfarin therapy.
Conclusion : Holistic nursing care plays a crucial role in ensuring patient safety and enhancing quality of life, particularly through the role of warfarin clinic nurses in comprehensive assessment, planning, and care across physical, psychological, social, and spiritual dimensions. Such care enables patients to gain knowledge and understanding of their disease and medication, perform appropriate self-care, remain free of complications, and engage their families as active partners in effective care.
Keywords: Nursing care, Atrial fibrillation, Warfarin
