For the patient with Atrial Fibrillation, in addition to assessing Presence of Exhaustion M1033-8 and Shortness of breath M1400 on OASIS home health assessment, also include these MyHomecareBiz Best Practice assessment strategies:  

Best Practice Nursing Assessment Strategies for Atrial Fibrillation

Assess apical pulse, assess heart rate, rhythm. Document dysrhythmia. Tachycardia, in addition to the irregularity of atrial fibrillation, is usually present (even at rest) to compensate for compromised cardiac output.

Assess strength of peripheral pulses. Decreased cardiac output may be reflected in diminished radial, popliteal, dorsalis pedis, and post tibial pulses. Pulses may be fleeting or irregular to palpation, and pulsus alternans (strong beat alternating with weak beat) may be present.

Monitor BP. In early, moderate, or chronic atrial fibrillation, BP may be elevated because of decreased perfusion.

Inspect skin for pallor, cyanosis. Pallor indicates inadequate cardiac output and anemia. Cyanosis may develop. Dependent areas are often blue or mottled as venous congestion increases.

Monitor urine output, noting decreasing output and concentrated urine. Kidneys respond to reduced cardiac output by retaining water and sodium. Urine output is usually decreased during the day because of fluid shifts into tissues but may be increased at night because fluid returns to circulation when patient is recumbent.

Monitor oxygen saturation and ABGs. Determines effectiveness of blood oxygenation.

Assess for fatigue. Fatigue is a side effect of some medications (beta-blockers, tranquilizers, and sedatives). Pain and stressful regimens also extract energy and produce fatigue.

(M1033) Risk for Hospitalization: 8 - Currently Reports Exhaustion

Patients with Atrial Fibrillation often experience weakness and fatigue during activity because of increased heart rate and oxygen demands. For PDGM, presence of this risk factor also contributes to increased reimbursement.

(M1400) When is the patient dyspneic or noticeably Short of Breath?

• 0 - Patient is not short of breath
• 1 - When walking more than 20 feet, climbing stairs
• 2 - With moderate exertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet)
• 3 - With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation
• 4 - At rest (during day or night)

Best Practice Assessment Strategies for OASIS M1400

• If the patient uses oxygen continuously, select the response based on assessment of the patient’s shortness of breath while using oxygen.
• If the patient uses oxygen intermittently, mark the response based on the patient’s shortness of breath WITHOUT the use of oxygen.
• The response is based on the patient’s actual use of oxygen in the home, not on the physician’s oxygen order.
• The responses represent increasing severity of shortness of breath.
• For a chairfast or bedbound patient, evaluate the level of exertion required to produce shortness of breath.
• The chairfast patient can be assessed for level of dyspnea while performing ADLs or at rest. Response 0 would apply if the patient has not been short of breath during the day of assessment. Response 1 would be appropriate if demanding bed-mobility activities produce dyspnea in the bedbound patient (or physically demanding transfer activities produce dyspnea in the chairfast patient). See Responses 2, 3, and 4 for assessment examples for these patients as well as ambulatory patients

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