...Cardiac arrest claims the lives of hundreds of thousands of people each year. Cardiac arrest can occur both outside of the hospital and in the hospital. Outside of hospital cardiac arrest is associated with a lower survivor rate. Immediate response is necessary in order to increase the chance of survival. According to the American Heart Association, 359,400 people experienced out of hospital cardiac arrest in 2013 with only a 9.5% survival rate, while 209,000 experienced in hospital cardiac arrest with a survival rate of 23.9% in adults and 40.2% in children (American Heart Association, 2015). When a person experiences cardiac arrest, their heart unexpectedly stops beating. The heart’s electrical system suddenly malfunctions and is not able to pump oxygenated blood to the body’s vital organs. Life saving measures are initiated in an attempt to restart the heart’s electrical system. Once return of spontaneous circulation (ROSC) is achieved, efforts to improve neurological recovery may be initiated. Therapeutic hypothermia is one intervention that has been shown to improve neurological outcomes for comatose victims of cardiac arrest (Field, et al., 2010). Hypothermia reduces cerebral oxygen consumption and suppresses the effects of the damaging chemical cascades initiated by reperfusion, the so called...
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...electrical activity refers to a cardiac arrest situation in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse but is not. Under normal circumstances, electrical activation of the cardiac muscle cells precedes mechanical contraction of the heart. Pulseless electrical activity is also referred to as PEA or, by the older term, electromechanical dissociation. Pulseless electrical activity is the clinical condition characterized by unresponsive and lack of a palpable pulse in the presence of organized cardiac electrical activity. Electrical activity is a necessary but not sufficient condition for mechanical activity. In pulseless electrical activity, the heart either does not contract or there are other reasons why this results in an insufficient cardiac output to generate a pulse and supply blood to vital organs. This condition is usually noticed because a person loses consciousness and stops breathing spontaneously. This is confirmed by examining the airway for obstructions, observing the chest for airway movement (rise and fall, and feeling a pulse (which is usually the carotid pulse) for a ten second period. The possible causes of pulseless electrical activity is remembered as the six Hs and the six Ts. The six Hs are as followed: hypovolemia, hypoxia, hydrogen ions (acidosis), hyperkalemia/hypokalemia, hypoglycemia, and hypothermia. The six Ts are also as followed: toxins (drug overdose), cardiac tamponade, tension pneumothorax...
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...In Pre-Hospital Cardiac Arrest Patients, How Does Hands-Only CPR Compared To Standard CPR, Affect Neurological Outcomes? Abstract Summary Out-of-hospital cardiac arrest is the leading cause of death in the U.S. Increasing bystander-initiated CPR through “hands-only” CPR and EMS dispatcher instructed “hands-only” CPR improves survival rates. Methods CINAHL, PubMed, and OvidMD were searched for the following key terms or combination thereof: “hands-only”; “compression-only”; chest compression-only”; “bystander”; “CPR”; “dispatcher”; and “neurological affect”. We initially restricted our search to peer-reviewed studies published in English between January 2004 and June 2014, but agreed by consensus to use a 2000 study located during a manual search of included study references. Results We identified nine Level II, III, and IV studies comparing “hands-only” CPR and “standard” CPR, published between 2000 and 2013, and occurring in the countries of Japan, London, Sweden and the U.S. All but one of the study results recommend that “hands-only” CPR is at least equal or superior to “standard” CPR. Conclusions Guidelines should be established to teach bystander “hands-only” CPR nationwide, to increase public awareness of the effectiveness of “hands-only” CPR and start to teach out-of-hospital “hands-only” CPR. Introduction Sudden cardiac arrest is the leading cause of death in the United States (Neumar, Barnhart, Berg, Chan, Geocadin, Luepker,… Nichol, 2011). According...
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...than three sentences in each cell of the table. | Qualitative | Quantitative | Articles | Living with unexplained chest pain | Predictors of vascular complications post diagnostic Cardiac Catheterization and Percutaneous Coronary interventions | Research question | How patients experience unexplained chest pain and how it affects their everyday life? | How to identify risk factors associated with cardiac catheterization and percutaneous coronary interventions to prevent complications? | Problem | Often there is no clear explanation for heart disease it makes it difficult to know what nursing interventions to provide for the patient. | There are increased risks for vascular complications found in patients 70 years or older | Purpose | To determine the type of heart disease the patient has so nursing can know what type of signs and symptoms to look out for. | For nurses to identify early signs/symptoms and risk factors to prevent complications. Also to develop safe protocols to care for these type of patients. | Hypothesis | Patients physical and mental status has a direct effect on their perception of chest pain especially if there is no cardiac issue is present | A patient’s age, sex, health status and comorbidities has a positive correlation to the incidence of complications in post cardiac catheterization and percutaneous coronary interventions. | Independent variable | Independent variable is “a stimulus or activity that is manipulated or varied by the researcher to...
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...three sentences in each cell of the table. | Qualitative | Quantitative | Articles | Living with unexplained chest pain | Predictors of vascular complications post diagnostic Cardiac Catheterization and Percutaneous Coronary interventions | Research question | How patients experience unexplained chest pain and how it affects their everyday life? | How to identify risk factors associated with cardiac catheterization and percutaneous coronary interventions to prevent complications? | Problem | Often there is no clear explanation for heart disease it makes it difficult to know what nursing interventions to provide for the patient. | There are increased risks for vascular complications found in patients 70 years or older | Purpose | To determine the type of heart disease the patient has so nursing can know what type of signs and symptoms to look out for. | For nurses to identify early signs/symptoms and risk factors to prevent complications. Also to develop safe protocols to care for these type of patients. | Hypothesis | Patients physical and mental status has a direct effect on their perception of chest pain especially if there is no cardiac issue is present | A patient’s age, sex, health status and comorbidities has a positive correlation to the incidence of complications in post cardiac catheterization and percutaneous coronary interventions. | Independent variable | Independent variable is “a stimulus or activity that is manipulated or varied by the researcher...
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...Sciences Center, St Joseph's Hospital, and the Colorado Collective for Medical Decisions, Denver, Colorado, USA Abstract Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposalfor selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. J7ustice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated...
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...the background of the organization, describe the four p’s and how they are important to success, examine the marketing relationships with the partnerships, and determine the target market, including demographics and psychographics, and data from the general area in which the organization is located, with an explanation of why understanding the target market is vital to a successful marketing plan. Baylor’s Heart Hospital Background Baylor’s Heart Hospital offers all types of patients five star service with a medical quality. The hospital, within itself, contains an equipped and advance imaging department with a 64-slice CT scanner, a cardiac emergency department, an onsite cardiac rehabilitation center, an endovascular suite, an eight-bed-post-anesthesia recover unit with three electrophysiology labs, three operating suites, and three cardiac catheterization labs. With the above mentioned features help Baylor’s Heart Hospital to be a very comprehensive and impressive outpatient and inpatient service. This hospital also includes a nursing station in between every guest suite that makes staff accessible to each patient and guest for responsive and quick care of delivery. For patients needing rehabilitation, a walking lane is located on each floor to...
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...RTT1 Organizational Systems Task 2 The purpose of this paper is to analyze the unfortunate sentinel event of Mr. B, a sixty-seven-year-old patient presenting with severe left leg pain at the emergency room. A root cause analysis is necessary to investigate the causative factors that led to the sentinel event. The errors or hazards in care in the Mr. B scenario will be identified. Change theory will be utilized to develop an appropriate improvement plan to decrease the likelihood of a reoccurrence of the outcome of the Mr. B scenario. A Failure Modes and Effects Analysis (FMEA) will be used to project the likelihood that the suggested improvement plan would not fail. Lastly, key roles nurses would play in improving the quality of care in the Mr. B scenario will be discussed. A. Root Cause Analysis A root cause analysis (RCA) is “a process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event” (Cherry & Jacob, 2011, p. 442). The participants during the root cause analysis would be the emergency room physician (Dr. T.), the Mr. B’s LPN and RN (Nurse J) during the time of the sentinel event, the emergency room nurse manager, and the chief nursing officer (CNO) of the hospital. These members would meet in a root cause analysis meeting to discuss the causative factors that created Mr. B’s sentinel event. The first step in a root cause analysis on the sentinel event that caused...
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...taken any phosphodiesterase medications within 12 hours. However, there are no parameters for the administration of oxygen. Coronary heart disease is the leading cause of death within the US. Oxygen has long been advocated as standard treatment in the management of chest pain and myocardial ischemia, although, for over 60 years the scientific background for this has been questioned (Ripley, Riley, Shome, Awan, McCloskey, Murphy & DeBelder, 2012). Recent studies have shown possible negative reactions with the administration of pure oxygen with patients that were not presenting with hypoxia. The possibility for oxygen toxicity to those with ACS could cause more cardiac tissue injury due to vasoconstriction and decreased cardiac output (Williams, Gandy, & Grayson, 2013). The result of this could be poorer patient outcomes. The American Heart Association (AHA) has also been...
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...Living with unexplained chest pain. Journal of Clinical Nursing, 14, 956-964. Retrieved from http://onlinelibrary.wiley.com | Dumont, C.J., Keeling, A.W., Bourguignon, C., Sarembock, I.J., Turner, M. (2006, May/June). Predictors of vascular complications post diagnostic cardiac catheterization and percutaneous coronary interventions. Dimension of Critical Care Nursing, 25(3), 137-142. Retrieved from http://journals.lww.com | * Research question | * How does unexplained chest pain affect the everyday life from a patients’ perspective and how can this help fill in the gaps of nursing knowledge and improve nursing practice (Jerlock, Gaston-Johansson, Danielson, 2005). * | * “What was the incidence of vascular complications post CC and PCI at the University of Virginia Heart and Vascular Center during the years 2001 through 2003? What patient demographic, comorbid, and procedural variables are statistically predictive for vascular access complications” (Dumont, Keeling, Bourguignon, Sarembock, Turner, 2006, p.137)? * | * Problem | * “Living with unexplained chest pain” (Jerlock et al., 2005, p.956). * | * Identifying risk factors or predictors of vascular complications after diagnostic cardiac catheterization and percutaneous coronary interventions (Dumont et al, 2006). * | * Purpose | * Describe patients’ experience of unexplained chest...
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...Standardized terminology (ST) has allowed nurses to agree upon a common terminology to describe assessments, interventions, and outcomes related to the documentation of nursing care. Nurses from different units, hospitals, geographic areas, and countries will be able to use commonly understood terminology to identify the specific problem or intervention implied and the outcome observed (Rutherford, 2008). Within ST there are organizations that have standardized the terminology for nurses. NANDA, NOC, and NIC are the organizations that will be discussed throughout this paper and how they related to patient care based on a provided scenario. The scenario I will be discussing is: 47yr male patient presenting to the ED with c/o SOB and CP x 3 days. Pt is pale and diaphoretic on arrival. VSS are HR 130; BP 123/74; O2 sat 96% on 4L NC; pt. with shallow rapid respirations rate 36. NANDA is an organization that has developed more than 200 nursing diagnoses. “NANDA International will be a global force for the development and use of nursing's standardized terminology to ensure patient safety through evidence-based care, thereby improving the health care of all people” (NANDA, 2014). NANDA committed to improving the quality of nursing care and improvement of patient safety through evidence-based practice (NANDA, 2014). From NANDA, two branches, Nursing Outcomes Classification (NOC) and Nursing Interventions Classifications (NIC), were developed to evaluate the effects of interventions...
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...[Refer to www.policies.curtin.edu.au/documents/unit_outlines_plagiarism_state.doc for plagiarism and copyright information.] I have retained a copy of this assignment for my own records. Signed: Date: | PART C – to be completed by Lecturer: Comments to Student | | | | | | | | | | | | Recorded Mark: | | Lecturer: | | Date: | Content Page 1) Introduction 2) Objective 3) Information Source 4) Key search terms and Boolean Operators 5) Critical Appraisal Checklist 6) Conclusion 7) References Introduction Nurses are the front liners in many diverse ways of healthcare. Many a time, nurses stand as the primary contact person of witnessing a patient who collapse and reach a state of cardiac arrest (Heng, Seow & Tham, 2011). Therefore, the nurses’ response following that is crucial, showing how essential it is for a nurse to be well-educated with resuscitation skills to not only...
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...comprehensive information related to the cardiopulmonary resuscitation (CPR) process, patients’ outcome, and characteristics of both the patients and the hospitals. The purpose of the registry data is to provide information that can be used to improve the outcomes of sudden cardiac arrest (SCA) patients and to update the protocol for CPR. Unfortunately, we do not have a similar national or...
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...Background Hypothermia (hi-po-THUR-me-uh) is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. The term “hypo” refers to less, and “thermia” refers to temperature. Normally, the core body temperature is 98.6 degrees F. Hypothermia occurs as your body temperature passes below 95 F (35 C). When your body temperature drops, your heart, nervous system and other organs cannot work correctly. Left untreated, hypothermia can eventually lead to severe heart and respiratory failure, and in some cases, death. Hypothermia is most often caused by long term exposure to cold weather or or and unexpected immersion into in the face of a cold stressor. Hypothermia, though, is not always the result of exposure to extremely cold outdoor temperatures. History Hypothermia has been applied therapeutically since antiquity. The Greek physician Hippocrates, the namesake of the Hippocratic Oath and arguably the world’s first modern doctor, advocated the packing of wounded soldiers in snow and ice.[3] Napoleonic surgeon, Baron Dominque Larrey recorded that officers who were kept closer to the fire survived less often than the minimally pampered infantrymen using snow and ice.[3] In modern times the first medical article concerning hypothermia was published in 1945.[3] This article focused on the effects of hypothermia on patients suffering from severe head injury. In the 1950s hypothermia established its first medical...
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...failure. Heart failure is manifested by the heart’s inability to provide adequate perfusion to the body. This occurs due to other conditions or diseases such as chronic hypertension or a previous myocardial infarction. Clinical findings may include a decreased blood pressure, dizziness, or signs of hypoxia. The body senses this decrease in cardiac output and attempts to maintain homeostasis. Baroreceptors detect inadequate pressure and norepinephrine is released by the adrenal gland. This causes profound vasoconstricion, as well as an increase in inotropy, chronotropy, and dromotropy. This just means that the heart is beating faster and harder due to the catecholamine release. The kidneys also lend a hand by releasing Angiotensin Converting Enzyme, or ACE. ACE converts angiotensin I into angiotensin II, which is yet another vasoconstrictor. The body will also act to increase volume by inhibiting fluid release. The heart itself produces a peptide called Brain or B-type Natriuretic Peptide (BNP). All of these compensatory mechanisms acting together cause the cardiovascular system to go into overdrive. Too much vasoconstriction and cardiac force cause increased afterload. Afterload is the pressure in which the heart is pumping against. This is also known as arterial pressure and an increase results in an increase in palpable blood pressure. Since the heart can’t pump blood out efficiently against the increased after load, blood backs up. It first backs into the atria from the left...
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