...Med/Surg- Telemetry/ RN/ Traveler 09/08-01/09 Number of Beds in Unit: Approximately 35 Nurse to patient ratio: 1:7 Responsibilities included but not limited to: Telemetry monitoring, EKGs, admitting, assessing, IV therapy, O2 therapy, and administering blood and blood products. Pt and family teaching, chart audits, and discharge planning. Rush Foundational Hospital Meridian, MS Telemetry/ RN/ Traveler 11/19/07-8/16/08 Number of beds in Unit: 23 Nurse to patient ratio: 1:5 Responsibilities included but not limited to: Cardiac drips, cardiac monitoring, EKGs, admitting, assessing, IV therapy, O2 therapy, and administering blood and blood products. Pt and family teaching, chart audits, and discharge planning. Northwest Regional Medical Center Clarkesdale, MS Telemetry/RN/Traveler 09/07- 11/07 Number of beds in unit: Approximately 40 Nurse to patient ratio: 1:7 Responsibilities included but not limited to: Cardiac drips, cardiac monitoring, EKGs, admitting, assessing, IV therapy, O2 therapy, and administering blood and blood products. Pt and family teaching, chart audits, and discharge planning. Wesley Medical Center Hattiesburg, MS Pulmonary/Traveler/RN 4/11/06- 9/08/07 Number of beds in Unit: 30 Nurse to patient ratio: 1:7 Provided care to following kind o patients: Acute and chronic cardiac pt, CAD, HTN, post cath and intervention pts, post pacemakers, Diabetic, MI, CHF, COPD, and Renal Failure...
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...Weighing Important of Cardiac Patients Student’s Name Institution Consistent Daily Weighing Important of Cardiac Patients In almost all parts of the world, cardiac-related problems are one of the most leading causes of death (Windale, 2010). The term cardiac problems often connote a deadly disease, silent killer and/or a type of illness related to diabetes, stroke and coronary heart disease. Studies conducted reveal that chronic heart failure and other forms of cardiac disorders account for high hospitalization and high mortality rate (Bushnell, 1992). According to Windale (2010), the three most prevalent types of cardiac problems, which are based from the World Health Organization statistics, are in the form of diabetes, heart failure and coronary artery diseases. People from various countries suffer from this threatening problem, and it often manifests in the form of angina or chest pains. Windale pointed out that such disorder is associated with cultural lifestyle of various nations (2010). Patients with cardiac problems often seem to have lowered functional and physical impairment, decreased quality of life (QoL), increased caregiver responsibilities, especially during hospitalizations (Remme & Swedberg, 2001). Increased hospitalizations for cardiac patients are one of the results of the problem. However, compliance to intervention strategies often poses a greater problem for the healthcare community. Such intervention strategies done by the...
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...Standardization of Nursing Protocol for Cardiac Arterial Bypass Patients Abstract Evidence-Based Practice (EBP) is an important factor in determining medical courses of action. Nurses have long used tradition rather than evidence in making decisions about beside care; to convince them to switch practice, it is useful to draw a comparison between the efficacy of these disparate routes. Our study designed a research question based on the PICOT model for the cardiac floors and designed procedures using the Kotter and Cohen’s Model of Change. In order to study the effect discussed in our PICOT question, a web search was conducted and the quality of each pertinent study reviewed. Introduction In the nursing staff of an adult Cardiac Surgical Care unit, how does the buy-in from the staff for Evidence-Based Practice (EBP) changes in a new Coronary Arterial Bypass Graft (CABG) pathway affect the decreases in infection rate among this patient population when compared to the old way of delivering patient care through nursing tradition in a six month time frame? The formation of a guideline for practice in nursing is not a new occurrence; books and manuals have been a reality for many years. However, in the past these resources lacked the evidence for standards of care, which traditionally have been based on professional consensus and tradition. The Joint Commission has recognized processes that can be measured regarding patient outcomes and care in order to meet standards for Medicare...
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...at Glendale Adventist Medical Center on the Cardiac Interventional Telemetry Unit. Glendale Adventist Medical Center is a community hospital located in Glendale, California. Cardiac Interventional Telemetry is a unit in the hospital that specializes in the care of critically ill cardiac, medical, and surgical patients. This unit is dedicated to patients who have had procedures that require vascular access; they also receive ER admissions for angina and heart attack as well as post-operative procedures such as open-heart surgery, angioplasty, and heart transplants. The patients on this unit are monitored with mobile heart monitors that allow them to ambulate with a cardiac monitoring device, which monitors their heart rate and rhythm. There is a monitor technician who serves as a unit secretary and observes the cardiac rhythm presented on the screens inside the station. The nurses on this unit are experts with medication that affect the heart, as well as, interventions and discharge education. For the patients on this unit, there are educational brochures on cardiac diseases & procedures that are easy to read and understand that explain cardiac disease conditions and cardiac procedures. A service that Glendale Adventist Medical Center offers the community is free Care Screening Events, where patients can get measurements and screening of their heart and identify whether there are any red flags or markers that may lead to future cardiac health problems. The professional services...
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...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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...balloon.1 Early bleeding is common after tracheostomy and attributed to surgical causes; however, delayed bleeding is less common and may be a sign of impending massive hemorrhage. 2 A high level of suspicion and prompt surgical intervention is imperative in the diagnosis and successful management of TIF. 3 Case Report A 49-year-old female with a history of cirrhosis was hospitalized for episodes of hepatic encephalopathy requiring intubation. Patient was extubated and re-intubated for hypercapnic respiratory failure after developing stridor treated with racemic epinephrine nebulizer treatments. Hospital course was complicated by acute respiratory distress syndrome (ARDS) versus hospital-acquired pneumonia (HAP), acute...
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... A: Post-Resuscitation Care B: Post-Cardiac Arrest Care C: Post-Hypothermia Induction Care The correct sequence for Basic Life Support is? A: D-A-B B: A-B-C C: C-B-D D: C-A-B True or False? Healthcare workers can tailor the sequence of rescue actions to the most likely cause of arrest The correct depth of compressions for an adult is: A: ½-1” B: 1-2” C: 2” A patient is found to be in asystolic cardiac arrest, what action(s) are no longer recommended? A: CPR and epinephrine B: pacing and atropine C: epinephrine and atropine The new Class I airway management recommendation is: A: Supraglottic advanced airways should be used first before endrotracheal tube placement B: Quantitative waveform capnography should be used to confirm and monitor endotracheal tube placement C: Chest x-ray and auscultation of breath sounds are used as primary confirmation of placement and continued management True or False? Routine use of carotid pressure during airway management is a Class I recommendation Your patient is in a stable monomorphic wide-complex tachycardia with a regular rate. What medication would you use to diagnose and treat this rhythm? A: Vasopressin B: Lidocaine C: Atropine D: Adenosine It has been determined that your patient is in PEA. Would you use Atropine to treat this patient? Yes No True or False? Post-Cardiac Arrest Care consists of bundled, goal-oriented management and interventions to achieve optimal outcome in victims...
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...Nursing Research Utilization Project Proposal Abstract The issue of controlling and preventing hospital-acquired infections is a major problem in the Healthcare system. Most patients admitted to hospitals are at some risk of contracting a hospital-acquired infection (Paterson, 2012). Some patients are more vulnerable than others; these include the elderly, patients with defective immune systems, and premature babies. Hospital-acquired infections remain a major concern, and they can occur in any care setting, including acute care within hospitals, outpatient surgery centers, clinics, and long-term care facilities (such as nursing homes or rehab centers). Four categories account for 75% of all acquired infections in the acute care hospital setting. These are surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections (Nassof, 2009). Urinary tract infections comprise the highest percentage (Paterson, 2012). These infections usually are spread by the contaminated hands of healthcare providers or the patient’s family members. They are also caused by contaminated surfaces or hospital equipment that has not been properly cleaned (Nassof, 2009). The rate of exposure to infectious materials could be reduced if healthcare providers adhered to certain standard precautions such as hand hygiene. The proposal for this nursing research utilization project is to educate nurses on the importance...
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...Cardiopulmonary Arrest PNCI - Learner Robert Johnson Age: 60 Weight: 70 kg Base: Stan D. Ardman Patient History Past Medical History: Hypertension well-controlled by medication, hypercholesterolemia and obesity; minor car accident three weeks ago in which he sustained whiplash Allergies: No known drug allergies Medications: Lopressor (metoprolol), Zocor (simvastatin) Code Status: Full Code Social/Family History: Married with two adult children who live locally; Does not smoke, drink or use illicit drugs Handoff Report Situation: The patient is a 60-year-old male in room 425 on the Orthopedic Unit who is recovering from an anterior-posterior interbody fusion of L4 – L5 performed two days ago. His has had an uneventful recovery. He is in his room eating breakfast. Background: Hypertension, hypercholesterolemia and obesity. The hypertension has been well controlled by his medication. He is wearing a soft neck collar for support following a minor car accident three weeks ago in which he sustained whiplash. The patient has no known drug allergies and is awake and alert. Assessment: Vital signs: HR 87, BP 128/62, RR 18, SpO2 has been 98% on room air, Temp 37.1oC Cardiovascular: No telemetry; HR regular Respiratory: Clear in both lung fields GI: Advanced to full liquid diet and tolerating it well GU: Voiding clear, yellow urine Extremities: Pink, warm and with adequate turgor; Movement is strong in all four extremities (4+) Skin: Warm and dry; No signs of infection...
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...effective when providing care to their patients and families about symptoms of CHF. The length of stay for an average hospital visit can be two days however, for more chronic issues warrant an even longer stay. To avoid readmission of the disease processes of CHF warrants additional care and resources during and after discharge. . Some patients cannot follow up with their primary care physician because of transportation, language barriers and economic status. These lessen their chances of follow-up care causing frequent hospitalizations. The strategy used for the study conduct a Cochrane Q and I squared statistics reviewed 141 studies with screening by the title and the abstract. 119 papers were eliminated because of data including the interventions and the electronic data related to CHF. 22...
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...INTRODUCTION Hypoplastic Left Heart Syndrome (HLHS) is a rare form of pediatric congenital heart defect that affects only 1% of all congenital cardiac disease. HLHS accounts for 23% of all cardiac deaths within the first week of life. HLHS exists under any or all of the following: “hypoplasia of the left ventricle, stenosis/atresia of the aortic valve, stenosis/atresia of the mitral valve, and varying degrees of hypoplasia of the ascending aorta and aortic arch” (Dadlani and Bradley 2011). Without surgical intervention, HLHS is uniformly a fatal condition. Research shows that before the use of these surgical interventions, nearly 90% of all patients diagnosed with HLHS died within the first 30 days of life. Advancements in both pediatric cardiac surgery as well and pediatric cardiology has significantly decreased the fatality rate in HLHS patients over the past decade. When looking at courses of treatment for HLHS there are four main approaches that are commonly used worldwide: The Norwood Palliation,...
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...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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...“Critical Care Paper” Critical Care Nursing Background Information L.G. is a 75 year old man that presented to Fairfax ED with complaints of SOB and lower extremity edema. L.G. is married with two adult children. He lives with his wife in a colonial style home in Great Falls, Virginia. L.G. hobbies include playing golf with his friends at his Country Club, playing bridge, and gardening with his wife on the weekends. L.G is a retired Navy Captain with 40 years of active duty service. During his years as an active duty sailor he worked as the “Air Boss”. The “Air Boss” is in charge of every plane and sailor involved on the flight deck of an aircraft carrier. His job was very stressful and he admitted to not sustaining the best diet and was a long time smoker. However, L.G. denies use of smokeless tobacco. L.G. has a family history of heart disease. His father suffered a heart attack when he was a child. He does not know the age of his father when he had the heart attack. L.G. also states he has a family history of atherosclerosis. L.G. denies any other significant family medical history. L.G. denies illicit drug use and also denies alcohol use. L.G. denies any allergies to any medications, foods, or environmental factors. Past Medical History L.G. has a past medical history of hypertension, congestive heart failure, renal artery stenosis, atherosclerosis of the coronary artery, myocardial infarction x 4, Type 2 DM, permanent atrial fibrillation, hyperlipidemia, and anemia...
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...Injury) Patient Profile Mr. J. is a 55-year-old African American man who was admitted 72 hours ago to a general surgical unit after surgery for a bowel obstruction. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. During surgery his systolic blood pressure dropped to 70 mm Hg. Seven units of packed red blood cells and 4 L of normal saline were administered intravenously to restore blood loss and circulating volume. He is receiving 60% O2 through an aerosol face mask. He is being monitored with a cardiac monitor and pulse oximeter. He has a central intravenous catheter in place and is receiving 0.9% normal saline IV at 125 ml per hour. A urinary catheter is in place. Subjective Data • Complains of shortness of breath, inability to lie flat, and diffuse abdominal pain Objective Data Physical Assessment • General: alert, well-nourished man who appears restless and anxious; head of bed elevated 45 degrees; skin cool with moderate diaphoresis • Respiratory: no accessory muscle use, retractions, or paradoxic breathing; respiratory rate 28 breaths/min; SpO2 88%; fine crackles at lung bases. The nurse also assessed the patient’s chest and abdominal wall excursion as well as depth and pattern of respiration. • Cardiovascular: blood pressure 100/60 mm Hg; cardiac monitor shows sinus tachycardia at 120 beats/min, with equal apical-radial pulse; temperature 101° F (38° C) orally. ...
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...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 provided by nurses and other health care professionals...
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