Procedure for Atrial Fibrillation

/in /by

Less Invasive Procedure to Treat Atrial Fibrillation for Better Outcomes:

The treatment discussed in the article is a less invasive procedure called catheter ablation. This procedure is now considered first-line treatment for atrial fibrillation and replaces the need of surgery for treatment of atrial fibrillation that fails to heal with medications alone. Ablation treats abnormalities of the heart’s electrical system by purposely creating scar tissue that acts as a barrier to the abnormal electrical signals. This allows the heart to return to a normal sinus rhythm.

Advances in catheter ablation: The idea is to more closely identify the area of the heart that is causing the atrial fibrillation. In doing so, this would increase the success rate of treating atrial fibrillation. I support the continued research in order to find the best practice in treating patients with all conditions, specifically atrial fibrillation. It is important to implement the most updated treatment methods that have the most  evidence of success to increase patient health outcomes.

The article discussed that they are aware that there is further research that needs to be done to improve this treatment and that they believe patients should have an updated view of what doctors know. I appreciate this statement because it is important for potential recipients of a treatment to be aware of the latest research and evidence regarding something that they may choose to do in order to improve their health.

http://www.everydayhealth.com/heart-health/new-ablation-methods-results-in-advanced-afib-treatment.aspx

 

project 2

/in /by

https://docs.google.com/document/d/1f41gz4KllDgc2gd8vHhVvhvBVjNU7OY0cRKB4Ok9DJc/edit?usp=sharing

click her for poster link

Listening…Something So Simple, Yet Done So Wrong

/in /by

After participating in the ‘Listening’ exercise in class, I realized how much I must work on myself. Because of this activity, I learned that I need to work on giving individuals my full attention. I realized that I tend to not look people in the eyes. I also noticed that my eyes tend to wonder around the room instead of being focused on the individual. Looking at an individual is important when they are speaking because you can get a glimpse of what the individual is feeling from their body language. I did not necessarily feel the need to jump in and comment while my partner was telling me their frustrations, but I did feel the need to throw in a “”mhmm” or a “yeah” every once in a while to validate that I was listening. I am not sure if this is a good or bad thing.

Of the ten characteristics associated with a helping relationship, I feel the ones that come most naturally to me considering my current helping style are:

  • The Helping Relationship Involves Feelings
  • The Helping Relationship Demonstrates Respect for Individual Self-Worth

I believe these come naturally to me because I am very sensitive and understanding towards other peoples problems and feelings. I personally believe it is very important to always respect others and their decisions because I would want others to do the same for me.

The characteristics that are presently difficult to model and try out would have to be:

  • The Helping Relationship Shows a Clear Structure
  • The Helping Relationship Involves Communication and Interaction.

I see these as the characteristics that I need to work on. First of all, I tend to be all over the place when I talk with an individual. It is easy for me to get sidetracked from the true purpose of the conversation. As I stated above, I need to work on how I personally communicate with the individual I am having a one-on-one with. I have to work on directing my whole attention to the individual, especially my non-verbal actions.

To better myself, I have to integrate these more difficult characteristics into my current helping style. For example, if I engage in a conversation with an individual, I have to remind myself to look at the individual and not at the surroundings around the room; or I might remind myself what the purpose of this conversation is and not stray far from that objective (even if I really want to). I have to learn to catch myself when I am not following the helping guidelines and I must redirect myself. I have to work at this until it becomes a habit.

 

Troponin-T Levels: New A-fib Risk Factor?

/in /by

A study published last month found that serial measures of high sensitivity cardiac troponin-T (hs-cTnT) levels may be used to predict incident atrial fibrillation (AF) independent of traditional risk factors. The study suggests that circulating troponin levels caused by either myocyte damage or protein turnover predispose older adults to AF and that it is a important part of the cardiac remodeling process. Higher baseline levels of Troponin-T were associated with a higher likelihood of developing incident AF. There are currently no interventions available for elevated troponin-T levels as a risk factor for developing AF but this association is important to advance knowledge regarding the mechanisms that lead to AF.

I believe that this is an interesting study because usually sometimes people may not even recognize symptoms of A-fib and the diagnosis may be delayed if people to not seek treatment, which could potentially lead to poorer outcomes. Although there are currently no interventions for elevated troponin-T levels as predictors of A-fib, the idea of an additional risk factor for A-fib could at the very least make providers more aware of the problem so that they could monitor patients closely and educate them of the signs and symptoms of A-fib if it does occur. Hopefully in the future we will be able to use this biomarker to “catch” A-fib and implement interventions before it even happens.

 

Hussein A, Bartz T, Gottdiener J, et al. Serial measures of cardiac troponin-T levels by a highly sensitive assay and incident atrial fibrillation in a prospective cohort of ambulatory older adults. Heart Rhythm 2015; DOI:10.1016/j.hrthm.2015.01.020

Helping Relationships

/in /by
  • What are the characteristics that seem most natural to you given your present style of helping?

The characteristics that seem most natural to me in my given style of helping are that it is meaningful, involves communication and interaction, and understanding and involvement. A meaningful relationship comes natural for me because I look for meaning in everything I do. If it is helping someone out when they came to me for help it means they trust me and that is meaningful. Also a relationship that involves communication and interaction comes natural to me because I like to communicate with others and if communication helps someone even better. Interaction is also natural because I believe when I interact it makes others feel better and makes them feel like I do care. Lastly it would be understanding and involvement because I need to understand what is  going on without judging or jumping to conclusions, Involvement is also natural because is someone came to me for help it’s because they need help in something that I could possibly help them in.

 

  • So what characteristics may be difficult for you presently to model or try out?

The characteristic that may be difficult for me to presently model or try out are being approachable and secure as a person, and shows a clear structure. It’s not hard for me to be secure as person but to seem approachable because I feel like I am very honest and I feel like some people may take that as me being mean. Also I sometimes look like I am angry when walk or don’t talk because of my face expressions. Also showing a clear structure would be hard for me because when someone approaches me for help there is no clear way where things will go.

 

  • Now what can you do to integrate some of these more difficult characteristics into your helping style?

I can integrate them by trying to be honest in a nicer way and thinking before I speak because I can be too honest at times. Also I can try to control that when someone approaches me with a problem I try control where the situation is going so it doesn’t get out of control. It will be a bit difficult for me to learn how to integrate these characteristics I am having difficulty with because it’s something new. But, by doing small activities everyday I think it can become a natural characteristic. What I can do is start by thinking before I speak because other can take offence to what I say. Also I can try to smile more so I look more approachable as a person. This will not only help me be a better leader but it will help me overall.

Post CABG hospital readmission

/in /by

tdp

I found this article that studied predictors or risk factors for readmission after a CABG surgery. The study was done in 2011, and they determined post CABG readmission rates remained high. Consequently, this was a big problem since the procedure itself is expensive and the possibility for complications that influence readmissions are vast. Additionally, the readmission will ultimately not be covered if it falls within the 30 day limit established by medicare after the surgery, which further emphasizes the importance for nurses to be vigilant for possible complications or risk factors that indicate a complication. In 2004, hospital readmissions accounted for about 17 billion dollars out of the total 102 billion dollars paid by medicare that year. One can only imagine how those numbers are duplicated to present time. The results indicated that the most common reasons for readmission after a CABG were infection, heart failure, and other complications of surgical or medical care. As nurses, we  are responsible for preventing such occurrences. some ideas are to assess for complications, assess for comorbidities that can further cause complications such as Diabetes Mellitus. in situations like these, education is key! Educate and stress to the patient about the importance of proper glycemic control and the repercussions of failing to do so. Regarding heart failure, we can further educate the importance of following a drug regimen that is prescribed to them as well as emphasize the importance of contacting a physician in case they feel something wrong or if we detect the regimen is not functioning.

Source:

Hannan, E., Zhong, Y., Lahey, S., Culliford, A., Gold, J., Smith, C., et al. (2011). 30-day readmissions after coronary artery bypass graft surgery in new york state. Journal of American College of Cardiology , 4 (5).

Transcatheter Aortic Valve Replacement (TAVR)

/in /by

I am fascinated with how technology has advanced and how it works, especially to fix cardiovascular diseases. I would like to share with everyone the coolest procedure that fixes aortic stenosis, called transcatheter aortic valve replacement, best known as TAVR. This procedure is for patients who suffer from severe aortic stenosis and whose advanced age puts them at high risk for death if they were to have open-heart surgery. The University of Iowa Heart and Vascular Center is one of a select group of centers across the nation, and the first in Iowa to offer this procedure to those qualified candidates (University of Iowa Hospitals and Clinics, 2015). In 2011, this center was the first in the nation to receive certification for its cardiac valve program from The Joint Commission (University of Iowa Hospitals and Clinics, 2015). It is important to note that this procedure is minimally invasive for the repair and replacement of the aortic valve. This procedure can be performed through two distinct sites, either from the patient’s thigh through the femoral artery or through a small incision on the lower left side of the patient’s chest. Sometimes the elderly have disease of the leg blood vessels; hence, the chest can be an alternative site (University of Iowa Hospitals and Clinics, 2015).

 

Basically, with this procedure, the damaged aortic valve is replaced with a prosthetic valve. This new technology uses a catheter inserted through a small incision in a patient’s thigh that travels though blood vessels and can be used to replace a person’s failing heart valve in the aortic artery. This procedure involves a team of interventional cardiologists, cardiac surgeons, and imaging specialists of the heart (University of Iowa Hospitals and Clinics, 2015). The recovery of this procedure is faster as opposed to open-heart surgery and it has proven to be a successful procedure. As we know, the blood passes through the aortic valve and then into our body where it perfusses our tissues and organs. If the valve is stenotic, then small amounts of blood can pass through this valve and symptoms develop such as shortness of breath and one can easily become tired. In the story of a 90-year-old woman, she would complain of being tired on a day-to-day basis and that led her to visit her doctor (University of Iowa Hospitals and Clinics, 2015). She then was diagnosed with aortic stenosis and the doctor recommended for this procedure. She agreed to undergo TARV and she admits it was the best decision made for improving her health. After four days, she was allowed to go home and she says she had no pain at all after the procedure (University of Iowa Hospitals and Clinics, 2015). She recommends this procedure for those who need it and overall she is doing well. Patients who don’t get treated for aortic stenosis can develop heart failure or cardiac arrest, and most importantly can die within a year of this problem (University of Iowa Hospitals and Clinics, 2015). By the way, check out the article below and you can watch the animated video of this procedure, which is amazing!

 

Reference:

University of Iowa Hospitals and Clinics. (2015). Transcatheter aortic valve replacement. Retrieved    from        http://www.uihealthcare.org/2column.aspx?id=227967

University of Iowa Hospitals and Clinics. (2015).

Alma’s story: New lease on life.       Retrieved from    http://www.uihealthcare.org/2column.aspx?id=230803

 

 

Oh! My beating heart…

/in /by

What fortuitous timing that we should be covering cardiac intensive care during February, our National Heart Health Month! There was a smorgasbord of articles to choose from, but I was drawn to one on hemodynamics since just spent a good week or so completely immersed in that wild and wooly world…

Since 1996, pulmonary artery catheters, once considered the gold standard in hemodynamic monitoring, have been falling out of favor due to mounting, yet inconclusive, research finding that they are associated with increased likelihood of patient death. Central venous pressure monitoring has similarly been found to have minimal effect on patient outcomes when treating shock, compared to the use of conventional fluid replacement protocols (Johnson & Ahrens, 2015). Rather, Johnson & Ahrens (2015) propose that effective hemodynamic management of critically ill patients is best achieved by focusing on stroke volume optimization.

Stroke volume is the earliest and most reliable sign of hypovolemia because it is least affected by compensatory mechanisms, and the most effective means by which to measure stroke volume while maintaining the context of preload, contractility and afterload, is esophageal Doppler imaging (Johnson & Ahrens, 2015). This article proposes that correction of hypovolemia is best achieved through stroke volume optimization (SVO), a type of cyclic fluid replacement algorithm that recommends administration of fluid boluses for improvement of stroke volume by increments of 10% or more. When stroke volumes no longer increase by the full 10%, no more fluid is needed (Johnson & Ahrens, 2015). Hemodynamic monitoring of SVO protocol utilizes esophageal Doppler imaging, (or other indirect methods measuring cardiac output when contraindicated) (Johnson & Ahrens, 2015).

Implementation of SVO is supported by 11 large-scale, randomized controlled trials conducted by agencies such as the National Health Service, the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services and Aetna. And though esophageal Doppler imaging, bioimpedance, and pulmonary artery catheters are all reimbursed by Centers for Medicare and Medicaid Services, esophageal Doppler monitoring is the only one of these endorsed by the Agency for Healthcare Research and Quality (Johnson & Ahrens, 2015).

I just can’t wait until next week when I have my very first day in ICU…

Reference

Johnson, A., & Ahrens, T., (2015). Stroke volume optimization: The new hemodynamic algorithm. Critical Care Nurse (35)1: 11-27.

 

Basic ECG from a Mobile Device: AliveCor

/in /by

AliveCor is a mobile ECG device and app that attaches to a smartphone and interprets the heart’s electrical activity equivalent to a basic 1-lead ECG. While it does not replace the standard 12-lead ECG, it does allow patients to monitor their basic heart rhythms as they go about their daily lives. AliveCor is FDA-approved to detect Atrial Fibrillation and a study published in JAMA has shown it to be able to detect wide complex tachycardia. When used to its full potential, the device and app can track an individual’s heart rhythms as they correspond to daily life. The individual records their ECG tracing then can enter details about their activity, diet, medications, etc. All of this information is stored for later reference and comparison or it can be sent to the patient’s cardiologist by email for immediate review. This device enables cardiologists to gather more comprehensive data about the activity of their patients’ hearts instead of having to rely on office visit ECG monitoring that may not be an accurate reflection of the patients’ varying conditions. As we truly live in a mobile world with increasing use and dependence on smartphones, it is exciting to see healthcare providers begin embracing the use of  smartphones in their practice to improve the health of their patients.

References:

Home

http://www.alivecor.com/research

Waks, J. W., Fein, A. S., & Das, S. (2015). Wide complex tachycardia recorded with a smartphone cardiac rhythm monitor. JAMA Internal Medicine.

doi:10.1001/jamainternmed.2014.7586.

Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=2091739#

BNP for Heart Failure Treatment? Yes!

/in /by

dc89d4cdb899c0337dc338b57fa858d8

     While reviewing for the exam doing case studies, the book I was reviewing pointed out a new therapy about BNP not only being used as a marker for heart failure, but also as therapy.

While BNP is elevated in acute exacerbations of heart failure, it is also available for IV administration and is marketed as nesiritide (Melander, 2004). Nesiritide is a recombinant human brain natriuretic peptide, BNP 1-32, and is a vasodilator that has undergone clinical trials in patients with acute heart failure (Colucci, 2015). The high level of vasoconstrictors and high systemic vascular resistance and possibly low levels of bioactive BNP in patients with heart failure provides the rationale for therapy with vasodilators, such as nesiritide (Colucci, 2015). Nesiritide has been proven to reduce preload and afterload, and increase cardiac output in people who are experiencing an acute exacerbation of heart failure (Melander, 2004). Also, when compared to it has been proven to improve hemodynamics more quickly than nitroglycerin (Melander, 2004).

            I think further studies should be done on this drug and there should be greater awareness in hospitals about this treatment. The window for treating patients when they are in an acute exacerbation of heart failure should be narrowed so that the damage that is done can be minimized. Since BNP is already produced by the heart as a peptide secreted by the ventricle in response to fluid overload, investigating further in the advantages of using a naturally occurring peptide for treatment should be looked into!

 

References

Colucci, W.S. (2015). Nesiritide in the treatment of acute decompensated heart failure. UptoDate. Retrieved from http://www.uptodate.com/contents/nesiritide-in-the-treatment-of-acute-decompensated-heart-failure

 

Melander, S.D. (2004). Case studies in critical care nursing. Philadelphia, Pennsylvania: Elsevier.