The role of the nurse in enhancing quality of life in patients with an implantable cardioverter-defibrillator: the Swedish experience

During the last 10-15 years, the implantable cardioverter-defibrillator (ICD) has become an important mode of treatment for patients suffering from grave ventricular arrhythmias, but ICD implantation involves psychosocial adjustments for both patients and relatives. The aim of this pilot study was to design a plan of education and to follow a selected group of patients with interviews, observations, and a questionnaire. The goals included seeing how well they accepted their situation after the operation when they had ongoing support of the nurse, in comparison to a control group who received conventional patient education by the physician. The patients were randomly allocated into two groups. Twenty patients were recruited, 10 in the study group and 10 in the control group, between February, 1997 and April, 1998. There were 16 men (average age, 63) and four women (average age, 57). The Nottingham Health Profile was used to measure health-related quality of life. Sleep disturbances were the greatest problem in both the study group and the control group before ICD implantation. In the study group, there was a significant improvement (p<0.05) after ICD implantation in four patients. The study also revealed a difference between men and women, with women having more sleep disturbances before ICD implantation than men (p<0.05). In both groups, there was a lack of energy and emotional reactions, both before and after ICD implantation. Few considered family life a problem before or after the study. In the control group, the patients missed the lack of contact with health care personnel more than in the study group. There was also a greater need for group meetings after the hospital stay. By means of the questionnaire, interviews, and observations, it became evident that there was a great need for information, and a plan of patient education in addition to follow-up by the nurse was felt to be very important.

Common cardiac arrhythmias

The interpretation of cardiac arrhythmias plays an important role in the diagnosis of cardiac disorders. Helen Hand examines the physiology of the heart, the electrical conduction mechanism, cardiac rhythm disorders and cardiac monitoring.

Cardiopulmonary resuscitation. Detecting cardiac arrhythmias in cardiac arrest

This article weighs the evidence for and against giving women in labour the choice of whether or not to eat and drink. While in the 1940s UK midwives were advised not to offer women such a choice, current research has swung in the opposite direction.

Perianesthesia care of cardiac surgery patients: a CPAN review

Postoperative nursing management of cardiac surgery patients is considered part of perianesthesia nursing core curriculum by ASPAN. In many hospitals, however, these patients bypass the PACU and are admitted directly to the ICU. For that reason, perianesthesia nurses who do not have cardiothoracic surgical ICU experience need information related to the immediate postoperative routine and nursing care regimen of cardiac surgery patients. Bleeding, cardiac tamponade, low cardiac output syndrome, and dysrhythmias are postoperative complications that are discussed. A brief overview of postoperative nursing management and several "nursing pearls of wisdom" are also presented.

The clinician's approach to evaluating patients with dysrhythmias

As cardiac arrhythmia services and the ability to perform electrophysiologic testing become more prevalent in the hospital setting, advanced practice nurses (APNs) are continually challenged to keep their skills in evaluating patients with dysrhythmias sharp and current. The experienced APN evaluates the patient's history, recognizes physical findings, and uses noninvasive data to help diagnose, anticipate, and even prevent dysrhythmias. This article reviews the essential components of a systematic evaluation of patients with a known or potential rhythm disturbance.

A systematic approach to pacemaker assessment

Despite the increasing use of pacemaker therapy, assessment of pacemaker function and electrocardiogram (ECG) interpretation continue to challenge even experienced critical care nurses. Accurate assessment of pacemaker function is essential in the evaluation of patients, especially patients with symptoms that may be related to pacemaker malfunction such as syncope or palpitations. This article will review pacing concepts and pacing system components. A systematic approach to ECG interpretation will be presented that can be used in a variety of clinical settings.

Living with an implantable cardioverter-defibrillator: a review of the current literature related to psychosocial factors

Sudden cardiac death (SCD) is responsible for 300,000 deaths annually. Lethal ventricular dysrhythmias account for the majority of SCDs. Implantable cardioverter-defibrillators (ICDs) are the emerging treatment for lethal dysrhythmias. Although reductions in SCD mortality with ICDs are clear, the psychologic and social consequences of these devices reveal a mixed success. Patients with ICDs have high levels of anxiety and depressive symptoms. Conversely, most studies of quality of life in patients with ICDs report that the device is well accepted despite fears of being shocked. The ICD shocks are a unique aspect of treatment and have the potential to cause psychologic distress. Nursing needs to provide care from a holistic perspective. Support groups provide reassurance and allow patients to discuss expectations and fears related to the ICD. Research needs to be conducted to explore the impact of these devices on the lives of patients and their families.

Clinical dysrhythmias after surgical repair of congenital heart disease

Innovations in surgical and medical treatment continue to improve the outlook for children with complex congenital heart disease. Although mortality continues to decrease, disease-related morbidity is increasing as a large cohort of these patients is reaching young adulthood, pursuing careers, marrying, and in many cases having children of their own. Chronic recurrent dysrhythmias are a frequent cause of long-term morbidity in this population and result in frequent, unanticipated emergency room visits and hospitalizations. Although not usually life threatening, they can pose considerable challenges to the patients and the providers who care for them. This article provides an overview of the most common dysrhythmias encountered in this population, dysrhythmia substrates, and therapeutic options.

Cardiovascular effects of acute stroke

A wide variety of dysrhythmias, conduction defects, and repolarization abnormalities have been observed following all types of stroke, most likely related to disruptions in the autonomic nervous system. Patients at highest risk for developing ECG changes include those with hemorrhagic stroke, those with strokes involving the right cerebral hemisphere, and elderly patients with stroke. Nursing interventions for these patients revolve around vigilant monitoring of both neurologic and cardiovascular status, to identify any negative consequences from the interaction of these systems. Strict blood pressure monitoring is required, with different management goals depending upon the type of stroke. Also important is the prevention of further exacerbation of ECG abnormalities by maintaining normal electrolyte levels.

Outcomes, problems and quality of life with the implantable cardioverter defibrillator

The survey aimed to assess the outcomes, problems and quality of life (QOL) in recipients of the implantable cardioverter defibrillator (ICD). Average QOL was 6.4 (1-10 scale), but lower in those who had received shocks (p < 0.05); 54% of patients had been shocked at least once. Usual daily activities were resumed by 72%, and driving by 76% of patients; 96% would recommend the ICD to others. Primary information sources were the implanting cardiologist and manufacturer's booklet. This study concluded that most ICD recipients have good QOL, but it is reduced in those who have been shocked by the defibrillator. Most eventually know enough about living with the ICD, but desire more education and support at the time of ICD insertion. Nurses could meet this need.

Linking the physical examination and electrocardiography

This article will help critical care nurse managers raise staff awareness of the crucial link between electrocardiography and the physical examination.

The use of ECGs to record heart activity

Most ECG recorders are single- or multi-channel. PC-based recorders are slowly evolving. Electrodes must be placed precisely to ensure accurate recording.

Anesthesia for cardioversion

Elective electrical cardioversions are commonly scheduled to be performed in the PACU because of the availability of nursing and anesthesia support. This report examines preanesthetic patient preparation as well as a review of the procedural aspects of electrical cardioversion. The commonly used anesthetic agents are contrasted with regard to their pharmacodynamic considerations. The indications, contraindications, and complications associated with the procedure are reviewed.

Teaching Basic Dysrhythmias: What Is the Best Approach?

Nurses' ability to accurately interpret cardiac dysrhythmias has resulted in decreased mortality. Four educational approaches to teaching dysrhythmia interpretation were evaluated. Major findings revealed learning was more effective when the lecture-discussion approach was used over a 5-week to 10-week period of time. Nurses also felt more comfortable with their ability to interpret dysrhythmias. These findings have several implications for continuing education departments regarding how and over what period of time this content should be taught.

Patients at risk for atrial dysrhythmias after coronary bypass grafting

Coronary artery bypass grafting (CABG) is widely used to treat patients with coronary artery disease. The most common complication after CABG is cardiac atrial dysrhythmias. Definitive patient characteristics that predict the development of atrial dysrhythmias postoperatively have not been identified. The authors review past research studies regarding predictors of atrial dysrhythmias and present research-based recommendations for clinical practice.

Arrhythmia detection and response in a monitoring technician and pocket paging system

Technologically advanced telemetry systems have begun to produce alternatives to the need for continuous visual observation of the electrocardiogram (ECG). Few studies have been conducted to determine the efficacy of these systems in the clinical setting. The purpose of this study was to describe two different approaches to communication of arrhythmia events and corresponding nurse response. One approach, on a cardiac medical unit, utilized a monitoring technician to continuously observe ECGs at a central monitoring technician station (MTS) and notify the nurse of changes. The other approach, on a general medical unit, eliminated the use of the monitoring technician and utilized a pocket paging system (PPS). The PPS interfaced with the computerized arrhythmia detection system from the ECG monitor, which directly alerted the nurse to arrhythmia events. A quasi-experimental comparative post-test design was used. The sample consisted of 50 randomly selected, 2-hour observation periods on each unit during a 3-month period. Data collectors recorded the interaction of the monitoring technician with the arrhythmia detection system and the nurse on the MTS unit, or the nurse using the PPS. Results of this study revealed all arrhythmia events activated an alarm by the computerized arrhythmia detection system. Length of time to notify the nurse was within 0 to 1 minute for both systems. This study demonstrated that the PPS is a viable approach to arrhythmia detection and communication in the medical/cardiac patient population.

Issues related to cardiac monitoring on an orthopaedic unit

Nurses on a variety of medical surgical units are being asked to care for patients being monitored for cardiac dysrhythmias. Basic information needed by nurses caring for these patients includes understanding the fundamentals of cardiac monitoring such as the components of the cardiac cycle and electrode placement. A working knowledge of cardiac dysrhythmia interpretation is essential. Protocols for emergent treatment of dysrhythmias must be in place, and a program for maintaining proficiency should be developed. Yearly refresher programs can be provided, including validation of dysrhythmia interpretation skills and problem solving of case-based scenarios. Any program supporting development and maintenance of a skill such as cardiac monitoring requires ongoing validation.

Cognitive therapy for ventricular dysrhythmia patients

Living with a serious ventricular dysrhythmia and its treatment poses certain psychological stressors including anxiety, depression, fear, and a sense of loss of control. Additional stressors related to side effects and technology issues may be present depending on whether the patient is treated with antidysrhythmic medications, an internal cardioverter defibrillator, or both. Cognitive therapy has been used with some success to reduce patient fear and improve psychological outcomes in some patient populations with illnesses characterized by loss of control including cancer and epilepsy. This article outlines a cognitive therapy approach for use with patients who have a serious ventricular dysrhythmia.

Foundations of arrhythmia interpretation

Basic arrhythmia monitoring is being used with increasing frequency in both inpatient and outpatient care settings. Nurses are being asked to interpret cardiac rhythms and develop critical thinking skills that assist in evaluating the significance of the rhythms identified for individual patients. The foundations needed for nurses to evaluate cardiac rhythms and assess the significance of the rhythms identified are provided. Cardiac anatomy, physiology, and cardiac properties are used to provide a framework for interpreting and understanding rhythms.

Living on the edge--patients with an automatic internal cardioverter defibrillator (AICD): implications for nursing practice

Automatic internal cardioverter defibrillator (AICD) therapy is an expanding treatment option for patients experiencing sudden cardiac death events [Author: is this the correct term? It sounds as if they have in fact died. Could we say 'experiencing sudden, potentially fatal, cardiac events'?]. The paper outlines the background to the technique and the nursing care of such patients and their families. It recommends that future nursing research should focus on exploring the impact, on the patients and their families, of living with this device.

Assessment of the agreement between cardiac output measured by bolus thermodilution and continuous methods, with particular reference to the effect of heart rhythm

Cardiac output (CO) is a fundamentally important haemodynamic parameter and its continuous measurement has the potential to enable early recognition of haemodynamic trends and earlier therapeutic response. A method of continuous cardiac output (CCO) monitoring is now available for clinical use. The accuracy and reliability of this method has been confirmed in clinical trials but not, to our knowledge, in the presence of abnormal heart rhythms. A comparison was made between CCO and bolus thermodilution methods, to determine if there is a greater difference between their respective determinations of CO when heart rhythm is abnormal. A convenience sample of 38 intensive care patients was used to obtain 410 comparisons of CCO and bolus CO determinations. Heart rhythm associated with each comparison was determined. The comparison produced a measurement bias of -0.07 l/min and limits of agreement of -1.77 to 1.63 l/min. The bias of the two measurements was -0.35 l/min for sinus rhythm, -0.19 l/min for sinus tachycardia and -0.12 l/min for atrial flutter/fibrillation. Increased temperature and heart rate did not affect measurement agreement. In conclusion, the agreement between the bolus and continuous methods is clinically acceptable and is unaffected by the heart rhythms of sinus rhythm, sinus tachycardia and atrial flutter/fibrillation.

Dysrhythmia formation in the older adult

Cardiac dysrhythmia in the older patient is a common finding during critical illness. Changes in the functional anatomy and physiology of the cardiac conduction system are associated with the direct and indirect effects of aging. The pathophysiology and clinical manifestations related to changes in cardiac cellular and neural structures are presented. Knowledge of these changes will guide the critical care nurse in planning care aimed at producing positive patient outcomes.

Bedside electrocardiographic assessment

Excellence in bedside monitoring is achievable when attention to detail is practiced. The cardiovascular nurse must choose a monitoring lead to best identify dysrhythmias and a lead to best identify myocardial ischemia with ST segment monitoring. Multilead viewing is preferrable but not possible with most current systems, which provide observation of one precordial lead at a time. Above all, the nurse must first place the leads correctly on the patient's chest. A quality assurance approach that involves all levels of nursing can help to integrate current research into practice. Nursing practice can be improved when changes are linked to science.

Cerebrally induced cardiac arrhythmias (CICA)

Cerebrally induced cardiac arrhythmias pose a challenge in the care of the intensive care patient. Although prognosis is based mainly on the neurologic status, treatment of the arrhythmia should be instituted promptly especially where cardiac function is impaired. Correct diagnosis is of prime importance because delay of surgical intervention or inadequate choice of anticoagulants or antiarrhythmic drugs may be deleterious. Although descriptions of this phenomenon have appeared in the literature for decades, with the increasing capability of better and more successful management and the recognition of the significance of these on cardiac function, new attention should be focused on the subject. A review of the literature, diagnosis, and management of cerebrally induced cardiac arrhythmias is presented. Examples are given of patients without antecedent heart disease in whom cardiac arrhythmias secondary to neurologic compromise later manifested.

The nurse's role in continuous dysrhythmia monitoring

One of the areas of clinical management where nurses have the most diagnostic influence is cardiac rhythm monitoring and dysrhythmia detection. The critical care nurse must recognize that continuous monitoring is a nursing responsibility, and competence in this skill must be assured. It is essential that nurses understand the significance of accurate electrode placement in obtaining a specific monitoring lead. In addition, the nurse must use current research in determining which monitoring lead is most appropriate for the patient requiring cardiac monitoring in the critical care environment. The author reviews the current research on continuous bedside monitoring and lead selection, examines why nurses continue to make less than optimal lead selection decisions, and offers recommendations to improve the consistency with which patients are accurately monitored.

Update on new antiarrhythmic drugs

Although strides have been made in the surgical and technological management of arrhythmias, the widespread use of antiarrhythmic drugs continues as a therapeutic approach. Based on a review of cellular electrophysiology and the classification system of antiarrhythmic drugs, this article addresses the actions, indications, adverse effects, and nursing implications for new antiarrhythmic drugs. Nurses are provided with the essential information about these drugs so that safe and effective therapy can be achieved.

Basic cardiac arrhythmias: a review for postanesthesia care unit nurses

Nurses in PACUs care for a variety of patients who may have or who are at risk for arrhythmias. Surgical trauma and anesthesia may exacerbate underlying heart disease and promote arrhythmias. This article reviews the basic cardiac conduction system and gives a brief description and illustration of both normal and ectopic rhythms. Nursing interventions and common pharmacological and nonpharmacological treatments are discussed. Through accurate detection and prompt interventions, nurses may contribute significantly to lower morbidity and mortality in the PACU.