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Kupchik N, Green J. A Case of Heart Palpitations and Shortness of Breath. Am J Nurs 2021; 121:61-64. [PMID: 34009167 DOI: 10.1097/01.naj.0000753672.64281.f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
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Affiliation(s)
- Nicole Kupchik
- Nicole Kupchik is an independent clinical nurse specialist at Nicole Kupchik Consulting, and Joel Green is a staff nurse at University of Washington Medical Center, both in Seattle. Kupchik also coordinates Strip Savvy . Contact author: Nicole Kupchik, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Çıkrıkçı Isık G, Şafak T, Tandoğan M, Çevik Y. Effectiveness of the CRISP Method on the Primary Cardiac Arrhythmia Interpretation Accuracy of Nurses. J Contin Educ Nurs 2020; 51:574-580. [PMID: 33232505 DOI: 10.3928/00220124-20201113-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accurate electrocardiogram (ECG) interpretation is key to quickly providing attention to patients, and the first health staff who evaluate ECGs are nurses. METHOD This was a prospective study with a pre-posttest design. The study test included 15 ECGs related to primary cardiac arrhythmias. After pretest nurses were instructed on arrhythmia interpretation using the Cardiac Rhythm Identification for Simple People (CRISP) method, posttests were completed. RESULTS There was a significant difference between the pretest scores of nurses who had postgraduate education on ECG interpretation and who did not (p = .002). Median test score increased from 3 (interquartile range [IQR] = 2-5) to 7 (IQR = 5-9) (p < .001). Participants mostly missed questions about heart blocks and were most successful with questions about fatal arrhythmias after education. CONCLUSION The CRISP method is an effective, simple, and easy method for accurate ECG interpretation by nurses. The posttest scores of the participants, especially accurate interpretation of fatal arrhythmias, increased significantly after training. [J Contin Educ Nurs. 2020;51(12):574-580.].
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Accurate Dysrhythmia Monitoring in Adults. Crit Care Nurse 2018; 38:84. [PMID: 30275068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
Electrocardiogram (ECG) is one of the most commonly performed investigations in emergency departments (EDs), and is an extremely useful adjunct that guides diagnosis, prognosis and treatment. In most cases nurses are the first healthcare professional to assess patients and record an ECG, yet anecdotal evidence suggests that few emergency nurses review, interpret and act on ECG findings. Research suggests this may be due to lack of confidence in, or knowledge about, interpretation of results, often because of inadequate training. This article aims to help emergency nurses understand and interpret the cardiac rhythms commonly encountered on ECGs in EDs, to enable them to support earlier diagnosis and treatment. It describes a simple, five-step method for evaluating the main components of cardiac rhythm.
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Affiliation(s)
- Anthony McGrath
- Adult Nursing and Midwifery, London South Bank University, England
| | - Michael Sampson
- British Heart Foundation, St George's University Hospitals NHS Foundation Trust
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Lev B. [In process]. Pflege Z 2017; 70:39-44. [PMID: 29426079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
Patients present to the emergency department (ED) with a wide range of complaints and ED clinicians are responsible for identifying which conditions are life threatening. Cardiac monitoring strategies in the ED include, but are not limited to, 12-lead electrocardiography and bedside cardiac monitoring for arrhythmia and ischemia detection as well as QT-interval monitoring. ED nurses are in a unique position to incorporate cardiac monitoring into the early triage and risk stratification of patients with cardiovascular emergencies to optimize patient management and outcomes.
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Affiliation(s)
- Jessica K Zègre-Hemsey
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, USA.
| | - J Lee Garvey
- Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA
| | - Mary G Carey
- Clinical Nursing Research Center, School of Nursing, Strong Memorial Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 619-7, Rochester, NY 14642, USA
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Keogh K. Nursing staff could play a major part in detecting heart disorders. Nurs Stand 2014; 28:13. [PMID: 24446603 DOI: 10.7748/ns2014.01.28.21.13.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hunt J, Cadd L. Treatment of inherited cardiac conditions. Nurs Times 2013; 109:16-18. [PMID: 24380184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Inherited cardiac conditions are difficult to detect and screen for Part 2 of our six part series on rare diseases explains why health professionals need to be aware of the symptoms associated with inherited cardiac conditions so they can make swift referrals to expert services.
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Nock H. [Protecting the hearts of children from heat]. Kinderkrankenschwester 2013; 32:324. [PMID: 23971153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Wise A, Annus C. Benefits of arrhythmia care coordinators. Nurs Times 2013; 109:18-20. [PMID: 23991534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Arrhythmias (abnormal heartbeats) are common but can be life threatening. Symptoms can be severe and include palpitations, dizziness, blackouts, breathlessness and even chest pain. These can be highly distressing for patients, causing them severe anxiety and depression if they are not well supported. Early diagnosis is essential to reduce mortality and improve quality of life--the most common arrhythmia--atrial fibrillation--can cause a stroke if left untreated or inadequately treated. While sudden cardiac death is less common in a young person, it is usually due to an inherited cardiac condition that has resulted in a critical arrhythmia. Screening family members at risk can provide timely assessment, psychological support through counselling and treatment with the implantation of a cardioverter defibrillator if necessary. In 2005, a chapter setting out best practice for arrhythmia care was added to the National Service Framework for Coronary Heart Disease. This highlights the need for early diagnosis and expert patient support. In response, the British Heart Foundation launched a pilot programme to fund specialist nurses as arrhythmia care coordinators. Its aim was to develop and improve care pathways, and provide continuity and support for patients diagnosed with an arrhythmia to improve clinical care and emotional wellbeing. An independent evaluation by the University of York showed that these posts significantly improved patients' experiences of arrhythmia services, prevented thousands of readmissions and cut costs for the NHS. This article explains how the new role was successfully implemented.
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Affiliation(s)
- Alexandra Wise
- British Heart Foundation, Royal Brompton and Harefield Foundation Trust
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[Fetal cardiac arrhythmias are mostly benign]. Kinderkrankenschwester 2013; 32:280. [PMID: 23901612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Lehmann C. [Nursing care of heart patients with temporary pacemaker]. Kinderkrankenschwester 2013; 32:171-173. [PMID: 23755441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Christiane Lehmann
- Fachschwester für pädiatrische Intensivmedizin und Anästhesiepflege, UKSH Campus Kiel.
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Deutsches Grünes Kreuz. [Out of sync rhythm: doctor visit in arrhythmias after common colds]. Kinderkrankenschwester 2012; 31:339. [PMID: 22937620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Higgins D. ECGs 3: identifying cardiac rhythms. Nurs Times 2011; 107:26-27. [PMID: 21941732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Dan Higgins
- University Hospitals Birmingham Foundation Trust
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Higgins D. ECGs 2: analysis of a rhythm strip. Nurs Times 2011; 107:22-23. [PMID: 21941722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Dan Higgins
- University Hospitals Birmingham Foundation Trust
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Palatnik A. Too fast, too slow, too ugly: dangerous dysrhythmias. Nurs Manag (Harrow) 2011; 42:26-35. [PMID: 21285746 DOI: 10.1097/01.numa.0000394570.58857.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Woodrow P. Introduction to electrocardiogram interpretation: part 2. Emerg Nurse 2010; 18:28-36. [PMID: 20527455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Twelve-lead electrocardiograms (ECGs) record 12 different views of cardiac electrical activity, or leads. They therefore provide more information than bedside monitors, which usually record one or sometimes two leads. Many acutely ill patients have 12-lead ECGs recorded either on admission to hospital, before undergoing operations or when specific cardiac concerns have arisen. Traditionally, ECGs have aided clinical diagnoses and, by learning how to understand and interpret them, nurses will know when they need to summon expert help. This article describes what each of the 12 leads represents, outlines the main indications for recording 12-lead ECGs and identifies likely causes of error in interpreting them.
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Affiliation(s)
- Philip Woodrow
- Intensive Therapy Unit, Kent and Canterbury Hospital, Kent
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Abstract
BACKGROUND The practice standard for electrocardiographic monitoring in hospitals recommends use of atrial electrograms after cardiac surgery to help diagnose cardiac arrhythmias. OBJECTIVES To determine whether use of atrial electrograms significantly improves nurses' ability to diagnose cardiac arrhythmias and to assess nurses' perceptions of the ease of obtaining and interpreting electrograms, the frequency of use of atrial electrograms, and the correlation between nurses' experience with the technique and arrhythmia scores. METHODS In total, 282 nurses completed a test consisting of 5 electrocardiographic rhythms for which use of atrial electrograms might improve interpretation. A standardized educational session on obtaining and interpreting atrial electrograms was given to 165 nurses who had not previously received such education. In a second test, the same rhythms were provided along with atrial electrograms to 261 nurses. Overall changes in total test scores and individual changes in interpreting rhythms were analyzed. Demographic information, perceptions of the ease of obtaining and interpreting atrial electrograms, and the frequency of use were collected. Correlation between scores on the second test and nurses' years of experience in interpreting atrial electrograms was determined. RESULTS Use of atrial electrograms significantly increased overall arrhythmia interpretation scores. Nurses rated obtaining atrial electrograms as easy and interpreting the findings as moderately easy. Despite this reported ease, 57.1% of nurses obtained atrial electrograms less than monthly and only 3.4% obtained them daily. Correlation between experience with atrial electrograms and arrhythmia test scores was not significant. CONCLUSIONS Nurses' use of atrial electrograms improves diagnoses of cardiac arrhythmias.
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Affiliation(s)
- Marion E McRae
- Toronto General Hospital, University Health Network and the Toronto Congenital Cardiac Centre for Adults, University of Toronto, Ontario, Canada.
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Palatnik A. Too fast, too slow, too ugly: dysrhythmias that every nurse should recognize. Nursing 2009; 39:38-46. [PMID: 19701015 DOI: 10.1097/01.nurse.0000360246.36372.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Fountain RA, Alfred D. Student satisfaction with high-fidelity simulation: does it correlate with learning styles? Nurs Educ Perspect 2009; 30:96-98. [PMID: 19476073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to explore how learning styles correlate with student satisfacation when high-fidelity human simulation is used in a baccalaureate nursing program. Seventy-eight undergraduate students enrolled in an advanced medical-surgical course completed the Student Satisfaction and Self-Confidence in Learning scale after participating in an experiental learning lab activity that included high-fidelity human simulation-enhanced cardiac case scenarios. Data were then correlated with learning styles identified by a nurse entrance test. Analyses of the data revealed positive relationships between the social and solitary learning styles and student satisfaction with simulation.
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da Silva GLDF, Thomé EGDR. [Complications of the hemodialysis procedure in acute renal failure patients: nursing interventions]. Rev Gaucha Enferm 2009; 30:33-39. [PMID: 19653553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
This retrospective study has identified both the prevalence of complications during hemodialitic treatment in patients carrying acute renal failure (ARF) in an intensive care unit of a university hospital and the nursing conduct performed during those episodes. We have assessed sixty-five (282 sessions) records of ARF patients who underwent renal replacement therapy and presented complications during hemodialysis sessions. We have noticed that the most prevalent intradialitic complications were: arterial hypotension (35%), hypothermia (29%), and lack of flow in the vascular access (24.1%). The nursing interventions prioritized during episodes of clinical complications involved clinical assessment (66.8%) and evaluation of patients' consciousness level (59.9%). The search for nursing procedures that are suitable to different situations experienced by patients during hemodialysis, as well as the continuing education of the nursing team are actions that may minimize the intercurrence rate.
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Joss M. [Finding coherence in difficult professional encounters]. Krankenpfl Soins Infirm 2009; 102:45-47. [PMID: 19348366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
Technological advances and the global economy in the 21st century have shifted the traditional practices in adult education and lifelong learning in healthcare organizations. Thomas Jefferson University Hospital changed its traditional 2-day nursing classroom dysrhythmia course to an e-learning platform. The role of the clinical nurse specialist in the planning and implementation of this case is presented. Nursing staff development and the clinical nurse specialists proved to be driving forces for the transformation of the course, reinforcement of learning, and promotion of future educational technology.
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Affiliation(s)
- Elizabeth C Elkind
- Graduate Nursing Informatics Program, Thomas Jefferson University, Jefferson School of Nursing, Philadelphia, Pennsylvania 19107, USA.
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Tsiperfal A, Scheibly K, Matsuda K. Can QRS Widening be a result of propafenone overdose? Prog Cardiovasc Nurs 2008; 23:193-194. [PMID: 19067986 DOI: 10.1111/j.1751-7117.2008.00016.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Reilly T, Humbrecht D. Fostering synergy: a nurse-managed remote telemetry model. Crit Care Nurse 2007; 27:22-6, 29-33; quiz 34. [PMID: 17522190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Terry Reilly
- Abington Memorial Hospital in Abington, PA 19001-3788, USA.
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Abstract
With technological advances, changes in provision of healthcare services and increasing pressure on critical care services, ward patients' severity of illness is ever increasing. As such, nurses need to develop their skills and knowledge to care for their client group. Competency in cardiac rhythm monitoring is beneficial to identify changes in cardiac status, assess response to treatment, diagnosis and post-surgical monitoring. This paper describes the basic anatomy and physiology of the heart and its conduction system, and explains a simple and easy to remember process of analysing cardiac rhythms (Resuscitation Council UK, 2000) that can be used in first-line assessment to assist healthcare practitioners in providing care to their patients.
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Affiliation(s)
- Joanna Sharman
- Birmingham New Hospitals Project, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham
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Abstract
Cardiovascular nursing practice includes accountability for the clinical and organizational processes to ensure positive outcomes for patients having cardiac dysrhythmias. For patients with supraventricular dysrhythmias, nurses have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, and symptoms. Nurses have also explored these same outcomes associated with the management of supraventricular dysrhythmias. In addition, nurses have contributed to understanding organizational outcomes such as healthcare utilization and costs associated with these patients. For patients with atrial fibrillation after cardiac surgery, nurses have studied patient and organizational outcomes related to mortality, morbidity, symptoms, psychological and physical functioning, and economic outcomes. This research has included numerous interdisciplinary studies, and most of it has been descriptive or observational in design. Areas for future nursing outcomes research, including more interventional studies, are discussed.
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Affiliation(s)
- Marjorie Funk
- Yale University School of Nursing, New Haven, CT, USA
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Lindner UK. [Recognizing and understanding diseases: pulse irregularity as guiding symptom]. Pflege Z 2007; 60:106-8. [PMID: 17343099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
Maternal heart disease complicates 0.2 to 3% of pregnancies and is responsible for 10% to 25% of maternal deaths. Many healthy women manifest subtle signs of cardiac failure during uncomplicated pregnancy and birth. Classic symptoms of heart disease mimic common symptoms of late pregnancy, such as palpitations, shortness of breath with exertion, and occasional chest pain. A complete cardiovascular examination assists the healthcare team to fully assess and evaluate the pregnant woman with known heart disease. Detailed assessment of the woman throughout pregnancy may lead to initial discovery of heart disease. Compilation of these objective data with subjective functional capacities allows for risk stratification and assignment to a New York Heart Association functional classification.
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Affiliation(s)
- Yvonne A Dobbenga-Rhodes
- Division of Patient Care Services, Washington Hospital Healthcare System, 2000 Mowry Ave, Fremont, CA 94538, USA.
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Abstract
OBJECTIVE The objective is to identify and describe critical care nurses' perception of arrhythmia knowledge. In addition, this study is the first step in developing levels of arrhythmia competency. DESIGN A qualitative research design was used. Focus group technique using a semistructured group session, with a moderator, was used to gather data. Data were analyzed by the constant comparative method. SUBJECTS The subjects were critical care nurses who work in acute care settings where they read electrocardiographic data and make treatment decisions. PROCEDURES Five focus groups were conducted over a period of 12 months. Group size ranged from four to eight participants. Participants were asked to describe their perceptions of arrhythmia knowledge and to assign a rating score related to the level of knowledge needed to identify specific arrhythmias. RESULTS Basic, intermediate, and advanced levels of arrhythmia knowledge were identified. This study revealed a deficit in nurses' ability to recognize and identify specific arrhythmias including heart block, aberrant conduction, and tachyarrhythmias. Understanding of lead placement concepts varied greatly among participants. CONCLUSIONS The insight and perspective of critical care nurses related to the level of arrhythmia knowledge are needed for the development of competency measures and evidence-based teaching strategies.
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Affiliation(s)
- Kathryn Buchanan Keller
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida 33431, USA
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32
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Plebani L, Occhetta E. [Nurses and doctors in the management of arrhytmic complications: the case of electric storm in patients with an implantable cardioverter defibrillator]. Assist Inferm Ric 2006; 25:157-62. [PMID: 17080624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The evolution of arrhythmologic technology introduced new therapeutic opportunities for cardiology patients. Competence, continuity of care, integration and collaboration between medical doctors and nurses allow a safe management of short and long term complications. A typical example of a new arrhythmic complication is the "electrical storm" or "arrhythmic warm up" in patients implanted with a cardioverter-defibrillator (ICD). The definition and epidemiology of the electrical storm stress the relevance of this clinical situation; its dramatic emergency involves several aspects of nursing care, clinical, prognostic, ethical and deontological. The definition and implementation of an integrated protocol for the treatment of this condition is described and ethical and unresolved questions are rised. One of these problems is the recommendation to offer the patient the opportunity to receive information about the option of inactivating the ICD.
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Affiliation(s)
- Laura Plebani
- S.S.v.d.O. Elettrofisiologia e Cardiostimolozione, Dipartimento Cardiovascolare, AO Moggiore della Carità, Novara
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Affiliation(s)
- Janice Thompson
- Department of Nursing, Quinnipiac University, Hamden, Conn., USA
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Jacobson C. Tools for teaching arrhythmias. AACN Adv Crit Care 2006; 17:230-2. [PMID: 16767025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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West JC. Long-term care. Agreement to arbitrate disputes may be unenforceable if it contravenes remedial rights. Romano v. Manor Care, Inc., 861 So. 2d 59 (Ct. App. 4th Dist. 2003). J Healthc Risk Manag 2005; 24:36-8. [PMID: 16383267 DOI: 10.1002/jhrm.5600240110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- John C West
- AIG Consultants, Inc., Healthcare Management Division
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37
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Abstract
MANY NURSES STRUGGLE with identifying electrocardiogram (ECG) rhythms, but rapidly interpreting primary ECG rhythms is an essential skill that every nurse should master. THIS ARTICLE PROVIDES an algorithm that nurses can use to easily interpret basic ECG rhythms.
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Abstract
Sudden cardiac death (SCD) is a major healthcare problem worldwide. The majority of SCD events occur in patients with clinically recognized heart disease and most episodes result from ventricular tachyarrhythmias. Implantable cardioverter defibrillator (ICD) therapy prevents SCD in specific patient populations. Significant progress in the design and technology has been made since the Food and Drug Administration first approved the ICD in 1985. First-generation ICDs were large, were implanted in the abdomen, required a thoracotomy for placing epicardial defibrillation patches, and were nonprogrammable. Contemporary ICDs have been substantially downsized, are implanted via a transvenous approach, and are multiprogrammable. Device implantation has been simplified to be similar to that of a permanent pacemaker. In addition to treating life-threatening ventricular arrhythmias, ICDs now treat bradyarrhythmias, atrial arrhythmias, and congestive heart failure. The purpose of this article is to describe the evidence supporting the use of ICD therapy and to explain the current devices used in clinical practice.
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Affiliation(s)
- Melanie T Gura
- Pacemaker & Arrhythmia Services, The Heart Group, Inc, Akron, Ohio 44236, USA.
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39
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Hutton D. A novel systematic approach to ECG interpretation. Dynamics 2005; 16:19-21. [PMID: 16447532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Regardless of the patient's symptoms, the 12-lead electrocardiogram (ECG) needs to be assessed in a comprehensive and systematic manner in order to avoid missing critical information. The RIRI approach to ECG interpretation offers a fast, reliable and systematic method to ensure that all aspects of interpretation are covered. The acronym is easy to remember and can be used by all health care practitioners ranging from novice to expert. RIRI reminds us to check the rate, intervals, rhythm and ischemia/infarction. Becoming familiar with the RIRI approach and consistently using this method will reduce the amount of time spent on the interpretation of the ECG and increase the time spent with the patient.
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Affiliation(s)
- Darlene Hutton
- QRS Educational Services, Seneca College Critical Care Program
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40
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Abstract
Cardiovascular nurses contribute significantly to health outcomes and frequently assume responsibility for the clinical and organizational processes to ensure positive outcomes for patients and families. In ventricular dysrhythmia populations, nurses have provided evidence for practices that influence outcomes and have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, symptoms, and family responses. Additionally, nurses have contributed to understanding organizational outcomes, such as costs and resource use related to patients with dysrhythmias. Most ventricular dysrhythmia outcome studies are descriptive. More intervention research is needed to develop a cohesive and comprehensive body of evidence upon which to base dysrhythmia nursing care to improve patient outcomes.
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Affiliation(s)
- Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
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41
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Abstract
BACKGROUND Although implantable cardioverter defibrillator (ICD) therapy has been found to be effective in preventing and treating life-threatening arrhythmias, adjusting to the ICD and resuming a normal lifestyle are often difficult. There are few intervention trials reported in the literature to aid in adjustment after receiving a primary ICD. OBJECTIVE This article describes the content and structure of a nursing intervention program designed to improve physical functioning and psychologic adjustment after ICD implantation. The nursing intervention program was based on social cognitive theory and the data from a previous investigation covering 7 areas of concern after ICD implantation. CONCLUSION Hospital-based education programs begin the process of recovery after ICD implantation, but they must be supplemented with further interventions to return the patient to baseline physical and psychologic functioning. This is a beginning effort in deriving and testing evidence-based intervention programs for patients with an ICD.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle 98195-7266, USA
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Hutchisson B, Cossey S, Wheeler RM. Basic electrocardiogram interpretation for perioperative nurses. AORN J 2003; 78:572-81, 585-90; quiz 591-4. [PMID: 14575183 DOI: 10.1016/s0001-2092(06)60665-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CHANGES IN PRACTICE have made knowledge of the cardiac conduction system and basic electrocardiogram (EKG) interpretation a necessity because perioperative nurses are required to manage an increasing number of patients undergoing i.v. conscious sedation who require EKG monitoring. RAPID EKG INTERPRETATION can reveal arrhythmias before a patient becomes symptomatic. An EKG can reveal underlying cardiac problems and uncover electrolyte imbalances that, if left untreated, could hinder positive patient outcomes. THE CONDUCTION AND CORONARY ARTERY SYSTEMS of the heart are described to enable identification of normal and abnormal EKG rhythms. Each arrhythmia is described, and potential causes and probable treatments are discussed.
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Affiliation(s)
- Philip Woodrow
- Intensive Therapy Unit, Kent and Canterbury Hospital, Canterbury
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44
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Abstract
Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.
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Affiliation(s)
- Janet Pettit
- Neonatal Intensive Care Unit, Doctors Medical Center, 1441 Florida Ave, Modesto, CA 95350, USA.
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45
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Docherty B, Douglas M. Cardiac care: 1. Interpretation of electrocardiogram rhythm strips. Prof Nurse 2003; 18:322-5. [PMID: 12630243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
This is the first in a series of three papers that aim to explain the anatomy and physiology related to cardiac conductivity and to describe some common and less common arrhythmias that ward nurses may come across. This first paper examines the background to ECG monitoring, the anatomy and physiology of the heart and ECG recording and interpretation.
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46
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Abstract
BACKGROUND In the UK, access to psychological support for people with implantable cardioverter defibrillators (ICDs) is arbitrary, despite the fact that the National Institute for Clinical Excellence (NICE) recognises that the provision of adequate support can positively affect recovery. The author evaluates the available literature. CONCLUSION This review identifies that, although a lot of information is available about the effects of ICD technology on patients, there have been few systematic evaluations of care interventions that aid adjustment to living with an ICD. Equally, it has not yet been established whether nurses are equipped to effectively assess and meet the complex care needs of this patient population. The development and evaluation of national standards of care, in association with ICD patients and their families, is recommended.
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Flanagan J, Horwood L, Bolin C, Sample R. Heart failure patients with ventricular dysynchrony: management with a cardiac resynchronization therapy device. Prog Cardiovasc Nurs 2003; 18:184-9. [PMID: 14605519 DOI: 10.1111/j.0889-7204.2003.02005.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Despite an array of treatment modalities, the overall prognosis for patients with severe heart failure remains bleak. Biventricular pacing, or cardiac resynchronization therapy, is gaining increasing acceptance as a compelling treatment for those individuals with advanced heart failure (New York Heart Association functional class III or IV). This article provides a brief description of the atrial and ventricular conduction disturbances common in patients with advanced heart failure. Current indications for therapy are outlined, as are recent results of cardiac resynchronization therapy trials. The implant procedure is described to provide a comprehensive overview of this innovative approach to re-establishing normal electromechanical activity and synchronous right and left ventricular contractions. Patient care, before and after device implant, is also summarized. The focus on patient education throughout this article may allow it to serve as a reference for health care providers involved in the care of patients with severe heart failure.
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Affiliation(s)
- Jean Flanagan
- Washington University Medical Center, St. Louis, MO, USA
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Ribeiro ADC, Ribeiro MIRF. [The nurse and a patient undergoing an electrophysiological study]. Servir 2002; 50:264-9. [PMID: 12599865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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49
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Frank E. [Nursing care in cardiac pacemaker therapy: new multiplicity]. Pflege Z 2002; 55:779-82. [PMID: 12494687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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50
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Chart smart: keeping tabs on arrhythmias. Nursing 2002; 32:82. [PMID: 12402901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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