The Journal of cardiovascular nursing
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Coronary heart disease is the primary health risk for all Americans. Acute coronary syndromes (ACS) is the term used to denote any 1 of 3 clinical manifestations of coronary heart disease: unstable angina, non-ST elevation myocardial infarction, and ST-elevation MI. The major challenge to healthcare providers is the rapid and accurate identification of patients with ACS who would benefit from immediate thrombolysis or percutaneous coronary interventions. The purpose of this article is to describe the incidence, causes, risk factors, assessment, and diagnosis of patients presenting with ACS as well as current recommendations for nurses who treat patients with ACS.
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The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas Computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. ⋯ The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, time frames, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.
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Atrial fibrillation is the cardiac arrhythmia encountered most often in clinical practice. It is triggered by many conditions such as thyroid dysfunction, cardiac disease, alcohol, and pulmonary disease. Patients with chronic obstructive pulmonary disease (COPD) are susceptible to many insults that can lead to an acute deterioration superimposed on chronic disease. ⋯ The treatment of COPD exacerbation may include beta-adrenergic agonist and theophylline, which can precipitate atrial fibrillation with rapid ventricular response. Pharmacologic and electrical cardioversion may be ineffective in the management of atrial fibrillation in patients with COPD until respiratory decompensation has been corrected. This article focuses on the management of atrial fibrillation in patients with COPD.
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End-of-life care involves not only the care of patients but also the care of those providing care for patients. The routine demands of providing care for patients in end-of-life situations often prevent nurses from working through the grief associated with the death of a patient, resulting in frustration, depression, stress, and eventually, burnout. It is important to recognize that grief and mourning are necessary steps in adjusting to the loss associated with the death of a patient or a loved one. ⋯ As nurses providing quality end-of-life care, we can provide an opportunity for a patient's family to begin the process of grieving through appropriate interventions while the patient is still in the hospital or care facility. Recognizing and respecting the appropriateness of individual differences in grief responses creates a means of support for both patients and professionals in healthcare settings. By understanding grief as a predictable, yet individual, response to the loss of a patient or a loved one, we, as nurses, can take care of ourselves while providing quality end-of-life care for our patients.
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High blood pressure has become increasingly prevalent and is an important risk factor for cardiovascular disease. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has redefined normal blood pressure as less than 120/80 mm Hg and created a new blood pressure category called "prehypertension" for those with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg. This new blood pressure category was created to identify adults considered to be at risk for developing hypertension and to alert both patients and healthcare providers of the importance of adopting lifestyle changes. Recognition of prehypertension provides important opportunities to prevent hypertension and cardiovascular disease.