The evolving role of genetics in the diagnosis and management of heart disease.

The role of genetics in heart disease diagnosis and management is expanding daily. Clear genetic components have been found for diseases such as hypertrophic cardiomyopathy, heart failure, and coronary artery disease. Rhythm disturbances with genetic components are atrial fibrillation and long QT syndrome. Gene therapies to treat cardiac diseases include those designed to prevent vein graft stenosis and those that promote coronary angiogenesis.

An exploratory study of developmental growth in adults with heart failure.

Persons with heart failure face a myriad of challenges due to the physical limitations imposed by the chronic illness. Despite these changes, each person must continue to face the developmental challenges of adulthood. This exploratory study was conducted to examine the impact that this chronic illness has on the developmental processes of adults. Methods triangulation was used to examine the content of unprompted, written goals and the results of surveys of life satisfaction and mood states of 138 persons with heart failure. Younger adults had higher anger, depression, and anxiety scores than older or middle-aged adults and had lower scores of life satisfaction. This may reflect the emotional reaction to the realization that their lives may be shortened by this chronic illness. Analysis of their goals reflected the developmental challenges described by Erikson. Despite severe physical limitations, these individuals demonstrated growth and achievement of developmental tasks by transcending usual time lines.

Foundations of genetics: genetic structure, function, and therapeutics.

Molecular genetics provides the basis for understanding patterns of health and disease in people and is part of the scientific foundation on which acute and critical care nurses should build their practice. The human genome, defined as all the genetic information in the cells of humans, provides the blueprint for protein production and cellular function in the body. Alterations in protein production may result in illness or organ malfunction that has a genetic derivation. One therapeutic strategy that holds promise to manage genetic diseases is gene therapy. Gene therapy, or human gene transfer, occurs when scientists or physicians modify the genetic material in cells for therapeutic purposes. Genetic structure, function, and therapeutic reflect the science of the present and future and have profound practice implications for acute and critical care nurses.

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.

A blueprint for an undergraduate healthcare informatics course.

Healthcare informatics has been taught at the graduate level for a number of years. With the proliferation of computer uses and information management systems, all nurses must interface with computer technologies. Healthcare informatics courses can no longer remain limited to specialists at the graduate level. Undergraduate nursing educators must incorporate information management content into their curricula. The authors provide a detailed description of an undergraduate healthcare informatics course.

Care and safety of pacemaker electrodes in intensive care and telemetry nursing units.

BACKGROUND: Temporary pacing leads with electrodes are a potential risk, because microshock inadvertently transmitted across the catheter or wire can paradoxically cause lethal dysrhythmias. Much attention has been paid to this complication in clinical guidelines, but little is known about actual practices used to protect patients. OBJECTIVES: A national survey was done to describe current practices related to the care of patients with temporary epicardial or transvenous pacing catheters. The survey focused on environmental factors that affect generation of static electricity, equipment used with temporary pacing, and nursing practices used when handling temporary pacing electrodes. METHODS: The Pacemaker Electrical Care and Safety Survey was developed, validated, and pilot tested before it was mailed to all 895 hospitals that perform cardiac surgery. Surveys were sent to the coronary care unit, cardiac surgical ICU, and telemetry units of each hospital. RESULTS: Responses were received from 476 units representing 388 (43%) of the 895 institutions. Most respondents reported using gloves, although few hospitals had policies mandating this practice. The insulating materials used most often, in order, were a glove or finger cot, tape, and gauze. Few units (25%) use any measure to reduce static electricity generated by movement over carpeting. Little attention was paid to insulating exposed epicardial temporary pacing electrodes at the generator. CONCLUSIONS: Temporary pacing electrodes were usually handled in an electrically safe manner; however, little attention was paid to environmental sources of microshock or connections between the generator and the cable. Although the respondents reported using a variety of insulating materials, the ideal cover for the exposed tips of the electrodes has not yet been determined.

Medical devices and attachment: holistic healing in the age of invasive technology.

The environment is filled with wonderful examples of medical technology that provide emergency life support, improve well-being, and offer the possibility of a longer and more productive life. But these devices are no longer only a part of the external environment. As technology advances, more devices are becoming a part of the internal environment (i.e., our bodies) as well. For some people an implanted mechanical device, such as a cardiac pacemaker or a cardioverter defibrillator, is readily accepted; for others it may be seen as an encroachment. It may be a symbol of loss and debilitation or of independence and resilience. What makes the difference? How can nurses facilitate a healthy adjustment and healing in an era permeated with technology? A discussion of the symbolism, related theory, and nursing implications is provided.

Infection precautions with temporary pacing leads: a descriptive study.

OBJECTIVE: To describe infection precautions used by nurses when caring for patients with temporary epicardial and transvenous pacemakers. DESIGN: Descriptive, nation-wide survey. SETTING: All U.S. hospitals performing cardiac surgery. RESPONDENTS: Nurse managers and clinical specialists from cardiac and thoracic intensive care, coronary care, and telemetry units at all U.S. hospitals performing cardiac surgery. INTERVENTION: The Pacemaker Electrode Care and Safety Survey. RESULTS: Responses came from 43% (388) of the 895 hospitals. Most respondents indicated that they wore gloves when handling electrodes (approximately 96%); usually the gloves were nonsterile (73%). A sterile procedure was often used to perform site care (37% for epicardial and 65% for transvenous). The most common agent used for site cleansing was povidone-iodine. Concern has been expressed in the literature about use of this agent. Gauze was the most common type of dressing (used by 60% for epicardial dressings and 31% for transvenous). CONCLUSION: There is diversity in clinical practice. Further study is recommended to establish the safety, efficacy, and cost-effectiveness of identified infection precautions.

Gender bias in the diagnosis and treatment of coronary artery disease.

Women are at high risk for cardiovascular disorders, but referrals for both diagnostic and therapeutic procedures seem to reflect a gender bias. Procedures and therapies currently used have been developed predominantly or exclusively for men. Medical history demonstrates a disregard of women's health problems that still may be operative today. Women are older and sicker when they have angioplasty or bypass grafting, and they receive far fewer implantable cardioverter defibrillators and heart transplantations. They have more hypertension, diabetes, longer stays in intensive care units, and poorer outcomes. This may be the result of a problem with referral or a difference in the way women experience cardiac symptoms. It may also be related to the way women perceive themselves and their illness. Efforts are being made to provide equitable and relevant health care for women and to conduct research that will describe women's cardiac symptoms and their responses to cardiovascular technology.

Bringing nursing informatics into the undergraduate classroom.

Nursing informatics is not formally addressed in most undergraduate nursing education programs. Nurses usually rely on their employer and/or device vendors to provide this education. Few nurses are able to capitalize on the potential of computer technology because they have not been sufficiently exposed to nursing informatics during their nursing education. Biomedical computer technology/informatics needs to be brought into the classroom, away from the pressures of the work environment. Informatics training needs to be incorporated into undergraduate nursing education through an integrated systems approach, combining elements of nursing, systems analysis, and engineering. In this article, a university-based state-of-the-art classroom and education plan using an integrated approach to educate nurses in nursing informatics is described.