RESUMO
Ventricular assist devices provide therapeutic options for patients with severe heart failure who have exhausted available medical therapies. With restoration of organ perfusion with ventricular assist devices, the heart failure resolves and quality of life and functional status improve. The current generation of continuous-flow devices present novel challenges to the clinical assessment of patients by substantially reducing or nearly eliminating any palpable pulse. Patients therefore generally have inadequate arterial pulsatility for most noninvasive monitoring devices such as pulse oximeters or automated blood pressure cuffs to work accurately. This article describes the function of continuous-flow devices and how this function affects common monitoring options, as well as how to clinically assess recipients of continuous-flow devices to promptly identify those whose condition may be deteriorating or who may be receiving inadequate perfusion.
Assuntos
Determinação da Pressão Arterial/métodos , Testes de Função Cardíaca/métodos , Coração Auxiliar , Monitorização Fisiológica/métodos , Determinação da Pressão Arterial/enfermagem , Eletrocardiografia/métodos , Eletrocardiografia/enfermagem , Testes de Função Cardíaca/enfermagem , Frequência Cardíaca , Humanos , Monitorização Fisiológica/enfermagem , Oximetria , Ultrassonografia DopplerAssuntos
Insuficiência Cardíaca/diagnóstico , Testes de Função Cardíaca/instrumentação , Monitorização Ambulatorial/instrumentação , Próteses e Implantes , Ensaios Clínicos como Assunto , Desenho de Equipamento , Insuficiência Cardíaca/enfermagem , Testes de Função Cardíaca/enfermagem , Hemodinâmica/fisiologia , Humanos , Monitorização Ambulatorial/enfermagemAssuntos
Cardiologia , Papel do Profissional de Enfermagem , Designação de Pessoal/organização & administração , Pessoal Técnico de Saúde/organização & administração , Cardiologia/educação , Competência Clínica , Educação Continuada em Enfermagem , Testes de Função Cardíaca/enfermagem , Humanos , Capacitação em Serviço , Autonomia Profissional , Pesquisa/educação , Recursos HumanosRESUMO
This AANA Journal course discusses the American College of Cardiology (ACC) and American Heart Association (AHA) guideline on perioperative cardiovascular evaluation for noncardiac surgery. The intent of the ACC/AHA guideline is to assist clinicians in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, and prevention of cardiac diseases. Optimizing the anesthetic management of the cardiac patient undergoing noncardiac surgery is becoming increasingly important: as the percentage of Americans older than 65 years continues to grow, so does the prevalence of cardiac disease in this population. Simply accepting a preoperative cardiology clearance for the cardiac patient undergoing noncardiac surgery provides little information that can be used for risk assessment and management of anesthesia. While national practice patterns vary significantly, there is an important need to standardize cost-effective preoperative cardiac evaluation. By using evidence-based studies, the ACC/AHA guideline delineates methods to objectively categorize cardiovascular risk and use data from the cardiology consultation to refine anesthetic management. Use of the guideline can lead to more efficient evaluation of the noncardiac patient with cardiac disease, which can decrease morbidity, mortality, and cost.
Assuntos
Cardiopatias/diagnóstico , Cuidados Pré-Operatórios/métodos , Algoritmos , Anestesia/métodos , Anestesia/enfermagem , Anestesia/normas , Cardiologia , Árvores de Decisões , Medicina Baseada em Evidências , Cardiopatias/complicações , Cardiopatias/epidemiologia , Testes de Função Cardíaca/métodos , Testes de Função Cardíaca/enfermagem , Testes de Função Cardíaca/normas , Humanos , Enfermeiros Anestesistas/educação , Enfermeiros Anestesistas/organização & administração , Papel do Profissional de Enfermagem , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/normas , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/enfermagem , Encaminhamento e Consulta , Medição de Risco/métodos , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Since the evolution of the thrombolytic era, thrombolytic agents have become the first-line therapy recommended for patients with acute myocardial infarction (AMI). This recommendation has important implications for nursing practice. Nurses see AMI patients in a variety of hospital settings and are often the first contact patients have when entering the medical system. Nurses can have an important effect on patient outcomes and are essential in the successful implementation of thrombolytic therapy. This article examines the evolution of the thrombolytic era, types of thrombolytic agents, and the nurse's role in assessment, implementation and evaluation of the therapy. Strategies for recognizing and screening potential candidates, decreasing in-hospital delays, and minimizing complications due to thrombolytic therapy are discussed.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/enfermagem , Contraindicações , Fibrinolíticos/farmacologia , Fibrinolíticos/uso terapêutico , Testes de Função Cardíaca/enfermagem , Humanos , Avaliação em Enfermagem , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidadeRESUMO
In this study we examined the relationship between cardiac output (CO) measurements obtained from the proximal injectate lumen and the proximal infusion lumen of a thermodilution pulmonary artery catheter. The research was predicated on the belief that a strongly significant relationship would provide the clinician with an alternative lumen for measuring CO. Twenty-one subjects were selected by using a nonprobability convenience sampling method. With ice temperature injectate, four injections were performed into one lumen followed by four injections into the alternate lumen. CO values were computed with installed data management physiologic monitors. A Pearson's Product-Moment Correlation Coefficient was calculated, and the result verified a strong positive correlation between CO values (r = 0.96, p = less than 0.0001). Results of a paired t test demonstrated no statistically significant differences between CO means. These findings lend direction for minimizing the potential risk of catheter contamination associated with the manipulation of intravenous lines containing vasoactive medications. It also may save time for the critical care clinician who is trying to balance tasks such as CO measurements and titration of vasoactive or inotropic medications.