Significant changes

     I was talking with a patient recently who suffered an MI about four months ago.  He has some permanent damage, but maintains an ejection fraction of about 40%.  A comment he made has stuck with me.  He told me that he's eating well, is exercising and has lost some weight, and he has quit smoking.  Then he said that he feels he isn't doing any of these things for pleasure, but is simply following directions so he didn't die and leave his wife alone.  He keeps expecting to have another attack at any time.  He had lost the joy for living that he used to feel. 
     Sometimes when a patient survives a heart attack, we have an expectation that they will appreciate everything in their life even more than they did prior to the MI, and we may convey that expectation without being aware of it.  But we need to be careful to listen to what they are telling us.  I spoke with him at length, and he is going to join a support group and speak to his primary physician about these feelings.  I was able to relate that my father experienced some of those same feelings after he had a heart attack, too, and worked through them.  My father is now very happy and active.  If, however, I had not had the experience with my father, I would have been surprised about how this patient was feeling.  It isn't so surprising, though, if we consider that he experienced a life-altering event and that the significant change won't be easy to get used to.
     So the next time a patient doesn't respond the way you expected, look again and see if you can figure things out from the patient's perspective, not the nurse's.               Take care of yourselves.   Barbara

Answer to mystery EKG rhythm

Class, here is the result from the mystery EKG:  it is a normal sinus rhythm.  This means that the impulse started in the SA node and depolarized the atria.  The impulse was then held in the AV node to allow time for the ventricles to fill with blood while the atria contract.  This extra filling time for the ventricles increases the cardiac output by up to 30%.  After being held in the AV node, the impulse travels down the super highway of the bundle branches so that the ventricles depolarize simultaneously, resulting in an effective contraction.  And that's the way it's supposed to work!  

Using the Law of Supply and Demand

Whenever we take care of patients with cardiac ischemia, we have to think about balancing oxygen supply and demand.  Using this diagram as a guide, see if you can come up with three ideas of how we help to increase oxygen supply, and decrease demand (decrease the workload).  These can be medical or nursing interventions.  I look forward to your thoughts!          Barbara

Created using Inspiration!

EKG Practice

Sometimes, when you haven't done something for a while, you have to force yourself to try again.  I think we all have a fear of failure so we are sometimes reluctant to try.  As nurses, we have to be sure to not let that reluctance get in the way of trying to do the right thing for our patients.  And as educators, we have to try new methods of teaching and evaluating our results.  We may need to spend extra time practicing - just like with EKG rhythms - so that we can provide the best learning experience for our students.     Barbara

Here's an easy one for you :)

Name this rhythm.!
Remember that the normals are:
Rhythm is regular
Rate is 60-100
P waves look alike and are matched 1:1 with QRS
PR interval is 0.12 - 0.20 seconds long
QRS is 0.06 - 0.10 seconds long
And don't forget to evaluate the ST segment, the QT interval, and the T wave.

 Submit your answers (including guesses) and comments and I'll let you know the results on Feb 19th.

Auscultating Heart Sounds

Hi class, in response to your expressed need about assessing heart sounds, I found this great site to practice listening and assessing.  Listen to it loudly at first, then turn the volume WAY down, and listen with your stethoscope. 

Use the suggested words to help distinguish S3 and S4.  Think of S3 as SLOSH -ing in, and S4 as "a STIFF wall".  This not only helps you remember what it sounds like, but why it sounds that way. 

http://www.wilkes.med.ucla.edu/inex.htm

Preliminary Results of Learning Needs Assessment

Hi class, I don't have the final results of the learning needs survey, but here are some preliminary results.  I find it very interesting that each question resulted in only two selections chosen.

80% of you indicated that you were most comfortable with taking history, and 20% were most comfortable with assessing heart sounds.

For skills with which you are least comfortable, 80% chose interpreting rhythm strips and 20% chose assessing heart sounds.

Based on this information, I'll be sure to spend some extra time on these areas and provide extra resources for you.

Learning Needs Survey

Hi Class,
Please complete this brief survey to help focus our discussions moving forward.


Cardiac Care Class Survey

I'll post the results soon!

Wenckebach

Many of you have asked me about how to remember the different AV blocks when we talk about EKGs in our Care of the Cardiac patient class.  One of my favorite blocks is 2nd degree AV Block Type I.       I  think I like it because I like to say it's other name: Wenckebach.  Watch this video to help you remember the hallmarks of the EKG and what to do for the patient who has it.

Fatigue in the Cardiac Patient

Many of the patients we care for experience fatigue.  And sometimes our patients also experience depression.  How can we tell the difference between cardiac-related fatigue and depression-related fatigue?

Fatigue related to cardiac status is worse in the evenings.  Fatigue due to anxiety or depression occurs all day or is worse in the morning.

So the next time your are obtaining a history from your patient with cardiac disease and she tells you she is experiencing fatigue, be sure to ask some follow-up questions to help pinpoint the cause of the fatigue.  She may be showing signs of depression, which developed as a result of dealing with her new, chronic diagnosis and need medication or a referral to a specialist.

Case Study

Your patient is here for hip replacement surgery, but is placed on a monitor because of his age and a strong family history of cardiac problems.  You note on his monitor that his heart rate is 120, and it is a sinus tachycardia.  You check his vital signs and find that his temp is 97.8 T, RR 24, and BP is 130/80.  He denies exertion as a cause for his tachycardia.   What are some things that could be happening with this patient?
There are many possibilities, but one that we want to rule out right away is pulmonary embolism.  You should have a high index of suspicion for pulmonary embolism in unexplained tachycardia!
Keep watching those patients!                   Barbara

Another blog? Yes, just for us!

Hello everyone,
     I'm going to use this blog to share some of my thoughts and feelings about caring for cardiac patients with you, and I'll pass along some resources too.  I hope you will feel free to share comments and questions, and certainly any tips or resources that you have for the rest of us.  Check back frequently during this course for new postings, I'll try to post a few times each week.
    
     I have taken care of patients with cardiac issues for years, both in medical-surgical units, and in Intensive Care Units - adult and neonatal.  One thing I've learned for sure, when the heart isn't working right, everything is affected.  As we explore the world of cardiac patients, including EKG interpretation, it is important to remember that physiology and pathophysiology are essential to understand, but we need to relate that information to our patient and how it will impact his or her life.  The patient, or client, is the center of what we do and why we do it.

     To start, you can check out this site:  http://www.skillstat.com/PDF/mceCO.pdf  It's a great review of cardiac output!

     Take care,
     Barbara