Cardiovascular Patients Jacqueline Septimo Frances Venuti Lok Wong

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Cardiovascular Patients Jacqueline Septimo Frances Venuti Lok Wong Issak Katanov Natalie Saralegui

Cardiovascular Patients Jacqueline Septimo Frances Venuti Lok Wong Issak Katanov Natalie Saralegui

Common Database • • Patient assessment e. MAR Admission notes Progress notes Patient interview

Common Database • • Patient assessment e. MAR Admission notes Progress notes Patient interview Databases Internet

Patient Overview Lok Frances Issak Natalie Jackie 76 yr old White M 64 yr

Patient Overview Lok Frances Issak Natalie Jackie 76 yr old White M 64 yr old Hispanic M 62 yr old white M 85 yr old Hispanic F 80 yr old white F Primary diagnosis Cardiac dysrhythmia • HF Stable angina/ Gangrene amputation HTN urgency Unstable angina Chief Complaint • Epitasis • Chest pain Chest pressure HTN urgency • DOE • Chest pressure Co morbidities • HTN • Hyperlipidemia • bladder cancer • MI 14 years ago • A. fibb. • HTN • Renal failure • DM II • GERD • CAD • Gangrene on right big toe • HTN • Hypothyrodism • CKD STAGE IV • OA • spinal stenosis • DM II Social history Nonsmoker • Nonsmoker • occasional alcohol use • 40 pack year history • Quit smoking 15 yrs ago Denies • Nonsmoker • Nondrinker Family history Denies • Older brother: 4 Denies heart attacks, • younger bro: heart problems • Mom: RIP d/t heart attack Denies • HTN • Emphysema • asthma

Common Patient Themes Lab Values • ↓ RBCs, HCT, Hg. B • ↑ PT,

Common Patient Themes Lab Values • ↓ RBCs, HCT, Hg. B • ↑ PT, PTT • ↑ BUN CV Signs & Medication Symptoms patients • Anti- • Angina • Dyspnea on exertion • Activity intolerance coagulants • Vasodilators • Lipid lowering agents

Nursing Diagnoses • • • Acute chest pain Risk for decreased cardiac output Risk

Nursing Diagnoses • • • Acute chest pain Risk for decreased cardiac output Risk for ineffective tissue perfusion Risk for fluid and electrolyte imbalance Risk for falls Risk for imbalanced nutrition Activity intolerance Disturbed sleep pattern Fear and anxiety related to ineffective coping

QSEN Competencies: Evidence-Based Practice According to Ackley, Ladwig & Swan, 2008: • Administer LMWH

QSEN Competencies: Evidence-Based Practice According to Ackley, Ladwig & Swan, 2008: • Administer LMWH as prophylactic anti-coagulant. • Perform uninterrupted telemetry monitoring by a “dedicated monitor watcher. ” • Provide bed rest for 12 -24 hours for patients with STEMI.

QSEN Competencies: Teamwork & Collaboration • Physicians (Cardiologists) • Cardiac NPs • Nurses •

QSEN Competencies: Teamwork & Collaboration • Physicians (Cardiologists) • Cardiac NPs • Nurses • Case managers • Surgeons • Social workers • Xray techs • Physical Therapists • Respiratory therapist • Nutritionist • CNAs, PCTs • Family • Clerk • Housekeepers • Chaplain

QSEN Competencies: Patient-Centered Care • • • Interdisciplinary approach Patient preferences Advocate Empowerment Holistic

QSEN Competencies: Patient-Centered Care • • • Interdisciplinary approach Patient preferences Advocate Empowerment Holistic approach Culturally-sensitive care

QSEN Competencies: Safety • • • Risk for falls Telemetry Anti-septic hemodynamic monitoring Skin

QSEN Competencies: Safety • • • Risk for falls Telemetry Anti-septic hemodynamic monitoring Skin integrity Polypharmacy

QSEN Competencies: Informatics • • Bar Code System EKG PIXIS PDA’s CPOE’s Hospital Intranet

QSEN Competencies: Informatics • • Bar Code System EKG PIXIS PDA’s CPOE’s Hospital Intranet Bedside Monitors • Electronic Health Record • Computerized Nursing Care Records • Nurse Tracking System • Paging System

QSEN Competencies: Quality Improvement • Falls • • • Pressure Ulcers Infection Control Patient

QSEN Competencies: Quality Improvement • Falls • • • Pressure Ulcers Infection Control Patient Satisfaction Pain Management Medication Reconciliation

References Ackley, B. J. , Ladwig, G. B. , & Swan, B. A. (2008).

References Ackley, B. J. , Ladwig, G. B. , & Swan, B. A. (2008). Evidencebased nursing care guidelines, medical-surgical interventions. Mosby. Brunner, & Suddarth. (2010). Brunner and Suddarth's texbook of medical surgical nursing. Philadelphia, PA: Lippincott Williams & Wilkins. Copstead, L. C. , & Banasik, J. L. (2010). Pathophysiology. (4 ed. ). St. Louis: W B Saunders Company. Deglin, J. H. , Vallerand, A. H. , Sanoski, C. A. (1988). Davis’s Drug Guide for Nurse. Philadelphia, PA: F. A. Davis Company. Gulanick, M. , et. al. , (1986). Nursing care plans: Nursing diagnosis and intervention. St. Louis, MO: Mosby Elsevier. Pagana, K. D. , & Pagana, T. J. (2009). Mosby's diagnostic and