Archive for August 16th, 2010

Cardiac Care and Informatics Technology

August 16, 2010

The human heart is an amazing structure.  Serving as a pump for the approximately 5.5 liters of blood, it sends nutrients, oxygen electrolytes, and blood cells throughout the body and removes carbon dioxzide and wastes, beating approximately 60-100 beats per minute, every minute of our lifetime starting at about the fourth week after conception – all this without us ever having to think about it!  Technology has given us insight as to the normal and abnormal function of the heart.  When someone comes into the ER with crushing chest pain, we immediately think IV, O2, monitor – and proceed, if appropriate, with MONA – morphine, oxygen, nitroglycerin and aspirin.  The monitor can give us information on rate and rhythm, conduction, angina or AMI,  indigestion, anxiety or cardiac event. Without the monitor, we would just be guessing and perhaps delay treatment which would increase  progression of cardiac damage (i.e. time=muscle).  Other studies we can expect the physician to order are CBC, CMP, PT/INR, chest xray, possibly CT or prep for cardiac cath.  All these studies are based on technology and informatics with the promise of rapid retrieval of information, therefore preserving cardiac function and life.  Bedside charting via electronics in the ER can also help maintain cardiac function.  While waiting for labs and further orders, the nurse can remain at the bedside and not be fumbling through papers, therefore monitoring the patient and cardiac monitor constantly.  Some technological programs are checklists, which can also serve as cues for the nurse, plus allow easy access to information as needed.   If the MI progresses to Vtach or Vfib, the nurse is at the bedside and can initiate defibrillation immediately.  If it progresses to asystole, the nurse can start CPR without delay.  It is both calming and reassuring to the patient and family to have the nurse present continuously.  Prior to advances in technology, delay in care was a major contributing factor to cardiac loss and death.  While delays in care still occur, medical technology has definitely improved the outcome of cardiac events.  Many patients proceed to rapid cardiac cath with subsequent bypass surgery if appropriate and are discharged within several days with a much more positive prognosis than in the past.  While AMI is still a very serious health problem, informatics and technology have improved the outcome both in the acute phase and the post MI period.

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Physical therapy in the ICU

August 16, 2010

Working in the ICU many of our patients are on bedrest for an average minimum of 2 days, with many as long as weeks and months. As a critical care RN, my main focus is keeping the patient hemodynamically stable and thus the musculoskeletal system takes a back seat. However, eventually once the patient is more stable, physical reconditioning takes place. When is the right time?

I think the answer is as soon as possible! I read a research study that stated one day of muscle atrophy from bedrest can take a week of physical therapy to regain. This statistic shocked me and as a result I have tried to be more cognizant of the need for physical therapy for my patients. As an advocate for my patients I try to discuss the need for physical therapy during interdisciplinary rounds as early as possible. Also, when the physical therapist is working with patients I listen so I can learn ROM exercises that I can help them perform. For our chronically ill patients that have been on bedrest for weeks or months, I attempt to do simple exercises with them such as resistance or stretching as they can tolerate. However, there are times when I simply do not have time to consistently work with them, and the physical therapists are usually stretched thin and can only visit once a day. With this said, how can the void be filled?

I feel that family is the best option. As nurses and physical therapists we need to include the family in learning and teaching exercises. Research shows that families cope better when they are involved in their loved one’s care. They are at the bedside often times most of the day and it has been my experience that they are more than happy to assist in patient care.  Involving the family early in bedside care can also help with the transition home.

I would be interested to hear what others think and what interventions they implement to help their patients recondition. I also want to know what healthcare informatics resources are available for the nurses and the families.

Telecardiology

August 16, 2010

In an era with a shortage of nurses and primary care providers in rural areas, telemedicine is a innovative way to reach out to and underserved population. Within the umbrella of telemedicine, we also have telecardiology specifically, which is a new concept for most. However, the first major use of telecardiolgy was in 1975 in India where EKG’s were sent via phone lines for evaluation. In North Carolina many patients must travel hours to reach a city equipped to manage their cardiac disease. This creates physical and often times financial strain on the patients resulting in lack of follow up care.

This is where modern health care and brilliantly engineered cardiac devices come into play. Patients can now send information via their pacemakers or internal cardiac defibrillators (ICD) directly to their physician for evaluation, all of which is done over phone or internet. The physician can monitor heart rate, rhythm changes, or see if their ICD has implemented a shock. The physician can then change settings on their pacemaker or ICD from a computer that will better help the patient’s cardiac arrhyhmias. Medications can also be prescribed or changed based the transmitted data. This is a major benefit for patients who live far from their physician’s hospital or office.

I get excited to think how modern medicine will continue to grow and how it will continue to benefit disadvantaged patients.


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