Essay WEEK 3 ASSIGNMENT

M.G., a “frequent fl ier,” is admitted to the emergency department (ED) with a diagnosis of heart failure

Pain occurred at multiple sites in patients with advanced cardiac failure. So, it is required to assess patient’s pain, its location, character, frequency and severity by using scales (Kohan & Hamill-Ruth, 2011). It provides a mean to find out what causing the pain and to monitor progress towards controlling pain (Kohan & Hamill-Ruth, 2011). To reduce the work of heart, it is necessary to administer Vasodilators. It helps blood to flow more easily through the blood vessels (Tiziani & Havard, 2010). Another important consideration is to alleviate abdominal discomfort by proper positioning, change positions every two hours and provide comfortable environment. Again, to check if these interventions are working or not, it is crucial to check vital

1. The pressure announced on last night's television weather broadcast was 29.92. Explain how this was measured and give the units. Would this be considered an unusually large or low pressure value?

The teacher has to be responsible for designing the scheme of work, lesson plans, obtaining up to date qualification handbooks, agree individual learning plans, carrying out risk assessments, write realistic aims.

Offer- This is defined as a clear manifestation of willingness to enter an agreement made by another person with full understanding that their assent to the bargain is an invitation and is concluded.

1) You can call the module several times instead of writing it out each time.

Facilities, performing coronary CTA, should develop and adhere to evidence based coronary CTA protocols for optimal, high quality, cost-effective, patient-centered care. A comprehensive review of the literature was performed using CINAHL, PubMed, MEDLINE, and Medscape search engines, and with the terms ?coronary CTA?, ?protocols?, ?guidelines?, ?radiation?, ?contrast?, ?beta-blockers?, and ?radiology nursing?.

that do not have any statistics available will be eliminated from the study. Statistics will be

It is difficult to draw any conclusions regarding risk factors of inadvertent arterial catheterizations due to the lack of a control group. However, four of eleven (36 %) inadvertent arterial catheterizations were made urgently in patients with major trauma in Study III, whereas only 5 % of venous cannulations in Study IV were carried out in emergent situations, indicating that this truly is a risk factor. As indicated by our results, a diagnosis of inadvertent arterial catheterization is often obvious immediately or during initial clinical use due to local symptoms of bleeding or abnormal back-flow of blood through the catheter. Other clinical bedside signs facilitating this diagnosis – in normovolemic patients without central hypoxaemia – include the spout, at systemic pressure, of bright red and/or well oxygenated (confirmed on blood gas analysis) blood by the catheter (Shah 2004).

May perform sensitivity analysis, in which individual studies are includes or excluded to ensure no particular study drastically affects the results. Will often discuss this in the paper.

These patients can be receiving blood transfusions or can be on cardiac drips with minimal titration. The acuity level of the average patient is relatively high. Taking into consideration the acuity of the patients already assigned to a nurse, if a post op cardiac cath patient is admitted, the potential for error, or missed vitals and site checks, is elevated. In the past 90 days, there have been four post op complications, varying from site bleeding to decreased blood pressure. All incidents required intervention and increased the patient’s length of hospital stay. According to Schuman (2014), high risk, high volume negative patient events often occur as a result of several factors, including workforce shortages and lack of knowledge. Vascular complications expose patients to additional discomfort, extended hospital stay, and higher hospital costs, including additional treatment, such as blood transfusions and vascular surgery (“Strategies to minimize”, 2007).

It is hypothesized that the the GRACE score is accurate in the acute phase and over the longer term assessment for prognostic risk stratification of post-AMI patients. In the research article which was conducted in 2010 (28), 154 patients were studied, 53% female, 46% defined in admission as infarction without ST elevation and the others as unstable angina. The time between the onset of symptoms and initial treatment had a median of 4.6 hours. The median GRACE score was 117 whereas the TIMI score presented a median of 3. 105 patients underwent coronary angiography during hospitalization and 97 of these did so as part of an invasive stratification strategy. The remaining 8 patients underwent coronary angiography after positive scintigraphy for ischemia as part of selective invasive strategy. The GRACE score has shown a greater prognostic value (26,27,28). This study had limitation such as,

There is no detail information on the quality of evidence. therefore there is no information on the design, methodology limitations, appropriateness/relevance of the selected evidence.

Pain assessment with a Visual Analogue Score on first post-operative day after the catheter removal and at the end of fourth week.

The current practice for post op cardiac catheterization (cath), to include percutaneous coronary intervention (PCI) is to provide the initial recovery in the cath lab, then transfer to the floor for the next several hours of monitoring. PCI is the placement of a stent into a narrowed cardiac artery with administration of high dose anticoagulants to maintain patency. Initial recovery consists of the first hour post cath, with vitals and site checks every 15 minutes (“Fort Walton Beach Hospital”, 2014). The current policy states that if the first hour post op is stable, which means minimal changes in vitals and unchanged site checks, then the next several hours of recovery can be provided on the progressive care unit (PCU). According to the policy, after the first hour, vitals and site checks will be completed every 30 minutes times 4, then every hour times 4 (“Fort Walton