Journal: The Journal of cardiovascular nursing
Systemic lupus erythematosus (SLE) is associated with increased risk of cardiovascular disease because of the premature development of atherosclerotic plaques. It is a complex autoimmune disorder characterized by the production of autoantibodies against self-antigens. These self-antigens include nucleic acids, blood cells, coagulation proteins, and phospholipids that cause disease manifestations in virtually every organ system. Over the last 3 decades, treatment modalities and preventive therapies for SLE patients have substantially improved, producing decreases in mortality from the disease. However, as life expectancy among SLE patients has increased, the incidence of cardiovascular disease has increased as well. Multiple studies suggest that patients with SLE have between a 9-fold and 50-fold increase in risk of developing cardiovascular disease compared with non-SLE patients. It is thought that these increases result from a combination of traditional risk factors, as well as the dysfunctional immune and inflammatory mechanisms in patients with SLE. At this time, there is limited evidence to support specific treatment guidelines for the prevention of cardiovascular disease in SLE patients. The treatment of these patients currently remains to identify and treat the traditional and SLE-related risk factors.
BACKGROUND:: Nurses lack a standard tool to stratify the risk of chest pain in triage patients. The type of risk stratification may correspond to the type of acuity rating of the 5-level triage scale adopted by nurses for chest pain triage, based on the Front Door Score, simplified from the Thrombolysis in Myocardial Infarction Risk Score for unstable angina or non-ST-segment elevation myocardial infarction. AIM:: This study aimed to evaluate the ability of using the Front Door Score to enhance the accuracy of emergency nurse triage decisions for patients who present with chest pain. DESIGN:: A cross-sectional descriptive design was used. METHODS:: A convenience sample of 200 subjects was obtained from an emergency department in Hong Kong. Data were collected via a questionnaire. The final physician diagnoses were used as the gold standard in justifying the appropriateness of the risk stratification of chest pain. The agreement rates among the final physician diagnoses, Thrombolysis in Myocardial Infarction Risk Score for unstable angina or non-ST-segment elevation myocardial infarction, nurses using the triage scale, and nurses using the Front Door Score were computed using κ statistics. RESULTS:: A significant substantial agreement was observed between the final physician diagnoses and nurses using the Front Door Score. In comparison, the agreement between the final physician diagnoses and nurses using the triage scale was poor. CONCLUSION:: The chest pain triage reliability of nurses using the Front Door Score was found to be much more credible than that of nurses using the triage scale. A suggested conversion of the scales of Front Door Score was established. CLINICAL IMPLICATIONS:: The Front Door Score should be considered as a standard tool to enhance the chest pain triage accuracy of emergency nurse triage decisions.
BACKGROUND:: Individuals with heart failure are frequently rehospitalized owing to a lack of knowledge concerning how to perform their self-care and when to inform their healthcare provider of worsening symptoms. Because there are an overwhelming number of hospital readmissions for individuals with heart failure, efforts are underway to discover how they can be supported and educated during their hospitalization and subsequently followed by a nurse after discharge for continued education and support. PURPOSE:: The purpose of this integrative review was to critically examine the interventions, quality of life, and readmission rates of individuals with heart failure who are enrolled in a transitional care program. The second aim was to examine the cost-effectiveness of nurse-led transitional care programs. CONCLUSIONS:: The results of this integrative review (n = 20) showed that transitional care programs for individuals with heart failure can increase a patient’s quality of life and decrease the number of readmissions and the overall cost of care. The types of interventions that were most successful in decreasing readmissions used home visits alone or in combination with telephone calls. There is a need for nurse researchers to address gaps in transitional care for heart failure patients by performing studies with larger randomized clinical trials and measuring outcomes such as readmissions at regular intervals over the study period. CLINICAL IMPLICATIONS:: The Patient Protection and Affordable Care Act will change reimbursement for heart failure readmissions and presents opportunities for healthcare teams to build transitional care programs for patients with conditions such as heart failure. This integrative review can be used to determine effective intervention strategies for transitional care programs and highlights the gaps in research. Healthcare teams that use these programs within their practice may increase continuity of care and quality of life and decrease readmissions and healthcare costs for individuals with heart failure.
Aortic stenosis is the most common valve disease in Western countries, and its prevalence is increasing because of the aging population. Some patients, denied surgery because of high risk, can be offered transcatheter aortic valve implantation (TAVI). These patients are old and have comorbidities, and it is not always easy for them to make the decision about accepting TAVI.
Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure.
A rare, yet serious, complication of mechanical heart valves is symptomatic obstructive prosthetic valve thrombosis. The risk of valve thrombosis is magnified in patients who are nonadherent to prescribed anticoagulation. In this case report, we describe a 48-year-old male patient with a history of mechanical aortic valve replacement surgery, who stopped taking prescribed warfarin therapy 2 years before presentation and subsequently developed acute decompensated heart failure secondary to valvular dysfunction. Low-dose alteplase therapy was administered successfully with no bleeding complications and a complete return of valvular function.
Depressive symptoms are common in stroke survivors and their family caregivers. Given the interdependent relationship between the members of dyads in poststroke management, improving depressive symptoms in dyads may depend on their partner’s characteristics. Self-esteem, optimism, and perceived control, all known to be associated with depressive symptoms in an individual, may also contribute to their partner’s depressive symptoms.
Acute stroke care includes cardiac rhythm monitoring in the first 24 hours. The method of monitoring varies, as do the reported findings. The nurses' role in this process can be intensive, including primary response and review of all data. Competency is critical as the acute stroke setting can be associated with life-threatening dysrhythmias as well as the detection of atrial fibrillation that affects therapy. Limited studies exist to evaluate the effectiveness of a unit-based cardiac monitoring system for which the bedside nurse has primary responsibility.
General medical-surgical units struggle with how best to use cardiac monitor alarms to alert nursing staff to important abnormal heart rates (HRs) and rhythms while limiting inappropriate and unnecessary alarms that may undermine both patient safety and quality of care. When alarms are more often false than true, the nursing staff’s sense of urgency in responding to alarms is diminished. In this syndrome of “clinical alarm fatigue,” the simple burden of alarms desensitizes caregivers to alarms. Noise levels associated with frequent alarms may also heighten patient anxiety and disrupt their perception of a healing environment. Alarm fatigue experienced by nurses and patients is a significant problem and innovative solutions are needed.
Functional health literacy (FHL) has become an increasingly prevalent topic of discussion in patient health and well-being. Although FHL has been studied in a variety of populations, it has not been investigated in patients with pacemakers and implantable cardioverter defibrillators (ICDs).The purpose of this study was to evaluate FHL in a primarily older, urban-dwelling ICD/pacemaker population. A secondary objective was to compare 2 commonly used instruments for assessing FHL.A convenience sample of 116 patients was recruited from an urban ICD/pacemaker clinic. Participants were asked to complete the Short Test of Functional Health Literacy in Adults (STOFHLA) followed by the Test of Functional Health Literacy in Adults to assess reading comprehension and numeracy. Logistic regression was used to assess the association between FHL and patient descriptors.The population was 68 ± 13 years of age, and 62.7% were men. The sample was ethnically diverse: 37.1% white, 39.7% Hispanic, and 22.4% African American; 77.4% of the population reported finishing high school. Of the 109 completing the Test of Functional Health Literacy in Adults, 60.6% had adequate FHL, 10.1% had marginal FHL, and 29.4% had inadequate FHL. The presence of coexisting chronic conditions such as diabetes mellitus, hyperlipidemia, and hypertension was associated with inadequate/marginal FHL (P = .007, P = .004, and P = .02, respectively). Of the 113 completing STOFHLA, 67.3% had adequate FHL, 7.1% had marginal FHL, and 25.7% had inadequate FHL. The presence of diabetes mellitus, hyperlipidemia, and hypertension was also associated with inadequate/marginal FHL as assessed by STOFHLA (P = .009, P = .02, and P = .004, respectively).In this older, urban, ICD/pacemaker population, approximately 40% had inadequate/marginal FHL. These results warrant further investigation of FHL in other cardiovascular populations.