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Cardiac chest pain nursing management

Kannikar Wechkunanukul, Hugh Grantham, Raechel Damarell, Robyn A Clark
BACKGROUND: Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies...
July 2016: JBI Database of Systematic Reviews and Implementation Reports
Ayan Sen, Joel S Larson, Kianoush B Kashani, Stacy L Libricz, Bhavesh M Patel, Pramod K Guru, Cory M Alwardt, Octavio Pajaro, J Christopher Farmer
Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment...
June 25, 2016: Critical Care: the Official Journal of the Critical Care Forum
J B Chambers, E M Marks, V Russell, M S Hunter
BACKGROUND: Non-cardiac chest pain (NCCP) affects up to 80% of patients attending chest pain clinics, but its treatment is suboptimal. AIM: To describe the outcomes of a pilot, stepped care, biopsychosocial management programme in terms of improvements in chest pain, psychosocial scores and use of healthcare resources. METHODS: Of 198 referrals, 77 patients were suitable for the clinic and received a one hour biopsychosocial assessment. Stepped care consisted of assessment only, low intensity Cognitive Behaviour Therapy (CBT), or high intensity CBT...
September 2015: International Journal of Clinical Practice
Stephanie Harper, Sen Devadathan
BACKGROUND: NICE clinical guideline (CG 95) recommended risk stratification and management of patients presenting with chest pain of recent originusing a new protocol driven pathway. There has been variable adoption of the NICE guidance on chest pain of recent origin (CG 95) across the country and this has not been implemented in Cornwall, mainly because of the concerns regarding the increased demand for non invasive investigations and its cost implications. Patients referred with chest pain of recent onset are clinically evaluated in the specialist nurse lead rapid access chest pain clinics (RACPC)...
June 2014: Heart: Official Journal of the British Cardiac Society
Jessica Heardman
Paramedics' abilities to carry out quick, accurate and prioritised assessments of patients complaining of chest pain are paramount to ensure good outcomes and prognoses. They also require sound knowledge of underlying pathophysiology, clinical evidence and protocols. This article aims to increase emergency nurses' awareness of the scope of paramedic practice in the UK by analysing the pre-hospital management of a patient diagnosed with myocardial infarction.
March 2014: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Chris Ellis, Greg Gamble, Gerard Devlin, John Elliott, Andrew Hamer, Michael Williams, Philip Matsis, Richard Troughton, Isuru Ranasinghe, John French, David Brieger, Derek Chew, Harvey White
AIMS: To audit all patients admitted to a New Zealand (NZ) Hospital with a suspected or definite acute coronary syndrome (ACS) over a 14-day period, to assess their presentation type and management in hospital and at discharge, with emphasis on time delays for invasive management and revascularisation treatments. METHODS: We updated the established NZ ACS Audit group of 39 hospitals admitting ACS patients across NZ, and enrolled NZ patients in conjunction with the bi-National Australia and NZ ACS 'SNAPSHOT' audit...
2013: New Zealand Medical Journal
Praba Rabasse, Collette Johnson, Nadim Malik
In 2000 the National Service Framework for Coronary Artery Disease (CAD) prompted the development of rapid-access chest pain clinics (RACPCs). The aim of such clinics is to provide prompt assessment of chest pain to identify CAD with the use of an exercise tolerance test. In 2010, the National Institute for Health and Clinical Excellence (NICE) guidelines recommended using imaging studies based on CAD risk scoring and not an exercise tolerance test to exclude angina in patients with no previous history of known CAD...
May 9, 2013: British Journal of Nursing: BJN
Jaimi H Greenslade, Louise Cullen, Lauren Kalinowski, William Parsonage, Suetonia Palmer, Sally Aldous, Mark Richards, Kevin Chu, Anthony F T Brown, Richard Troughton, Chris Pemberton, Martin Than
STUDY OBJECTIVE: This study seeks to examine whether the finding of an abnormal estimated glomerular filtration rate (eGFR) in the emergency department (ED) was associated with acute coronary syndrome in the population of patients presenting for investigation of chest pain. METHODS: We used prospectively collected data on adult patients presenting with suspected acute coronary syndrome to 2 EDs in Australia and New Zealand. Trained research nurses collected clinical data with a customized case report form...
July 2013: Annals of Emergency Medicine
Jennie Craske, Fran Dooley, Linda Griffiths, Liz McArthur, Elvina White, Mary Cunliffe
Removal of chest drains is a painful procedure and distresses patients, parents and nurses. To identify problems and improve management we developed a concerted approach to both assessment and treatment using audit. An initial prospective audit of post-op cardiac children undergoing chest drain +/- pacing wire removal was undertaken. A clinical tool was developed, to assess children before procedures and provide a treatment plan aimed at reducing pain and distress. The tool incorporated the intensity of the procedure, the child's usual response to procedures and previous experience...
June 2013: Journal of Child Health Care: for Professionals Working with Children in the Hospital and Community
Kathleen T Hickey, James Reiffel, Robert R Sciacca, William Whang, Angelo Biviano, Maurita Baumeister, Carmen Castillo, Jyothi Talathothi, Hasan Garan
AIMS AND OBJECTIVES: To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. BACKGROUND: While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. DESIGN: Prospective, cross-sectional single-centre study. METHODS: A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States...
February 2013: Journal of Clinical Nursing
Siba Prosad Paul, Sarah Blaikley, Camilla Peevers, Lin Fitz-John
This article describes the management in emergency departments of supraventricular tachycardia (SVT) in children. Of all forms of symptomatic arrhythmia in infants, children and adolescents, SVT is the most common. Its clinical presentation varies with the child's age, and it can be difficult to diagnose in infants and young children. It is important that the nurses in the emergency department consider a diagnosis of SVT in young children with histories of poor feeding, lethargy, irritability, excessive sweating or pallor (Zeigler 1994) and in older children with histories of palpitations, dizziness, chest pain, syncope or shortness of breath (Uzun 2010)...
October 2012: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Caroline Patterson, Leoni Bryan, Mark Duncan, Julian Collinson, Simon Padley
BACKGROUND: Cardiac computed tomography (CCT) is a non-invasive imaging technique for the diagnosis of coronary artery disease (CAD). The National Institute for Health and Clinical Excellence (NICE) recommend CCT for selected patients in the assessment of chest pain of recent onset. AIMS: To assess the feasibility and utility of CCT in a nurse-led, protocol-based assessment of chest pain. METHODS: Patients admitted over 4 months with suspected angina were assessed for eligibility for CCT by a specialist nurse...
February 2013: European Journal of Cardiovascular Nursing
Ezra A Amsterdam, J Douglas Kirk, David A Bluemke, Deborah Diercks, Michael E Farkouh, J Lee Garvey, Michael C Kontos, James McCord, Todd D Miller, Anthony Morise, L Kristin Newby, Frederick L Ruberg, Kristine Anne Scordo, Paul D Thompson
The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective...
October 26, 2010: Circulation
Tammy J Bungard, Marcie J Smigorowsky, Lucille D Lalonde, Terry Hogan, Katharine M Doliszny, Ghimay Gebreyesus, Sipi Garg, Stephen L Archer
BACKGROUND: Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-ofentry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists)...
December 2009: Canadian Journal of Cardiology
S Y Liaw, F G Chen, P Klainin, J Brammer, A O'Brien, D D Samarasekera
This study aimed to evaluate the integration of a simulation based learning activity on nursing students' clinical crisis management performance in a problem-based learning (PBL) curriculum. It was hypothesized that the clinical performance of first year nursing students who participated in a simulated learning activity during the PBL session would be superior to those who completed the conventional problem-based session. The students were allocated into either simulation with problem-based discussion (SPBD) or problem-based discussion (PBD) for scenarios on respiratory and cardiac distress...
August 2010: Advances in Health Sciences Education: Theory and Practice
Shanaz Shalli, Diyar Saeed, Kiyotaka Fukamachi, A Marc Gillinov, William E Cohn, Louis P Perrault, Edward M Boyle
BACKGROUND: Blood accumulating inside chest cavities can lead to serious complications if it is not drained properly. Because life-threatening conditions can result from chest tube occlusion after thoracic surgery, large-bore tubes are generally employed to optimize patency. AIMS: The aim of this study was to better define problems with current paradigms for chest drainage. MATERIALS AND METHODS: A survey was conducted of North American cardiothoracic surgeons and specialty cardiac surgery nurses...
September 2009: Journal of Cardiac Surgery
John W Albarran
Within cardiac practice, one area that has seen much development involves the nurse assessing, diagnosing, and prescribing thrombolytic therapy for patients with a myocardial infarction. Alongside this, a variety of titles aimed at defining these new roles have emerged, but instead of clarifying the situation they have created more confusion about the actual characteristics and functions of nurses engaged in these innovative posts. In addition advice regarding the nature of preparation and training required to ensure the competency of nurses for these specific roles has been sparse and inconspicuous...
March 2004: Nurse Education in Practice
Marit Leegaard, May Solveig Fagermoen
AIM AND OBJECTIVES: To provide new insights into the postoperative pain experiences of women after coming home following cardiac surgery. BACKGROUND: Studies show that many patients experience postoperative wound discomfort after cardiac surgery and women experience more pain than men before discharge. Male experiences have shaped the accepted biomedical theories on how cardiac surgery influences the lives of women. This has led to more cardiac studies with only female respondents in the past 10 years, but few focus on pain and pain management after early discharge...
August 2008: Journal of Clinical Nursing
Angelo B Biviano, Steven R Bergmann, Joseph Tenenbaum, Jennifer Sullivan, Eileen Hurley, James Giglio, Leroy E Rabbani
We describe the development and institution of an initiative based on a clinical diagnostic algorithm and treatment pathways, facilitated by cardiac nurse practitioners, for the treatment of the diverse group of patients with chest pain who seek treatment at our urban-based institution. We believe that our chest pain initiative incorporates previous strategies of rapid emergency department management with inpatient-based care while providing a framework for outpatient follow-up and secondary prevention. These strategies allow our hospital to meet its goals of providing chest pain patients with standardized, high-quality, and expeditious care, given the challenges faced by an academic urban hospital...
June 2003: Critical Pathways in Cardiology
Stephen A Stowers
BACKGROUND: The prolonged length of stay for patients who seek treatment in the emergency department with chest pain and normal or nondiagnostic electrocardiogram has led to a backlog of patients in the emergency department and the telemetry unit. Correct early management requires risk stratification processes that can effectively separate the majority of these patients into low-risk, low/intermediate-risk, intermediate-risk, and high-risk subsets. METHODS AND RESULTS: Patients who seek treatment in the emergency department with chest pain are risk-stratified into low-risk, low/intermediate-risk, and high-risk categories using a Risk Score to determine who would benefit from immediate exercise stress testing...
June 2003: Critical Pathways in Cardiology
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