Nov 21, 2018 in Medicine

Impact of the Phenomena on Health Care Delivery

Asystole is a life-threatening condition that can cause death easily. It is characterized by absence of cardiac electrical activity. There is no heartbeat hence it compromises perfusion of the peripheral tissues. The most delicate tissue, the brain, can be deprived of oxygen for four minutes before it starts to die off.thus making Asystole treatment an emergency. When observing the electrocardiogram, there is no ventricular depolarization, which is essential for cardiac output. Electrical activity of the heart emanates at the sinoatrial node and then through the electrical channels moves to the Purkinje fibers.

Asystole can be classified as either primary or secondary depending on the cause of electrical inactivity of heart muscles. Primary asystole is caused by intrinsic factors of the heart that may include degeneration, for example, sclerosis of pacemakers. The pacemakers that can be affected are either the sinoatrial node or the atrioventricular node. The effect of asystole on the heart is the bradycardia accompanied with dysrhythmias that are caused by the sinus node’s block areas or complete heart block.

Secondary asystole occurs when causative factors for poor electrical activities of the heart do not originate from the cardiac electrical activity system. The main effect of the asystolic heart is poor perfusion of body tissues. Some of the body tissues are delicate and cannot sustain oxygen deficiency for long. For example, the brain can only survive four minutes of oxygen deficiency before it dies off. The fatality of the condition has led to revamped medical care of patients suffering from this problem. Patients always need continuous monitoring of their heart activities by use of monitors. Further in case of inactive pacemakers, there are artificial pacemakers developed, so that they can aid in the initial generation of the impulses.

Impact of the Phenomena on Nursing Care

Sudden loss of heart’s electrical activity needs prompt management by health care providers. It involves the whole team of health care providers for the fact that it is delicate to handle. Health care education curriculum has provided training on the basic life support so as to enable each health care provider to have knowledge on how to go about the care of patients in this condition. With the advent of critical care by nursing, there has been a tremendous training and study of heart activities in order to facilitate an adequate care. Therefore, nurses in their undergraduate training have the incorporation of critical care that extensively covers patients with cardiac arrests.

During the care of the patients with asystole, the primary care involves basic cardiopulmonary resuscitation and defibrillation as the drugs come in later. Therefore, the disease has led to the development of nurses in terms of prioritizing their actions. It clearly shows how important it is to prioritize actions in order to save patients’ lives. By the fact that nurses have to give close monitoring of the patients, there is the increased responsibility of the nurses in the care of the patients. It has increased the seriousness, with which nurses need to care for the patients, since mismanagement of systolic patients is as good as compromising their lives.

There are frequent developments in the care of patients with these conditions with better technology and drugs developed each day. With that in mind, nurses have been motivated to keep gaining knowledge on new inventions and the modality of care. It has instilled the need to gather more knowledge for better patient care among nurses in critical care units.

 
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Asystole and Pulseless Electrical Activity

Cardiovascular 7: Asystole Treatment Portal

The prognosis of patients with Asystole is, usually, poor with the only remedy being identification of the cause that is reversible. Asystole is, usually, a consequence of a terminal condition. The five Hs and Ts forms part of the causative agents of Asystole. Therefore, the treatment modality bases on reversing the identified cause.

Hs

  • Hypoxia
  • Hypovolemia Hydrogen ion (acidosis)
  • Hypo/Hyperthermia
  • Hypo/Hyperkalemia

Ts

  • Tablets/Toxins
  • Tamponade
  • Tension pneumothorax
  • Thrombosis, Coronary (ACS)
  • Thrombosis, Pulmonary (embolism)

In the case of severe hypoxia, the treatment of choice is the provision of appropriate management of the airway. It includes the insertion of the endotracheal tube and ventilation so as to aid in the oxygenation. Hyperkalemia is detrimental to the heart muscles. Its treatment needs adequate and timely administration of regular insulin and dextrose, calcium chloride, sodium bicarbonate and Lasix. All the modalities are aimed at lowering the level of potassium in the blood. For instance, insulin, pushes the potassium ions to the intracellular, it has to be given together with dextrose so as to prevent the patient from developing hypoglycemia. In case the level of hyperkalemia persisted to be high, the patient is then put on a dialysis machine so as to wash away the excess potassium. In the case of hypokalemia, intravenous potassium is administered.

In the case of preexisting acidosis, treatment is aimed at maximizing oxygen and ventilation. Correcting the underlying problem. In the case of low pH, sodium bicarbonate is administered. In the case of hypothermia, the patient is rearmed with prolonged.

Acute Care 14: Asystole Algorithm

Adult and Pediatric

In the first instance, the patient is assessed for breathing or responsiveness. Thereafter, the emergency response system should be activated. And lastly get a monitor / defibrillator or automated external defibrillators.

asystole

Then after that a pulse should be checked. The check time should be less than 10 second. In an instance of loss of pulse, begin Cardiopulmonary resuscitation immediately.

asystole

In place of a pulse, the next step is identification of Asystole in a number of leads. In such a case, the priority is to look for evidence to avoid resuscitation. The main evidence being obvious death signs or Do not resuscitate order.

asystole

Epinephrine 0.01 mg/k for pediatrics intravenously. For adults, double ode may be given eternally.

PEDS: 0.1 mg/kg ET using 1:1000 preparation).

Repeat every 3 to 5 minutes.

(40 units IV push) for the second or even the first dose of epinephrine.

asystole

Secure and confirm airway with an advanced airway. After that an effective ventilation and oxygenation. Then administer appropriate drugs for the condition and rhythm. Lastly, treat reversible causes.

In case of persistent Asystole, stop resuscitation.

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Supra-Ventricular Tachycardia Stable and Unstable

The condition is rapid heart rhythm that originates above the atrioventricular node. It can be differentiated from dangerous arrhythmias that arise from the ventricular tissues. The patients with this condition feel like their heart beats up to two hundred times in a minute and then goes back to normal. The supraventricular tachycardia is not as much life-threatening, but rather uncomfortable. However, it can be life-threatening in patients with myocardial ischemia. The incidents are treated as they occur with minimal interval treatment as prophylaxis to recurrence. Depending on the cause, there are different modalities involved. For instance, if atrioventricular node (AV) is involved there, I need to deal with it by blocking it. There are a number of ways in which it can be done and they include physical maneuvers and atrial fibrillation.

Physical Maneuvers

A number of maneuvers raise the AV node resistance in conveying the impulses. The maneuvers stimulate the parasympathetic nervous system. The transmission to the heart is performed via the vagus nerve. Hence, vague maneuvers are the name that is given to the manipulations. The cassava maneuver, which works towards the increase of intrathoracic pressure should be the first one to be done. It affects baroreceptors on the aorta hence initiating the reflex for decreased heart rate from the nervous system. On the other hand, the patient can lie while raising his legs vertically against the wall. By so doing, the episode may be terminated with the reduced breath rate. Also, the use of alcohol, coffee, and tobacco should be reduced to ensure proper healing.

Medication is not widely used. But in cases where it necessitates, the atrioventricular node blocking agents should be used. The most commonly used short-acting atrioventricular node locking agent is adenosine. It only comes in with the failure of vagus nerve. Then after that there should be a follow-up therapy with diltiazem, metoprolol, or verapamil involved. Adenosine is safely used during pregnancy, while amiodarone and sotalol can be used in patients where atrioventricular node is not involved. Lastly, synchronized electoral conversion works as the latest and last result mode of treatment. It comes in after other methods of treatment have failed utterly. The modalities of treatment have been evolving over time for the past number of decades now with an accelerated growth experienced in the past decade.

Atrial Fibrillation: Stable Versus Unstable

This is characterized by the lack of the P-wave or an unequal pulse. The key objective of management is to prevent the circulatory unsteadiness and stroke. There is a rhythm and rate control to avert circulatory volatility and the use of anticoagulants in an effort to prevent a stroke. The anticoagulation is achieved by the use of myriads of drugs. However, there should be only the use of one drug on one patient. Some of the drugs utilized in the care of patients include warfarin, heparin, and rivaroxaban. Aspirin, on the other hand, reduces the risk of stroke, even though it is quite inferior compared to warfarin.

The two methods of atrial fibrillation control that include rate control and rhythm control both have similar outcomes. The rate control lowers the heart rate to the normal acceptable rate of 60 to 100 beats per minute without interfering with the rhythm. While the rhythm control is restoration of normal heart rhythm in a process called cardio conversion. The use of medication is important in achieving of rate control. The drugs used to do this include the beta blockers, calcium channel blockers, and cardiac glycosides. In addition, amiodarone has a significant effect with intravenous administration.

Polk’s Theory of Resilience in Support BSN Student Achievement?

Resilience is the act of enduring and going through stressful environment favorable. Polk managed to synthesize four patterns of resilience. He did so from a single resilience literature. In his theory he stated that people could gain resilience in either dispositional pattern. These are achieved by the people having a sense of self-worth, autonomy, self-reliance, and lastly, good health and physical appearance. The BSN students in their training and clinical rotations go through a myriad of stressful environments as they try to get rich over their services. To ensure these stressful instances, they need to have several factors that will aid in alleviation. According to Polk’s theory, self-worth and self-reliance in provision of care have seen many students recollect themselves despite the experiences they go through.

Secondly, in essence of evading stress or triumphing stressful occasions, according to Polk’s Theory, is the relationship that the student nurses have with others. The roles they play in the relationship range depending on the state of the relationship. For instance, when handling patients who have developed a close relationship with each other, will ensure a fruitful outcome without any stress. Students, as they interact with these helpless patients, should develop that intimate relationship and the desire to help the desperate patients. Hence, the desire to help goes on to empower the students as they go through the training. Further, there is a situational pattern that involves the link of students with stressful situations. The link may come into being for the fact that these people have the expertise and ability to solve some particular problems.

Finally, the most basic and prevailing tool for making sure that stress is clarified in the philosophical prototype, is that the students should be in a position to employ the thoughts like that of illustrating a constructive sense out of experience, the thought that there is a self-development in anything we do at any time, and finally the thought that life is determined. We undertake the duties that we ought to, and that is the reason for our existence.

What May Need to Be Investigated in the Present or Future

The condition is a life-threatening one when it ensures with that in mind it has always attracted much more attention in a bid to deter eventuality from taking place. However, despite the nature of the condition, its delicate nature and complexity, there is a lot of knowledge available on the phenomena. The major causes of the phenomena have been established, and they continue guiding the modalities of care in those patients. There has been shown an increased desire to develop more knowledge on the same at the same time providing that care that the patients desperately need at that moment of time.

The treatment modalities have been improved over time so as to provide the best care to the patients who are at the verge of losing their lives. The treatment measures have always upheld the life of an individual. Each decision made on the care modalities has been developed so as to ensure that maximum care of the patient is achieved.

The nursing profession has not been left behind in the care of these patients. In the training, the modalities of care have been incorporated with the encouragement of continuous reading. The essence of continuous reading is to keep abreast with the modalities of care and conform to the most appropriate care. However, there is a minimal consideration of emotional turmoil of health care providers. The patients need psychological care after the ordeal by heart problem treatments. It is assumed that most of the patients receive counseling and guidance from the nurses after recovery. However, in order to ensure that each patient has the right to that kind of care it should be included in the care as mandatory. Therefore, there can be an investigation on the level of psychological care and psychological outcome of patients recovering from this life-threatening condition.

A Potential Performance Improvement Concern

Lastly, from the study conducted above and through review of the secondary data available, there is a decreased psychological care among the patients recovering from the disease. Despite the dismal rate of recovery and poor prognosis, the patients should undergo a special mandatory guidance and counseling so as to alleviate anxiety about peace of mind. Patients in the advanced stage of the condition may not be able to express themselves so as to know what they are going through. Because of that, most of the patients are left on their own going through the turmoil.

Therefore, there should be an improved performance in psychological care of people that involves their families and friends. To ascertain the need for these very special services, a study can be conducted to determine psychological outcome of the patients recovering from asystole on pulseless electrical activity.

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