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N049 Drug Infusion Studies for Diagnosis of Inherited Arrhythmic Syndromes: Nursing Protocol Development and Case Study
S435
CCCN Abstracts
such seemingly pointless care can lead to burnout and negative effect on the healthcare system (Meltzer, & Huckabay, 2004). The healthcare team needs to communicate openly and effectively with patients and their families regarding prognosis and transition from active intensive care to end-of-life care. An interprofessional team approach should include the patients (if they are able to) and their families as partners in care. The purpose of this presentation is to examine current EOL decision-making practices in the CICU of a large, academic teaching center and the emotional trauma nurses suffer because of providing EOL care to patients. The expectation is this paper will create awareness of the emotional trauma to nurses when providing such seemingly pointless care, the need to provide support for CICU nurses, promote practice changes, and encourage interprofessional team collaboration in making endof-life decisions. Ethical principles should be the underpinning foundation to guide the decisions and patients be allowed to die with dignity, as the line is clearly drawn in end-of-life care (Meltzer, & Huckabay, 2004). Meltzer, L., & Huckabay, L. (2004). Critical care nurses’ perceptions of futile care and its effect on burnout. American Journal of Critical Care, 13 (3), 202-208.
N048 GASTROINTESTINAL HEMORRHAGE IN CARDIOVASCULAR SURGERY PATIENTS: PATIENTS AT RISK F Krawiec, B Kent, L Poirier, A Maitland, K Then, P Faris, N Gwadry, Z Zjalic Foothills Medical Centre, Calgary, AB
Gastrointestinal hemorrhage following Cardiovascular Surgery is rare (0.2 to 5%) but carries a high risk of morbidity and mortality, prolonged length of stay and increased health care costs. GI bleeds (GIBs) represent approximately one third of all Gastrointestinal complications (GICs). Patients following cardiac surgery are particularly vulnerable to GI complications and in particular GIBs because of the potential risk of hypoperfusion causing splanchnic/mesenteric ischemia during cardiopulmonary bypass, and use of anticoagulation, antithrombotic, or non-steroidal anti-inflammatory agents during the pre and post operative period. Factors contributing to gibs include: older age, higher NYHA score, congestive heart failure, renal insufficiency, peripheral vascular disease, and atrial fibrillation. To date, few recent comprehensive Canadian studies have been done to examine GI bleeds post cardiovascular surgery. A comprehensive retrospective review of 9221 post operative cardiac surgery patients during the period of January 2002 to January 2012 has been undertaken in an effort to identify risk factors specific to significant GI hemorrhage. Early results show an overall incidence of GI complications of 5% and GI bleed incidence of 2.6%. Risk factors for GI bleeds include ASA Class IV symptoms, use of IABP, specific vasoactive inotropes, and intraoperative use of transesophageal echocardiograms. This presentation will review the results of this retrospective GI
bleed study, subgroups most at risk and implications for nursing practice. Further discussion will focus on risk assessments, preventative and protective treatment and evidence based practices for nursing care. Early nursing assessment and identification of GIB cues will lead to timely intervention and management strategies.
N049 DRUG INFUSION STUDIES FOR DIAGNOSIS OF INHERITED ARRHYTHMIC SYNDROMES: NURSING PROTOCOL DEVELOPMENT AND CASE STUDY G Inglis, L Brooks, M Nelson, K Charron The University of Ottawa Heart Institute, Ottawa, ON
Sudden cardiac arrest most commonly occurs in people who have underlying structural cardiac disease such as coronary artery disease or abnormal left ventricular function. There is, however, a small population with healthy hearts who have unexplained cardiac arrests. The advancement of the study of cardiac ion channel abnormalities has lead to the discovery of several electrical syndromes that may cause sudden death. Testing is also being done to identify variations in genes that may cause these electrical arrhythmias. Long QT Syndrome (LQTS), Brugada’s Syndrome, and Catecholamine Sensitive Polymorphic Ventricular Tachycardia (CPVT), have given a diagnosis to many unexplained cardiac arrest victims. In an ambulatory cardiac day unit, the medications Adrenalin and Procainamide are administered to elicit 12 lead ECG abnormalities that are markers for these inherited arrhythmic syndromes. It was recognized that protocols and education were necessary to implement safe and informed nursing practices. Brugada’s Syndrome, CPVT, the drug infusions, and the ECG changes that are potentially provoked by these medications will be described. This presentation will review the development and implementation of the protocol, the education delivered, and the collaboration required of the multidisciplinary team. A case presentation of a patient diagnosed with Brugada Syndrome will highlight the interesting facets of diagnosing this particular genetic syndrome.
N050 CARDIOVASCULAR MEDICATION COMPLIANCE AMONG THE SOUTH ASIAN POPULATION: LITERATURE REVIEW T Ens, K King-Shier, C Seneviratne, T Green, C Jones University of Calgary, Faculty of Nursing, Calgary, AB
This narrative review examines the current state of knowledge regarding compliance with cardiac medication among South Asian cardiac patients. South Asians experience higher rates of cardiovascular disease than any other ethnic group. Medication is a first line treatment to limit morbidity and mortality. Thus medication compliance becomes an important issue. There is
CCCN Abstracts
such seemingly pointless care can lead to burnout and negative effect on the healthcare system (Meltzer, & Huckabay, 2004). The healthcare team needs to communicate openly and effectively with patients and their families regarding prognosis and transition from active intensive care to end-of-life care. An interprofessional team approach should include the patients (if they are able to) and their families as partners in care. The purpose of this presentation is to examine current EOL decision-making practices in the CICU of a large, academic teaching center and the emotional trauma nurses suffer because of providing EOL care to patients. The expectation is this paper will create awareness of the emotional trauma to nurses when providing such seemingly pointless care, the need to provide support for CICU nurses, promote practice changes, and encourage interprofessional team collaboration in making endof-life decisions. Ethical principles should be the underpinning foundation to guide the decisions and patients be allowed to die with dignity, as the line is clearly drawn in end-of-life care (Meltzer, & Huckabay, 2004). Meltzer, L., & Huckabay, L. (2004). Critical care nurses’ perceptions of futile care and its effect on burnout. American Journal of Critical Care, 13 (3), 202-208.
N048 GASTROINTESTINAL HEMORRHAGE IN CARDIOVASCULAR SURGERY PATIENTS: PATIENTS AT RISK F Krawiec, B Kent, L Poirier, A Maitland, K Then, P Faris, N Gwadry, Z Zjalic Foothills Medical Centre, Calgary, AB
Gastrointestinal hemorrhage following Cardiovascular Surgery is rare (0.2 to 5%) but carries a high risk of morbidity and mortality, prolonged length of stay and increased health care costs. GI bleeds (GIBs) represent approximately one third of all Gastrointestinal complications (GICs). Patients following cardiac surgery are particularly vulnerable to GI complications and in particular GIBs because of the potential risk of hypoperfusion causing splanchnic/mesenteric ischemia during cardiopulmonary bypass, and use of anticoagulation, antithrombotic, or non-steroidal anti-inflammatory agents during the pre and post operative period. Factors contributing to gibs include: older age, higher NYHA score, congestive heart failure, renal insufficiency, peripheral vascular disease, and atrial fibrillation. To date, few recent comprehensive Canadian studies have been done to examine GI bleeds post cardiovascular surgery. A comprehensive retrospective review of 9221 post operative cardiac surgery patients during the period of January 2002 to January 2012 has been undertaken in an effort to identify risk factors specific to significant GI hemorrhage. Early results show an overall incidence of GI complications of 5% and GI bleed incidence of 2.6%. Risk factors for GI bleeds include ASA Class IV symptoms, use of IABP, specific vasoactive inotropes, and intraoperative use of transesophageal echocardiograms. This presentation will review the results of this retrospective GI
bleed study, subgroups most at risk and implications for nursing practice. Further discussion will focus on risk assessments, preventative and protective treatment and evidence based practices for nursing care. Early nursing assessment and identification of GIB cues will lead to timely intervention and management strategies.
N049 DRUG INFUSION STUDIES FOR DIAGNOSIS OF INHERITED ARRHYTHMIC SYNDROMES: NURSING PROTOCOL DEVELOPMENT AND CASE STUDY G Inglis, L Brooks, M Nelson, K Charron The University of Ottawa Heart Institute, Ottawa, ON
Sudden cardiac arrest most commonly occurs in people who have underlying structural cardiac disease such as coronary artery disease or abnormal left ventricular function. There is, however, a small population with healthy hearts who have unexplained cardiac arrests. The advancement of the study of cardiac ion channel abnormalities has lead to the discovery of several electrical syndromes that may cause sudden death. Testing is also being done to identify variations in genes that may cause these electrical arrhythmias. Long QT Syndrome (LQTS), Brugada’s Syndrome, and Catecholamine Sensitive Polymorphic Ventricular Tachycardia (CPVT), have given a diagnosis to many unexplained cardiac arrest victims. In an ambulatory cardiac day unit, the medications Adrenalin and Procainamide are administered to elicit 12 lead ECG abnormalities that are markers for these inherited arrhythmic syndromes. It was recognized that protocols and education were necessary to implement safe and informed nursing practices. Brugada’s Syndrome, CPVT, the drug infusions, and the ECG changes that are potentially provoked by these medications will be described. This presentation will review the development and implementation of the protocol, the education delivered, and the collaboration required of the multidisciplinary team. A case presentation of a patient diagnosed with Brugada Syndrome will highlight the interesting facets of diagnosing this particular genetic syndrome.
N050 CARDIOVASCULAR MEDICATION COMPLIANCE AMONG THE SOUTH ASIAN POPULATION: LITERATURE REVIEW T Ens, K King-Shier, C Seneviratne, T Green, C Jones University of Calgary, Faculty of Nursing, Calgary, AB
This narrative review examines the current state of knowledge regarding compliance with cardiac medication among South Asian cardiac patients. South Asians experience higher rates of cardiovascular disease than any other ethnic group. Medication is a first line treatment to limit morbidity and mortality. Thus medication compliance becomes an important issue. There is