- Email: [email protected]
Roles of Nurses in the Care of Acute Heart Failure
S154 Journal of Cardiac Failure Vol. 12 No. 8 Suppl. 2006 Panel Discussion 3
Panel Discussion 3
Clinical Pathway for the Management of Acute Heart Failure; Present and Future TAKASHI HONDA, KOICHI NAKAO, TAEKO MURAMOTO, MIYUKI KUZE, SACHIKO HORIKAWA, KUMIKO HAYASHI, YASUHIRO KAWANAMI Department of Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
Role of a Clinical Engineer in the Treatment of Patients with Acute-cardiac Failure KYOICHI KENMOKU School of Biomedical Engineering, Faculty of Health and Medical Care, Saitama Medical University
In 2005, we admitted 297 emergency cases of acute heart failure in our CCU. Upon their arrival, a team of allied health professionals activate protocols for survival under the medical supervision; they examine vital signs, deliver oxygen, sample blood, establish venous line, place ECG monitor, infusion pumps and introduce mechanical ventilation, IABP, PCPS, or blood purification therapy. In our CCU, physicians and nurses are primarily in charge, assisted by full-time clinical engineers (CE). These patients often require respiratory support and CEs are set values of ventilators and assist physicians during weaning. They also monitor pressure during Swan-Ganz catheterization, set up and service monitors, and manage IABP and blood purification systems. They constantly monitor patient hemodynamics as nurses do. Case management based on clinical pathway is practiced for some time in our center. With acute heart failure, however, due to advanced age and diversity of complications and severity, when mechanical ventilation or IABP is required, the clinical course becomes so diverse and application of clinical pathway is limited to a subset of patients. On the other hand, different subspecialties and consultation services are involved in the care of acute heart failure, at admission, discharge preparation and rehabilitation. That is exactly when a team approach guided by clinical pathway can excel in quality of care by standardizing services and securing patient safety.
Panel Discussion 3 Co-medical Role in the Management of Acute Heart Failure and its Development AKI UEYAMA Nursing Department of Kitasato University Hospital, kanagawa, Japan Patients in the intensive care unit (ICU) always receive treatment and nursing care based on the data obtained from the latest monitoring equipment. Nursing care, at times, requires that rapid and appropriate measures be taken for initial symptoms and abnormalities caused by acute heart failure. Medical equipment is useful to obtain the necessary information from the patient as quickly as possible, however number and type of machines have increased around the patient year by year which have many complicated functions. To interpret the complex monitoring data obtained from the equipment requires that the nursing staff understand the basic information provided. Nursing care in the ICU not only includes interpreting monitoring data and judging what emergency measures should be taken, but also understanding and managing the equipment. Appropriate nursing care using the equipment leads to suitable treatment and the opportunity to reduce the term of hospital admission for the patient. To offer high quality nursing, it is especially important to collaborate with the medical engineer, pharmacist, dietetician, medical doctor and the other co-medical stuff. In this session, we are going to discuss about the future of nursing care in the ICU concerning points of the current monitoring equipment and term of hospital admission by comparing these with those ten years ago.
Panel Discussion 3 Roles of Nurses in the Care of Acute Heart Failure AIKO KITAMURA Department of Nursing, Rinku General Medical Center The incidence of acute heart failure rises with age. Cardiogenic shock, pulmonary edema, and acute exacerbation of chronic heart failure can threaten the lives of patients. Nurses are expected to provide care based on understanding of the conditions underlying acute heart failure. When providing care to such patients, emphasis is laid on circulatory care, respiratory management, regulation of tissue oxygen metabolism, and mental support. Meanwhile, ethical aspects are reviewed and dealt with appropriately by the medical team. Nurses are required to act promptly and work with many other specialists while being aware of the fact that the patient is hovering between life and death. During this session, I will discuss the characteristics of patients and their families, citing cases where a circulatory assist system was used to deal with acute heart failure. Roles of nurses in the care of such patients will be discussed on the basis of my experience with major nursing intervention. I will also refer to the roles of nurses in introducing noninvasive positive pressure ventilation (NPPV) at our facility. (Consent has been obtained from the patients for the use of their data in this presentation for promoting advances in critical nursing care.)
When a patient with acute-cardiac failure shows no sign toward recovery by medical treatment, mechanical circulatory support with IABP, PCPS, or VAS, is needed. The most important role of clinical engineer is maintain these circulatory assist devices always in best condition enable to be available in the suitable timing. The major important points in management of theses devices. 1. Selection of assist device to obtain most effective circulatory support. 2. Initiation of mechanical support before multiple organ failure occurs. 3. If the effect is inadequate, more powerful mechanical assist device is needed. The following items are also important in the management of patients and successful results. 1. Maintenance of systemic circulation 2. Urine output 3. Ventilation 4. Anticoagulant therapy
Panel Discussion 3
Clinical Pathway for the Management of Acute Heart Failure; Present and Future TAKASHI HONDA, KOICHI NAKAO, TAEKO MURAMOTO, MIYUKI KUZE, SACHIKO HORIKAWA, KUMIKO HAYASHI, YASUHIRO KAWANAMI Department of Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
Role of a Clinical Engineer in the Treatment of Patients with Acute-cardiac Failure KYOICHI KENMOKU School of Biomedical Engineering, Faculty of Health and Medical Care, Saitama Medical University
In 2005, we admitted 297 emergency cases of acute heart failure in our CCU. Upon their arrival, a team of allied health professionals activate protocols for survival under the medical supervision; they examine vital signs, deliver oxygen, sample blood, establish venous line, place ECG monitor, infusion pumps and introduce mechanical ventilation, IABP, PCPS, or blood purification therapy. In our CCU, physicians and nurses are primarily in charge, assisted by full-time clinical engineers (CE). These patients often require respiratory support and CEs are set values of ventilators and assist physicians during weaning. They also monitor pressure during Swan-Ganz catheterization, set up and service monitors, and manage IABP and blood purification systems. They constantly monitor patient hemodynamics as nurses do. Case management based on clinical pathway is practiced for some time in our center. With acute heart failure, however, due to advanced age and diversity of complications and severity, when mechanical ventilation or IABP is required, the clinical course becomes so diverse and application of clinical pathway is limited to a subset of patients. On the other hand, different subspecialties and consultation services are involved in the care of acute heart failure, at admission, discharge preparation and rehabilitation. That is exactly when a team approach guided by clinical pathway can excel in quality of care by standardizing services and securing patient safety.
Panel Discussion 3 Co-medical Role in the Management of Acute Heart Failure and its Development AKI UEYAMA Nursing Department of Kitasato University Hospital, kanagawa, Japan Patients in the intensive care unit (ICU) always receive treatment and nursing care based on the data obtained from the latest monitoring equipment. Nursing care, at times, requires that rapid and appropriate measures be taken for initial symptoms and abnormalities caused by acute heart failure. Medical equipment is useful to obtain the necessary information from the patient as quickly as possible, however number and type of machines have increased around the patient year by year which have many complicated functions. To interpret the complex monitoring data obtained from the equipment requires that the nursing staff understand the basic information provided. Nursing care in the ICU not only includes interpreting monitoring data and judging what emergency measures should be taken, but also understanding and managing the equipment. Appropriate nursing care using the equipment leads to suitable treatment and the opportunity to reduce the term of hospital admission for the patient. To offer high quality nursing, it is especially important to collaborate with the medical engineer, pharmacist, dietetician, medical doctor and the other co-medical stuff. In this session, we are going to discuss about the future of nursing care in the ICU concerning points of the current monitoring equipment and term of hospital admission by comparing these with those ten years ago.
Panel Discussion 3 Roles of Nurses in the Care of Acute Heart Failure AIKO KITAMURA Department of Nursing, Rinku General Medical Center The incidence of acute heart failure rises with age. Cardiogenic shock, pulmonary edema, and acute exacerbation of chronic heart failure can threaten the lives of patients. Nurses are expected to provide care based on understanding of the conditions underlying acute heart failure. When providing care to such patients, emphasis is laid on circulatory care, respiratory management, regulation of tissue oxygen metabolism, and mental support. Meanwhile, ethical aspects are reviewed and dealt with appropriately by the medical team. Nurses are required to act promptly and work with many other specialists while being aware of the fact that the patient is hovering between life and death. During this session, I will discuss the characteristics of patients and their families, citing cases where a circulatory assist system was used to deal with acute heart failure. Roles of nurses in the care of such patients will be discussed on the basis of my experience with major nursing intervention. I will also refer to the roles of nurses in introducing noninvasive positive pressure ventilation (NPPV) at our facility. (Consent has been obtained from the patients for the use of their data in this presentation for promoting advances in critical nursing care.)
When a patient with acute-cardiac failure shows no sign toward recovery by medical treatment, mechanical circulatory support with IABP, PCPS, or VAS, is needed. The most important role of clinical engineer is maintain these circulatory assist devices always in best condition enable to be available in the suitable timing. The major important points in management of theses devices. 1. Selection of assist device to obtain most effective circulatory support. 2. Initiation of mechanical support before multiple organ failure occurs. 3. If the effect is inadequate, more powerful mechanical assist device is needed. The following items are also important in the management of patients and successful results. 1. Maintenance of systemic circulation 2. Urine output 3. Ventilation 4. Anticoagulant therapy