Theory Paper : Becoming A Master

With the health care system changing so rapidly, it is important that nurses are autonomous. It is necessary, as patient advocates, that we understand the cause and effect of all entities involving our patients. Critical thinking and making the correct judgment call clinically is vital. A patient situation which comes to mind is an 86 year old female, weighing 50kg, Vital Signs: Blood Pressure: 80/50, Heart Rate: 102 (Sinus Tachycardia), Respirations:

What is my leadership philosophy? That is a very good question which made me think for a while. First, what does the word philosophy really mean? The dictionary says the word philosophy comes from the Greek roots philo- meaning "love" and -sophos, or "wisdom." But what does it mean to me? Is it a way of life? Or simply what my values and beliefs are and the fact that I have control over it and it can be changed. After pondering over this question I can say my leadership philosophy is to make sure Soldiers are not being used as a

Patient Sallie Mae Fisher was released from the hospital last Saturday. This patient is eighty two years old and lives alone as her daughter lives too far away to be helpful. Her medical history includes chronic congestive heart failure (CHF), atrial fibrillation (AF), and hypertension (HTN). She has been hospitalized four times for CHF exacerbation in the last six months. She was discharged from the hospital after being there three day to treat increased dyspnea, an eight pound weight gain, and chest pain. This paper will identify, prioritize, and describe at least four problems with evidence for each problem and identify at least four medical or nursing interventions with rationale for the interventions included.

I chose this team and this topic because I am a nurse who recently started working in a CCU. We take care of cardiac patients, and we have to closely monitor their heart rhythms. So, I would like to learn to better identify dysrhythmias, to improve competency assessments, and to better implement current evidence-based practices.

Cardiac dysrhythmias come in different degrees of severity. There are heart conditions that you are able to live with and manage on a daily basis and those that require immediate attention. Atrial Fibrillation is one of the more frequently seen types of dysrhythmias (NIH, 2011). The best way to diagnosis a heart condition is by reading a cardiac strip (Ignatavicius &Workman, 2013). Cardiac strips play an chief part in the nursing world allowing the nurse and other trained medical professionals to interpret what the heart is doing. In a normal strip, one can clearly identify a P wave before every QRS complex, which is then followed by a T wave; in Atrial Fibrillation, the Sinoatrial node fires irregularly causing there to be no clear P

In her article Gathering “Pearls” of Knowledge for Assessing, Dr. Peg Gray-Vickrey discusses the importance of, but also the difficulties of, distinguishing between ordinary aging changes and possible signs and symptoms of disease. The best way to ensure older adults’ safety, she says, is to “always expect the unexpected” (Gray-Vickrey, 2010). In a patient over the age of sixty-five, a nurse may observe extra heart sounds; however, because the arterial walls of the heart tend to thicken with age, and because this often leads to left ventricular and atrial hypertrophy, it is quite common for older adults to experience, for example, S4 murmurs (Gray-Vickrey, 2010). On the other hand, nurses may mistake legitimate symptoms of disease for normal

Nursing is a practice of merging art and science together (Wilson, 2005, p. 116). The American Nurses Association (2003) defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (p. 6). When working in such a field that is patient oriented, a leader can make the largest of impacts. Research by Allen and Dennis (2010) express the difference when an organization and their managers place the patient at the center of decision making; it can develop a spirit that nurtures respect and understanding for everyone, impacting the staff treatment and fairness while ingraining knowledge of what governess and accountability really mean (Allen & Dennis, 2010).

Many ideas for change in practice come from surveillance, or recurrent clinical problems (LoBiondo-Wood & Haber, 2014). The topic of a new best practice can originate from problem-focused triggers or knowledge-focused triggers (LoBiondo-Wood & Haber, 2014). Obtaining a 12-lead electrocardiogram in

Another nursing management is to monitor vital signs. Assess adequacy of cardiac output and tissue perfusion, noting significant variations in BP/pulse rate equality, respirations, changes in skin color, temperature, and level of consciousness. The rationale although not all dysrhythmias are life-threatening, immediate treatment may be required to terminate dysrhythmia in the presence of alterations in cardiac output and tissue perfusion (Vera, 2013).

Atrial Fibrillation is one of the leading causes of death across the globe. (1) AF increases an individual’s risk of stroke by 4 to 6 times on average. (2)(3) The risk increases with age, in people older than 80 years old; AF is the straight cause of 1 in 4 strokes. (3) Even though Atrial Fibrillation can be considered a mild arrhythmia; it is still associated with serious morbidity and mortality. (4)(5) First, it raises the risk of having thromboembolism and stroke, due to blood stasis in the left atrium. Stroke is commonly caused by a thrombus or clot. In patients with AF, the thrombus or clot is usually comes from the left atrial appendage (a small sac in the left upper chamber of the heart). Because stroke in AF patients may be particularly distressing, it is quite important to identify patients who are possibly at high risk before it occurs to them. Second, the irregularly irregular heart beat can cause symptoms palpitations, shortness of breath, anxiety and reduced exercise tolerance in the patient, so it requires medical consideration. Third, Atrial Fibrillation causes a lot of cardiac and hemodynamic changes including decreased myocardial systolic function and cardiomyopathy caused by tachycardia. (6)(7) Sometimes AF is identified only with the onset of a stroke or a transient ischemic attack (TIA or "mini-stroke"). (8) Whether if it is asymptomatic or symptomatic, AF is a progressive disease, worsening with time and it is accounting for

Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med. 1995; 155:469-73.

Atrial fibrillation is a supraventricular tachyarrhythmia which results in very disorganized contractions of the atria. This disorganization can also be seen has electrical impulses that are fast, and chaotic. This prevents the atria from contracting or pumping blood into the ventricles. When applying what I

Anxiety is also one of the contributing factors of developing dysrhythmia. Therefore, the nurse must encouraging to verbalization of feelings and fears, and recognizing the feelings of anxiety, anger, or sadness is important. Client may also develop a system to identify possible cause, or influential factors for anxiety, which can be recorded in client’s diary or journal. Lastly, the nurse must establish in the patient education the patient and family action plan, in case of an emergency and, encourage a family member to obtain CPR training.

It should be mentioned that the patient has a history of atrial fibrillation, and was just recently started on amiodarone.

Over these past five weeks, I have learned to use my knowledge differently. Instead of reading that the patient has dyspnea, heart murmur, and chest pain, I now see the pathologies in front of me. Unlike patients on multiple-choice questions, real patients present with