Download HPRX 3004 Handouts

Excellence in Care:
Protocols for the Management of
Cardiac Conditions
Pam Bayles-Prevost RN, BSN
INDEPENDENT STUDY
Health Professions Institute
for Continuing Education
Austin Community College
The Austin Community College
Health Professions Institute, Continuing Education
5930 Middle Fiskville Road, Austin, TX 78752
INDEPENDENT STUDY: HPRX 3004: Protocols in Management of Cardiac Conditions
Description and Purpose: Pam Bayles-Prevost RN, BSN appears with Alyssa Monacelli RN, BSN,
instructor and coordinator with the Health Professions Institute of Austin Community College (ACC),
to discuss cardiac protocols; how they are used in a clinical setting and how they relate to cardiac
conditions. Ms. Bayles has 25 years experience working in critical care in the NICU, PICU, and adult ICU
settings. She currently teaches through the ACC Health Professions Institute and works clinically with
the Heart Hospital of Austin.
The purpose of this activity is to enrich the participant’s contribution to quality healthcare and the
pursuit of professional career goals by providing current and updated information on cardiac protocols
for use in management of cardiac conditions.
This offering is a self-paced learning activity developed to meet the individual needs of nurses, social
workers, and emergency medical services personnel requiring continuing education for relicensure.
Goals and Objectives: Upon completion of this activity, the student will be able to:
1. List the initial medications used in the treatment of clients experiencing a STEMI.
2. Identify the medications used for long-term and secondary treatment of clients experiencing
or have experienced a UA/NSTEMI.
3. Discuss the importance of hyperglycemic control in critically ill clients.
4. Describe three factors the DVT assessment tool categorizes.
5. Discuss the difference between systolic and diastolic heart failure.
Requirements for Successful Completion: The packet you have received contains a pre-test, DVD,
post-test and a program evaluation. To successfully complete this activity and earn continuing
education the participant must:
1. Complete the pre-test
2. View the DVD
3. Complete the post-test (score an 80 or more)
4. And, complete the evaluation
NOTE: Following the viewing of the DVD and completing the accompanying documents, questions
may be addressed by contacting Elizabeth Huss @ 512-223-7271 or [email protected]
Submit all of the documents (pre/post-test, evaluation) along with your completed Registration Form
(check or credit card), and payment to:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Within two business weeks from receipt of your material at ACC, your certificate of completion will
be available to be mailed, fax, or picked up at the address you provide… your choice.
Upon successful completion participants will be awarded a certificate of successful completion worth
2.0 contact hours.
Austin Community College is an approved provider of continuing nursing education by the Texas
Nurses Association, an accredited approver by the American Nurses Credentialing Center’s
Commission on Accreditation.
Contact hours for programs applicable to social work are approved for CEU’s by the Texas State Board
of Social Worker Examiners. This program is worth 2.0 contact hours or 0.2 continuing education
units (CEU’s).
Continuing education for Emergency Medical Personnel is approved by the Texas Department of
State Health Services. This program is worth 2.0 TDH (P) contact hours.
Conflicts of Interest: A conflict of interest occurs when an individual has an opportunity to affect or
impact educational content with which he or she may have a commercial interest or a potentially
biasing relationship of a financial, professional or personal nature. All planners and faculty/content
specialist(s) must disclose the presence or absence of a conflict of interest relative to this activity. All
potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing
nursing education activity. All activity planning committee members and faculty/content specialists
have submitted Conflict of Interest Disclosure forms.
The planning committee members and faculty/content specialists of this CNE activity have disclosed
no relevant professional, personal or financial relationships related to the planning or
implementation of this CNE activity.
Sponsorship or Commercial Support: This CNE activity received no sponsorships or commercial
support.
Non-Endorsement of Products: Approved provider status of Austin Community College refers only to
the continuing nursing education activity and does not imply a real or implied endorsement by Austin
Community College, the American Nurses Credentialing Center (ANCC) or the Texas Nurses
Association (TNA) of any commercial product, service, or company referred to or displayed in
conjunction with this activity, nor any company subsidizing costs related to this activity.
Off-label Product Use: This CNE activity does not include any information about off-label use of any
product for a purpose other than that for which it is approved by the U.S. Food and Drug
Administration (FDA).
Reporting of Perceived Bias: Bias is defined by the American Nurses Credentialing Center’s
Commission on Accreditation (ANCC COA) as preferential influence that causes a distortion of opinion
or of facts. Commercial bias may occur when a CNE activity promotes one or more product(s) (drugs,
devices, services, software, hardware, etc.). This definition is not all inclusive and participants may
use their own interpretation in deciding if a presentation is biased.
The ANCC COA is interested in the opinions and perceptions of participants at approved CNE
activities, especially in the presence of actual or perceived bias in continuing education. Therefore,
ANCC invites participants to access their “ANCC Accreditation Feedback Line” to report any noted bias
or conflict of interest in the educational activity. The toll free number is 1(866) 262-9730.
Expiration: This continuing nursing education activity will expire on March 1, 2014
Printed Name:
Date:
Instructions: Complete this pre-test PRIOR to watching the video. Choose the best answer by circling
the letter corresponding to your choice. Submit this pre-test, your post-test, completed evaluation,
completed registration, and payment to:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Pre-Test: Protocols for the Management of Cardiac Conditions
1. Protocols are:
a. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are evidence proven, and are standardized in Texas only.
b. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are evidence proven, and standardized in the United States.
c. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are not evidence proven, and are standardized in the United States.
d. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are not evidence proven, and are standardized for use in Austin, Texas.
.
2. A STEMI is:
a. A piece of mesh used to hold open a coronary artery.
b. ST Elevation Myocardial Infarction.
c. The “classical MI” presentation.
d. Both B and C.
3. The goal and national guideline for treatment of a STEMI is:
a. Reperfusion of the cardiac muscle within 90 minutes of onset of heart attack.
b. Reperfusion of the cardiac muscle within 60 minutes of onset of heart attack.
c. Reperfusion of the cardiac muscle within 30 minutes of onset of heart attack.
d. Reperfusion of the cardiac muscle within 2 hours of onset of heart attack.
4. Initial medical management of a STEMI is:
a. O2 therapy; Aspirin therapy; Nitroglycerin administration; Morphine for pain; Beta Blockers
b. O2 therapy; Aspirin therapy; NSAIDS; Demerol for pain; Calcium Channel Blockers
c. Aspirin therapy; Nitroglycerin administration; Morphine for pain; Beta Blockers
d. Aspirin therapy; Demerol for pain; Calcium Channel Blockers; Nitroglycerin administration
Pre-Test Page 2
Cardiac Protocols
5. The typical EKG path for a STEMI is:
a. ST elevation followed by an ST depression followed by a Q wave.
b. ST depression followed by a Q wave followed by an ST elevation.
c. ST depression followed by an ST elevation followed by a Q wave.
d. ST depression followed by a Q wave followed by an ST depression.
6. UA/NSTEMI is:
a. Unstable Angina and Non ST elevation myocardial infarction.
b. EKG changes include an ST depression.
c. Typically involves little to no cardiac enzyme changes.
d. All of the above.
7. Long-term therapy and secondary prevention of an MI along with medical management includes all of the
following (per the American Heart Association) EXCEPT:
a. Routine physician visits every six (6) months.
b. Lipid management and Flu vaccination.
c. Client compliance and participation.
d. Weight management, exercise, smoking cessation, blood pressure control.
8. The NICE-SUGAR Study found that:
a. Strict glucose control (81-108) among ICU clients increased mortality among adults.
b. Strict glucose control (81-108) among ICU clients decreased mortality among adults.
c. Glucose control targeting 144-180 among ICU clients resulted in lower mortality among adults.
d. Glucose control targeting 144-180 among ICU clients resulted in high mortality among
adults.
e. Both A and C
9. Protocol guidelines for UA/NSTEMI include the following anti-ischemic therapy:
a. Oxygen, Nitroglycerin, Morphine, Aspirin, Beta Blockers, ACE Inhibitors, Plavix
b. Oxygen, Morphine, ACE Inhibitors or Calcium Channel Blockers, Nitroglycerin
c. Oxygen, Nitroglycerin, Lovenox, IIb/IIIa platelet inhibitors, Morphine
d. Oxygen, Nitroglycerin, Morphine, Beta Blockers, ACE Inhibitors, IIb/IIIa platelet inhibitors
10. Protocol guidelines for UA/NSTEMI include the following anti-platelet & anti-coagulant therapy:
a. Aspirin, Plavix, ACE Inhibitors, Lovenox,
b. Aspirin, Plavix, Morphine, Lovenox, Beta Blockers
c. Aspirin, IIb/IIIa platelet inhibitors, Lovenox, Plavix
d. Aspirin, Calcium Channel Blockers, Morphine
Pre-Test Page 3
Cardiac Protocols
11. Risk assessment for DVTs includes:
a. Recent hip/joint surgery, fractures, trauma/spinal cord injury
b. History of DVT or blood clotting disorders
c. Pregnant within last month and/or use of birth control
d. Cancer, recent surgery, limited mobility
e. Chrohn’s disease, ulcerative colitis, obesity, MI, CHF, lung disease
f. All of the above are risks for DVTs.
12. Left sided heart failure is characteristically described as “wet” because:
a. The heart failure causes pressures to fall in the pulmonary vasculature.
b. Signs and symptoms include difficulty breathing and result from fluid accumulation in the
pulmonary vasculature (pulmonary congestion).
c. The cardiac output is increased causing decreased pressure in the left ventricle and left atrium.
d. All of the above.
13. Right sided heart failure is characteristically described as “dry” because:
a. Pressure decreases in the right side of the heart forcing blood into the pulmonary vasculature.
b. Signs and symptoms include neck vein distention, peripheral edema.
c. Both A and B.
d. Neither A nor B.
14. Systolic dysfunction of the heart includes all of the following EXCEPT:
a. Impairs the motion and ejection ability of the heart wall/muscle.
b. Is frequently caused by coronary artery disease.
c. Results in a filling impairment of the heart muscle.
d. Presents with an ejection fraction of <40%.
15. Diastolic dysfunction of the heart:
a. Presents with a normal ejection fraction or elevated.
b. Does not alter the chamber size of the heart.
c. Is associated with a filling impairment.
d. All of the above.
Excellence in Care: Protocols for the Management of Cardiac Conditions
Program Outline
Written:
I. Pre-Test
DVD Presentation:
II. Introduction to Heart Disease and Management: Current statistics on mortality and occurrences of heart
disease
III. Guidelines and Standards for Treatment of Cardiac Conditions
A. Defining STEMI and STEMI Guidelines
B. Management of STEMI
1) ACE Inhibitors in STEMI
2) ARBs (Angiotension Receptors Blockers)
3) Aldosterone Blockers
C. Defining UA/NSTEMI and UA/NSTEMI Guidelines
D. Management of UA/NSTEMI
1) Anti-ischemic therapy
2) Anti-platelet therapy
3) Anti-coagulant therapy
IV. Long-Term Therapy and Secondary Prevention of Cardiac Disease
A. Medical and Pharmaceutical Management
B. American Heart Association Guidelines
V. Hyperglycemic Control in Critically Ill Clients
A. Portland Diabetic Project findings
B. NICE-SUGAR Study
1) Why Important
2) Impact on Client Care
VI. DVT Prophylaxis
A. Current statistics on occurrence and mortality associated with DVTs
B. Risk Assessment
C. Prevention and Treatment
VII. Heart Failure
A. Systolic Dysfunction
B. Diastolic Dysfunction
C. Stages of Heart Failure- Treatment and Management
VIII. Summary
Written:
VI. Post-Test
VII. Evaluation
Evaluation
Title of Education Activity: Excellence in Care: Protocols for the Management of Cardiac Conditions
Location: DVD Video Format
Date: Participants check out and complete on own time
Purpose of this activity: The purpose of this activity is to enrich the participant’s contribution to
quality healthcare and the pursuit of professional career goals by providing current and updated
information on cardiac protocols for use in management of cardiac conditions.
Directions/Instructions: Please complete this evaluation questionnaire. Your anonymous
responses will be used to revise this activity and to plan future educational activities. Circle the
number that best fits your evaluation of this activity.
1 = Not at all
2 = Somewhat
3 = Almost completely
4 = Completely
1. Rate your achievement of these objectives:
1. List the initial medications used in the treatment
of clients experiencing a STEMI.
1
2
3
4
2. Identify the medications used for long-term and
secondary treatment of clients experiencing or have
experienced a UA/NSTEMI.
1
2
3
4
3. Discuss the importance of hyperglycemic control
in critically ill clients.
1
2
3
4
4. Describe three factors the DVT assessment tool categorizes.
1
2
3
4
5. Discuss the different between systolic and diastolic heart failure.
1
2
3
4
1
2
3
4
1
1
1
2
2
2
3
3
3
4
4
4
1
1
1
2
2
2
3
3
3
4
4
4
2. Rate the effectiveness of the teaching/learning resources?
3. Please evaluate the guest speaker- Pamela Bayles RN, BSN
a. Knowledge and currency of topic
b. Ability to make points clear
c. Ability to apply content to practice
4. Please evaluate the moderator- Alyssa Monacelli RN, BSN
a. Guides the discussion
b. Asks pertinent questions
c. Fosters clarification of presented information
Cardiac Protocols Evaluation Page 2
5. Were the objectives relevant to the overall purpose?
(see above)
1
2
3
4
5. How long (in minutes) did it take you to complete the entire activity (including taking the pretest, watching the video, taking the post-test, and completing this evaluation tool)? ________
Minutes
6. List two (2) ways you will integrate what you learned in this activity into your practice and/or
employment environment.
8. The following were disclosed prior to the beginning of this activity either in writing or verbally?
a. Requirements for successful completion
b. Conflicts of Interest
c. Commercial Support
d. Non-endorsement of Products
e. Off-label Use
9. Did you, as a participant, notice any bias that was not previously
presentation?
Yes
Yes
Yes
Yes
Yes
disclosed in this
Yes
No
If “Yes”, please describe who was biased and how.
10. Comments: If you answered (1) to any of the above, please comment.
11. Please list any suggestions or topics for future programming.
No
No
No
No
No
Printed Name:
Date:
Address (where you would like to receive your certificate of completion):
City:
State:
Zip code:
Instructions: Choose the best answer for each question listed below and circle the corresponding letter. A
passing score of 80% (answer 12 or more correctly) or more is required to earn continuing nursing education
(CNE). After you have completed this post-test, submit it along with your completed evaluation, pre-test,
registration form and payment to the address below:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Post-Test: Protocols for the Management of Cardiac Conditions
1. Protocols are:
a. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are evidence proven, and are standardized in Texas only.
b. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are evidence proven, and standardized in the United States.
c. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are not evidence proven, and are standardized in the United States.
d. A set of steps for healthcare professionals to follow for the purpose of achieving optimal outcomes,
are not evidence proven, and are standardized for use in Austin, Texas.
.
2. A STEMI is:
a. A piece of mesh used to hold open a coronary artery.
b. ST Elevation Myocardial Infarction.
c. The “classical MI” presentation.
d. Both B and C.
3. The goal and national guideline for treatment of a STEMI is:
a. Reperfusion of the cardiac muscle within 90 minutes of onset of heart attack.
b. Reperfusion of the cardiac muscle within 60 minutes of onset of heart attack.
c. Reperfusion of the cardiac muscle within 30 minutes of onset of heart attack.
d. Reperfusion of the cardiac muscle within 2 hours of onset of heart attack.
Post-Test Page 2
Cardiac Protocols
4. Initial medical management of a STEMI is:
a. O2 therapy; Aspirin therapy; Nitroglycerin administration; Morphine for pain; Beta Blockers
b. O2 therapy; Aspirin therapy; NSAIDS; Demerol for pain; Calcium Channel Blockers
c. Aspirin therapy; Nitroglycerin administration; Morphine for pain; Beta Blockers
d. Aspirin therapy; Demerol for pain; Calcium Channel Blockers; Nitroglycerin administration
5. The typical EKG path for a STEMI is:
a. ST elevation followed by an ST depression followed by a Q wave
b. ST depression followed by a Q wave followed by an ST elevation
c. ST depression followed by an ST elevation followed by a Q wave
d. ST depression followed by a Q wave followed by an ST depression
6. UA/NSTEMI is:
a. Unstable Angina and Non ST elevation myocardial infarction
b. EKG changes include an ST depression
c. Typically involves little to no cardiac enzyme changes
d. All of the above
7. Long-term therapy and secondary prevention of an MI along with medical management includes all of the
following (per the American Heart Association) EXCEPT:
a. Routine physician visits every six (6) months
b. Lipid management and Flu vaccination
c. Client compliance and participation
d. Weight management, exercise, smoking cessation, blood pressure control
8. The NICE-SUGAR Study found that:
a. Strict glucose control (81-108) among ICU clients increased mortality among adults.
b. Strict glucose control (81-108) among ICU clients decreased mortality among adults.
c. Glucose control targeting 144-180 among ICU clients resulted in lower mortality among adults.
d. Glucose control targeting 144-180 among ICU clients resulted in high mortality among
adults.
e. Both A and C
9. Protocol guidelines for UA/NSTEMI include the following anti-ischemic therapy:
a. Oxygen, Nitroglycerin, Morphine, Aspirin, Beta Blockers, ACE Inhibitors, Plavix
b. Oxygen, Morphine, ACE Inhibitors or Calcium Channel Blockers, Nitroglycerin
c. Oxygen, Nitroglycerin, Lovenox, IIb/IIIa platelet inhibitors, Morphine
d. Oxygen, Nitroglycerin, Morphine, Beta Blockers, ACE Inhibitors, IIb/IIIa platelet inhibitors
Post-Test Page 3
Cardiac Protocols
10. Protocol guidelines for UA/NSTEMI include the following anti-platelet & anti-coagulant therapy:
a. Aspirin, Plavix, ACE Inhibitors, Lovenox,
b. Aspirin, Plavix, Morphine, Lovenox, Beta Blockers
c. Aspirin, IIb/IIIa platelet inhibitors, Lovenox, Plavix
d. Aspirin, Calcium Channel Blockers, Morphine
11. Risk assessment for DVTs includes:
a. Recent hip/joint surgery, fractures, trauma/spinal cord injury
b. History of DVT or blood clotting disorders
c. Pregnant within last month and/or use of birth control
d. Cancer, recent surgery, limited mobility
e. Chrohn’s disease, ulcerative colitis, obesity, MI, CHF, lung disease
f. All of the above are risks for DVTs
g. None of the above
12. Left sided heart failure is characteristically described as “wet” because:
a. The heart failure causes pressures to fall in the pulmonary vasculature.
b. Signs and symptoms include difficulty breathing and result from fluid accumulation in the
pulmonary vasculature (pulmonary congestion).
c. The cardiac output is increased causing decreased pressure in the left ventricle and left atrium.
d. All of the above
13. Right sided heart failure is characteristically described as “dry” because:
a. Pressure decreases in the right side of the heart forcing blood into the pulmonary vasculature.
b. Signs and symptoms include neck vein distention, peripheral edema
c. Both A and B
d. Neither A nor B
14. Systolic dysfunction of the heart includes all of the following EXCEPT:
a. Impairs the motion and ejection ability of the heart wall/muscle.
b. Is frequently caused by coronary artery disease.
c. Results in a filling impairment of the heart muscle.
d. Presents with an ejection fraction of <40%.
15. Diastolic dysfunction of the heart:
a. Presents with a normal ejection fraction or elevated
b. Does not alter the chamber size of the heart
c. Is associated with a filling impairment
d. All of the above