Cardiovascular Diseases Commons^™

Implementing Lean Daily Management System To Improve Cvor First Case On-Time Starts, Haley Borchers, Kelly Fehlhafer, Barbara Mueller, Jessica Nichols, Sarah Talken, Mary Hunter, Kenneth Sam

Posters

No abstract provided.

Increasing Depression Screenings In Adults With Advanced Non-Surgical Heart Failure Using 2013 Accf/Aha Recommendations And Healthy People 2020 Target Goals, Valerie Valencia

Doctor of Nursing Practice

The purpose of this evidence-based practice project was to increase depression screenings in adults with non-surgical advanced heart failure using reliable and valid tools, 2013 American College of Cardiology Foundation/American Heart Association recommendations, and Healthy People 2020 Target Goals as a method to identify and facilitate appropriate mental health referral, patient education, and follow-up for depressive symptoms. Interventions took place June 5, 2017, through August 10, 2017. This intervention project involving 246 adults with advanced heart failure demonstrated that an evidence-based intervention for depression screenings increased the number of patients screened from 5% to 44%. At project completion, 65% of …

Improving Cardiology Patient Flow In Nuclear Medicine, Kelly Haar, Hannah Sullivan, Kathryn Laverdiere, Nuclear Medicine Department, Haley Pelletier, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

At baseline, a nuclear medicine department found it difficult to complete cardiac stress tests within scheduled times. Using the performance improvement process, a nuclear medicine department looked to improve patient experience related to wait times for this test.

Two goals were identified and a root cause analysis was initiated. After identifying some process issues, two KPIs were developed to address them.

A root cause analysis identified some processing issues and two KPIs were instituted to address them.

As a result, one outcome was to hire an additional physician assistant to address the barrier of inadequate cardiology coverage. Next steps include …

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

An Exploratory Study Of The Utilization Of Evidence-Based Pharmacological Treatment On Heart Failure Patients In Mississippi And Its Impact On Readmission, Keri A. Barron

Dissertations

The purpose of this study was to explore the relationship of adherence to evidence-based guidelines for pharmacologic management by select Mississippi hospitals and their hospital readmission rates. This was an exploratory study with a retrospective design. This design offered insight into the relationship between readmissions of heart failure patients and adherence to the national guidelines for the pharmacologic treatment of heart failure. The study took place in a hospital in the southeastern section of the United States. Data were collected from a database of patients with heart failure seen between January 2011 and June 2014.

The unit of analysis for …

Assessing Provider Adherence To The 2013 Acc/Aha Hyperlipidemia Guideline, Adrienne Johnston

DNP Projects

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and accounts for more than 17.3 million deaths per year with hyperlipidemia as one of the leading risk factors. The 2013 American Heart Association/American College of Cardiology (AHA/ACC) hyperlipidemia guideline recommends healthy lifestyle habits, risk estimation of the development of cardiovascular disease using a risk calculator, and intensity dosed statin therapy. There has been controversy among providers resulting in confusion and inconsistent application of the guideline. Purpose: The purpose of this project was to examine provider adherence to the AHA/ACC hyperlipidemia guideline in a primary …

Influences On Self-Care In Women With Heart Failure: A Pilot Study, Joy Corcione

Dissertations and Theses (Open Access)

Background: Heart Failure self-care becomes exceedingly difficult to perform as the disease progresses; therefore social support becomes important in facilitating heart failure self-care. Woman with heart failure represent a significant and growing vulnerable population. Women tend to have lower self-confidence in providing self-care, experience greater negative emotions, decreased social support, experience more adverse psychosocial factors affecting self-care and experience greater psychosocial adversity than do men. Self-care is vital in managing heart failure and social support greatly facilitates self-care behaviors.

Purpose: The purpose of this pilot study was to gain a deeper understanding about the sources of perceived social support and …

Physical Activity Among Older American Indians And Alaska Natives, David Hodgins, Linda Larkey, Barbara E. Ainsworth, Colleen Keller

Journal of Health Disparities Research and Practice

Introduction: Life style behaviors contribute to poor health among older Americans Indians/Alaska Native (AI/AN) in the United States, with low levels of physical activity (PA) particularly tied to the chronic disease profile of this population. Searched reviews of physical activity among AI/ANs are limited in assessing prevalence and correlates to PA among older adults > 40 years.

Methods: A literature search of reported physical activity studies among older AI/AN was assessed for prevalence and predictive factors associated with levels of physical activity.

Results: Fourteen studies were included in this review that either specifically quantified the amount of physical activity among older …

Kawasaki Disease In Pediatric Patients, Cassandra F. Krinn

Nursing Student Class Projects (Formerly MSN)

Kawasaki Disease (KD) is an idiopathic, multi system disorder that is characterized by vasculitis of the arteries, capillaries, and veins. It typically affects children 5 years old or younger and is predominately seen in male children of Japanese decent. The inflammation of the blood vessels seen makes Kawasaki disease the leading cause of acquired heart disease in children, with 20% of those affected developing coronary artery aneurysms, cardiac arrhythmias, and heart failure. Diagnosis is based on criteria including presence of fever for 5 days, bilateral conjunctivitis, erythema of the lips and oral mucosa, changes in extremities, rash, and cervical lymphadenopathy. …

A Structured Telephonic Transition Program For Heart Failure Patients, Julia E. Robinson

Doctor of Nursing Practice Final Manuscripts

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors.

The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior …

The Effect Of Heart Failure Education On Knowledge And Readmission, Sara A. Golden

Evidence-Based Practice Project Reports

Heart Failure (HF) is a chronic progressive disease affecting over 5 million individuals with an expected increase in incidence as the population ages (Yehle & Plake, 2010). The costs associated with managing HF continue to increase and the Centers for Medicare and Medicaid Services (CMS) have attempted to identify ways to improve patient management of HF to reduce the revolving door of hospital readmissions and decrease expenditures. According to 2006 data, as many as one fourth of the Medicare beneficiaries discharged from acute care to skilled nursing facilities (SNF) were readmitted to the hospital within 30 days and the majority …

National Institute Of Health Stroke Scale (Nihss) Inter-Rater Reliability And Confidence Among Nihss Certified Nurses: Implementation Of A Standardized Patient Simulation, Kelly J. Trieglaff

Evidence-Based Practice Project Reports

The National Institute of Health Stroke Scale (NIHSS) is the most common stroke assessment used by nurses. Nurses certified on the NIHSS do not consistently demonstrate inter-rater reliability nor are they confident when assessing stroke patients using the tool (Josephson, Hills, Johnston, 2006). This EBP project evaluated a standardized patient simulation for maintaining inter-rater reliability and confidence in NIHSS certified nurses. A literature review showed that a decrease in inter-rater reliability occurs within four weeks to three months of NIHSS certification. A single cohort of intensive care nurses and emergency department nurses used the NIHSS tool in a standardized patient …

Association Of Self-Care Confidence And Hospital Readmission Following Student Nurse Led Congestive Heart Failure Transitional Care Project, Peyton A. Phelps

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Over 5 million Americans have been diagnosed with heart failure, and that number is growing. This disease is burdensome to the patient as it lessens their quality of life and to the healthcare system due to costliness and frequent readmissions. This study aims to evaluate if a student nurse led transitional care program can increase patient self-care confidence, in turn reducing 30 day hospital readmission rates. Twenty patients completed the Self Care of Heart Failure Index before and after a 14-week transitional care program. These reported data were compared using a paired samples t-test. There was not a …

The Effects Of Congestive Heart Failure On Quality Of Life: As Evaluated By The Minnesota Living With Heart Failure Questionnaire, Diana G. Gonzalez

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Congestive heart failure (CHF) is a chronic disease that impairs the quality of life (QoL) of patients and is associated with both high hospital readmission rates and healthcare resource utilization such as emergency services. This study proposed use a student led transitional care program in providing home care to NYHA functional class II and III CHF patients. It evaluated the impact of the program on their quality of life as measured by the Minnesota Living with Heart Failure Questionnaire© (MLWHFQ), the percentage of patients requiring readmission to the hospital within 30 days of initial hospitalization, and healthcare utilization. Thirty-six …

The Effects Of Patient Education And Knowledge Of Chf Patients As Evaluated By The Paksac Survey, Nabil Tovar

The Eleanor Mann School of Nursing Undergraduate Honors Theses

After diagnosis, management of congestive heart failure (CHF) can pose quite a struggle to many patients, since it requires that lifestyle changes be implemented into their daily life. Patients require the sufficient knowledge and education in order to best manage symptoms and improve their quality of life after being diagnosed. Use of Patient Knowledge of Self-care activities in Congestive Heart Failure^© (PaKSAC) survey in transitional care programs could identify patient gaps in knowledge, as well as decreasing acute care service use. The purpose of this research study was to investigate the knowledge level of CHF patients at the time …

Transitional Care To Reduce 30-Day Heart Failure Readmissions Among The Long-Term Care Elderly Population, Shantha Franks

Seton Hall University DNP Final Projects

Throughout the nation, there is an increased focus on reducing preventable hospital readmissions. This initiative started with the Patient Protection and Affordable Care Act (PPACA) (CMS, 2014), which sets forth certain provisions for Medicare spending. Hospitals with higher than usual readmission rates, especially in terms of preventable readmissions, are receiving reductions in Medicare reimbursements (Stone & Hoffman, 2010, CMS, 2014). Congestive Heart Failure (CHF) or Heart Failure (HF) is recognized as a primary cause of 30-day hospital readmissions. Causes of HF readmission include inadequate patient education and planning for discharge, inappropriate medication reconciliation, and poor or inadequate follow-up in the …

Non-Valvular Atrial Fibrillation And Stroke: Novel Oral Anticoagulants Versus Vitamin K Antagonists, Kathryn A. Viglietta

Nursing Student Class Projects (Formerly MSN)

Atrial fibrillation (afib) is the most common sustained cardiac arrhythmia and second most common cardiovascular condition in adults in the United States (Zarraga & Kron, 2012). •2.2 million affected, increases risk of stroke 4 to 6 times (National Institute of Neurological Disorders and Stroke [NINDS], 2015). •Vitamin K antagonists (VKAs) have been mainstay of therapy for over 60 years (King, Holley& Moores, 2013). •Limitations with VKAs such as variability in response, need for frequent lab draws, food and drug interactions which decrease patients adherence and under prescribing by physicians (Halperin & Goyette, 2012). •Novel oral anticoagulants (NOACs) have been approved …

Thrombotic Thrombocytopenia Purpura, Ann Oliva

Nursing Student Class Projects (Formerly MSN)

Patients with Thrombotic Thrombocytopenia Purpura, or TTP, are often times seen in the emergency department and subsequently admitted to the inpatient or the critical care unit. The problems that TTP patients can present with vary greatly and astute nursing assessment plus knowledge of the pathophysiology behind the diagnosis is vital to deliver excellent nursing care. Thrombotic Thrombocytopenia Purpura or TTP is a rare but potentially fatal condition that occurs as result of decreased levels of ADAMTS-13, a cleaving protease for von Willebrand factor (vWF), which causes platelet aggregation and microvascular thrombi and subsequent end-organ damage, along with thrombocytopenia, hemolytic anemia, …

Gout As A Significant Risk Factor For Cardiovascular Disease: A Case Study, Emily Leonhard

Nursing Student Class Projects (Formerly MSN)

Gout, an inflammatory arthritis caused by elevated serum uric acid levels, is emerging as a significant risk factor for cardiovascular disease (CVD). Recently, a nurse practitioner (NP) was caring for a patient who was suffering from a particularly severe gout attack while being treated in the ICU for new onset Atrial Fibrillation. The patient reported that he had never had an attack this severe before. He asked the NP if his history of gout could be related to his recent heart problems. The nurse practitioner, in order to answer the patient’s question, spent time researching the disease process of gout, …

Deep Venous Thrombosis In Surgical Orthopedic Patients, Kelly Marsh

Nursing Student Class Projects (Formerly MSN)

•The term venous thromboembolism (VTE) is defined as a syndrome that collectively comprises both deep vein thrombosis (DVT) and pulmonary embolism (PE). Each year approximately 350,000-900,000 people in the United States develop VTE and approximately 100,000 people die according to this cause (Streiff et al., 2014). Unfortunately, the reoccurrence rate for VTE remains very high, with an estimated risk of 10%-30% of VTE patients will develop another VTE within five years of the first incident (Streiff et al., 2014). •Deep vein thrombosis (DVT) is blood clot that forms in a large vein, usually in areas of slow blood flow such …

Effects Of Enhanced External Counter Pulsation Therapy On Patients With Angina, Valerie Jones

Nursing Student Class Projects (Formerly MSN)

According to the literature, coronary heart disease (CHD) is responsible for 370,000 deaths annually in the United States (Centers for Disease Control and Prevention [CDC], 2015). A symptom commonly associated with CHD is angina (US Department of Health & Human Services, National Institute of Health, National Heart, Lung, and Blood Institute [NIH], 2011). An estimated 300,000 to 900,000 patients in the United States have refractory angina pectoris (RAP), with nearly 100,00 new cases diagnosed yearly (Manchanda, Aggarwal, Aggarwal, & Soran, 2011). Kones describes refractory angina as continued angina class III/IV, in the nonsurgical candidate, with objective evidence of ischemia despite …

The Pathology Of Heart Failure, Kevin Ahman

Nursing Student Class Projects (Formerly MSN)

The topic I have chosen to research is heart failure. I have chosen this topic because I have treated many patients in the ICU with this condition, and find it an interesting pathology. Heart failure affects a significant portion of the patient population, and the rates are increasing. 5.1 million Americans ≥20 years of age have heart failure, projections show that by 2030, the prevalence of HF will increase 25% from 2013 estimates. At 40 years of age, the lifetime risk of developing HF for both men and women is 1 in 5. At 80 years of age, remaining lifetime …

Takotsubo Cardiomyopathy, Angela J. Occidental

Nursing Student Class Projects (Formerly MSN)

Takotsubo cardiomyopathy is a rare, reversible form of cardiomyopathy. First cases of takotsubo cardiomyopathy were described in Japan, twenty years ago (Milinis, & Fisher, 2012). takotsubo cardiomyopathy is a transient left ventricular dysfunction, typically triggered by severe emotional or physical distress. Left ventricular ballooning is characteristic of Takotsubo syndrome. Images of this ballooning resemble a takotsubo vessel used in Japan for collecting octopus, thus the reason for the syndrome name (Pelliccia, et. al, 2014). In recent years, this cardiomyopathy has been described as “Broken heart syndrome” because severe emotional stress has been implicated as the cause of this cardiomyopathy in …

Cardiac Tamponade, Ashley Miner

Nursing Student Class Projects (Formerly MSN)

The topic the author chose to research is cardiac tamponade. Cardiac tamponade occurs when fluid builds up in the pericardial cavity, which is the cavity that surrounds the heart. Cardiac tamponade can occur due to various reasons, including myocardial infarctions, pericarditis, traumas, and placement of pacer wires. Palpitations, chest pain, and shortness of breath are common symptoms that occur with cardiac tamponade. Pericardiocentesis and a pericardial window are two interventions that are commonly used to treat cardiac tamponade. Cardiac tamponade is a medical emergency and without any intervention, may lead to cardiac arrest and possible death. The author chose cardiac …

Abdominal Aortic Aneurysm: A Silent Killer, Kristen Springer

Nursing Student Class Projects (Formerly MSN)

Rupture of an abdominal aortic aneurysm (AAA) is a significant cause of mortality in the United States. “Often asymptomatic, AAA is considered a silent killer because it frequently remains undiagnosed until the time of rupture or the patient’s death” (Gordon & Toursarkinssian, p. 242). As healthcare professionals, being aware of the pathophysiology, risk factors and symptoms influencing this disease is important in aiding early diagnosis and treatment, helping to reduce complications and mortality rates of those affected.

Heart Failure Patient Self-Care: An Evidence-Based Outpatient Management Program, Christine Marie Ensign, Shelley Hawkins, Barry Greenberg

Doctor of Nursing Practice Final Manuscripts

Background: According to the American Heart Association, there are over 5 million people in the United States with heart failure (HF) and projections suggest the prevalence of HF will increase by 46% through 2030. HF is the most common cause of hospital admissions in the United States for patients age 65 years or older and despite improvement outcomes, national readmission rates remain high at 23%. Current guidelines recommend health professionals provide comprehensive HF education and counseling that is not only focused on knowledge, but also on skills of management and self-care behaviors. In order to achieve quality patient-centered care, …

Evaluating The Effectiveness Of A Heart Improvement Toolkit Program: A Pilot Project, Cheryl L. Mitchell

Doctor of Nursing Practice Projects

Heart failure (HF) is a chronic, debilitating disease resulting in over one million hospitalizations with an estimated 30.7 million dollars in total health care cost per year (Go et al., 2014). Evidence shows that HF education programs that promote adherence to pharmacological and non-pharmacological provider recommendations are effective in reducing 30-day HF recidivism rates, increasing self-care behavior, and decreasing adverse clinical events. The purpose of this evidence-based project was to implement the Heart Improvement Toolkit (HIT) Program which is a one-on-one, comprehensive HF-specific education program, for patients with a HF diagnosis who have been admitted to non-cardiac specialty units. Program …

Comparing Must And The Nri Tools In The Identification Of Malnutrition In Heart Failure Patients, Cassondra D. Degener

DNP Projects

The purpose of this project was to test the performance of albumin, NRI and MUST screening tools in comparison to the standardized measure of prealbumin among HF patients admitted to the University of Kentucky Chandler Medical Center. Inclusion criteria included all HF patients with the 428 diagnostic code, admitted from January 1, - December 31, 2013, ages 18 and older, with all laboratory values available specified in the data collection tool (Appendix A). A retrospective electronic medical record (EMR) review was performed for 100 patients who met the inclusion criteria. All data were collected through the University of Kentucky’s secure …

Accurate Intervention In Visceral Aneurysms, Megan Hoying

Nursing Student Class Projects (Formerly MSN)

A 30 year old male presented to the ED with a one week history of fever, abdominal pain, and poor PO intake due to nausea and emesis. He was given a GI cocktail and sent home for a presumed diagnosis of gastritis. After having persistent pain the patient returned to the ER the following day and was admitted for further testing. The patient died 3 days later. This is an interesting case presentation, and was in no way straightforward.

Hypertrophic Obstructive Cardiomyopathy, Tiffany Branson

Nursing Student Class Projects (Formerly MSN)

Hypertrophic obstructive cardiomyopathy or HOCM, is a genetic disease that is described as hypertrophy or enlargement of the left ventricle which obstructs the blood flow to the body (Yue-Cheng et al., 2012). HOCM is a disease that cannot be cure, but can be treated. One of the main goals of treatment is to focus on treating the symptoms. HOCM can be asymptomatic or symptomatic and can cause some major complications. Some of the complications of HOCM are arrhythmias and sudden cardiac death, “which is defined as natural death to due cardiac causes, heralded by abrupt loss of consciousness within one …