We had a lesson about ICU nursing and care for critically ill patient about two weeks ago. We got an assignment related to that lesson. We were supposed to to choose one type of heart arrhythmia and write about here in the blog. I chose supraventricular tachycardia (SVT). I didn't have any special reason why I chose SVT.
The Evidence-Based Medicine Guidelines (EBMG) define SVT: "it is typically a narrow-complex regular arrhythmia with an abrupt onset and termination". SVT starts rapidly and lasts usually from minutes to hours. Structure which causes the arrhythmia is located in the atrium or somewhere between the atrium and ventricular of the heart. SVT causes pulsating feeling in the chest and low blood pressure because the minute volume of the heart decreases 40% from the normal during arrhythmia. Usually the drop in blood pressure is improved quickly back to normal because of the compensatory mechanisms used by the cardiovascular system. The drop in blood pressure causes symptoms like dizziness, nausea, vapour, blurring of the vision, decreased level of consciousness, pain or feeling of constriction in the chest. Need to urinate more often than usually can be linked into the attack also the person might be tired after the attack. Even though these attacks are mainly harmless minor of these attacks might be dangerous if they are prolonged.
The attack may occur when there is a combined effect of a trigger, right kind of circumstances, and a structure in the heart which causes arrhythmia. Extrasystoles are the most common triggers of tachycardia also moves (e.g. bending over, yawning, coughing, be frightened, or after hard physical or mental stress) which causes abrupt vagal nerve stimulation. The right kind of circumstances for the tachycardia may occur if the person is tired, stressed, has used great amounts of substances, has infectious disease etc. If the conduction pathway are unusual or the heart tissue has changed because of a disease the structure of the heart is more likely to cause arrhythmia.
Usually SVT stops by itself and they occur seldom. If SVTs starts to occur more often and the symptoms become more severe curative treatment (catheter ablation) and prophylactic treatment (drug therapy) should be considered. If the diagnosis has been made and the person tolerates the arrhythmia quite well the agal stimulation is the first-line treatment for a acute episode of SVT. If the vagal stimulation is ineffective the person should be given adenosine i.v.. If the tachycardia is very fast or the person doesn't tolerate the arrhythmia cardioversion might be needed.
I have used Terveysportti as a reference in this report.
http://www.terveysportti.fi.ezproxy.jamk.fi:2048/ebmg/ltk.koti
http://www.terveysportti.fi.ezproxy.jamk.fi:2048/dtk/oppi/koti?p_artikkeli=kar00059&p_haku=supraventricular%20tachycardia
tiistai 19. helmikuuta 2013
sunnuntai 3. helmikuuta 2013
Perioperative simulations
We had skill lab lessons last Wednesday and during those lessons we had perioperative simulations. We had one case and from that case we had two different simulation practices. In the case we had an elderly lady with hip fracture and she was about to have a surgery so the simulation practices were about scrubbing and circulating, and anesthesia.
I was in a group which made first the circulating and scrubbing simulation. In that simulation we were supposed to get lady ready for operation. Half of the group was first did the circulating part and the other half did the scrubbing. I did first the circulating part so I was helping the scrub nurses with their sterile gowns and I also opened the sterile packages. The rest from the circulating group were washing the site of surgery. When we had got the patient ready for the operation we switched parts so in the second time I was in the scrubbing group. At first we performed the hand wash and after that we put the sterile gowns and gloves. We we had all the sterile clothes on we did the sterile draping which means that we covered up the patient with sterile paper sheets so that only the operation side is showing.
The second simulation was about the anesthesia preparations before the surgery. At first we got the patient's background information and we were supposed to gather all the things needed in spinal anesthesia. We were working as a one group and we first made the list about the things we would need in this anesthesia. After we had made the list we gathered all the things from the anesthesia table. When we got all the things ready the anesthesiologist came and started the anesthesia. After the anesthesia was ready the patient got sick so we needed to give her some antiemetic drug. Her pulse was also quite low so we had to treat also that.
I didn't learn that much new things during those simulations since I have already been practicing in operation room but it was very nice and useful revise about all the things related to the surgery preparations.
I was in a group which made first the circulating and scrubbing simulation. In that simulation we were supposed to get lady ready for operation. Half of the group was first did the circulating part and the other half did the scrubbing. I did first the circulating part so I was helping the scrub nurses with their sterile gowns and I also opened the sterile packages. The rest from the circulating group were washing the site of surgery. When we had got the patient ready for the operation we switched parts so in the second time I was in the scrubbing group. At first we performed the hand wash and after that we put the sterile gowns and gloves. We we had all the sterile clothes on we did the sterile draping which means that we covered up the patient with sterile paper sheets so that only the operation side is showing.
The second simulation was about the anesthesia preparations before the surgery. At first we got the patient's background information and we were supposed to gather all the things needed in spinal anesthesia. We were working as a one group and we first made the list about the things we would need in this anesthesia. After we had made the list we gathered all the things from the anesthesia table. When we got all the things ready the anesthesiologist came and started the anesthesia. After the anesthesia was ready the patient got sick so we needed to give her some antiemetic drug. Her pulse was also quite low so we had to treat also that.
I didn't learn that much new things during those simulations since I have already been practicing in operation room but it was very nice and useful revise about all the things related to the surgery preparations.
sunnuntai 27. tammikuuta 2013
Study visit to A&E
We had a study visit to the A&E (accident and emergency) department of Central Finland's central hospital here in Jyväskylä last Wednesday. We were going to see what happens to the patients when they arrive in the hospital. Were also going to see what happens to the patients who come to the hospital by ambulance since last week we practiced paramedics work on the field.
When we arrived into the A&E we were told about the triage nurse's job since everyone is going to meet him/her at first. The triage nurse is the one who makes the decicion what kind of care the patient will need. There are five different letters as a classifications for urgency of a patient. The most urgent patients will get classification A which means that the patient's care has to be started immediately. The next urgent patients get the B classification and their treatment has to be started within 15 to 30 minutes. Patients with classification A or B are usually the ones who come by ambulance and they are first treated in the so called shock room. In the shock room there are all the monitors needed and also there is easy access to the x-ray and CT. Patients who recieve the classification C will need care within two hours and patients with classification D will need care within three hours. Usually patients with classification C or D are the ones who come from home by themselves or the ones who come from health centre with a referral. These C and D patients go in the hospital either to the basic health care side or to the specialized health care side. There can also be patients with the classification of E which means that they won't need any acute care which means that they will recieve some care instructions or they are referred to the health centre to the doctor's or nurse's appointment. There are at least two triage nurses working all the time. The other one is for patients who come by ambulance and the other one is for patients who come to the hopital by themselves with a referral or not.
The A&E department of Central Finland's central hospital is open 24/7 and it is the only A&E department in the Central Finland and that is why there are patients coming quite far away aswell. The A&E department also has the basic health care's duty during weekdays from 4pm till 8am, during weekends from Friday 4pm till Monday 8am, and during the holidays. During those times there will be doctor's and nurse's appointment available for the patients with an E classification.
The visit was nice and even though I was a pretty familiar with the A&E I got lots of new information. It was also nice to see the shock room because you are not able to see that unless you are working at the A&E or you work as a paramedic. The visit was a bit shorter than we expected and it would have been nice to see the accident and emergency and infection ward (päivystys ja infektio osasto) but maybe some other time.
When we arrived into the A&E we were told about the triage nurse's job since everyone is going to meet him/her at first. The triage nurse is the one who makes the decicion what kind of care the patient will need. There are five different letters as a classifications for urgency of a patient. The most urgent patients will get classification A which means that the patient's care has to be started immediately. The next urgent patients get the B classification and their treatment has to be started within 15 to 30 minutes. Patients with classification A or B are usually the ones who come by ambulance and they are first treated in the so called shock room. In the shock room there are all the monitors needed and also there is easy access to the x-ray and CT. Patients who recieve the classification C will need care within two hours and patients with classification D will need care within three hours. Usually patients with classification C or D are the ones who come from home by themselves or the ones who come from health centre with a referral. These C and D patients go in the hospital either to the basic health care side or to the specialized health care side. There can also be patients with the classification of E which means that they won't need any acute care which means that they will recieve some care instructions or they are referred to the health centre to the doctor's or nurse's appointment. There are at least two triage nurses working all the time. The other one is for patients who come by ambulance and the other one is for patients who come to the hopital by themselves with a referral or not.
The A&E department of Central Finland's central hospital is open 24/7 and it is the only A&E department in the Central Finland and that is why there are patients coming quite far away aswell. The A&E department also has the basic health care's duty during weekdays from 4pm till 8am, during weekends from Friday 4pm till Monday 8am, and during the holidays. During those times there will be doctor's and nurse's appointment available for the patients with an E classification.
The visit was nice and even though I was a pretty familiar with the A&E I got lots of new information. It was also nice to see the shock room because you are not able to see that unless you are working at the A&E or you work as a paramedic. The visit was a bit shorter than we expected and it would have been nice to see the accident and emergency and infection ward (päivystys ja infektio osasto) but maybe some other time.
perjantai 18. tammikuuta 2013
Simulation practices
We got started with our acute nursing studies yesterday when we had couple of different kinds of simulation practices in our skill lab lessons. We were supposed to act as paramedics in those simulation practices. There were three different cases. The cases included elderly patient with acute myocardial infarction, elderly person with a hip fracture, and a one-year-old baby with burns in his feet. It was quite challenging at first since I don't have any experience about emergency care but once we got started it was really fun! I also noticed that in all of those cases you could find the same connective thing which is the vital signs. So the basic things are the most important thing to remember in emergency care and in nursing on the whole.
We also had punch of new "teachers" which was nice! The new "teachers" were nursing students like us but they already have some work experience from emergency care. For them being a teacher in these simulation exercises were part of their studies and the same kind of "teaching" is waiting for us aswell later this spring. It was really nice to hear how things are done in the field at the moment. It was also a bit more relaxed to do these simulation exercises with other students than teachers.Even though we have great teachers teaching us variety is the spice of life.
Overall it was a different day at school but I enjoyed it very much, learnt lot of new things, and went through some already learnt things. It was very productive day and I hope we'll have many days like this ahead of us!
We also had punch of new "teachers" which was nice! The new "teachers" were nursing students like us but they already have some work experience from emergency care. For them being a teacher in these simulation exercises were part of their studies and the same kind of "teaching" is waiting for us aswell later this spring. It was really nice to hear how things are done in the field at the moment. It was also a bit more relaxed to do these simulation exercises with other students than teachers.Even though we have great teachers teaching us variety is the spice of life.
Overall it was a different day at school but I enjoyed it very much, learnt lot of new things, and went through some already learnt things. It was very productive day and I hope we'll have many days like this ahead of us!
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