Student needs advice from nurses on essay!

Pediatric Critical Care Columnist · Nov 20, 2009

I think you might get more help from the CCU/Coronary/Cardiac forum on that first topic, which would be a great one for your paper. So I'll move this over there and we'll see what shakes out. Meanwhile you could look at the threads there and see if anything has already been posted that might be useful.

Pediatric Critical Care Columnist · Nov 20, 2009

So this article may help you out: http://www.emedicinehealth.com/heart_attack/article_em.htm

Nurses do most of the work in hospitals when it comes to patient care. There's a standing chest pain protocol that ER nurses follow as soon as the patient arrives, which includes oxygen, nitroglycerin to dilate the coronary arteries and aspirin to decrease the stickiness of platelets which slows down clot formation. The physician's actions will be to do a focused examination of the patient (after the nurse has done one and communicated pertinent findings), order tests (but often the ER nurse has already done them), interpret the 12 lead ECG (which the ER nurse will have looked at and analyzed already), interpret the chest xray and lab results (that the nurse has already looked at and begun treating), arrange for angioplasty if indicated and formally admit the patient.

Care outside of the ER can be much more complex and I'll let the CCU nurses give you that lowdown.

Twiggi · Nov 20, 2009

Thank you for moving me Janfrn and for the article, I like that it's 15 pages and it gives me great information on a MI.

So that's chest pain protocol, is all the medication administered after they determine someone might be having a heart attack?

Also I have a couple of other questions :)

1. Is there a standard triage evaluation that er nurses do, and what are the typical combined stats / symptoms that the patient would have to exhibit before being suspected a heart attack... If there is a standard triage, what's it called so I may find it on google.

2. If complications occur that may require nursing intervention where the patients life maybe be imminently at risk, or at risk. Do nurses intervene to save a life or is that all up to the doctors?

I know from personal experience that when I went to emergency for chest pains and shortness of breath, I did not see a doctor too much except to read my ecg and do some sort of an exam, but a nurse did not leave me alone and was quite kind :).. It would make sense if she were AT LEAST the first to intervene.

3. What do the Ccu do with heart attack patients?

I'm not trying to get you guys to do my dirty work, but if you can briefly answer my questions or give me keywords that i'm unaware of so I can google and research myself, I would be forever indebted to you! The angle of my essay is to advocate that nurses are perhaps the most critical and largest component in treating a heart attack. :)

Thanks guys!

Pediatric Critical Care Columnist · Nov 20, 2009

Twiggi, I work with kids and they don't have MIs as a rule so I'm leaving most of that to the experts. But I can tell you that during a cardiac arrest resus, it's the nurses who are doing the intervening. Typically the doc stands off to the side out of the way and directs traffic, so to speak. If there's a need for cardioversion or defibrillation, the nurse applies the "paddles" although we're moving toward quick-combo pads that do the same job and stay in place between interventions. And it's the nurse who charges the system and delivers the shock. The last code I was involved in, there was a nurse doing compressions most of the time. A nurse (me) drew up the necessary drugs for the second resus nurse to give. A fourth nurse was doing documentation and a respiratory therapist managed the patient's airway and respirations. (They will also do compressions; we like it when there are several guys on for the RT side when the patient is bigger, because there's a LOT of energy expended in doing compressions! Superior upper body strength is very useful.)

Our unit does something called ECPR, where the goal is to get the patient onto extracorporeal life support in the shortest time possible. It involves ongoing advanced cardiac life support (compressions, artificial respiration, drugs and whatever else) while a surgeon inserts large tubes into the big blood vessels in the patient's neck or groin. Once they're in place the patient is put on what amounts to cardiopulmonary bypass and all the work of the heart is taken over by a machine. During ECPR the second surgeon may give the drugs or do compressions for improved control of the surgical field. I know this is way more information than you need, but no education is ever wasted.

Twiggi · Nov 20, 2009

Thank you so much :) You got my foot in the door and I think I can write/research the rest of my essay from here.

That's so weird that the doctor doesn't take more part, that is absolutely not how they are represented in media.. That's another essay topic for another time though!

Again thanks :)

Pediatric Critical Care Columnist · Nov 20, 2009

You're welcome! Good luck for a great paper.

That's so weird that the doctor doesn't take more part, that is absolutely not how they are represented in media.. That's another essay topic for another time though!

Ain't that the truth!! As a future nursing student you might learn a lot from: The Truth About Nursing about popular stereotypes. Don't let it scare you off though!