core measures notes

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The required treatment for heart failure

· Echocardiogram (ECHO) is used to monitor the left ventricle function of the heart. It is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart.

· Beta blockers at discharge are used to decrease heart rate and force of contraction, as a result lowering blood pressure. ( ex. medications ending in olol bisoprolol and carteolol) Use cautiously in patients with resp. disease such as COPD.

· Monitor cholesterol level and Statin at discharge and use cautiously in patients with liver failure.

· Angiontension converting enzyme ( ACE ) or ARB at discharge (meds ending in pril ex. linospril) or angiontension - receptor blockers (ARBs) (ex medications ending in tan Losartan) are medication used to decease after load on the heart, use caution in renal failure patients.

· Diuretics are used to get rid of excess fluid, makes it easy for the heart to pump and decrease blood pressure (ex. Lasix, and Bumex ) which in return will decrease after load.

· Recent or current treatments; ECHO to monitor the ejection fraction if less than 35% ACE and or ARB are required. If the ACE or ARB are contraindicated the physician is required to indicate the reason why (ex. renal failure and or aortic stenosis ).

Patient education on heart failure before discharged from the hospital. Patients should be assessed for cardio pulmonary rehabilitation, educated on when to call 911, follow up doctors visit must be documented in the discharge planning records, medications at discharge, risk factors/ warning signs, and symptoms of heart failure, and low sodium diet education. (Conns 2007).

Mnemonics

U Upright

N Nitrates (if for chest pain)

L Lasix

O oxygen

A Ace Inhibitors

D Digoxin (given for fast heart rate)

F Fluids (decrease)

A After load

S Sodium Retention

T Test (dig level, ABG, Potassium level)

The required treatment for stroke

• Venous VTE prophylaxis is used to prevent any additional clots, ex Heparin or Lovenox.

• Patients should be discharged on antithrombotic therapy ( ex. Xarelto, Eliquis and Coumdain), is used to prevent mortality and morbidity (inhibits blood clotting).

• Anticoagulation therapy may be used if the patient has a-fib/ flutter- this medication will reduce blood clotting (ex Praxdox, Heparin or Lovenox). Do not use anticoagulation if the patient is taking Xarelto and or Eliquis.

• Thrombolytic therapy- is used on patient who arrive at the hospital less than two hours of s/s of a stroke and meets the criteria for the medication ( ex. Streptokinase).

• Monitor patient's cholesterol level and Statin at discharge. The medication will secondary prevent or decrease cardiovascular disease. This medication should be used with caution when treating patients with liver failure.

• Stroke patients should be educated on when to call 911, follow up on discharge planning, medications at discharge, risk factors, warning signs and symptoms of a stroke.

• Assessed patients for rehabilitation- the goal is to improve outcome by preventing complications and minimizing impairment with maximizing function.

• Test to diagnose a stroke are CT-scan and or MRI or the brain ( Mower, D. 1997).

The required treatment for pneumonia

· Chest xay- is use to diagnose the severity of the pneumonia.

· Blood cultures before the antibiotic to determine if the infection is in the blood.

· Antibiotics are used to treatment the pneumonia (ex. abx for simple pneumonia; Levaquin and or Rocephin and Zithromax) ( Driver, 2014).

The required treatments for acute myocardial infarction and current trends

• Aspirin on arrival given within 24 hours before or after arrival to hospital; Aspirin is use as a antiplatelet effects by stopping the binding together of platelets and preventing a patch over damaged walls of blood vessels.

• ECHO is used to monitor left ventricle function of the heart

• Beta blockers at discharge is used to decrease heart rate and force of contraction by lowering blood pressure ( meds ending in olol, ex, bisoprolol and carteolol) use cautiously in patients with resp. disease such as COPD

• Patient should be prescribed a aspirin at discharge.

• Patients cholesterol level should be monitored and Statin at discharge, use with caution in patients with liver failure.

• ACE or ARB at discharge (meds ending in pril ex. linospril) or ARBs (ex meds ending in an Losartan) medications are used to decease after load on the heart, use with caution in renal failure patients. These medications are used if the patients' ejection fraction is less than 35%.

• Other treatments are reperfusion ex Fibrinolysis or percutaneous cath intervention, could be consider if patient meets the criteria.

· Testing ECG (ST elevation, ST/T abnormalities), biochemistry markers CISO,with MB-Bands, and trophin q6hrs-8hrs for a total of 24 hours, if their is an increase in bi-markers this could indicate patient is having an AMI ( Conns 2007).

Mnemonics

M Morphine use to relax smooth muscles and decrease the oxygen

O Oxygen helps increase the oxygen supply to the heart

N Nitroglycerine use is to aid in vasodilation.

A Aspirin

Requirement of pulmonary embolus

• Anticoagulation is the treatment for pulmonary embolus. If warfarin is used it should be followed with Heparin or Lovenox for at least for five days. This is called overlap treatment. Patients should have their PT and INR monitored to check the effectiveness of the warfain. If the PT and INR is within acceptable range the Lovenox or Heprain be discounted. Other examples of anticoagulation are Xeralto or Eliquis.

• Test used to diagnose a pulmonary embolus are VQ-Scan or CT-Scan of pulmonary arteries.

• Patients should be educated on bleeding precaution ( Posters 2009 ).

References

Coons, J., & Fera, T. (2007). Multidisciplinary team for enhancing care for patients with acute myocardial infarction or heart failure. American Journal Of Health-System Pharmacy, 64(12), 1274-1278 5p. doi:10.2146/ajhp060281

v Available in the UA Library

Driver, C. (2014). The common causes of community-acquired pneumonia...second article of this three-part series. Nursing & Residential Care, 16(4), 202-205 4p.

Mower, D. (1997). Brain attack: treating acute ischemic CVA. Nursing, 27(3), 34-48 8p.

Posters. (2009). Journal of Thrombosis & Haemostasis, 7317-1168. doi:10.1111/j.1538-7836.2009.03473_2.x

Rymer, M. M., Anderson, C. S., Harada, M., Jarosz, J., Ma, N., Rowley, H. A., & ... Bornstein, N. M. (2014). Stroke service: How can we improve and measure outcomes? Consensus summary from a global stroke forum. Acta Neurologica Scandinavica, 130(2), 73-80. doi:10.1111/ane.12256

Google Images.

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(Mnemonics from) Google Imgage.

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