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Catheterization, Central Venous↗
Biomedical subjects
Barbara Leeper
Publications and source records attributed to Barbara Leeper.
Resynchronization therapy for the management of heart failure.
Biventricular pacing offers real benefit to some patients with HF, but several questions remain unanswered. One is which patients will benefit the most from this technology. Although there are some indications, the ideal patient group has yet to be identified. The best electrical configuration for pacing and the best pacing site have not been identified for all patients. Another question is whether resynchronization will improve mortality rates. A final question is the cost-effectiveness of this therapy. Studies in progress may answer some of these questions. Meanwhile, this intervention offers hope for improved quality of life and perhaps survival in this high-risk patient population.
Cardiac Pacing, Artificial↗
Continuous ST-Segment Monitoring.
Continuous ST-segment monitoring has been shown to be beneficial for patients with acute coronary syndromes as well as for other patients in the intensive care unit (ICU). This article reviews the significance and value of continuous ST-segment monitoring with emphasis on the value of 12-lead ST-segment monitoring across the continuum of care from the emergency department, to the cardiac catheterization laboratory, the ICU, and the telemetry unit.
Critical Care↗
Monitoring right ventricular volumes: a paradigm shift.
The resuscitation of critically ill patients frequently requires the administration of fluids for the purpose of increasing cardiac output and oxygen delivery to the tissues. The assessment of the patient's preload status during this process is vital. Traditionally, preload assessment has been through the use of right atrial pressure and pulmonary artery occlusion pressure, which are often referred to as the "filling pressures." The use of these filling pressures is based upon the assumption that ventricular compliance does not change. In recent years studies have demonstrated a poor correlation between these pressures and cardiac output. More recently, the ability to measure right ventricular end-diastolic volume (RVEDV) at the bedside using a modified pulmonary artery catheter became available. Initially the measurement was obtained using intermittent bolus measurements. Today, near continuous measurements of RVEDV are available. The shift from using pressure measurements for the purpose of assessing preload to the new paradigm of using right ventricular volumetric measurements is challenging. The purpose of this article is to review pertinent anatomy of the right ventricle and the interdependence of the ventricular chambers. The volumetric parameters are presented followed by a discussion of research supporting the use of the volumetric parameters in lieu of pressure measurements for preload assessment in a variety of patient populations. The technology providing continuous RVEDV measurements is presented followed by a discussion of a case study demonstrating the value of continuous measurements. Specific implications for the advanced practice nurse are addressed.
Cardiac Output↗
Management of heart failure: use of biventricular pacing.
Congestive heart failure (CHF) is a clinical syndrome that affects more than 4 million people in the United States. The grim prognosis for this population has led to a search for new therapies to treat CHF. Resynchronization of the ventricles is one such therapy. The pathophysiology associated with conduction defects and the evolution of the use of pacing technologies for this patient population will be discussed. Early data have been encouraging, suggesting that patients may gain important hemodynamic, functional, and quality-of-life improvements with biventricular pacing.
Cardiac Pacing, Artificial↗
Nursing outcomes: percutaneous coronary interventions.
Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.
Activities of Daily Living↗