breathing in heart failure and the resulting impact of readmission rates. The design included patients admitted to cardiac intensive care unit at the Hospital of the University Of Pennsylvania, for HF, arrhythmias, and myocardial infarction between January 2012 and March 2013 with an observed sleep disordered breathing pattern. 106 patients met inclusion criteria. The left ventricular ejection fraction of these patients was 32.7% ± 19.8. A type III sleep study was completed on that admission. 81 patients were found to have a SBD defined here as an apnea-hypopnea index (AHI) of ≥ 5 events/h. The low AHI was used for the potential over-estimation of sleep time from the lack of EEG use. An auto-CPAP or auto-BiPAP with pressures of 5-20 cm of water …show more content…
Data was collected on readmissions including emergency room visits. None of the full users were readmitted within 30 days. 6 partial users and 5 non-users were readmitted. Findings in this small sample group reveal that an in-patient sleep study on HF patients can help diagnose a SBD and, if compliant with prescribed therapy, possibly reduce hospital and emergency room admissions. Kamel, Munzer, & Espiritu (2016) conducted a cohort study of 413 patients with a history of obstructive sleep apnea admitted to Saint Louis University Hospital between July 2012 and July 2014. The author’s objectives were to determine the effects of in–hospital continuous positive airway pressure (CPAP) on length of stay (LOS), 30-day readmission, and time to readmission (up to 90 days). The study included 413 patients. All of which currently used CPAP at home prior to admission. Inclusion criteria: age ≥ 18 years, general or surgical ward admission, past or current obstructive sleep apnea diagnosis with current home CPAP use. Researchers compared demographics and outcomes and found that in-hospital CPAP use was the primary independent variable in the
There is high risk of death and poor neurological function with unconscious survivors in out of hospital cardiac arrest. Trails were undertaken with the patients after awakening from cardiac arrest, which was compared with Ther...
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes an acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used; a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiratory pressure.
Fontana, C. J. (2010). Sleep Deprivation Among Critical Care Patients. Critical Care Nursing Quarterly , 75-81.
Heart disease is the leading cause of death in the United States and the estimated cost of treatment is $32 billion yearly. Approximately 5 million people living in the United States suffer from congestive heart failure (CHF) and half of those diagnosed will die within 5 years. An individual may present to the hospital with weakness, short of breath (SOB), swelling of the extremities, ascites, and breathing difficulties while lying down. The quality and length of life for someone suffering from heart failure can be improved with early diagnosis, medication, physical activity, and diet modification (CDC, 2013).
My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Sleep deprivation is a common condition that occurs if you don’t get enough sleep. In case of sleep deprivation people have trouble falling and staying asleep for a long period of time. In order to understand how serious sleep deprivation can be, one must need to know causes and consequences of sleep deprivation, how much sleep do we need? What does sleep do for us? And how we can cure sleep deprivation.
We live our entire life in two states, sleep and awake1. These two states are characterized by two distinct behaviors. For instance, the brain demonstrates a well-defined activity during non-REM sleep (nREM) that is different when we are awake. In the study of sleep by Huber et. al., the authors stated that sleep is in fact a global state2. It is unclear whether this statement means that sleep is a state of global behavioural inactivity or the state of the global nervous system. The notion that sleep is a global state of the nervous system served as basis for sleep researchers to search for a sleep switch. The discovery of the sleep switch, in return, provided evidence and enhanced the notion that sleep is a global state of the nervous system. The switch hypothesis developed from the fact that sleep can be initiated without fatigue and it is reversible1. It was hypothesized that there is something in the brain that has the ability to control the whole brain and initiate sleep. Studies have found a good candidate that demonstrated this ability3. They found a group of neurons in the Ventrolateral Preoptic (VLPO) nucleus. It was a good candidate because it was active during sleep, has neuronal output that can influence the wakefulness pathway, and lesion in the area followed reduce sleep3. The idea that there is something that can control the whole brain and result sleep state supports the idea that sleep is a global state of the nervous system.
In certain cases patients are provided with mouthpieces and other breathing apparatus which helps them sleep properly.
There are many causes, treatments, symptoms and ways to diagnose insomnia. With that in mind there are also different kinds of insomnia. There are three main types of insomnia each type has their own symptoms and behaviors that go along with it.
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
There are still many barriers interfering with sleep in the hospital, as the disruption of sleep is common through frequent monitoring and procedures, noise, lighting, and anxiety about being in the hospital (Robinson et al., 2005). Another barrier is the critical care environment, which has more invasive monitoring and tests and noise from monitors and ventilators (Eliassen & Hopstock, 2011).
The four stages of sleep are REM (rapid eye movement sleep), NREM1 (non-rem), NREM2, and NREM3. During the REM stage “your heart rate rises, your breathing becomes rapid and irregular, and every half-minute or so your eyes dart around in momentary burst of activity behind closed lids” (Myers, 2014, p. 96).
Sleep is a very important factor in the human function. Our body and brain is able to reset itself and rejuvenate while we sleep. When we do not get the required amount of sleep, we start to feel lethargic and foggy minded, because our mind and body wasn’t able to replenish itself. Sleep is imperative that an insignificant rest deficiency or lack of sleep can affect our ability to remember things; decisions and can affect our temperament. Chronic sleep deficiency can get the body to feel agitated and it could lead to serious health problems such as, heart problems, stress, acne, and obesity.
Maynard, W., & Brogmus, G. (2006). Safer shift work through more effective scheduling. Occupational health and safety, 16.