Hello, I agree that individuals with COVID-19- related symptoms tend to visit the emergency room to be tested. People presented with COVID-19 symptoms start their treatment process at the triage for their vitals, including blood pressure, temperature, heart rate, weight, height, and saturated oxygen level to be measured. The readings of the patient’s vitals indicate the patient’s level of danger, guiding clinicians in prioritizing care delivery to patients seeking treatment at the emergency. Patients at high risk are attended to first to prevent them from potential dangers, including deterioration of their health conditions or death. The heart rate of the patient who was encountered last weekend was 180. The client reported an extensive cardiac history characterized by an internal pacemaker/defibrillator. Diagnostics were required to gather more health-related information, which would guide the clinician in making an appropriate diagnosis and providing high-quality care using evidence-based interventions. According to Melnyk and Fineout-Overholt (2018), evidence-based practices lead to high-quality care and superior health outcomes. I support that EKG effectively detects cardiovascular disorders, making it an appropriate diagnostic test for this client.
The patient’s EKG detected Ventricular Tachycardia, which is a stress-induced cardiac channelopathy. Furthermore, I agree with the choice of pharmacological interventions in treating this patient. According to the Ottawa Hospital Research Institute. (2019), medication treatments effectively manage cardiovascular symptoms and improve the patient’s quality of life. However, the clinician should consider the patient’s preference when developing a treatment plan. A patient is more likely to comply with the prescribed treatment if his or her interests, values, and preferences were considered in developing the treatment plan. Thus, involving the client in making significant decisions regarding his treatment would result in superior health outcomes.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
Over this past weekend, I had a patient enter the emergency room because he thought he had COVID and wanted to be tested. We triaged him and found that his heart rate was 180. The patient had an extensive cardiac history, including an internal pacemaker/defibrillator. An EKG was performed and found that this patient was in Ventricular Tachycardia, a lethal, stress-induced cardiac channelopathy (Wleklinski et al., 2020). The defibrillator would not shock unless his heart rate exceeded 200. The patient had been shocked before and did not want this to be the first line of treatment, and we incorporated the patient preference into consideration. Hours began to pass, and several medication attempts failed, including Adenosine, Cardizem, and Amiodarone. At this point, two hours total since door time passed, and he said the famous phrase all nurses pucker at, “I do not feel so good.” While he begins perfusing sweating, I now cannot obtain a blood pressure. Let us just say the patient’s preference is no longer appropriate, and we must shock immediately. The shock was administered, and the patient was back into sinus rhythm. I also obtained a “decent” blood pressure while he slowly woke up. Considering the patient’s preference could have cost his life if we did not act fast enough.
The patient’s preference was included in the treatment plan as he did not want to be shocked if necessary. Most physicians try medications first anyhow, so I also foresaw Adenosine as the first-line treatment. “Adenosine has been used in the emergency treatment of arrhythmia for more than nine decades” (Gupta et al., 2021). We were also questioning whether or not the patient was in a wide-complex tachycardia vs. ventricular tachycardia because he walked through the front door with no problem.
For my patient decision aid, I researched Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)? Even though the patient already had a pacemaker/defibrillator, this would also be a good tool for patients with heart conditions that do not understand or are unsure about getting one. The aid gives information for patients to think about, including, “there are several risks to getting an ICD. Problems can happen during and soon after the surgery to implant the device” (A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute, 2022). I would be able to give this valuable tool to patients that may have questions about their specific concerns.
A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute. (2022). The Ottawa Hospital. Retrieved August 8, 2022, from https://decisionaid.ohri.ca/AZsumm.php?ID=1418
Gupta, A, Lokhandwala, Y, Rai, N, Malviya, A. (2021). Adenosine—A drug with myriad utility in the diagnosis and treatment of arrhythmias. J Arrhythmia 37: 103– 112. https://doi.org/10.1002/joa3.12453
Wleklinski, M.J., Kannankeril, P.J. and Knollmann, B.C. (2020), Molecular and tissue mechanisms of catecholaminergic polymorphic ventricular tachycardia. J Physiol, 598: 2817-2834. https://doi.org/10.1113/JP276757