Every Nurse Is A Leader

1. Discuss a formal role where a nurse is in a position of leadership. Outline the essential responsibilities of that role and the educational preparation required. Explain what leadership traits, styles, or qualities are required to be successful in this role and why.

2. The influence of leadership can be far-reaching in practice and improving patient outcomes even when not in a formal role. Describe advocacy strategies that you can use as a leader to create positive change in your current workplace. In response to peers, describe a time when you provided leadership and the outcome. Was there anything that you would do differently?

1 HEART FAILURE EXERCISE Student name: ___________________________ Date: ______________ How was your patient’s heart failure diagnosed? symptoms on admission _________________________________________________________________ diagnostic tests and results: BNP______________ Echocardiogram________________________________________________________________ MUGA scan: ___________________________________________________________________ Cardiac catheterization: __________________________________________________________ Other: ________________________________________________________________________ Possible cause(s) of your patient’s heart failure (look at history): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Does your patient have left or right sided heart failure or both (list symptoms)? __________________________________________________________________________________________________________________________________________________________________________________________ What stage Heart Failure is your patient in and why did you choose this stage? __________________________________________________________________________________________________________________________________________________________________________________________ Medications prescribed (include generic and trade names and dosage): diuretic __________________________________________________________________________ Beta blocker ______________________________________________________________________ ACEI ____________________________________________________________________________ ARB _____________________________________________________________________________ Digitalis___________________________________________________________________________ Statin _____________________________________________________________________________ Anticoagulant/ platelet inhibitor _______________________________________________________ Referring to the CORE measures for CHF, is your patient getting the appropriate treatment? If not, what is missing and why do you think it is missing? _________________________ ______________________________________ __________________________________________________________________________________________________________________________________________________________________________________________ What about for his/her stage of CHF? If not, what is missing? ___________________________________________ _____________________________________________________________________________________________ Evaluation of your patient’s treatment since admission (trending): Subjective: ____________________________________________________________________________ ______________________________________________________________________________________ Objective signs (VS, labs…use measurable outcomes): _________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________- Discharge teaching started/done (be specific about what was taught and how): activity level ___________________________________________________________________________ diet _________________________________________________________________________________ Fluid intake ___________________________________________________________________________ weight monitoring _____________________________________________________________________ what to do if symptoms worsen ____________________________________________________________ _____________________________________________________________________________________ discharge medications: _________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Follow up instructions with MD ____________________________________________________________ List any barriers to learning? _____________________________________________________________________ List any ancillary consultations you would recommend for this patient .____________________ _______________ ______________________________________________________________ _______________________________ Heart Failure Guide Types of Heart Failure Signs/Symptoms Left- Sided Heart Failure Right-Sided Heart Failure Edema Mild to moderate Moderate to Severe Fluid Retention Pulmonary edema/ Pleural Effusion Ascites Organ Enlargement Heart Liver (Jaundice may be present) Respirations Dyspnea prominent, PND Dyspnea possible but not as prominent JVD Mild to moderate Neck veins visibly distended GI symptoms Mild Loss of appetite, bloating, constipation Stages of Heart Failure Stage A Pts at High Risk: HTN, CAD, DM, Metobolic syndrome; pts using cardiotoxins Treatment: Treat HTN, smoking cessation, treat lipid disorders, exercise, discourage ETOH and drug abuse, control metabolic syndrome Meds: ACEI or ARB in appropriate pts Stage B Patients with Structural heart disease w/o symptoms of HF: (Hx of MI, LV remodeling including LVH and low EF), asymptomatic valve disease Treatment: All measures under Stage A Meds: Same as A, plus Beta- blockers in appropriate pts Stage C Structural heart disease with symptoms of HF and sob, fatigue, reduced exercise tolerance Treatment: All measures under A and B, dietary salt restriction Meds: Same as for A& B, plus diuretics for fluid retention, may include Aldosterone antagonist/ Hydralazine/ nitrates Devices in selected patients: Pacemakers/AICDs Stage D Refractory HF –needing special interventions: symptoms at rest despite maximum drug therapy Treatment: All appropriate measures under A, B, and C. Decision making to choose appropriate level of care. Compassionate end of life care/hospice. Heart transplant, chronic inotropes, permanent mechanical support, experimental surgery/drugs. CORE Measures Congestive Heart Failure 1. Evaluation of left ventricular systolic function (LVSD) can be found: · narrative description in the progress notes · cardiac cath lab report · echo report · MUGA scan report · gated heart scan report 2. ACEI or ARBI for left ventricular systolic dysfunction -or contraindications documented · ACEI/ARB allergy · moderate/severe aortic stenosis · chronic renal failure or renal insufficiency 3. Smoking cessation counseling 4. Discharge teaching including: · activity level after discharge · diet/fluid intake after discharge · all discharge medications · follow up instructions with MD/APN/PA · weight monitoring · what to do if symptoms worsen Heart failure exercise KBurns