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- Stress echocardiogram
- Nuclear stress testing
- Transesophageal echocardiogram (TEE)
- Holter monitoring
Transthoracic echo (TTE)
US of heart with transducer placed on outside of chest
Purpose of echo
Look for the cause of abnormal heart sounds (murmurs or clicks), an enlarged heart, unexplained chest pains, shortness of breath, or irregular heartbeats.
Check the thickness and movement of the heart wall.
Look at the heart valves and check how well they work.
See how well an artificial heart valve is working.
Measure the size and shape of the heart's chambers.
Check the ability of your heart chambers to pump blood (cardiac performance).
Calculate how much blood your heart is pumping during each heartbeat (ejection fraction). You might have a low ejection fraction if you have heart failure.
Look for blood clots and tumors inside the heart.
Tranducer passed into esophagus, view without obstruction by lungs, bones, clearer image; pt sedated
Done just before and just after exercise on a treadmill or stationary bike; determines whether there is a lack of blood flow at exercixe
Dobutamine stress echo
Pharmacologic stimulation of heart to exercise, may ID CAD
Nuclear stress testing
IV radiopharmaceutical, such as thallium or sestamibi, EKG, BP monitoring.
Followed by stress echo and reinjection of thallium/sestamibi during peak exercise.
Show how the radiopharmaceutical has traveled through your blood and into your heart.
If you are not able to exercise, your doctor may give you a medicine called a vasodilator, which dilates your heart arteries. Or you may get a medicine that will make your heart beat faster and harder, similar to when you exercise.
Pregnancy conflicted with job duties, afraid of getting hurt
Did not want 12.5 hrs after delivery
Why come back
- Love OB, maintain PD position
- Want to branch out and learn new skills
- Want to grow professionally, no room to do so at current job
Recent Rhythm ID, ACLS, enjoy cardiology, pertains to every pt
Schedule is perfect for me - there will be no work-family balance issues
Really excited to work with Alan again
- - bright, can learn new skills, follow protocol
- - resume shows hx of doing well in diverse fields-look for new challenges and embrace them
- - motivated to do excel, ask questions on the job, go home and study what needs to be improved, very willing to take additional coursework/certification, I am not looking to be mediocre, important to be excellent
- -want to absorb as much as I can, perform the best that I can
- -greatest skill is customer service -nurses here as well as at alere will verify kindness to pts, take time to educate pts; never lazy, always fu, always communicate to MDs/other staff
- -quality nursing starts there- dedication to serve your pt population - all else falls into place
What do I lack
Limited experience with cardiac care
- HTN pts (chronic and PIH), coagulopathies, arrthymias
- but it will be a steep learning curve
Didn't I like
- Difficult staffing, OB is hard to staff, 23 pts!
(Manager: difficult communication, angry/defensive)
Conflict with staff
Stay out of the way, nonconfrontational, ignore insult to me unless its a pattern, unless interferes with pt care
Report 2 colleagues, 1 a friend, necessary bc really dangerous for pts, liability issue for company and also for RNs, both showed this repeated pattern
RN upset that I was orienting travel RN, wouldn't allow my babies into the nursery; later upset when pt reported her and I facilitated that report
Man: break protocol for staffing
Conflict with pt
Never - try to resolve pt concerns, if unable bring management into it
Pt upset - needed hosp eval for possible infected PICC