在执业护士领导的心力衰竭诊所中整合护理点超声波。

IF 1.2 4区 医学
Christina Light Craigo, Theresa Brown, Ilan Kedan, Deborah Koniak-Griffin, Holli A DeVon
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引用次数: 0

摘要

背景:尽管生存率有所提高,但每五名心力衰竭(HF)患者中就有一人在出院后 30 天内再次入院。评估体液状况具有挑战性,仅靠体格检查估计只有 50%的准确率。肺充血是再入院的风险因素之一,可在症状出现前数周表现出来。目的:开展一项试点研究,利用护理点超声波(POCUS)评估胸腔积液,并评估下腔静脉(IVC)不塌陷性作为体液状态的标志:在住院 12 天内,由执业护士 (NP) 主导的出院后门诊对成人高血压患者(n = 21)进行了方便抽样调查。地点是一家大型三级甲等医院。纳入标准是确诊为高血压且参加了医疗保险的患者。护士长使用 VSCAN POCUS 设备测量 IVC 直径、评估塌陷度并检查胸膜腔。对数据进行了描述性分析:结果:3 名患者(14.3%)通过 POCUS 发现胸腔积液,并转诊进行胸腔穿刺术。5名患者(23.8%)的下腔静脉不通畅,其中每名患者都需要对容量超负荷进行干预:结论:护士可利用护理点超声来识别胸腔积液患者,这些患者可能受益于胸腔穿刺术。下腔静脉不塌陷可能是容量超负荷的预测因素:意义:护理点超声检查为 NP 提供了有效管理高血压的额外工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Integration of point-of-care ultrasound in a nurse practitioner-led heart failure clinic.

Background: Despite improved survival, one in five patients with heart failure (HF) is readmitted within 30 days of discharge. Assessing fluid status is challenging, with an estimated 50% accuracy when relying on physical examination alone. Pulmonary congestion is a risk factor for readmission and can manifest weeks before symptoms occur.

Purpose: To conduct a pilot study to assess for pleural effusion with point-of-care ultrasound (POCUS) and to evaluate inferior vena cava (IVC) noncollapsibility as a marker of volume status.

Methods: A convenience sample of adults with HF (n = 21) were seen in a nurse practitioner (NP)-led postdischarge clinic within 12 days of hospitalization. The setting was a large tertiary care hospital. Inclusion criteria were patients with an HF diagnosis and Medicare insurance. The NP measured IVC diameter, assessed for collapsibility, and examined pleural cavities using a VSCAN POCUS device. Data were analyzed descriptively.

Results: Pleural effusions were identified in three (14.3%) patients with POCUS and referred for thoracentesis. Inferior vena cava was noncollapsible in 5 (23.8%) patients; each of these patients required intervention for volume overload.

Conclusions: Point-of-care ultrasound can be used by NPs to identify patients with pleural effusions who may benefit from thoracentesis. Inferior vena cava noncollapsibility may be a predictor for volume overload.

Implications: Point-of-care ultrasound equips NPs with an extra tool to effectively manage HF.

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来源期刊
自引率
16.70%
发文量
172
期刊介绍: The Journal of the American Association of Nurse Practitioners (JAANP) is a monthly peer-reviewed professional journal that serves as the official publication of the American Association of Nurse Practitioners. Published since 1989, the JAANP provides a strong clinical focus with articles related to primary, secondary, and tertiary care, nurse practitioner education, health policy, ethics and ethical issues, and health care delivery. The journal publishes original research, integrative/comprehensive reviews, case studies, a variety of topics in clinical practice, and theory-based articles related to patient and professional education. Although the majority of nurse practitioners function in primary care, there is an increasing focus on the provision of care across all types of systems from acute to long-term care settings.
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