EOA 3b. Educational Program
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Transcript of EOA 3b. Educational Program
LVAD Assessment, Management and
Maintenance in the Home
Victoria C. E. CrawleyNUR/590B
University of Phoenix
Goal and ObjectivesGoal: Students will be competent in the
assessment, management and maintenance of the LVAD patient in the home.
Objectives: By the end of this course:Students will be able to describe basic
components of LVAD technology. Students will be able to identify and implement
the various stages of the Roper-Logan-Tierney Model of Living.
Students will demonstrate application of the Roper-Logan-Tierney Model when caring for the LVAD patient.
Students will express various complication prevention techniques with LVAD technology.
Course OutlineIntroduction
History of the LVADLVAD
Technology basicsPlacementUses Potential Complications
Course OutlineThe Roper-Logan-Tierney Model of Living
The 12 components:Maintaining a Safe EnvironmentCommunicationBreathing Eating and DrinkingEliminationWashing and DressingControlling TemperatureMobilizationWorking and PlayingExpressing SexualitySleepingDeath and Dying: Ethical Considerations
Course OutlineThink-Pair-Share
Find a partnerDiscuss two scenarios
DiscussionSharing of thoughts from Think-Pair-
ShareQuestion and Answer Session
Write down any questions you may have during the presentation and save for the end of the class.
IntroductionOrigins of the LVAD
Indications Nurses Role in Care
Photo Credit: money.cnn.com
What is an LVAD? A Refresher
Available for patients with severe myocardial infarct by which the heart cannot sustain itself
Available for chronic CHF patients for which treatments are no longer an option
Implantable device Portable Prolongs life by up to 3-5 years
LVAD UsesBridge to recoveryBridge to transplantation Destination therapy
Photo Credit: www.beliefnet.com
Placement and Equipment
Photo Credit: www.mylvad.com
Potential Complications: an Overview
Pump malfunction Impaired renal function GI bleed Driveline infection NauseaClotting disordersStroke
Photo Credit: www.physioinmotion.ca
Roper-Logan-Tierney Model of Living
Photo Credit: www.palliative-ostschweiz.ch
Photo Credit: freepages.history.rootsweb.ancestry.com
Photo Credit: www.persoo.co.uk
Components of the Model
Maintaining a Safe Environment
Use caution with environments that could cause infection
Emergency planning in case of a power outage
General home safety such as safe walkways, removing throw rugs, and handrails in the shower and doorways
Photo credit: www.health-first.org
CommunicationFamily is the most important part of the
interdisciplinary team and must be kept informed and included!
Keep it simple! Instruction should be at the level of the patient; do not use large medical terms!
Facilitate open discussion and therapeutic communication among family members, and to the nursing staff.
“Communication works for those who work at it.” –John Powell
BreathingProvide oxygen as needed Assess lung sounds for fluid retentionMonitor pulse oximetry, if able Assess for shortness of breath secondary
to complications
Photo Credit: rr.proquest.com
Eating and DrinkingNauseaCachexia, malnutrition and
hypoalbuminemia Refer to nutritionist if necessary or
requested Maintain a healthy diet and weight
Photo Credit: www.nutritionyoudesign.com
EliminationGastrointestinal problems are commonAssess bowel sounds and outputReduced gastrointestinal motility
Constipation is common Request stool stofteners
GI bleeding is a common complication which may be seen in stool
Renal function is impaired in 10% of the LVAD population
Washing and DressingShowering only after surgical site has
healedInstruct family on sponge bathing until
surgical site healed Stabalization devices must be worn
under clothing Holsters for batteries are worn outside
the clothing Effect of LVAD on sense of self secondary
to clothing restrictions
Controlling TemperatureAvoid extremes in temperature Instruct proper monitoring of
temperature daily
Photo Credit: www.telegraph.co.uk
MobilizationPatient may not go out alonePatient may not drive Carry extra batteries when leaving home!
Photo Credit: www.lifession.com
Working and PlayingCardiac rehab to strengthen patient after
implantation Encourage patient to improve physical
performanceNo strenuous activities or sportsMay return to work
No heavy lifting or machineryMinimize stress
Clip Art
Expressing Sexuality May resume sexual activity Patients report that resuming sexual
activity is important to quality of life Photo Credit: icoachingzone.com
SleepingSleep disruption due to noise from pump is
common Assess sleep each visit Request sleep aid from doctor if needed
Photo Credit: www.matrac.hu
Death and Dying: Ethical considerations
Patient’s desire to deactivate device may cause ethical dilemma in family or medical staff
Decreased self esteem, depression, anxiety or other complications may lead to desire to deactivate the device
Palliative care team initiated immediately after surgery to implant device for support and guidance
Think-Pair-Share
Photo credit: www.pcworld.com
Scenario One: Mrs. Mendez is a 56 year old patient with chemotherapy induced cardiomyopathy with underlying CHF. She has been given the option to receive an LVAD device as she is not a candidate for transplant. She arrives home after two weeks in the hospital and is admitted by your CHHA. She believes that she can resume her “normal life” of eating foods from her culture, and she continues to smoke. Mrs. Mendez has concerns about her self image, and how people are going to see her when she is in public. Additionally, she is fearsome that her husband will not find her attractive anymore. What education would you provide to this patient?
Scenario Two: Billy is a 12 year old newly implanted LVAD patient. He suffers from a congenital heart disease that has required many surgeries in the past. The doctors have given Billy a grim prognosis if he does not receive a donor heart soon. Billy’s family opts for an LVAD device as a bridge to transplantation. He is sent home three weeks post implantation and, being a typical 12 year old boy, wants to play with his friends, go to school, and resume his activity with the swim team. Billy’s mother has expressed fear over the sterile dressing change, even though she says they “taught her in the hospital.” How would you best care for this family?
Questions??
Conclusion Feel free to contact me with further questions or to discuss a patient:
Victoria C. E. Crawley, RN Oswego County Health
Department 70 Bunner Street, Oswego NY
315-349-3414
References Andrus, S., Dubois, J., Jansen, C., & Kuttner, V. (2003). Teaching documentation
tool: Building a successful discharge. Critical Care Nurse, 23(2), 39-48. Retrieved from http:// search.proquest.com.contentproxy.phoenix.edu/ docview/228205461/accountid=458
Baker, K., Flattery, M., Salyer, J., Haugh, K. H., & Maltby, M. (2010). Caregiving for patients requiring left ventricular assistance device support. Heart and Lung, 39(3), 196-200.
Bartell, L. A. (2005). Ventricular assist devices: Preparing for catastrophic environmental events. Progress in Transplantation, 15(3), 264-270.
Casida, J. M., Peters, R. M., & Magnan, M. A. (2009). Self-care demands of persons Living with an Implantable left-ventricular assist device. Research and Theory for Nursing Practice, 23(4), 279-93.
Hasin, T., Topilsky, Y., Schirger, J. A., Li, Z., Zhao, Y., Boilson, B. A., . . . Kushwaha, S. S. (2012). Changes in renal function after implantation of continuous-flow left ventricular assist devices. Journal of the American College of Cardiology, 59(1), 26-36. doi:http://dx.doi.org/10.1016/j.jacc. 2011.09.038
King, M.L., Thomas, R., & Pina, I. (2010). Cardiac rehabilitation for patients with ventricular assist devices: An offer to improve strong collaborative relationships. Journal of the American College of Cardiology 55(10),
1053- 1054. doi:doi:10.1016/j.jacc.2009.11.044
References Lachman, V. D. (2011). Left ventricular assist device deactivation:
Ethical issues. Medsurg Nursing, 20(2), 98-100. Marcuccilli, L., & Casida, J. (2012). Overcoming alterations in body image
imposed by the left ventricular assist device: A case report. Progress in Transplantation, 22(2), 212-6. Retrieved from http:// search.proquest.com/docview/1022994016?accountid=458
McCrae, N. (2012). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health
care. Journal of Advanced Nursing , 68(1), 222-229. doi:http:// dx.doi.org.contentproxy.phoenix.edu/10.1111/j.1365. 2648.2011.05821.x
Newsom, L.C., & Paciullo, C.A. (2013). Coagulation and complications of left ventricular assist device therapy: A primer for emergency
nurses. Advanced Emergency Nursing Journal, 35(4), 293-300. doi: 10.1097/TME.0b013e3182a8ab61
Nursing Theory . (2013). Retrieved from http://www.nursing-theory.org/ theories-and-models/roper-model-for-nursing-based-on-a-model-of- living.php
References O'shea, G., Teuteberg, J. J., & Severyn, D. A. (2013). Monitoring patients
with continuous-flow ventricular assist devices outside of the intensive care unit: Novel challenges to bedside nursing. Progress in Transplantation, 23(1) 39-46.
Salvage, J. (2006). Model thinking. Nursing Standard, 20(17), 24-25. Retrieved from http:// search.proquest.com.contentproxy.phoenix.edu/docview/21983621 4?accountid=458
Schweiger, M., Vierecke, J., Potapov, E., & Krabatsch, T. (2013). Management of complications in long-term LVAD support. International Journal of Artificial Organs, 36(6), 444-446.
Tylus-Earl, N., & Chillcott, S. L. (2009). Mental health and medical challenges. Journal of Psychological Nursing & Mental Health Services, 47(10), 43-49.
Wilson, S. R., Givertz, M. M., Stewart, G. C., & Mudge, G. H. (2009). Ventricular assist devices: The challenges of outpatient management. Journal of the American College of Cardiology, 54(18), 1647-1659.