Sample Week 10 paper (1).doc

Sample Week 10 paper (1).doc - 1 Course Project NURS 6052...

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1 Course Project: [] NURS 6052: () Essentials of Evidence-Based Practice [Name] [Date]
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2 Introduction At present, approximately 26 million people worldwide are living with heart failure (Ponikowski et al, 2014). As an emergency room nurse, the symptoms of an acute heart failure exacerbation are apparent as soon as the patient arrives. Their breathing is labored, retractions are visible, wheezing is often audible as they are bent over in a tripod position trying to catch their breath. Edema is primarily noted in their lower extremities or possible, in all four extremities and abdomen. Heart failure is the impaired ability of the heart to fill with or eject blood at physiological filling pressures (Piper & McDonagh, 2014). Nitroglycerin causes venous and arterial dilation which results in a balanced vasodilation of both sides of circulation and reduces elevated left ventricular filling pressures (Piper & McDonagh, 2014). BIPAP (bilevel positive airway pressure) has been shown to drastically improve ABG’s, end tidal CO2, and respiratory work in acute heart failure (Iurilli et al, 2017). BIPAP paired with a vasodilator such as nitroglycerin to help open the vessels and drive fluid out of the lungs is a current and successful treatment and one now often used in the emergency department. As a nurse, I was hesitant of this change in practice initially. However, the results are amazing. Patients who we were initially preparing to intubate began to breathe easier and shortly after, recovered completely. As a soon-to-be practitioner, I wanted to investigate this practice and research its credibility and how it compares to the more traditional treatment. With a diagnosis such as congestive heart failure that is extremely prevalent in the United States and with such a high mortality rate, this problem deserves research into the best evidence-based practice to treat our patients appropriately. The purpose of this paper is to research the latest data regarding vasodilators as part of the treatment for acute heart failure exacerbations, perform a literature review, and discuss how to implement this practice.
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3 Background Questions PICOT (population/patients, intervention/influence, comparison, outcome, timeframe) is a standard acronym used in evidence-based practice guidelines to help practitioners develop well-worded questions that facilitate a search for evidence (Polit & Beck, 2017). According to Polit and Beck, background questions are general, foundational questions about a clinical issue and the answers to them are typically found in textbooks (Polit & Beck, 2017). My background questions include: 1.) What is the pathophysiology of heart failure? 2.) What is the primary treatment for an acute heart failure exacerbation? 3.) How effective is BIPAP in preventing intubation? 4.) What is the effect of IV nitroglycerin in an acute heart failure exacerbation? 5.) Is IV nitroglycerin more effective than diuretics? These questions have high research-ability as they are not of a moral of ethical nature which cannot be researched (Polit & Beck, 2017). I feel these questions are feasible as they can be studied in the allotted amount of time for this project. While
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  • Fall '16
  • Cheryl Wagner
  • pulmonary edema

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