The first day was a little slow at first because several patients had to be discharged so most of the nurses and cardiologists were stuck in the office doing paperwork. Dr. Renata Gomes was really great about explaining the different diagnosis of each patient and their course of treatment thus far. I am proud to say that I understood each diagnosis and general condition, lab work, etc.
The second half of the 1st day was spent watching patients get cardiac stress tests. Cardiac stress tests are used to measure the heart's ability to respond to stressful stimuli in a controlled environment. There are 2 general methods of inducing stress: exercise or drug stimulation. The exercise portion (which I saw) consists of having patients walk on a treadmill (or pedal on a bike) with a gradual increase in speed and incline which forces the patient to work harder. Throughout the process you are hooked up to an electrocardiogram (ECG) and your heart rate (HR) and blood pressure(BP) is being monitored. These parameters are measured during maximum exertion and at rest. The goal of the stress test is to get to a "target" HR. The target HR is 85% of the maximum HR for a specific age. There is no specific time for which the stress tests lasts... rather its based on the pts ability to reach and stay above the target HR for an extended period of time. This number can be calculated with the following formula.
220 - pts age in yrs = Maximum HR
Max HR x 85% = target HR
ex: 220 - 49 = 171 max HR 171 x 0.85 = 145 target HR
2 out of the 3 stress tests that I observed were normal. One ECG showed 3 spikes on one of the leads attached to the pt showing slight ventricular fibrillation. The cardiologist was not concerned with only 3 spikes of vfib but noted it in her analysis. I have seen several stress tests in the US and I have to say that they are very similar. Yes the equipment is a little more up to date at UNC Hospital but the tests went off without a flaw.
The 2nd day on the unit was even better! I got to shadow a nurse for a little bit and was able to ask questions about the unit. I also watched her do a blood draw and do teaching for a patient who was just prescribed Lovenox (a low molecular weight heparin). Even though the teaching was in Portuguese I was able to follow the gestures and body language exchanged between nurse and patient. Then the nurse had the pt lift their shirt and explained how you must take an alcohol wipe and clean the area on the abdomen, pinch the subcutaneous (SQ) tissue, and insert the reloaded syringe with Lovenox at an angle into the SQ. She then made the motion of changing injection sites by circling the umbilicus in either a clockwise or counterclockwise position. Afterwards I asked if I would be able to help with blood draws and that I had experience from clinical in the US and also started IV's in the OR at HSEAH. I left the unit to watch 2 pacemakers get put in before I was able to assist with blood draws and IV's so my hope is that I will be allowed to tomorrow.
I also got to watch 2 pacemakers get put in! The general idea of the pacemaker is to send electrical impulses via electrodes into the hearts various chambers to regulate the beating of the heart. The first pt was a 39 year old (yo) male with Down Syndrome, who was getting his pacemaker replaced for the 3rd time because his electrodes were not in the correct position. He was put under general anesthesia and local anesthesia (Lidocaine). The process was amazing! The x-ray technician was really great about explaining what was going on and what I was seeing on the screen. One of the nurses also spoke beautiful English and was able to explain in further detail the procedure. This specific patient was getting a 2 electrode pacemaker which according to the cardiologist afterwords performing the procedure is a special type and is not used as often as a 1 electrode pacemaker.
The 2nd pt we saw was getting a pacemaker for the 1st time. The pt was a 78 yo female who was partially def and was given only local anesthesia (Lidocaine). I have not seen a pacemaker get put in in the US, but I thought it was strange that only local anesthesia was given to the pt and MOST pts receiving a pacemaker. Throughout the procedure the pt was anxious and moving and had to be held down. This pt received a 1 electrode pacemaker.
Being around cardio again makes me want to work in the cardiac intensive care unit (CICU) sooooo bad after graduation. It is my plan to work in either a CICU or a Pediatric intensive care unit (PICU) after graduation for 1-2 years and then eventually go back to school for nurse anesthesia to become a certified registered nurse anesthetist (CRNA). I had just finished up my pediatric rotation before I left for the Azores and the PICU was the front runner in my mind for after graduation... now I'm not so sure. I have always loved the heart... it is an amazing organ... and now CICU is looking pretty darn good.
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