QTc...what does it mean to me?

The letters QTc probably would not register as anything besides letters to most people.  However, I continue to learn and be amazed at how important this is to clinical nursing.  As a cardiac nurse especially, I must be familiar with this term.  In clinical practice alone, a QT interval measurement is meaningless because if its negative correlation with heart rate.  For it to be meaningful, it must be independent of the patient's underlying heart rate.  A rate formula is used to calculate what that is the corrected QT interval, also know as QTc interval.  The formula looks like this:¹

Comparing multiple QT intervals overtime is especially important after administration of drugs known to prolong the QT interval.  When potentially proarrhythmic drugs are being administered, a baseline QT/QTc interval should be established before administration of the first dose. Depending on the drug's risk, the ongoing QT/QTc monitoring may be as frequent as every 20 minutes after the dose is administered, or every 4, 8, or 12 hours.  The upper 99th percentile limit of QTc intervals is 470 ms for men and 480 for women.  A QTc that is prolonged greater than 60 ms from baseline after QT drug administration and/or a QTc interval greater than 500 ms should be considered abnormal and necessitates immediate assessment and evaluation.²  A study performed by the American Heart association reported that with increasing baseline QTc interval, the risk of death systematically increases.³

You as a nurse are a great clinician to monitor for and detect QT-interval abnormalities.  Always remember that you are your patients' advocate!  Make sure you understand each medicine you administer, as well as side effects and contraindications.  

References

1. British Journal of Anesthesia. (2013). Retrieved from http://ceaccp.oxfordjournals.org/content/8/2/67/F2.expansion

2. Pickham, D. (2013) Understanding and documenting QT intervals. Critical  Care Nurse, 33(4), 73-75.

3.  Brendorp, B., Elming, H., Jun, L., Kober, L., Malik, M., Jensen, G.B., & Torp-Pedersen, C. (2001). QTc interval as a guide to select those patients with congestive heart failure and reduced left ventricular systolic function who will benefit from antiarrhythmic treatment with dofetilide. American Heart Association Circulation, 103, 1422-1427. doi: 10.1161/​01.CIR.103.10.1422

Build Your Core

Nurses are always on their feet. Always. Then when you actually sit down to chart you are slouched over a computer. You boost up a patient in a rush and the bed is too low. You decide that this patient suddenly became a 1 person assist after being a 2 max. Our brains get fuzzy and funny after a long day.

The truth is we need to build our core.  It helps with great body mechanics and keeping our bodies happy for our long work days.

I asked Ray Tuttle, a NASM certified personal trainer to fill me in on his recommendations on core-strengthening exercises. The following 5 simple exercises are easy, short and sweet ways to build your core for a stronger work day (R. Tuttle, personal communication, August 5, 2013):

Back Extension

First, lay on your stomach with your hands behind your head. Exhale as you lift your torso up and hold for 3-5 seconds. Inhale as you lower back down, and rest 2-3 seconds. Repeat 10-15 reps per set. Remember to keep your neck in a neutral position, and do not pull your head back as you do this exercise.

Bridge

Lay on your back with your hands and palms down and knees bent. Exhale as you lift your pelvis up while squeezing your glutes and abs, and hold for 3-5 seconds. Inhale as you lower back down, and rest 2 to 3 seconds. Repeat 10 to 15 reps per set.  Remember not to squeeze your hamstrings.

Band Row

Stand in a plank position with knees slightly bent.  Keep your feet parallel to each other while gripping the band straight out in front of you. Exhale as you slowly pull back, counting to 4 until your elbows are at 90 degrees. Hold for 1 second.  Then, inhale as you slowly go back to the starting position, counting to 4. Do 10-15 reps per set. Remember to keep your body straight and head in a neutral position.

Horizontal Wood Chops

Stand with your knees slightly bent, while your feet are parallel to each other gripping the band off to one side with straight arms. Meanwhile, tighten your abs. Exhale as you twist your body to the other side counting to 4. Pull with your arm opposite the band keeping your arms straight. You can pivot on the ball of the foot closest to the starting side. Hold for 1 second. Inhale as you return to the starting position counting to 4, pivoting back on the same foot. Do 10-12 reps per side and then switch sides. Remember to keep your head in a neutral position.  Your head can follow the movement of your hands.

Crunch

Lay on your back, knees bent and hands behind your head. Tighten your abs and exhale as you curl upward counting to 2. Hold for 1 second. Inhale as you lower your back to the ground counting to 2. Do 15-20 reps per set. Remember to keep your neck in a neutral position, do not push it forward.

You did it!  Feel free to reward yourself with some ice cream.  You deserve it!  

An Apple A Day Keeps the Doctor Away

Have you ever heard this saying?  Eating healthy can be a challenge, especially when you are a nurse.  However, it is so important to maintain a healthy diet and weight.  You have a responsibility not only to your family, but also to your patients.  Often, they need help figuring out a healthy diet and achieving weight goals too! 

According to a recent Canadian study, nurses who worked at night and those who had mixed schedules were associated with having an important elevation in body mass index (BMI).¹  In fact another nursing study that included a sample of pediatric nurses found increased BMI among nurses correlating with decreased sleep quality.²  The higher your BMI, the higher your risk for certain diseases such as heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers.³  These are definitely not any afflictions I want!

One of the great things about living in this day and age is that we have so much more access to helpful resources to give us good food and nutrition tips, healthy ideas, and recipes.  I have compiled and reviewed some sites listed below that you might find helpful to investigate. At the very least you can find some healthy recipes for the family and work week!

1) http://www.katheats.com/.* A mom, dietician, bakery owner and self professed food lover and registered food blogger, there are no shortage of topics and recipes here.

2)http://www.eatingwell.com/. *Diet, nutrition health, and menus all under one roof.  The web version of the magazine. Has helpful newsletters, videos, and easy ways to give feedback.

3)http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Recipes/Recipes_UCM_001184_SubHomePage.jsp. * A site promoted by the American Heart Association, recipes cater to AHA guidelines, and there are detailed nutrition facts for each recipe.

References

1. Smith P., Fritschi, L., Reid, A., & Mustard, C. (2013). The relationship  between shift work and body mass index among canadian nurses. Applied Nursing Research, 26(1), 24-31. Retrieved from http://www.appliednursingresearch.org/article/S0897-1897(12)000730/fulltext 

2. Huth, J., Eliades, A., Handwork, C., Englehart, J.L., & Messenger, J. (2013). Shift worked, quality of sleep, and body mass index in pediatric nurses. Journal of Pediatric Nursing. doi:10.1016/j.pedn.2013.02.032.  [Epub ahead of print]

3. National Institutes of Health. (2013). Assessing your weight and health risk. Retrieved from http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm

*I am not affiliated with any of the listed recipe sites.

Welcome to EEONS!

Being a nurse... what does that mean to you? No doubt it can be rough, but at the same time, so rewarding. Your day is not average. You are on your feet all day. You use your brainpower every second. You are your patient's caregiver, advocate, and confidant.  You are the liaison between doctors, CNAs, and the interdisciplinary team. You change, save and influence lives.

You are AWESOME!

We don't get told that enough. Society likes to focus on the negative. Your workplace can at times be hostile and unforgiving. This blog is not a place for that.

I wanted to create a space where nurses and those who are in, have been in, or who are interested in the nursing field, can come to feel encouraged and empowered.  Where you can find a spot to share your dreams and goals.  Where you can come to be uplifted from being let down. Where you can learn new things; whether it is for your work, home, family or health.

Here it is.  Thank you for coming along this journey with me and I appreciate all feedback and comments.