ECG Interpretation of the Post Anaesthetic Patient - Essay Example

Reflective Clinical Practice in ECG Interpretation of the Post Anaesthetic Patient Monitoring of patients who have experienced a postoperative or preoperative cardiac event is critical as it enables the nurse to respond to any abnormalities that the patient may display. In doing so, the nurse displays high standards of patient care and professional competence in a PACU setting. In my department, the PACU uses an ECG to monitor and measure the electrical activity of the heart. 12-leads are used to provide a comprehensive view of the electrical activity of the heart. Monitoring of these values enables the nurse to respond to any abnormalities that may be revealed. These abnormal values in electrical activity of the heart represent certain abnormalities on the heart that may require rapid intervention. This paper intends to utilize John’s model of reflection to provide a critical reflection of my learning experience in clinical practice in ECG interpretation of the post anaesthetic patient. For purposes of developing my clinical practice, I got an opportunity to work at stage two PACU. At the beginning of my clinical practice experience, my main objective was to learn how to interpret the ECG. Other objectives that I had include developing the skills and competency required in order to recognize an abnormal ECG, and developing competency in observing and monitoring the cardiac activity of a patient during recovery. According to ACORN (N6, 2011), a PARU nurse is expected to specialize in the clinical management and assessment of patients who are in the PARU. The PARU nurse is expected to conduct clinical monitoring and observation of the patients in PARU. The nurse must be fully aware of any clinical limitations and seek advice accordingly. The nurse must monitor, interpret and have the ability to respond to a patient’s clinical needs. It is important also that the PARU nurse optimizes the utilization of all available technologies in an effort to optimize the outcomes of the patient under their care. Among PARU patients, it is common for complications arising from coexisting diseases or anaesthesia surgery to occur. The PARU nurse is therefore expected to demonstrate vigilance in assessing and managing of patients while in PARU. Based on the patient’s history and or condition, it may be necessary to monitor the patient’s cardiac activity. ACORN (N6, 2011) statement 9 requires that nurses be working towards achieving knowledge on basic cardiac rhythm and arrhythmias that are life threatening. While working at PACU, I got an opportunity to gain relevant clinical practice experience with regard to the duties and responsibilities of the PACU nurse. I got an opportunity to monitor and observe one of the patients who was recovering in PACU after surgery. The patient was an 83-year-old female who had been admitted to the right cataract surgery. The patient had a medical history of AF, HTN, GORD, CCF, lung cancer and mild cognitive impairment. The patient had a permanent pacemaker inserted in her. The patient’s medication included Cardizem, Coumadin, Durogesic, Hydrea, Lasix, Movical, Nexium, Panadol Osteo and Oste Vit-D. The patient was allergic to Augmentin, Digoxin, Hiprex, Metopropl, Norspan, Oxycontin, Phenergan. The patient’s heart rate was 127 and other important values included QRDS 81, QT 338, QTcB 492, QTcF 434, and QRS 49. With regard to the patient’s observation and monitoring, I observed the patient and took the vitals. I was delighted that I was proficient when it comes to monitoring and obtaining patient vitals. More importantly, I obtained the patient’s ECG and discussed with my facilitator the accuracy and significance of the ECG reading. The patient had given me the consent to obtain her information. On discussing with my facilitator the reading, I was delighted to be informed that my reading was accurate. Apart from obtaining the ECG reading accurately, my interpretation was also correct according to my facilitator. As a result of the reading that I had taken, we were able to determine the status of the patient’s cardiac activity. Consequently, the patient’s state had been ascertained and therefore his health status guaranteed. This is because had the ECG that I took revealed abnormal activity, it would have been possible to take quick and timely action in order to safeguard the patient’s health. Taking the ECG reading and interpreting it correctly not only boosted my self esteem and confidence, but demonstrated my increasing knowledge and competence when it comes to obtaining and interpreting ECG. Although I was not confident while obtaining the ECG reading and interpreting it, I was glad that I had done it correctly. The ACORN requires that PACU nurses be able to monitor a patient’s cardiac activity and should be working towards gaining basic knowledge on cardiac rhythm and arrhythmias that are life threatening. My experience in monitoring the cardiac activity of patients is limited. I did not have many chances to practice and perfect my knowledge and skills on ECG reading and interpretation. My facilitator noted that I had gained knowledge and skills necessary to interpret a basic ECG but needed further knowledge and chances to practice reading and interpreting the ECG. I chose to enroll for an online program (CIAP) in order to increase my knowledge and skills in ECG interpretation. While working in the recovery, and on the recommendation of my facilitator, with consent from the patient, I decided to use the 12 lead ECG for the patient both preoperatively and intra-operatively. I compared the readings both preoperatively and intra-operatively and discussed with my facilitator in an effort to review my progress. I was happy to realize that, based on my facilitator’s assessment, my competency to read and interpret the ECG was improving and getting better. I believe that the online (CIAP) course would greatly enhance my knowledge and skills with regard to ECG interpretation and abnormal ECG detection, and most importantly enable me to meet the ACORN standards as expected of a PACU nurse. While undergoing my clinical practice, I encountered certain barriers. Based on my facilitator’s advice, it was prudent that I enroll for an ECG interpretation course in order to increase my knowledge and skills with regard to interpreting ECG. I had enrolled for a three day course but failed to secure study leave that would allow me to attend the course. This proved to be a major setback to my plan. I later opted to enroll for an online course that was flexible. I also had an intention of accessing as many opportunities to practice my ECG interpretation as possible, but that was difficult because I had to stick to recovery because of works force shortage in recovery. In recovery, there were hardly any patients who were in need of cardiac activity monitoring. My decision to enroll for an online ECG course and practicing on the patient (with her consent) enabled me to gain essential knowledge and skills on ECG reading and interpretation. While carrying out my duties, I had to rely on my facilitator for guidance and decision making. While at work, we only monitored the heart of those patients whom we suspected had experienced a preoperative or postoperative cardiac event. I have been negotiating with my facilitator/ educator on learning how to interpret the ECG. I intended to learn how to interpret the ECG by applying for a course that would teach me how to interpret the ECG as well as practicing on how to read the ECG by working on a patient who had experienced a postoperative cardiac event. I, however, was unable to take the three day study leave in order to purse the ECG course. I was left with two options to take the flexible ECG interpretation course or take the CIAP online interactive ECG course. I took the CIAP online ECG course and spent my own personal time to learn the ECG interpretation for half an hour every Thursday and Monday. At the hospital I was scheduled to work in the recovery for a single day for a period of 4 weeks. I decided to use the 12 lead ECG on the patient preoperatively and postoperatively. I was not able to use the ECG postoperatively because there was no need to monitor the patient’s heart postoperatively. I, therefore, compared the patient’s readings preoperatively and postoperatively and learnt how to interpret them. I used to interpret the ECG readings with the facilitator and reviewed my progress on ECG interpretation. I had also to get consent from the patient and abide by the hospitals ethics and code of conduct while making decisions. My facilitator played a primary role in guiding my actions and in the making of decisions. I believe that my actions were reasonable and my choices were good. Other barriers that I faced include the rostering process while I was attending PACU and inability to secure the study leave that I needed in order to attend the ECG interpretation course. While in PACU for the four days, I did not have a chance to experience a patient who had a cardiac problem. After working in PACU, I believe that I have gained essential knowledge and skills in the interpretation of ECG. I feel confident that I will be working within the PACU having met the requirements of ACORN. This experience has broadened my clinical practice understanding in PACU and equipped me with knowledge and skills that will have far reaching benefits. I also believe that the course will refresh and improve my ECG knowledge as well as practice in PACU. Works Cited “Standards.”acorn.org. ACORN.n.d. web. 14 April 2012. Read More