Nursing Administration of Oxygen Therapy - Essay Example

Independent Study - Nursing Administration of Oxygen Therapy is Vital in the Early Preventions following a Myocardial Infarction - Instructor’s Name Subject / Course Date Table of Contents I. Introduction ............................................................................. 3 II. Rationale for Choosing Myocardial Infarction ............................ 4 III. The Relevance of Myocardial Infarction to Cardiology Wards ..... 5 IV. Literature Research .................................................................. 5 a. General Information about Myocardial Infarction ........ 5 b. The Negative Impact of Having Myocardial Infarction .. 7 c. Importance of Early Intervention on Myocardial Infarction Attack ............................................. 8 d. Impact of Administration of Oxygen Therapy on Patients w/ Myocardial Infarction ...................................... 9 d.1 Critics of Oxygen Therapy Administration on Patients with Myocardial Infarction ........................... 11 V. Strengths and Limitations of Current Practice of Cardiology ......... 12 VI. Recommendations for Practice Development of Cardiology ......... 14 VII. Conclusion ................................................................................. 14 References ........................................................................................... 15 - 19 Introduction Cardiovascular Disease (CVD) such as myocardial infarction constitutes the primary cause of death worldwide. According to the World Health Organization (WHO), approximately 16.7 million people die annually (WHO, 2007); roughly more than 216,000 of deaths occur in the United Kingdom (British Heart Foundation, 2006 Edition); 4.35 million deaths in Europe and more than 1.9 million deaths in EU (Petersen, Peto and Rayner, 2005 Edition). Considering that roughly half of these individuals will die, with as much as 60 to 70 percent of deaths occurring before the individual reaches the medical care system, the incidence of sudden death and deaths that occur before these individuals could receive medical supervision constitutes the major challenge to the present system of cardiovascular care. (Harken, 2004; Wenger, 2004) In the United Kingdom alone, roughly 20 million local citizens survive from heart attacks and stroke each year who requires a continuous clinical care. (WHO, 2007) Considering that those individuals who have had heart attacks and strokes are at high risk of repeated attacks including death, it is essential for health care and clinical nurses particularly those who are working in a cardiology ward to learn more about the importance of proper administration of oxygen therapy immediately after a myocarial infarction attack. Aiming to enable the readers understand more about the topic, the researcher will discuss about the rationale for choosing the topic particularly the relevance of administering oxygen therapy with myocardial infarction as well as with working in a cardiology ward. Eventually, a literature review will be conducted focusing on the general information about myocardial infarction including the major causes of myocardial infarction; the negative impact of having myocardial infarction; the importance of early intervention on myocardial infarction attack; as well as the impact of oxygen therapy administration to patients with myocardial infarction. Based on the gathered literature study, the strengths and limitations of the current practice including some recommendations for the practice development will be thoroughly discussed. At the end of the study, the researcher will conclude whether it is advisable for cardiology nurses to administer oxygen therapy as an early prevention following a myocardial infarction attack. Rationale for Choosing Myocardial Infarction According to Dr. Richard Lippman, a renowned researcher, “oxygen deprivation is the major cause of heart attacks among 1.5 million people each year.” (OxyGenesis Institute, 2007) Oxygen, one of the most important elements and nutrients of all life, is delivered to the human cells by the blood. Considering that the coronary arteries or blood vessels of individuals with myocardial infarction narrows, the blood supply that flows through the arteries or the blood vessels is being restricted to flow smoothly throughout the heart tissue. (NHS, 2007) Particularly the heart muscle of the patients who has undergone myocardial infarction dies due to oxygen starvation or hypoxia. (NHS, 2007; Rosenthal and Tsao, 2001) In the absence of an artificial administration of oxygen therapy, it is possible for the patients heart to die permanently including the rest of the nerves, glands, internal body organs and tissues such as the brain, eyes (Butler et al., 2005), liver, lungs, etc. (Woerlee, 2003) The Relevance of Myocardial Infarction to Cardiology Wards Cardiology wards are exclusively established to support the health care needs and treatment of patients with heart diseases. Considering that myocardial infarction is one of the most serious heart diseases, it is the job of the nurses to conduct an intensive evidence-based research in order to determine whether it is advisable for the registered cardiology nurses to administer oxygen therapy as an early prevention following a myocardial infarction attack Literature Review General Information about Myocardial Infarction The human heart is considered as one of the most important organ of the human anatomy since it serves as a transport vehicle that carries oxygen, nutrients, call wastes, hormones, and a lot of other substances which are essential in the body’s homeostasis to and from the cells. (Marieb, 2004: p. 328) Each pump of the heart is basically supported by a high rate of myocardial consumption of oxygen, flow of blood, and the combustion of carbohydrates and fat which are essential in the production of adenosine triphosphate (ATP). (Stanley, 2001) In the absence of sufficient oxygen in the heart, the tissue in three zones known as infarction, injury, and ischemia, changes which can be traced with medical equipment such as the electrocardiogram (ECG). (Swedberg et al., 2005; Marieb, 2004: p.335) In general, the heart walls are composed with three important layers known as the outer epicardium, the myocardium, and the inner most endocardium. (Marieb, 2004: p. 329) In the case of a myocardial infarction, the heart beats at a very fast rate making the myocardium unable to receive sufficient blood supply because of the shortened relaxation periods wherein the blood flows to the heart tissue. (Marieb, 2004: p. 334) In the process, it is possible for the ischemic heart cells to die in case of a prolonged absence of oxygen supply. Weisfeldt and Zieman (2007) defined myocardial infarction as irreversible cell death in the myocardial tissue that has been caused by a long-term ischemia. This ischemia is a direct result of an occlusion in the vessels supplying the heart. If prolonged, necrosis in the myocardium causes the contractile functioning of the ventricles which causes the malfunctioning of the heart. The heart failure itself decreases the cardiac output that may cause a long-term damage to the human body organ and a possible death. (Redfern et al., 2007; Weisfeldt and Zieman, 2007; Buckley, 2006; Cobb, Brown, and Davis, 2006; Ehlke and Greenwood, 2006; Tough, 2005) Either blood clot or the presence of atheroma could block the large blood vessels from carrying the oxygen-rich blood to flow in the heart. (NICE, 2002) Research studies have shown that the underlying cause of such phenomenon is a gradual clogging of the arteries. (Hamilton, 2007; Wrigley and Pakrashi, 2004) In the process of clogging, it is possible for the fibrin strands found in the heart to create a mesh causing the blood components to form the clot. Pocock and Richards (2004) noted that the formation of a fibrin clot can either develop on the intrinsic pathways whereby the blood comes into direct contact with the injured vessel wall or the extrinsic pathways when the blood is exposed to damaged tissues like the wall of a traumatised vessel. Sometimes, the build up of atheroma or abnormal plaque causes atherosclerosis; which is considered to be the leading causal factor in all cardiovascular diseases. (Hamilton, 2007; Haslam, 2006; Tough, 2005; Goldstone and Davidson, 2004; Wrigley and Pakrashi, 2004) In rare cases, it is possible for the atheroma to rupture as a result of inflammation, flexion, or tension of the fibrous cap that causes the plaque to undergo the process of thinning or simply due to the stress that is caused by the flow of blood. (McCance and Huether, 2005) The Negative Impact of Having Myocardial Infarction When patients and individuals suffer from a myocardial infarction, it generally means that they are suffering from oxygen deprivation. In the process, sensitive body tissues and organs especially the brain and the eyes is highly affected. (Woerlee, 2003) Since the oxygen consumption in the human eyes or the retina is much higher than the normal consumption of oxygen in the brain, the first organ that is affected by oxygen deprivation are the human eyes. (Butler et al., 2005) In most cases, oxygen starvation may cause a single part of the brain to fail from its normal function. Since the brain stem which is responsible for the human consciousness is the most resistant to oxygen deprivation, it more likely for the patients to lose their vision first before losing their consciousness. Basically, a prolonged extreme hypoxaemia that has not been treated with oxygen therapy may lead to a severe brain damage and/or a cardiac arrest. (Strachan and Noble, 2001) For this reason, the patients’ cognitive and other brain functioning can be highly affected in the long-run. Importance of Early Intervention on Myocardial Infarction Attack Early intervention on myocardial infarction attack is crucial since allowing the patient to remain untreated for more than 20 minutes could lead to an irreversible myocardial cell damage as well as cell death. (DeWood, Stifter and Simpson, 2005) Newby and Fox (2001) noted that the most critical part of managing a myocardial infarction attack is the first 48 hours. Right after the patient has been admitted to the hospital, a quick diagnosis should be made based on the patients’ historical records as well as ECG. A proper monitoring and treatment should be provided after the assessment process. In case the patient is experiencing some pain. Gershlick (2001) stated that it is a standard operating procedure to immediately relieve the pain using intravenous opiate1. Considering that opiate analgesia (Newby and Fox, 2001) could induce vomitting, cyclazine (50 mg i.v) or metoclopramide (10 mg i.v.) should be administered including diamorphine (2.5 – 5 mg). The author also noted that oxygen administration as well as the process of obtaining a venous access are part of the important early intervention. (Newby and Fox, 2001; Gershlick, 2001; Strachan and Noble, 2001) In the process of early intervention, the use of available defibrillators and thrombolysis (NICE, 2002) are two of the most common for a patient with myocardial infarction. It is essential for health care providers not to disregard the patients’ chest pain especially those patients who has experienced angina in the past. In fact, Gershlick (2001) highlighted the importance of providing an immediate triage to patients who are experiencing chest pain. Considering that the heart muscle cells will become irreversible within the first 45 minutes of the ischaemia, it is critical for health care practitioners to provide the patients with an early intervention. (Reimer, Lowe, and Ramussen, 2001) NICE, a part of the NHS that is responsible in the provision of the national guidance on treatments and care throughout England and Wales, highly recommends that patients with thrombolysis due to an acute myocardial infarction should immediately be given thrombolysis as soon as the patient is admitted to a local hospital. (NICE, 2002) In line with the immediate pharmacological treatment, physicians must consider the benefits and risks of thrombolytic drugs such as alteplase, reteplase, streptokinanse, or tenacteplase on the patients’ health condition. In case the admitted patient has a record of being treated with streptokinase in the past, the physician should not administer the same drug to the patient again. According to Newby and Fox (2001), the provision of early intervention could prevent the thrombotic vessel occlusion in order to enable and enhance the flow of blood in the heart. Other common pharmacological and non-pharmacological treatments used in treating patients with myocardial infarction includes the use of β-blocker, aspirin, calcium channel blockers, nitrates (Lundberg and Weitzberg, 2005), magnesium, potassium channel openers, prophylactic anti-arrhythmic agents, and intra-aortic balloon pump. (Newby and Fox, 2001; Gershlick, 2001) Impact of Administration of Oxygen Therapy on Patients w/ Myocardial Infarction Newby and Fox (2001), Gershlick (2001), and Strachan and Noble (2001) highlighted that oxygen administration such as hyperbaric oxygen (HBO) therapy (Yildiz et al., 2004) is considered as an important part of early intervention right after administration of thrombosis drugs to the patient in order to unclog the block. (NICE, 2002) Particularly the HBO therapy enables the patient to breath a 100% oxygen via an endotracheal tube, a mask or a hood that is attached to a pressure chamber at 1 atmosphere absolute (ATA). Specifically the increased concentration of oxygen supply and the pressure coming from the HBO increases the overal oxygenation in the patient’s body. Yildiz et al. (2004) stated that the presence of ischaemia causes the concentration of adenosine triphosphate (ATP) to decrease while it increases the concentration of the lactic acid. What HBO therapy does is that is lowers the concentration of the lactic acid and helps maintain the ATP level in order to prevent the damaging the ischaemic tissue. The author also noted that the use of the HBO therapy stimulates the red granulation tissue production which consist of the development of new blood vessels. (Yildiz et al., 2004) Another important contribution of HBO therapy is the fact that is increases the vascular endothelial growth factor (VEGF) which could stimulate the angiogenesis. (Sheik et al., 2000) There is no specific rule that states the amount of oxygen a patient should receive. Strachan and Noble (2001) stated that only 25% of the normal 1000 mls/minute of oxygen that is transported from the lungs to the whole body circulation can be utilized when a person is at rest. As long as the patients’ oxygen saturation level exceeds 90% of oxygen found in air, it is safe to remove the supply of oxygen therapy from the patient. Basically, an insufficient supply of oxygen can do more harm to the human body as compared to having too much oxygen. In some cases, the specific health condition of the patients can be affected by the amount of oxygen the patient receives, health care practitioners such as the cardiology wards should strictly monitor the oxygen therapy including the period when it has been prescribed to each patient. With regards to the amount of oxygen a patient should receive, Dodd et al. (2001) strongly suggest the use of a specific oxygen prescription chart as part of the standard provision of care. In line with administrating oxygen therapy to patients with myocardial infarction, the guidelines published by the national and international societies (Swedberg, et al., 2005) strongly suggest and encourage the physicians and nurses should strictly go through and prescribe the evidence-based therapies as part of rendering a standard of care for the patients. (Squire, 2005) Critics of Oxygen Therapy Administration on Patients with Myocardial Infarction Despite all the positive evidence-based study conducted in the past with regards to the administration of oxygen therapy conducted in the past, the NHS and the Department of Health has noted that the “cardiac ward based staff should be able to understand the potential hazards involve with the use of oxygen therapy.” (NHS and DOH, 2006: 30) Aside from the NHS and DOH statement, a recent news report written by Andrew Sansom (2007) stated that “Cardiologists need to be placed on alert such that the use of oxygen therapy in treatment could harm the patients with heart-attack.” Richard Beasley et al. (2007) argued the same issue in the essay the authors wrote for the Journal of the Royal Society of Medicine entitled “Oxygen Therapy in Myocardial Infarction: An Historical Perspective.” According to Beasley et al. (2007), most of the research studies related to myocardial infarction and other heart diseases conducted between 1980s to 1990s are focused on “pharmacological agents like thrombolysis, aspirin, heparin, β – blockade, calcium antagonists, angiotensin-converting enzyme inhibitors, nitrates and magnisium.” In the essay journal written by Beaslery et al. (2007), the authors noted that a very few research studies have been conducted with regards to the impact of administering high flow of oxygen to patients with heart diseases. (Haque et al., 2007; Reinhart et al., 2007; McNulty, King, and Scott, 2005) Eventhough Oxygen purifies the blood stream; the research study of Haque et al. (2007) concluded that a high flow of oxygen being administered to a patient with congenital heart disease could disrupt the overall cardiac functioning. The study conducted by Reinhart et al. (2007) stated that infusing a very high flow of oxygen to a critically ill patient does not show a good benefit since it could only minimize the oxygen uptake in the patient’s body. Another study conducted by McNulty, King, and Scott (2005) presented a very good evidence showing that administering a high flow of oxygen to a patient with ischarmic heart disease due to myocardial infarction could result to a lesser coronary blood flow through the arteries. With regards to the essay journal written by Beaslery et al. (2007), the British Heart Foundation (BHF) suggested that we should still use the current practice of administering high-flow of oxygen therapy to patients with heart attack since there is still no current evidence-based research study conducted to prove that such action could harm the patients with heart diseases more than saving the patients’ lives. (Randerson, 2007; Sansom, 2007) Strengths and Limitations of Current Practice in Cardiology Considering the current clinical practice with regards to cardiology, a lot of evidence-based studies in the past has been conducted focusing on the pharmaceutical therapy that are essential as part of the early intervention for a myocardial infarction attack. (Lundberg and Weitzberg, 2005; Newby and Fox, 2001; Gershlick, 2001; Strachan and Noble, 2001) The numerous evidence-based research studies enables the national cardiology in England and Wales to strenthen its effectiveness and efficiency in saving the lives of the patients who are suffering from heart diseases especially a myocardial infarction. In fact Cathy Ross, a cardiac nurse at BHF, stated that “the rate of heart-attack deaths have decreased up to 44% since the last decade.” (Sansom, 2007) However, the evidence-based research studies on the impact of oxygen therapy administration to patients with heart diseases is still very limited. (Beasley et al., 2007; Sansom, 2007) Considering the statement of the NHS and DOH as well as the arguments of Richard Beasley et al. (2007), it is the job of the health care practitioners to consider such strong statement since the lives of the patients partly depends on the hands of the health care practitioners. Recommendations for Practice Development of Cardiology Even though the deaths related to heart attack have gradually decreased over the past decade, the researcher highly recommends that qualified cardiologists should consider conducting more evidence-based research studies with regards to the impact of oxygen therapy administration. This is the best and only way to remove the fear of the people concerning the possible harm that a flow of oxygen therapy could harm the physical health condition of the patients. Conclusion The most critical part of managing patients who has gone through a myocardial infarction attack is the first 48 hours. The early intervention on patients with myocardial infarction attack is crucial since failure to administer the right pharmaceutical drugs and oxygen therapy may lead to irreversible heart damage or a possible death. In the past, several evidence-based studies show the importance of such intervention on reviving the patients from oxygen deprivation. However, there are also several reports stating the possible harm that can be caused by the use of oxygen therapy. For this reason, conducting several evidence-based research studies regarding the impact of oxygen therapy to the physical health of patients with heart diseases in the near future is highly recommended. 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