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2 Minute EBP Challenge

Monday, February 08, 2010
Post-op Care for Pituitary Tumor
Your patient Mr. Lett has had a transsphenoidal resection of a pituitary tumor.  As his nurse, an important nursing assessment to make is:

Monday, February 01, 2010
You are a leader
As a staff nurse, you are a leader; you lead your peers, you lead your patients, you lead your institution, and you lead society. So, the question isn't whether or not you are going to be a leader, it is simply whether you are going to be a good one!

Monday, January 25, 2010
Heparin-induced Thrombocytopenia
Thrombocytopenias are a collection of conditions that cause the platelet count to decrease.  There are many ways that platelets can become activated and depleted in the clotting process.  The most common reasons for drops in platelet counts are depletion from pre-existing conditions such as sepsis, trauma, or surgery.  Approximately 5% of patients that receive heparin will develop an immune response that activates platelets causing life-threatening clotting and occasional bleeding.  This condition is called heparin-induced thrombocytopenia.

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Home > 2 Minute EBP Challenge > BNP and Respiratory Distress

BNP and Respiratory Distress

Monday, November 16, 2009

Stay up-to-date the easy way!

How would you answer this question?

Ms. Leslie has a Brain-Natiuretic Peptide (BNP) level of 1273 picograms/mL, as her nurse you should suspect:

a. Acute ischemic stroke
b. Acute renal failure
c. Heart failure
d. Hip fracture

The correct answer is "c" heart failure.

Brain-Natiuretic Peptide (BNP) is a protein produced by the heart in response to stretching of the ventricular wall.  Through a variety of mechanisms, BNP improves cardiac function by decreasing fluid overload on the heart.  The level of BNP measured in the blood can alert nurses to the extent of heart failure that exists.  Elevated BNP levels can also help nurses to differentiate between cardiac and noncardiac conditions that cause respiratory distress such as COPD and pulmonary edema.

For most patients a BNP level of >100 pg/mL is considered to be elevated and indicative of acute heart failure.  However, a study by Rogers, et al. recommended using the following cutoff levels in specific patient populations:
>184 pg/mL in patients >75 years of age
>150 pg/mL in patients with atrial fibrillation
>449 pg/mL in patients with an elevated creatinine (>2 mg/dL)
>25 pg/mL in obese patients with a BMI >35 kg/m2

In the question above Ms. Leslie has a BNP level of 1273 which is clearly elevated and would indicate heart failure.  This information would be useful if Ms. Leslie had a complicated symptom presentation, such as what often occurs in patients with multiple cardiac and pulmonary medical conditions.

From: Rogers, R.K., et al. (2009). Usefulness of adjusting for clinical covariates to improve the ability of B-type natiuretic peptide to distinguish cardiac from noncardiac dyspnea.  Am. J Cardiol, 104:689.

Congratulations to Patricia Mullins who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Patricia!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

Today's question comes from our brand new PCCN Success program.

(c) 2009 Ed4Nurses, Inc.  Feel free to print this e-mail and share it with your colleagues. Other forms of digital or print reproduction are prohibited without prior written consent from Ed4Nurses, Inc.
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