Inspired Nurses Calendar 2017: Meant to be a Nurse

Lippincott is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. Here is July's nurse story, “Meant to be a Nurse.” 
Meant to be a Nurse
Adriana Pirez, BSN, RN
Saint Luke's Cornwall Hospital, Medical/Surgical Unit
July-2017.pngAll my life I've wanted to be a nurse. The inspiration was in my family, as my aunt Mercedes was the nurse coordinator for a private hospital in my native country of Uruguay. She married a doctor and one of their sons became a doctor too.

On Sunday's when we would gather at grandma's house, as a little girl, I remember hearing conversations about new drugs in the market to fight illnesses, and many stories my cousin would tell about his experiences as a new doctor doing an internship in a local hospital ED. I was mesmerized by their stories, their intelligence and mostly for their love and dedication to their professions. It took me a long time as a woman, a mother, and a wife, in my forties to realize that that dream of being a vocational nurse could be possible here in the U.S. So, after working for years in different hospitals as a unit secretary and a registrar for the Emergency Department, I enrolled in a nursing program at my local community college.

Finally, after so many struggles, lack of support and discrimination from some professors for me speaking with an accent and being different, I maintained a positive attitude, and transferred to a new nursing program in a prestigious Christian College in Rockland County, NY. In 2013, I graduated with honors. It wasn’t always easy, but I would do it all over again – nine years, three colleges and a huge debt in student loans.
Today, I work in my local hospital, the one where the nurses in that ED inspired me even more. I love the smiles on my patients when they see me coming on my second day of my shifts. Their smiles and their trust in my care is the greatest support I can get, knowing that nursing is in my heart and in my Christian soul, and that I was truly meant to be a nurse.

To see all 2016-2017 stories or to share an inspiring story of your own about being a nurse, or how you were inspired by another, and enter to win prizes, visit  Be sure to check our blog every month for a new inspired nurse’s story.


Posted: 7/29/2017 6:01:23 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Inspiration

Preparing nurse leaders: An interview with F. Patrick Robinson, PhD, RN, FAAN [Podcast]

Robinson_formal_body-jpg_small.jpgLast week, I had the pleasure of speaking with Dr. Patrick Robinson, the Dean of the School of Nursing and Health Sciences at Capella University. Dr. Robinson has a wealth of experiences and achievements in academia and nursing leadership, as well as clinical expertise caring for HIV/AIDS patients. We spoke about his journey in nursing, along with the work being done at Capella University and the Nurses on Boards Coalition to prepare nurses to be leaders in health care.

Some highlights from our conversation include words of wisdom from Dr. Robinson’s own mentor, Joan Shaver, PhD, RN, FAAN, Dean of the School of Nursing at the University of Arizona. In fact, when presented with a problem or challenge, Dr. Robinson often asks himself, “What would Joan do?” Here are three takeaways from this advice:
  1. Don’t be afraid of resistance.
  2. Let people grow naturally.
  3. People have a spectrum for tolerance for change.
You’ll also be inspired by Dr. Robinson’s advice for ‘creating your leadership playbook’ and pursuing lifelong learning. Here are the three foundational ‘plays’ in his own playbook:
  1. People and their growth matter.
  2. If you’re going to be there, be present; and realize that you’ll need to be somewhat selective in what you take on. 
  3. Ego will be one of your greatest assets and one of your greatest liabilities – pay attention to it!
Take some time to listen to our full conversation here.


Thank you, Dr. Robinson for this inspiring conversation and for the important work that you do!
About Dr. Robinson:
F. Patrick Robinson, PhD, RN, FAAN is currently Dean of the School of Nursing and Health Sciences at Capella University. He obtained his bachelors and masters in nursing from Indiana University and holds a PhD in Nursing Science from Loyola University Chicago.   He completed a post-doctoral fellowship in biobehavioral nursing research at the University of Illinois at Chicago.  Prior, he served as Senior Vice President of Academics for Orbis Education, Dean of Curriculum and Instruction at Chamberlain College of Nursing, Executive Assistant Dean of the University of Illinois at Chicago College of Nursing and Chair of the Department of Health Management and Risk Reduction at the Niehoff School of Nursing at Loyola University Chicago.  

Prior to his academic career, Dr. Robinson held positions as an HIV/AIDS case manager, HIV/AIDS clinical nurse specialist, director of a HIV/AIDS specialty clinic and dedicated HIV/AIDS inpatient unit.  Dr. Robinson has a distinguished record of service to the HIV/AIDS care community and served as President of the national Association of Nurses in AIDS Care and as an officer of the HIV/AIDS Nursing Certification Board.  He maintains certification as an AIDS nurse (ACRN) from the HIV/AIDS Nursing Certification Board and is a Certified Nurse Educator (CNE) through the National League for Nursing.  In 2006, he was named distinguished alumnus of Indiana University School of Nursing and was awarded the Frank Lamendola Memorial Award for exemplary leadership in HIV/AIDS care. Also in 2006, the American Association of Colleges of Nurses named him an Academic Nursing Leadership Fellow.  In 2008, he was honored by the Illinois Board of Higher Education and the University of Illinois Council on Excellence in Teaching and Learning for distinguished achievement in teaching. In 2010, he was awarded the Life Time Achievement Award from the Association of Nurses in AIDS Care for sustained contributions to the field of HIV nursing. DeVry, Inc. named Dr. Robinson the inaugural recipient of the Doing Well By Doing Good award in 2011 in recognition for his contributions to community service. In 2014, Indiana University School of Nursing honored him as part of its centennial anniversary as one of the top 100 Alumni Legacy Leaders.  Previously, he served as executive vice chair of the board of directors of Howard Brown Health Center, one of the nation’s premier LGBT health centers. Dr. Robinson is a fellow of the American Academy of nursing (FAAN) and currently serves on the advisory council for the National League for Nursing Foundation.


Posted: 7/26/2017 11:34:00 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Leadership

Summer Reading for Nurses

summer-reading-for-nurses.pngSummer is a great time to catch up on reading - the days are longer, some of us take some time off from work, and things seem to slow down a bit. If you're like me, you've got a list of reading recommendations from friends and colleagues that you've been planning to read "someday." Well, as I prepare for a little beach time, I'm organizing and prioritizing my reading list. Have you read any of these titles? Or are any on your to-read list? 

For students and new nurses transitioning to practice...

Anatomy of a Super Nurse: The Ultimate Guide to Becoming Nursey
Kati Kleber, BSN, RN, CCRN
This is a revised version of Becoming Nursey: From Code Blues to Code Browns, How to Care for Your Patients and Yourself, which I’ve read several times. I look forward to catching up on the new additions that Kleber added to this must-read for students and new nurses. 

Intensive Care; The Story of a Nurse
Echo Heron
As a new RN in the ICU, I can remember reading this book and its sequel, Condition Critical; The Story of a Nurse Continues, many times! These true stories that are recounted in this book shed a light on what is happening every day in the lives of nurses and the patients we care for. 

For inspiration...

Reflections on Nursing
American Journal of Nursing
These personal accounts from actual nurses are inspiring and demonstrate the true work that nurses do every day. Reading these stories will help you remember why you became a nurse. 

Nightingale's Vision: Advancing the Nursing Profession Beyond 2020
Sue Johnson, PhD, RN, NE-BC
Just released, this book features a look at the status of each recommendation from the 2010 Institute of Medicine (IOM) Future of Nursing report. As “an essential reference to guide nurses in the advancement of their profession in the next decade and beyond,” it sounds like a must-read for all of us. 


Strictly for pleasure...

My Sister’s Keeper
Jodi Picoult
This one is recommended by a nurse friend, and while I remember being interested when this movie was released, I never did see it. Picoult is the author of 28 novels, and I am planning on picking up this one, and maybe a few others, soon.

Firefly Lane
Kristin Hannah
This is my favorite book and I’ve read it several times – and I will be bringing it along on my vacation again! A tale of friendship – and its ups and downs – that may remind you of some relationships in your own life. There is a sequel, Fly Away, that you’ll want to check out too!

What other books do you recommend? 
Posted: 7/23/2017 11:44:02 PM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Inspiration

Zika in 2017

The majority of healthcare providers in the United States (US) first became familiar with Zika virus in early 2016 when it gained national attention following a large Zika virus outbreak in Brazil in 2015. With this outbreak, a concurrent increase in rates of microcephaly and ocular abnormalities in newborns was observed, suggesting an association between the two (Martines, 2016). Subsequent, retrospective analysis of a Zika outbreak in French Polynesia in 2013-2014 further supported the association between Zika virus infection and neurologic birth defects in newborns (Martines, 2016). The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) first issued public health alerts in January 2016 and February 2016 to increase public awareness, mobilize resources, and expand knowledge of Zika virus. A priority of these efforts was preventing infection in pregnant women and women of reproductive age to avoid birth defects resulting from transmission of Zika virus to the fetus.

Since the initial public health alert, the CDC has provided extensive guidance and resources for healthcare providers based on current knowledge of Zika virus. Although the virus can be asymptomatic in adults, we know that it can cause significant morbidity and mortality to a fetus when contracted in utero, most significantly microcephaly and fetal demise.

Since the initial advisories of 2016, scientists and healthcare professionals have gained a better understanding of both transmission and the pathophysiologic effects of the virus. The CDC has an extensive system of surveillance, and a registry to monitor cases in the US as well as a registry of all pregnant women with Zika virus infection (the US Pregnancy Zika Virus Registry [USPZR]). All serologic testing for Zika virus is monitored through the CDC allowing for accurate and detailed surveillance.

zika-counseling.pngFrom the perspective of the healthcare provider, some of the more significant benefits of the CDC efforts have been the provision of straightforward guidelines for prevention and screening, and anticipatory guidance specific to pregnant women and women of reproductive age. Nurses play a critical role in educating patients and families and can be instrumental in reducing fears by providing patients with the accurate and up-to-date information necessary to remain healthy and reduce the risk of Zika virus infection and spread.

What We Know about Zika virus in 2017 (CDC, 2017):

  • Zika virus is spread primarily through the bite of the Aedes species of mosquito which are known to bite during both day and night.
  • Zika virus can be passed from a pregnant woman to her fetus and is linked to neurologic birth defects, specifically microcephaly.
    • Pregnant women should not travel to geographic regions with risk of Zika.
  • Zika virus can be passed sexually from a person who has Zika virus to his or her sex partners.
    • Pregnant women living with partners who have Zika virus or have traveled to regions with Zika virus should not have sex with their partner, or should use barrier protection/condoms during pregnancy.
    • Women of reproductive age (those reproductive planning and those at risk for unplanned pregnancy) should receive counseling similar to that of pregnant women in respect to risk reduction of Zika infection.
  • During the first week of infection, a person can spread Zika virus by being bitten by a mosquito that subsequently bites another person exposing them to blood containing Zika virus.
  • Most cases of Zika virus are asymptomatic; if symptoms are present, they may include fever, malaise, maculopapular rash, conjunctivitis, headache, and arthralgia.
  • There is no specific treatment or vaccine for Zika virus.
  • There has been mosquito-borne transmission of Zika virus in the continental US; the first confirmed case was August 1, 2016 in Miami, Florida.

Summary of CDC recommendations for the care of the pregnant woman (CDC, 2017): 

Major Recommendations
  • Pregnant women should not travel to areas with risk of Zika infection.
  • Pregnant women should use condoms/barrier protection with any sexual partner that lives in or has traveled to areas with risk of Zika.
Prenatal Care
  • Screen for potential Zika virus exposure at all prenatal visits. Examples of screening tools and testing algorithms can be found on the CDC website.
  • If exposure screening is positive, screen for symptoms (fever, rash, arthralgia or conjunctivitis) and/or fetal abnormalities on ultrasound.
  • Symptomatic women with possible Zika exposure should undergo serologic and/or urine testing for Zika virus.
  • Zika virus testing of asymptomatic women with potential Zika exposure varies based on region of travel.
 Zika virus testing includes:
  • Zika virus nucleic acid testing (NAT) (i.e. RNA) in urine and serum
  • Serum Zika virus and dengue virus immunoglobulin M (IgM)
    • If IgM is positive, equivocal, presumptive or possible, must confirm with serum plaque reduction neutralization test (PRNT) which tests viral specific neutralizing antibodies to Zika.
Management of pregnant women with Zika virus infection
  • Consider serial ultrasound every 3-4 weeks to evaluate for fetal abnormalities
  • Amniocentesis on a case by case basis
Management of pregnant women with potential exposure and no serologic evidence of Zika infection
  • Ultrasound to evaluate for fetal abnormalities.
    • If fetal abnormalities present, consider repeating Zika virus NAT and IgM testing.
    • If no fetal abnormalities, continue routine prenatal care and risk management for Zika virus exposure.
Postnatal recommendations in women with positive or presumptive Zika virus infection during pregnancy
  • Live birth: infant serum and urine testing for Zika virus NAT and Zika/Dengue IgM as well as Zika virus NAT and immune-histochemical (IHC) staining of umbilical cord and placenta; test CSF if available.
  • Fetal losses: Zika virus NAT and IHC staining of fetal tissues.
  • Breastfeeding is recommended. Zika virus has been found in breastmilk but there have not been reports of infection associated with breastfeeding; the benefits are thought to outweigh the theoretical risks of transmission via breast milk.
When a pregnant woman passes the Zika virus to her fetus during pregnancy, it can lead to congenital Zika syndrome (CDC, 2017b). While the full extent of potential health effects from Zika virus is unknown, we know that congenital transmission can lead to brain abnormalities including severe microcephaly, eye abnormalities, congenital contractures (clubfoot or arthrogryposis), hypertonia restricting movement soon after birth and hearing loss (CDC, 2017a, CDC, 2017b). There is guidance from the CDC for healthcare providers on neuroimaging of infants  with congenital Zika syndrome as well as specific guidance for the management of infants with Zika virus infection for the first 12 months, regardless of the presence of birth defects. The CDC is also responsible for the development of Zika Care Connect, which provides a network of referral sources and specialty healthcare services helping to facilitate access to resources for families affected by Zika virus.

Zika virus is a classic example of an emerging infectious disease in the US. The response from the CDC and WHO has been critical in making the public aware of this threat and successfully mobilizing resources to provide healthcare providers with the most current, scientifically-based evidence available. Nurses are often the first clinical contact a patient will have with the healthcare system.  We are in a position to educate and decrease fears associated with Zika virus, which was an unknown threat to most in the US less than 2 years ago. A major focus of education should be prevention, including educating patients on taking measures to prevent being bitten by mosquitos and efforts to reduce risk by informing patients of travel precautions to areas with risk of Zika infection for pregnant women, women of reproductive age and women and their partners trying to conceive. With this, we can contribute in public health efforts to prevent the spread of an emerging virus which poses serious health risks and the potential for catastrophic effects on newborn morbidity and mortality.

Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, (2017a). Zika Virus. Retrieved from: June 2017.
Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, (2017b). Zika, CDC Interim Response Plan, May 2017. Retrieved from:
Martines, Roosecelis Brasil et al. (2016). Pathology of congenital Zika syndrome in Brazil: a case series. The Lancet, 388(10047), 898-904.


Posted: 6/23/2017 11:18:52 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions

Inspired Nurses Calendar 2017: Hair and Hospice

Lippincott is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. Here is June’s nurse story, “Hair and Hospice.” Enjoy!
Hair and Hospice
Marcy Hof, RN
Hilton Head Hospital

hair-and-hospice.pngThirty-two years ago when I was 21, I got my cosmetology license and began working in a salon. My father had been diagnosed with malignant melanoma and went from hospital to hospital for different treatments and a clinical trial. It was at that time that I realized how valuable nurses are to the world, and how many different aspects of nursing there are. When my dad got to the point where he needed hospice care, I was the only one who could lift him or clean him up. He would tell people to go away and let me help them because I was stronger than my mom and sister. It was only after he passed away that I went to nursing school. I have been an RN for 24 years and today my daughter is in nursing school too! My father would have been so proud!! It is a very rewarding, frustrating, sad, and interesting career that I am glad I pursued!
To see all 2016-2017 stories or to share an inspiring story of your own about being a nurse, or how you were inspired by another, and enter to win prizes, visit  Be sure to check our blog every month for a new inspired nurse’s story.


Posted: 6/22/2017 8:02:15 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration

20 Years of Lippincott NursingCenter [Video]

LNC-20th-Ann-logoThis month, we celebrate the 20th anniversary of Lippincott NursingCenter! In June of 1997, the website formerly known as AJNOnline became Lippincott’s This look back at our evolution has been eye-opening [credit to the Internet Archive, Wayback Machine]. As a clinical editor on the NursingCenter team since 2002, there is much that I’d forgotten, as well as some previous features that are now inspiring me with new ideas!

Originally launched in 1993 with grant funding from the Department of Health & Human Services, Division of Nursing, was one of the very first Internet sites devoted exclusively to nursing. The site began as AJNNet, an electronic bulletin board system (BBS) for delivering continuing education to nurses in medically under-served areas. In January 1995, the BBS evolved into a full website called AJNOnline, the first website to deliver full-text nursing journals (including full-text versions of the American Journal of Nursing and The American Journal of Maternal/Child Nursing.)

In June of 1997, the site was renamed Lippincott's NursingCenter with more journals and continuing education offerings than any other nursing site. As more even more nursing resources and references were added, the site was completely redesigned and relaunched several times, always with the goal to be the most comprehensive online nursing portal. In April 2000, NursingCenter merged with SpringNet, Springhouse Corporation's award-winning website.

After several more iterations and redesigns, we’ve come to be known as Lippincott NursingCenter. Today, continues to expand, offering a growing library of cutting-edge original content to help nurses and students on their professional journeys.

Please join me on a little video journey through our history!

Twenty years ago, when the web was just in its infancy, Lippincott NursingCenter emerged as a premier online resource for nurses. Our authoritative content, created by nurses for nurses, continues to set us apart as an online nursing resource. We are proud of our exclusive content – enewsletters, nursing tip cards and mnemonics, infographics, and blog – that keeps nurses up-to-date clinically and professionally. And our portfolio of resources has grown to include over 6,000 peer reviewed articles from over 70 trusted Lippincott journals and more than 1,900 continuing education activities. Thank you for being a valuable member of our nursing community. 


Posted: 6/9/2017 7:20:31 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration

Confidence and Truthfulness

This blog is the first in a new series,
Nurses on Boards: Building a Healthier America. Wolters Kluwer is a Founding Strategic Partner of the Nurses on Boards Coalition.

Your presence on a board warrants confidence and truthfulness. In our turbulent health care environment, we are faced with old issues and new challenges that require immediate solutions and planning.  In the words of Helen Keller, “optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.” That being said, your role on a board places you in a position of influence. Your ideas, positions, and nursing experiences, provides you with a solid foundation to influence, empowered by confidence and truthfulness.

How can you be confident?

  1. Learn from setbacks, failures, and success.
  2. Become well versed on the topic of discussion.
  3. Be aware of your body language.
  4. Assert views in non-threatening, non-judgmental ways.
  5. Be articulate and concise when making your points.
Your nursing perspective is valuable to inform stakeholders about the realities of the issue, evidence-based information, new research, and stories. What we communicate may have an impact on colleagues, families, communities, or society. The information and perspective you share may be the foundation for an issue that may have political, economic, and social implications both in the short term and long-term.

How can you be truthful?

  1. Convey authenticity through openness, humility, and transparency.
  2. Be diligent in exercising your fiduciary responsibility.
  3. Represent nursing and other disciplines at board meetings.
  4. Communicate in a way as to maintain credibility and build relationships.
  5. When you don’t completely understand an issue, ask for clarification to gain full understanding.
According to Mary Beth Kingston, Executive Vice President and Chief Nursing Officer, Aurora Health Care, Milwaukee Wisconsin, and past AONE Board of Directors, "It is important to do 'due diligence', specific preparation prior to board service by learning about the organization, it's work or product and values.”

Call to Action

As you serve or aspire to be on a board, remember it calls for confidence and truthfulness. We hope our column serves as a reflective tool to strengthen your influence when serving on boards.

American Organization of Nurse Executives. (2015). Nurse executive competencies. Chicago, IL:
Author. Retrieved from
M. Lindell Joseph, PhD, RN, AONE Board of Directors and The University of Iowa College of Nursing
Laurie Benson, BSN, Executive Director, Nurses on Board Coalition
Posted: 5/30/2017 7:14:12 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership

Inspired Nurses Calendar 2017: Through the Stomach to the Heart

Lippincott is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. These stories are filled with heroic tales created by nurses, for nurses, and were chosen from hundreds of submissions from nurses around the United States. These nurse storytellers are compassionate, informative, and inspiring – we hope you enjoy them!

To kick this off, we are beginning with May’s nurse story, “Through the Stomach to the Heart.” Read the full story below.

Through the Stomach to the Heart
Simone Cheong, Magnet Project Coordinator
West Kendall Baptist Hospital

In a previous role working on an inpatient medical-surgical unit, I had an extraordinary opportunity to make a difference in the life of one patient. We had been caring for a patient who had worked for a cruise line and had become very ill, requiring prolonged hospitalization and medical therapy before being released to return home. He was from India and had no family or friends.

through-the-stomach-to-the-heart.pngThe staff explained that the patient was not eating and was losing weight. His mood was also depressed. The physical ailment included wound healing, and with insufficient nutrients, the body is slowed in its healing process. Although the dieticians tried their best to make accommodations, he was still not eating well, so I took it upon myself to go to a local Indian grocery store and buy some Indian food items. With the physician's permission, I proceeded to cook and provide him with Indian meals and snacks. The patient was thankful and overwhelmed with emotion, and over the course of his hospitalization, he began eating better, improving his nutritional intake along with his mood as well. He was subsequently released after several weeks. 

Over the years, the patient has called back to the nursing unit asking to thank me again and give me updates on his health status. That is what nursing is all about. Going above and beyond to meet the needs of the patient.

Through your strength, courage, and compassion, these stories will help to illustrate just how crucial nursing is to optimal patient care and the art of healing. Help pay it forward and inspire others on just what it means to be a nurse.

To see all 2016-2017 stories or to share an inspiring story of your own about being a nurse, or how you were inspired by another, and enter to win prizes, visit Be sure to check our blog every month for a new inspired nurse’s story.
Posted: 5/26/2017 11:28:47 AM by Cara Deming | with 0 comments

Categories: Inspiration

Systemic Vascular Resistance and Pulmonary Vascular Resistance: What’s the Difference?

In a previous blog post, we discussed preload and afterload. You may recall, preload is the amount of ventricular stretch at the end of diastole. Afterload is the pressure the myocardial muscle must overcome to push blood out of the heart during systole. The left ventricle ejects blood through the aortic valve against the high pressure of the systemic circulation, also known as systemic vascular resistance (SVR).1 The right ventricle ejects blood through the pulmonic valve against the low pressure of the pulmonary circulation, or pulmonary vascular resistance (PVR).1

Let’s dig a little deeper into these concepts.

Systemic vascular resistance (SVR)*

Systemic vascular resistance (SVR) reflects changes in the arterioles2, which can affect emptying of the left ventricle. For example, if the blood vessels tighten or constrict, SVR increases, resulting in diminished ventricular compliance, reduced stroke volume and ultimately a drop in cardiac output.1 The heart must work harder against an elevated SVR to push the blood forward, increasing myocardial oxygen demand. If blood vessels dilate or relax, SVR decreases, reducing the amount of left ventricular force needed to open the aortic valve. This may result in more efficient pumping action of the left ventricle and an increased cardiac output.2 Understanding SVR will help the bedside clinician treat a patient’s hemodynamic instability. If the SVR is elevated, a vasodilator such as nitroglycerine or nitroprusside may be used to treat hypertension. Diuretics may be added if preload is high. If the SVR is diminished, a vasoconstrictor such as norepinephrine, dopamine, vasopressin or neosynephrine may be used to treat hypotension. Fluids may be administered if preload is low.

SVR is calculated by subtracting the right atrial pressure (RAP) or central venous pressure (CVP) from the mean arterial pressure (MAP), divided by the cardiac output and multiplied by 80. Normal SVR is 700 to 1,500 dynes/seconds/cm-5.

Here’s an example:
If a patient's MAP is 68 mmHg, his CVP is 12 mmHg, and his cardiac output is 4.3 L/minute, his SVR would be 1,042 dynes/sec/cm-5.
Conditions that can increase SVR include1,2:
  • Hypothermia
  • Hypovolemia
  • Cardiogenic shock
  • Stress response
  • Syndromes of low cardiac output
Conditions that can decrease SVR include1,2:
  • Anaphylactic and neurogenic shock
  • Anemia
  • Cirrhosis
  • Vasodilation

Pulmonary vascular resistance (PVR)*

Pulmonary vascular resistance (PVR) is similar to SVR except it refers to the arteries that supply blood to the lungs. If the pressure in the pulmonary vasculature is high, the right ventricle must work harder to move the blood forward past the pulmonic valve. Over time, this may cause dilation of the right ventricle, and require additional volume to meet the preload needs of the left ventricle.1
PVR can be calculated by subtracting the left atrial pressure from the mean pulmonary artery pressure (PAP), divided by the cardiac output (CO) and multiplied by 80. To obtain the left atrial pressure, a pulmonary artery catheter (PAC) is needed to perform a pulmonary artery occlusion pressure (PAOP), also known as pulmonary artery wedge pressure (PAWP). Normal PVR is 100 – 200 dynes/sec/cm-5.

Here’s an example:
If a patient's mean PAP is 16 mmHg, his PAOP is 6 mmHg, and his cardiac output is 4.1 L/minute, his PVR would be 195 dynes/sec/cm-5.
Factors that increase PVR include1:
  • Vasoconstricting drugs
  • Hypoxemia
  • Acidemia
  • Hypercapnia (high partial pressure of arterial carbon dioxide [PaCO2])
  • Atelectasis
 Factors that decrease PVR include1:
  • Vasodilating drugs
  • Alkalemia
  • Hypocapnia (low PaCO2)
  • Strenuous exercise
The accuracy of SVR and PVR depends on the direct pressure measurements and indirect cardiac outputs from a pulmonary artery catheter which are subject to error. However, SVR can provide critical information when differentiating various types of shock and PVR is useful when diagnosing the severity of pulmonary hypertension.3 Understanding these parameters will help the bedside clinician better manage medications and hemodynamic instability.
*You may also see systemic vascular resistance index (SVRI) or peripheral vascular resistance index (PVRI) reported; these measurements are calculated by substituting cardiac index (CI) for CO in the equations.

1. Breitenbach, J. (2010). Putting an end to perfusion confusion. Nursing Made Incredibly Easy!. 5(3): 50 60
2. Gowda, C. (2008). Don’t be puzzled by cardiovascular concepts. Nursing Made Incredibly Easy!. 6(4): 27-30.
3. Silvestry, F. (2015). Pulmonary artery catheterization: interpretation of hemodynamic values and waveforms in adults. Uptodate. Retrieved on April, 17, 2017 from
Myrna B. Schnur, RN, MSN 



Posted: 5/25/2017 10:11:09 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Diseases & Conditions

National Conference for Nurse Practitioners (NCNP): Spring 2017

Last month, I had the pleasure of attending the National Conference for Nurse Practitioners at the Gaylord Opryland Resort & Convention Center in Nashville, Ten. The interest and enthusiasm were palpable at this sold-out show! From the opening session, where attendees were welcomed with live music, to the exhibit hall, where vendors updated us on the latest products and we enjoyed meals with our colleagues, this was the best NCNP yet!

Gaylord-Opryland.jpg  NCNP-Spring-2017-welcome.jpg  WK-in-the-exhibit-hall.jpg

From the Experts

At the conference this year, I was happy to see several sessions related to women’s health, which is my advanced practice area. I learned so much from these experts, as well as those who presented in the acute care and primary care sessions. Here are some things I learned:

“Virtually all cervical cancers are associated with persistent infection with high-risk HPV types.”
Update on Cervical Cancer Screening: Appropriate Use of Pap and HPV Testing
Nancy Berman, MSN, ANP-BC, NCMP, FAANP
“One treatment modality that improves survival in patients with COPD? Oxygen.”
Acute Care: COPD Across the Scale
“Primary care providers see 80% of patients with skin conditions. We need to know when it’s NOT acne.”
Acneiform-Pediatrics to Adults
Margaret Bobonich, DNP, DCNP, FNP-C, FAANP
“Sepsis is a medical emergency. First step in treatment is VOLUME -- 30mL/kg of crystalloid fluid within the first 3 hours.”
Acute Care: Understanding Sepsis
Sophia Chu Rodgers, ACNP, FNP, FAANP, FCCM
“Nearly 6% of deaths globally are attributable to alcohol (80K in U.S.)”
Alcoholism and Liver Disease,
Christopher Chang, MD, PhD
“Unlike vasomotor symptoms, vaginal atrophy can be progressive and is unlikely to resolve on its own.”
Comprehensive Menopause Management: An Update on Current Strategies
Nancy Berman, MSN, ANP-BC, NCMP, FAANP
“Maternal risk depends on complexity of primary cardiac lesion and if residual lesions or other clinical sequelae exist.”
Making Sense of Heart Disease in Pregnancy
Kismet Rasmusson, DNP, FNP-BC, FAHA, CHFN
“Switching between anticoagulants should be based on the pharmacokinetic profile of each anticoagulant, appropriate laboratory assessment of patient’s coagulation status, and the patient’s renal function.”
Acute Care: Understanding Direct Oral Anticoagulants
John Togami, PharmD, PhC
This is just a sampling of the takeaways I left with. What did you learn? What would you like to learn? Leave us a comment, and we’ll pass it along to the NCNP Planning Panel.

It’s very exciting that we are now able to bring this conference to nurse practitioners twice each year! Come see us in Las Vegas in October 2017!


Posted: 5/23/2017 10:11:13 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Continuing Education

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