Susan Ruppert - Academia.edu (original) (raw)
Papers by Susan Ruppert
The Internet Journal of Advanced Nursing Practice, Jun 4, 2013
Acute myocardial infarction (AMI) is a common disease diagnosis in industrialized society, with a... more Acute myocardial infarction (AMI) is a common disease diagnosis in industrialized society, with approximately 650,000 patients with new AMI and 450,000 experiencing a recurrent AMI each year in the United States. This diagnosis continues to carry a significant mortality rate, particularly in elderly males. This first of two articles presents a case study of an elderly patient who, after coronary intervention, develops a ST elevation myocardial infarction. The significance of interpreting the physical and diagnostic data in diagnosing the event is discussed along with the related pathophysiology. Treatment will be discussed in a subsequent article.
The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for prov... more The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for providing their professional time and expertise in providing quality peer reviews for the journal during the past biennium.
Dimensions of Critical Care Nursing, Mar 1, 1983
Journal of the American Association of Nurse Practitioners
The Internet Journal of Advanced Nursing Practice, Dec 18, 2013
The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for prov... more The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for providing their professional time and expertise in providing quality peer reviews for the journal during the past biennium.
Primary Care Diabetes, 2016
Critical care nursing quarterly
Dimensions of Critical Care Nursing, 1992
Dimensions of Critical Care Nursing, Jul 1, 1992
ST-segment elevation myocardial infarction (STEMI) is a medical emergency where the coronary arte... more ST-segment elevation myocardial infarction (STEMI) is a medical emergency where the coronary artery previously affected by atherosclerosis is abruptly occluded by a thrombus at the site of vascular injury. Oxygen and blood supply are blocked off to the heart muscle being supplied by the affected artery, causing death to the muscle. Outcomes following a STEMI may range from mild to severe heart failure to multi-system organ-failure and death. Immediate activation of the emergency cardiology STEMI team for reperfusion therapy followed by necessary medical treatments give the patient with STEMI possible improved outcomes. An interprofessional team approach is needed to maximize care and make critical treatment decisions aimed at providing timely treatment and mitigating complications. This second of a 2-part series of articles highlights specific effective treatments that support early goal achievement to improve outcomes for the patient, as well as common complications that might aris...
Journal of the American Association of Nurse Practitioners
The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse pra... more The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.
Journal of the American Association of Nurse Practitioners
ABSTRACT Telehealth is a tool used to diagnose and treat patients at a distance. Telehealth quick... more ABSTRACT Telehealth is a tool used to diagnose and treat patients at a distance. Telehealth quickly became essential during the COVID-19 pandemic as a result of stay-at-home orders. Regulatory waivers encouraged the use of telehealth as an alternative to the in-person encounter to limit the spread of disease. The pandemic incited a rapid growth in telehealth, and new legislation, new technologies, and providers new to virtual care changed the delivery of traditional telehealth. Postpandemic planning is necessary to support the safe integration of telehealth in the health care system. The purpose of this article is to discuss the current issues affecting telehealth and offer recommendations for safer virtual care. Critical considerations, beginning with an assessment of remote patient acuity, are needed to ensure the standard of care for telehealth is equivalent to the in-person setting. A triage protocol to screen patients seeking virtual services is required to prevent underestimation of severity of illness, sort patients to place of service, and determine if a need exists to escalate to an in-person evaluation or higher level of care. A standard approach to triage may minimize the risks to patient safety and support the appropriate use of telehealth technologies.
Journal of the American Association of Nurse Practitioners
The professional obligations to protect and promote nursing professional roles stem from the Amer... more The professional obligations to protect and promote nursing professional roles stem from the American Nurses Association Code of Ethics. Nurturing new generations of NPs to assume leadership role is foundational to succession planning and is critical to assuring NPs' continued contributions to health care. Making professional role development a priority at various points in educational programs, modeling ways to contribute to the profession, and encouraging professional organization membership are a few of the suggestions presented for the academic environment. In clinical settings, NP meetings are opportunities to engage NPs in legislative and policy issues important to practice. Attaining employee benefits, such as conference attendance, can promote commitment; and precepting NP students forges professional bonds. Present and future generations of NPs must assume responsibility for protecting and promoting the role. Many threats to NPs' scope of practice and other professional conundrums are ongoing. Instilling the values of protecting and promoting the NP role in students and colleagues and then identifying leaders to direct these efforts are essential to succession planning.
The Internet Journal of Advanced Nursing Practice
A 27-year-old male presented to the Emergency Department after suffering a rattlesnake bite with ... more A 27-year-old male presented to the Emergency Department after suffering a rattlesnake bite with envenomation to his left lower leg. After admission to the medical-surgical floor, his pain and swelling increased and a surgical consult was obtained. The diagnosis of acute compartment syndrome was made based on the clinical presentation of the patient and he was taken to the operating room for an emergency fasciotomy. This article describes the evidence-based management of a patient with compartment syndrome as a result of rattlesnake envenomation.
Journal of Diabetes Research, 2016
The aim of this study was to explore predictors of health related quality of life (HRQoL) among m... more The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men a...
The aim of this study was to explore predictors of health related quality of life (HRQoL) among m... more The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men a...
The Nurse Practitioner, 2015
cute pharyngitis accounts for 12 million healthcare encounters annually in the United States, app... more cute pharyngitis accounts for 12 million healthcare encounters annually in the United States, approximately 1% to 2% of all ED visits, and up to 6% of outpatient appointments. 1-4 Sore throats rank within the top 20 reasons patients present to healthcare providers. 4 In temperate climates, the incidence is highest during the winter and early spring (November to May). 5-7 The most common cause of pharyngitis is viral infection. Group A beta hemolytic streptococcal (GABHS) pharyngitis (also known as Group A streptococcal pharyngitis) accounts for between 20% to 30% of presentations in children and 5% to 15% in adults. 1,4,5,8 The peak incidence is in ages 5 to 15. 8 Symptoms can be similar in GABHS and nonstreptococcus forms of pharyngitis, making clinical diagnosis diffi cult. In cases other than GABHS pharyngitis, antibiotic therapy has not been shown to benefi t most bacterial causes. Noted exceptions are Corynebacterium diphtheriae and Neisseria gonorrhoeae, which are treated with antibiotics specifi c to these conditions. Accurate diagnosis negates the need for unnecessary antibiotic therapy in most other cases of pharyngitis. Treatment of GABHS pharyngitis is important in decreasing nonsuppurative postinfectious disorders (such as rheumatic fever [RF] and poststreptococcal glomerulonephritis) and suppurative complications (including peritonsillar abscess and cervical lymphadenitis). 5 ■ Differential diagnosis Pharyngitis can be defi ned as an infl ammation of the upper respiratory tract, including the pharynx, larynx, and posterior nares, with sore throat as the most common presenting symptom. 9 The chief complaint of sore throat can have multiple etiologies (see Causes of sore throat). Most are the results by a pathogenic infection from a variety of organisms. Other causes of sore throat include overuse of the voice, smoking, allergies, irritation by a foreign body, tumor, or clinical entities, such as Kawasaki syndrome or thyroiditis. 9 Diagnosis of the most common causes of pharyngitis, common viral, bacterial, and Epstein-Barr virus (EBV) will be discussed. ■ Presenting symptoms Viral pharyngitis. Viral etiology is the most common cause of pharyngitis and can be caused by a number of different viruses. The most common pathogens are rhinovirus and coronavirus, which cause the common cold, adenoviruses, and infl uenza viruses. 6 Coxsackievirus infections can present as hand-foot-and-mouth disease or herpangina. 6 Viral pharyngitis is a self-limited (5 to 7 days), generally benign, and is associated with systemic symptoms, such as cough, hoarseness, coryza, headache, malaise, joint pain, fatigue, and mild elevation of temperature or absence of fever.
Circulation, Jan 30, 2014
In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasiv... more In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST-segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on 1-year mortality. Vital status at 1 year was available in 936 of 944 (99.2%) and 941 of 948 (99.3%) patients in the PI and pPCI arm, respectively. At 1 year, all-cause mortality rates (6.7% versus 5.9%) were similar for PI and pPCI-treated patients (P=0.49; risk ratio, 1.13; 95% confidence interval, 0.79-1.62). Cardiac mortality rates were similar as well (4.0% ...
The Internet Journal of Advanced Nursing Practice, Jun 4, 2013
Acute myocardial infarction (AMI) is a common disease diagnosis in industrialized society, with a... more Acute myocardial infarction (AMI) is a common disease diagnosis in industrialized society, with approximately 650,000 patients with new AMI and 450,000 experiencing a recurrent AMI each year in the United States. This diagnosis continues to carry a significant mortality rate, particularly in elderly males. This first of two articles presents a case study of an elderly patient who, after coronary intervention, develops a ST elevation myocardial infarction. The significance of interpreting the physical and diagnostic data in diagnosing the event is discussed along with the related pathophysiology. Treatment will be discussed in a subsequent article.
The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for prov... more The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for providing their professional time and expertise in providing quality peer reviews for the journal during the past biennium.
Dimensions of Critical Care Nursing, Mar 1, 1983
Journal of the American Association of Nurse Practitioners
The Internet Journal of Advanced Nursing Practice, Dec 18, 2013
The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for prov... more The Internet Journal of Advanced Practice Nursing acknowledges the following individuals for providing their professional time and expertise in providing quality peer reviews for the journal during the past biennium.
Primary Care Diabetes, 2016
Critical care nursing quarterly
Dimensions of Critical Care Nursing, 1992
Dimensions of Critical Care Nursing, Jul 1, 1992
ST-segment elevation myocardial infarction (STEMI) is a medical emergency where the coronary arte... more ST-segment elevation myocardial infarction (STEMI) is a medical emergency where the coronary artery previously affected by atherosclerosis is abruptly occluded by a thrombus at the site of vascular injury. Oxygen and blood supply are blocked off to the heart muscle being supplied by the affected artery, causing death to the muscle. Outcomes following a STEMI may range from mild to severe heart failure to multi-system organ-failure and death. Immediate activation of the emergency cardiology STEMI team for reperfusion therapy followed by necessary medical treatments give the patient with STEMI possible improved outcomes. An interprofessional team approach is needed to maximize care and make critical treatment decisions aimed at providing timely treatment and mitigating complications. This second of a 2-part series of articles highlights specific effective treatments that support early goal achievement to improve outcomes for the patient, as well as common complications that might aris...
Journal of the American Association of Nurse Practitioners
The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse pra... more The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.
Journal of the American Association of Nurse Practitioners
ABSTRACT Telehealth is a tool used to diagnose and treat patients at a distance. Telehealth quick... more ABSTRACT Telehealth is a tool used to diagnose and treat patients at a distance. Telehealth quickly became essential during the COVID-19 pandemic as a result of stay-at-home orders. Regulatory waivers encouraged the use of telehealth as an alternative to the in-person encounter to limit the spread of disease. The pandemic incited a rapid growth in telehealth, and new legislation, new technologies, and providers new to virtual care changed the delivery of traditional telehealth. Postpandemic planning is necessary to support the safe integration of telehealth in the health care system. The purpose of this article is to discuss the current issues affecting telehealth and offer recommendations for safer virtual care. Critical considerations, beginning with an assessment of remote patient acuity, are needed to ensure the standard of care for telehealth is equivalent to the in-person setting. A triage protocol to screen patients seeking virtual services is required to prevent underestimation of severity of illness, sort patients to place of service, and determine if a need exists to escalate to an in-person evaluation or higher level of care. A standard approach to triage may minimize the risks to patient safety and support the appropriate use of telehealth technologies.
Journal of the American Association of Nurse Practitioners
The professional obligations to protect and promote nursing professional roles stem from the Amer... more The professional obligations to protect and promote nursing professional roles stem from the American Nurses Association Code of Ethics. Nurturing new generations of NPs to assume leadership role is foundational to succession planning and is critical to assuring NPs' continued contributions to health care. Making professional role development a priority at various points in educational programs, modeling ways to contribute to the profession, and encouraging professional organization membership are a few of the suggestions presented for the academic environment. In clinical settings, NP meetings are opportunities to engage NPs in legislative and policy issues important to practice. Attaining employee benefits, such as conference attendance, can promote commitment; and precepting NP students forges professional bonds. Present and future generations of NPs must assume responsibility for protecting and promoting the role. Many threats to NPs' scope of practice and other professional conundrums are ongoing. Instilling the values of protecting and promoting the NP role in students and colleagues and then identifying leaders to direct these efforts are essential to succession planning.
The Internet Journal of Advanced Nursing Practice
A 27-year-old male presented to the Emergency Department after suffering a rattlesnake bite with ... more A 27-year-old male presented to the Emergency Department after suffering a rattlesnake bite with envenomation to his left lower leg. After admission to the medical-surgical floor, his pain and swelling increased and a surgical consult was obtained. The diagnosis of acute compartment syndrome was made based on the clinical presentation of the patient and he was taken to the operating room for an emergency fasciotomy. This article describes the evidence-based management of a patient with compartment syndrome as a result of rattlesnake envenomation.
Journal of Diabetes Research, 2016
The aim of this study was to explore predictors of health related quality of life (HRQoL) among m... more The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men a...
The aim of this study was to explore predictors of health related quality of life (HRQoL) among m... more The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men a...
The Nurse Practitioner, 2015
cute pharyngitis accounts for 12 million healthcare encounters annually in the United States, app... more cute pharyngitis accounts for 12 million healthcare encounters annually in the United States, approximately 1% to 2% of all ED visits, and up to 6% of outpatient appointments. 1-4 Sore throats rank within the top 20 reasons patients present to healthcare providers. 4 In temperate climates, the incidence is highest during the winter and early spring (November to May). 5-7 The most common cause of pharyngitis is viral infection. Group A beta hemolytic streptococcal (GABHS) pharyngitis (also known as Group A streptococcal pharyngitis) accounts for between 20% to 30% of presentations in children and 5% to 15% in adults. 1,4,5,8 The peak incidence is in ages 5 to 15. 8 Symptoms can be similar in GABHS and nonstreptococcus forms of pharyngitis, making clinical diagnosis diffi cult. In cases other than GABHS pharyngitis, antibiotic therapy has not been shown to benefi t most bacterial causes. Noted exceptions are Corynebacterium diphtheriae and Neisseria gonorrhoeae, which are treated with antibiotics specifi c to these conditions. Accurate diagnosis negates the need for unnecessary antibiotic therapy in most other cases of pharyngitis. Treatment of GABHS pharyngitis is important in decreasing nonsuppurative postinfectious disorders (such as rheumatic fever [RF] and poststreptococcal glomerulonephritis) and suppurative complications (including peritonsillar abscess and cervical lymphadenitis). 5 ■ Differential diagnosis Pharyngitis can be defi ned as an infl ammation of the upper respiratory tract, including the pharynx, larynx, and posterior nares, with sore throat as the most common presenting symptom. 9 The chief complaint of sore throat can have multiple etiologies (see Causes of sore throat). Most are the results by a pathogenic infection from a variety of organisms. Other causes of sore throat include overuse of the voice, smoking, allergies, irritation by a foreign body, tumor, or clinical entities, such as Kawasaki syndrome or thyroiditis. 9 Diagnosis of the most common causes of pharyngitis, common viral, bacterial, and Epstein-Barr virus (EBV) will be discussed. ■ Presenting symptoms Viral pharyngitis. Viral etiology is the most common cause of pharyngitis and can be caused by a number of different viruses. The most common pathogens are rhinovirus and coronavirus, which cause the common cold, adenoviruses, and infl uenza viruses. 6 Coxsackievirus infections can present as hand-foot-and-mouth disease or herpangina. 6 Viral pharyngitis is a self-limited (5 to 7 days), generally benign, and is associated with systemic symptoms, such as cough, hoarseness, coryza, headache, malaise, joint pain, fatigue, and mild elevation of temperature or absence of fever.
Circulation, Jan 30, 2014
In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasiv... more In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST-segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on 1-year mortality. Vital status at 1 year was available in 936 of 944 (99.2%) and 941 of 948 (99.3%) patients in the PI and pPCI arm, respectively. At 1 year, all-cause mortality rates (6.7% versus 5.9%) were similar for PI and pPCI-treated patients (P=0.49; risk ratio, 1.13; 95% confidence interval, 0.79-1.62). Cardiac mortality rates were similar as well (4.0% ...