Meet Kristy Panichelli, MSN, CRNP, a heart and vascular nurse practitioner at Chester County Hospital in West Chester, PA. In this Q&A, she explains the role of a nurse practitioner in a cardiovascular setting, including caring for those with heart failure.
What is your background and how long have you been at Chester County Hospital?
I have been a nurse practitioner (NP) for just over 15 years and work with Chester County Cardiology Associates. I have a Master of Science in Nursing from Thomas Jefferson University and I am board-certified as an Acute Care Nurse Practitioner. Prior to becoming an NP, I worked as a bedside nurse in Telemetry, cardiac step-down (intermediate care), and cardiothoracic (CT) surgery for over seven years.
What inspired you to choose your career and work in health care?
I always had an interest in medicine when I was young and when looking at different careers, I felt that nursing -- and ultimately becoming a nurse practitioner -- was the best fit for me. I enjoyed learning about and working with cardiac patients, which is why I have focused my career in cardiology.
Can you share a few details about the role of a Heart & Vascular Nurse Practitioner in different settings?
The role of the Heart & Vascular Nurse Practitioner varies but I am very fortunate to work with a practice that empowers our team of nurse practitioners to work to our full capabilities.
In the outpatient setting, we practice like any health care provider by caring for patients and implementing treatment plans for those with a variety of cardiac conditions. We also coordinate care with other medical providers within our own office as well as the patient's primary care provider.
From the inpatient side, we round on patients, review their history and perform a physical examination and consultation, and discharge them when they are ready to leave the hospital. Throughout this process, we work with multiple members of the health care team to coordinate their care.
Although the role can be challenging at times, it is a very rewarding profession.
How do you care for heart failure patients during an inpatient stay?
Treatment during an inpatient stay would include using diuretics to remove excess fluid, which requires medication titration -- the process of determining the most appropriate dosage to help patients reduce their symptoms while avoiding as many side effects as possible. There is also significant education provided to patients by the nursing staff, heart failure educator, nutrition services and care providers. We coordinate care between attending physicians, cardiologists and case management to identify needs for the patient once they are ready for discharge.
I always review what a patient's discharge needs will be and what we can do to prevent them from being readmitted. I encourage patients to utilize services like home nursing care and cardiac rehab, and stress the importance of having close follow-up care with their cardiologist.
How does Chester County Hospital's Outpatient Diuretic Program impact patients with heart failure?
The outpatient treatment program was introduced to help patients avoid hospital readmissions. In the past, patients would be admitted to the hospital and given a round of intravenous diuretic therapy to help remove the buildup of extra fluid that can accumulate when the heart is not working properly. Patients are now able to receive this therapy the day after an office visit within an eight-hour same day stay.
In my role, I work with patients on medication titration and also help emphasize and reinforce the education the hospital's nursing staff provides.
Patients who have participated in the program have received it well and are glad there is another option than a prolonged hospital stay for treatment. Many enjoy having someone available to them on an outpatient basis to answer questions and review concerns as well.
What advice would you share to avoid an inpatient stay?
Take all medications as prescribed by your provider. It is important that patients weigh themselves every morning before breakfast to assess weight changes, and to notify their provider immediately if they gain weight. Often, when caught early, we can titrate diuretics through the outpatient program and prevent readmission. We review the symptoms of chronic heart failure with patients and educate them on when to seek treatment.
Patients should also follow a strict low sodium diet, avoid alcohol and be mindful of their fluid intake. Close follow-up care is needed, especially after an admission to help medication titration to prevent future readmissions. Most important, do not be afraid to call your provider with questions or concerns.
How can patients with heart failure combat possible anxiety as a result of their condition?
I would recommend going to cardiac rehabilitation to help regain strength and confidence. With approval from their medical provider, I would also recommend incorporating exercise into their lifestyle. The hospital also offers a support group for patients with heart failure where patients can meet others with the condition while also getting their questions answered by a heart failure nurse. If someone continues to experience anxiety or depression, I would recommend they speak with their primary care provider for additional treatment options.
Related Information from Chester County Hospital: