Cardiac Dysrhythmia Guide
ContentsWhat Is A Cardiac Dysrhythmia? Types Of Cardiac Dysrhythmias Risk Factors For Cardiac Dysrhythmias Symptoms Of Cardiac Dysrhythmias When To Seek Medical Treatment Treatment Of Cardiac Dysrhythmias Care Needs After Diagnosis Of A Cardiac Dysrhythmia Determining Level Of Care Required For A Cardiac Dysrhythmia Care Provider Options For Cardiac Dysrhythmias Selecting A Care Provider Effects On Caregivers Financial Considerations Legal Considerations FAQs About Cardiac Dysrhythmia
According to the American Heart Association, the human heart beats over 100,000 times in a day and over 2 billion times in the average person’s lifetime. Disruptions to the normal beating of the heart are known as a cardiac dysrhythmia.
What Is A Cardiac Dysrhythmia?
A cardiac dysrhythmia may also be called a cardiac arrhythmia or an irregular heart rhythm. With a cardiac dysrhythmia, or cardiac arrhythmia, the heart beats in an abnormal rhythm. Cardiac arrhythmias are caused by a change to the electrical impulses that cause the heart to beat. The resulting rhythm of heartbeats may be faster than normal, slower than normal, or at an uneven pace with cardiac arrhythmias.
Many individuals with a cardiac dysrhythmia do not have any associated symptoms or experience any long-term effects. However, a cardiac dysrhythmia in other people may be serious and potentially life threatening. Since the dysrhythmia causes the heart to beat abnormally, blood flow to the entire body is affected. This may result in negative effects and damage to other organs such as the lungs or brain.
Types Of Cardiac Dysrhythmias
Cardiac dysrhythmias alter the heart’s rhythm in different ways depending on the type of dysrhythmia. A normal heart rate for adults is between 60-100 beats per minute. A slower-than-normal heart rate is known as bradycardia and is a type of cardiac dysrhythmia. A faster-than-normal heart rate is known as tachycardia and is also a type of cardiac dysrhythmia. When the heart does not beat in a steady rhythm, an individual may be experiencing a premature contraction type of dysrhythmia in which an extra heartbeat or pulse is felt.
Some common types of cardiac dysrhythmia include:
- Atrial fibrillation - This irregular heart beat causes the atria (the upper chambers of the heart) to contract abnormally. It is a type of rapid heartbeat.
- Atrial flutter - This tachycardia dysrhythmia occurs when there is rapid electrical pulsing in the atrium. This condition generally occurs in people with heart disease or in people who have recently had surgery.
- Ventricular tachycardia - This irregular heart beat occurs when a rapid heartbeat is generated from the ventricles (the lower chambers of the heart). This condition may result in less blood pumping through the body and may be a serious medical concern.
- Paroxysmal supraventricular tachycardia (PSVT) - In paroxysmal supraventricular tachycardia, an individual experiences a rapid heartbeat that comes from the ventricles. PSVT is different from ventricular tachycardia because it begins and ends suddenly.
- Ventricular fibrillation - This dysrhythmia is a medical emergency. Ventricular fibrillation occurs when the ventricles quiver and fire electrical impulses in a disorganized manner which makes them unable to properly pump blood to the rest of the body.
- Long QT syndrome - The QT interval is an area on an electrocardiogram (ECG) that represents the amount of time it takes the heart muscles to contract and recover. An individual with long QT syndrome has a longer-than-average QT interval. This increases the risk for life-threatening cases of ventricular tachycardia. It is an inherited condition that requires medical treatment.
- Bradyarrhythmias - Slow heart rhythms are often caused by disorders of the electrical conduction system of the heart. Sinus nodal dysfunction and heart block are types of bradyarrhythmia. These conditions may require treatment with a pacemaker.
- Premature contractions - premature contractions may occur in the atria or ventricles of the heart. These are often felt as “skipped” heart beats. Premature contractions of the atria are known as premature atrial contractions. This dysrhythmia is harmless and does not generally need treatment. Premature contractions of the ventricles are known as premature ventricular contractions (PVCs). Premature ventricular contractions are usually harmless and may be related to stress, caffeine use, nicotine use, excessive exercise, an electrolyte imbalance, or in some cases, underlying heart disease.
- Wolff-Parkinson-White Syndrome (WPW) - This relatively rare syndrome occurs when there is an extra electrical pathway between the atria and ventricles. Wolff-Parkinson-White Syndrome may cause extra or rapid heartbeats and may lead to atrial fibrillation. As with long QT syndrome, WPW is an inherited condition.
Risk Factors For Cardiac Dysrhythmias
Cardiac dysrhythmias may not have a known cause in all cases. However, some common causes or risk factors include:
- High blood pressure
- A previous heart attack that resulted in scarring of heart tissue
- An overactive or underactive thyroid gland
- Cardiomyopathy or other changes to the structure or the heart
- Blocked heart arteries
- Drug abuse
- Alcohol abuse
- Consuming too much caffeine
- An electrolyte imbalance
- Certain medications or supplements
- Sleep apnea
- A currently-occuring heart attack
Cardiac dysrhythmias may occur in people of any age although atrial fibrillation is more common in seniors. Cardiac dysrhythmias are not always the result of heart disease and they may not be related to any other health condition a person has.
Symptoms Of Cardiac Dysrhythmias
A dysrhythmia may not cause any symptoms at all. In these cases, it may be found by a doctor during an ECG. Some common symptoms that may occur with cardiac dysrhythmias include:
- Weakness or feeling extremely tired
- A pounding sensation in the chest
- A feeling of a skipped or extra heartbeat (known as a palpitation)
- A feeling of dizziness or lightheadedness
- Shortness of breath
- Chest pain
- Heart palpitations
- Labored breathing
When To Seek Medical Treatment
An individual experiencing any symptoms of cardiac dysrhythmia on a regular and persistent basis should talk to their doctor about their symptoms. The doctor can determine if the dysrhythmia requires further medical care. If a person is experiencing any of the following dysrhythmia symptoms along with an irregular heart rhythm, they should seek emergency medical care and treatment:
- Shortness of breath
- Chest pain
Treatment Of Cardiac Dysrhythmias
In many cases, cardiac dysrhythmias do not require treatment. A doctor will monitor the dysrhythmia during regular checkups to ensure it is not developing into a more serious dysrhythmia or other condition. In other cases, the dysrhythmia may be significant and require medical treatment.
A doctor will perform various tests to determine if an individual has a cardiac dysrhythmia and what kind it is. These tests may include a/an:
- Holter monitor to observe the heart’s rhythm over an extended period.
- Stress test done on a treadmill to monitor the heart during physical activity.
- Echocardiogram which makes pictures of the heart using sound waves.
- Cardiac catheterization procedure to examine the heart internally.
- Electrophysiology study to test the electrical impulses of the heart.
After performing these tests, a doctor will be able determine what the best course of treatment for the cardiac dysrhythmia may be. These treatments may include medication changes, lifestyle changes, surgery, or a combination of these approaches.
A pacemaker is an electrical device that is surgically implanted in the body to regulate the rhythm of the heart. It is connected to the heart by small wires and delivers electrical impulses to the heart in order to stimulate heart beats. Many pacemakers work only when they are needed. These are called demand pacemakers and they are programmed to respond to certain rhythms of the heart. They may send an impulse when the heart rate drops below a certain threshold or when the beats becomes irregular.
Pacemaker surgery is generally noninvasive. A pacemaker may be placed temporarily or for long-term heartbeat control. Recovery after pacemaker surgery will likely include changes to medication and require a patient to have a pacemaker ID Card. This card will inform emergency response workers that an individual has a pacemaker. This information is necessary for performing any life-saving measures in case of an emergency. This ID card may also be used at airports and other facilities with metal detectors where the pacemaker may set these devices off.
Implantable Cardioverter-Defibrillator Surgery
An implantable cardioverter-defibrillator (ICD) is used to prevent sudden cardiac death and cardiac arrest that may be caused by ventricular tachycardia or other dysrhythmias. This device delivers an electric shock to the heart when an abnormal rhythm is detected. These devices are usually only used if a person’s dysrhythmia is considered potentially life-threatening. Many ICDs have a dual function and may also act as pacemakers to keep the rhythm of the heart steady.
Care Needs After Diagnosis Of A Cardiac Dysrhythmia
Most types of cardiac dysrhythmia are chronic conditions meaning they are expected to last for an extended period of time. An individual who is diagnosed with a cardiac dysrhythmia will likely need to manage this condition for the rest of their lives. However, this is not always the case. Some types of dysrhythmia such as atrial flutter may not be considered “chronic” since it may be a symptom of another illness or condition.
Chronic cardiac dysrhythmias may present a variety of care needs. A person with a chronic cardiac dysrhythmia will likely still be able to complete most daily tasks for themselves. However, because dysrhythmia may leave an individual feeling weak or lightheaded, they may not be able to care for themselves the way they used to. Chronic dysrhythmias may also lead to less blood flow to other organs such as the brain or lungs. This decreased blood flood can also make it difficult for a person to perform their own self-care.
An individual with a chronic cardiac dysrhythmia may require assistance with activities of daily living (ADLs). ADLs include activities such as bathing, dressing, eating, and toileting. These activities may be more difficult for a person with a chronic cardiac dysrhythmia. They may have trouble maintaining their balance in the shower or standing for long periods of time. When a person can no longer manage ADLs independently, they may need additional assistance to live safely and maintain their quality of life.
Due to lifestyle and medication changes associated with a diagnosis of a cardiac dysrhythmia, a person may be overwhelmed and need assistance with other tasks of managing daily life. These other tasks are known as instrumental activities of daily living (IADLs) and include activities such as medication management, money management, meal preparation, and transportation arrangements. These tasks are made more complex by the demands of managing a cardiac dysrhythmia and may require assistance.
A doctor may prescribe medication or medication changes when a cardiac dysrhythmia is diagnosed. These medications will vary depending on the individual, the type of dysrhythmia, and on other health conditions the person may have. Some commonly-prescribed medications for cardiac dysrhythmias include:
- Anticoagulants - An anticoagulant works by thinning the blood which reduces the risk of clots. Anticoagulants include warfarin and enoxaparin.
- Antiarrhythmic drugs - These drugs are used to control the abnormal beating of the heart in patients with tachycardia dysrhythmias. They include medications such as flecainide and sotalol.
- Beta blockers - A beta blocker is used to decrease the heart rate and output. These medications also treat high blood pressure and high adrenaline output. Beta blockers include medications such as metoprolol and atenolol.
- Calcium channel blockers - Calcium channel blockers are used to interrupt the movement of calcium in the heart and blood vessels. Calcium channel blockers include medications such as felodipine and amlodipine.
The medications used may change while the dysrhythmia is being medically monitored. It is important that an individual takes all medications exactly as prescribed to prevent potential fatal complications.
Even in patients with a cardiac dysrhythmia that is not thought to be causing problematic or harmful long-term health effects, a doctor may recommend some lifestyle changes. These changes will vary depending on the individual but may include:
- Monitoring and recording one’s pulse - An individual may be asked to learn to take their own pulse and record the readings. A doctor will tell the individual how often to do this and use the results to gain a better understanding of the dysrhythmia. This is often required in individuals who have had a pacemaker placed.
- Working to reduce high blood pressure and high cholesterol - High blood pressure damages blood vessels. High cholesterol can lead to a buildup of fatty deposits on the arteries. Both conditions may increase the risk of dangerous complications from a cardiac dysrhythmia. High blood pressure is often treated with medication and dietary changes.
- Avoiding tobacco and nicotine - Smoking increases the risk of serious heart conditions including complications from dysrhythmias. Smoking can damage blood vessels, reduce the amount of oxygen in the blood, increase the risk of serious clotting, and cause the body to produce more adrenaline which causes the heart to work harder.
- Avoiding or limiting caffeine and alcohol - Caffeine is a stimulant which may cause the heart to beat faster and aggravate an existing dysrhythmia. Alcohol consumption may disrupt the electrical signals of the heart resulting in a fast heartbeat.
- Avoiding certain medications - Some medications such as cough and cold medications, appetite suppressants and psychotropic medications (medications used to treat mental health concerns) may affect the rhythm of the heart. Other cardiac medications may also aggravate an existing cardiac dysrhythmia. It is important that an individual tell their doctor about all medications they are taking so that potential side effects may be monitored and prevented.
- Avoiding illegal drug use - Substance abuse can significantly damage the heart and blood vessels. If an individual is experiencing addiction, a doctor may prescribe a rehabilitation program to help them stop using the illegal substance.
- Eating a heart-healthy diet - A heart-healthy diet is made up of foods that provide benefits to the heart and cardiovascular system. This includes foods such as vegetables, fruits, whole grains, lean meats, low-fat dairy products, and healthy fats. A dietician may be able to help an individual develop a healthy eating plan around these foods.
- Losing any excess weight - Weighing more than is recommended for one’s age, height, and gender can put excessive strain on the heart. Eating a heart-healthy diet and following an exercise plan may help an individual lose excess weight and maintain a healthy weight.
An individual's treatment plan often includes sessions with professionals such as dieticians, physical therapists, and occupational therapists to help them achieve these lifestyle changes.
Determining Level Of Care Required For A Cardiac Dysrhythmia
Many people are able to live independently in their own homes while managing a cardiac dysrhythmia. However, because a cardiac dysrhythmia may affect one’s ability to complete ADLs and IADLs safely, they may require additional help. Individuals and their families should keep a person’s specific needs in mind when determining the most appropriate care option.
Some questions to consider when determining the type of care provider a person needs include:
- Is the individual able to cook for themselves?
Dietary changes are often an important part of lifestyle changes that are required following a cardiac dysrhythmia diagnosis. Since following a heart-healthy diet is often necessary to prevent additional complications, it is important to consider a person’s ability to cook for themselves. If an individual primarily relies on takeout options such as fast food or on restaurant dining, they will no longer be able to do so.
For individuals who are unable to cook for themselves and those who do not live with a caregiver who is able to cook appropriate meals, other options may need to be considered. There are several options available to seniors who need meals prepared for them. Some home care agencies are able to provide meal preparation services. Additionally, an individual and their family may want to have meals delivered, either from a paid service such as Silver Cuisine or from free community programs such as Meals on Wheels.
- Is an individual’s home safe?
Many homes have obstacles such as stairs, carpeting, poor lighting, large furniture, and other obstacles that may increase one’s risk of falling. Since people who are managing a cardiac dysrhythmia are often taking medication, their risk of falling is increased. Individuals and their families should ensure that the home environment is as safe as possible when planning care after diagnosis.
- How well is the individual able to move around on their own?
Many people are able to continue their normal level of activity following a cardiac dysrhythmia diagnosis. Other people may experience weakness, dizziness, or fatigue. Conditions such as depression or medication reactions may increase these symptoms. If a person’s ability to move around on their own is decreased, they may need assistance with ADLs and IADLs.
- How will the individual’s transportation be handled?
Managing a chronic condition often involves increased doctor’s visits and therapy sessions. For an individual who cannot drive on their own and does not live with a caregiver, this may present challenges. In many cases, transportation may need to be arranged.
- Does the individual have any other health conditions that may need monitoring?
Other health conditions such as diabetes, high blood pressure, and high cholesterol may require stricter management in an individual with a cardiac dysrhythmia. These conditions can aggravate a cardiac dysrhythmia. An individual who is trying to manage these conditions along with their new diagnosis may feel overwhelmed.
- Is the individual able to manage their medications?
With a cardiac dysrhythmia, many medications should be avoided or monitored. Even medications prescribed by a doctor to treat the dysrhythmia may worsen the dysrhythmia in some people. This makes proper medication management and monitoring vital after a cardiac dysrhythmia diagnosis. A person may find this overwhelming and may have trouble safely managing their medications.
- Is the individual’s home situation stressful?
Stress can make a cardiac dysrhythmia worse. A home situation that creates more stress for the individual may not be the best choice. For example, if an individual lives with a married child who is getting a divorce from their spouse, this may cause additional stress. However, not being in one’s own home or with family and moving to an inpatient facility may cause significantly more stress for some people. It is important to weigh one’s individual circumstances carefully.
Care Provider Options For Cardiac Dysrhythmias
The amount of care an individual with a cardiac dysrhythmia requires will depend on a number of factors including the type of cardiac dysrhythmia they have, how well they are able to manage this condition on their own, and other health conditions they may have.
When an individual wishes to stay in their own home after a cardiac dysrhythmia diagnosis but is unable to care for themselves independently, home care may be the best option. A home care agency will help the individual monitor their pulse, manage their medications and assist with lifestyle changes. Healthcare staff from the agency may also prepare meals and assist with IADLs such as cleaning. Having this assistance in one’s home can help an individual feel they are able to safely manage their cardiac dysrhythmia while maintaining their independence.
Home care staff is able to help an individual with ADLs and help them adjust to managing their cardiac dysrhythmia. In cases where an individual lives with a caregiver, home care staff may be able to teach the caregiver how to perform certain tasks, such as taking the person’s pulse. This may help the individual and their caregiver feel more knowledgeable about the condition and help them manage it better.
In some situations, a physician may recommend home care for a patient. This may occur when an individual with a cardiac dysrhythmia has had a pacemaker or ICD surgically placed or following a hospital stay for the care of a cardiac dysrhythmia. If a doctor certifies there is a need for home care, Medicare will cover 100% of the costs for 21 days. Medicare does not cover full-time home care or homemaker services.
When there is not a skilled need for the home care that is certified by a physician, or if the length or type of care does not meet Medicare’s requirement, home care will not be covered by Medicare. For these home care needs, Medicaid or private pay may be used. There are several private pay options that individuals and their families may consider. Home care agency staff can walk individuals and families through what payment methods they accept and how to apply for Medicaid if needed.
Different home care agencies provide different services and may be available for different lengths of time during the day. When an individual is selecting home care, they should discuss their specific medical and social needs with the agency. Ensuring that the selected home care agency suits one’s needs is an important part of managing a chronic cardiac dysrhythmia at home.
For some people, living at home safely while managing a cardiac dysrhythmia is not possible. In these cases, an individual and their family may want to consider inpatient facilities such as skilled nursing facilities (SNFs) or assisted living facilities (ALFs). Stays at inpatient facilities may be short-term or long-term depending on the needs of the individual.
SNFs are usually required for a short duration. A doctor may order a stay in a SNF if they feel it is not safe for a person to return to their home until certain requirements are met. For example, if an individual has had a pacemaker placed, a doctor might want to make sure it is working appropriately and that the surgical site is healing before the patient is discharged from a SNF.
During a hospital stay, the doctor and staff will let an individual and their family know if they do not feel it is safe for the person to return home without care at a SNF first. They will likely recommend various local SNFs with beds available. A family member may be able to visit different facilities to help an individual select the most appropriate facility before they are discharged from hospital.
If an individual has a skilled need and a qualifying hospital stay, Medicare will pay for 100% of an individual’s stay at a SNF for up to 20 days. On days 21 through 100, Medicare will pay a portion of the cost of care. After 100 days in a SNF, the individual or their family will be responsible for the entire cost of care. Medicaid and private pay options may be available to help cover these costs as well.
If an individual is unable to return home following a stay in a SNF but no longer needs the high level of care they provide, long-term care facilities such as ALFs might be the most appropriate choice.
In an ALF, an individual will have more independence and privacy than in a SNF while still having staff available to assist them at all times of the day. Staff at an ALF can assist with medication management and with ADLs. Care in an ALF is not covered by Medicare. Different ALFs accept different forms of payment including Medicaid, long-term care insurance, private pay, or a combination of payment options.
Some communities have ALFs and SNFs as part of their campus. These communities are known as continuing care retirement communities (CCRCs). In a CCRC, an individual will be able to move to different levels of care depending on their care needs. This may provide security and peace of mind as a person ages and their needs change.
Selecting A Care Provider
Choosing the most appropriate home care agency or long-term care provider is an important decision for individuals and their family. Taking this process slowly and step-by-step can ensure that the correct decision is made and a person is comfortable with the care they will be receiving.
Some important considerations to keep in mind when selecting a long-term care facility for an individual who has experienced a cardiac dysrhythmia include:
- Is the staff friendly and welcoming?
How the staff interacts with each other and with other residents is often an important indicator of the quality of care they provide. If an individual or their family is considering long-term care, it is recommended that they visit a facility and watch staff and residents interacting together.
- Does the agency or facility have experience in treating people with cardiac dysrhythmia?
Staff should have training about cardiac dysrhythmias and how to monitor this disorder. If an individual has a pacemaker or ICD, staff should be knowledgeable about these devices and know how to check these devices to ensure they are working correctly.
- Is the agency or facility staff trained on how to provide care for cardiac dysrhythmia?
All staff should be CPR-certified and the facility or agency should be able to provide records to verify staff have current certifications.
- Are heart-healthy meals served?
In a facility, dietary and kitchen staff need to be able to make meals that can accommodate a heart-healthy diet. If a home health agency will be preparing meals, it is important to make sure they are able to follow the individual's diet restrictions.
Effects On Caregivers
When caring for an individual with a cardiac dysrhythmia, a caregiver may feel overwhelmed, scared, depressed, or anxious. The American Heart Association has resources available for caregivers of individuals with heart conditions such as a cardiac dysrhythmia. Some steps caregivers can take to help a person with a cardiac dysrhythmia include:
- Learning as much as possible about cardiac dysrhythmias and the specific type of cardiac dysrhythmia that the individual.
- Assisting the individual to make and follow any required lifestyle changes and joining them in some of the changes, such as heart-healthy eating.
- Assisting the individual in taking and recording their pulse.
- Assisting with medication management, including watching for potential complications and side effects.
Long-term care for an individual with a cardiac dysrhythmia will often have costs associated with the diagnosis, regardless of the type of care that an individual needs. The costs of medication, home care, ALFs, CCRCs, and SNFs will need to be considered. Even if an individual is planning to pay for care using Medicare, it is important to note that not all facilities or agencies accept this form of payment.
According to the U.S. Department of Health and Human Services (HHS), long-term care services often cost several thousand dollars a month. This cost may increase depending on an individual’s specific care needs. Long-term care insurance, private pay, and Medicaid may be used to pay for this care when Medicare cannot be used to cover the costs.
After receiving a diagnosis of a cardiac dysrhythmia, an individual may be overwhelmed by all the choices that need to be made. They may not be sure how to select the best long-term care option or how to go about paying for it. For these reasons, it may be helpful to set up a power of attorney and allow that person to take care of financial decisions or request their assistance in making some of these decisions.
During the process of selecting a long-term care option for cardiac dysrhythmia management, setting up a living will is an important step. A living will protects an individual and ensures that their wishes regarding medical care are followed by medical professionals in the event that they are unable to convey those wishes during a critical event. An individual may also want to set up a funeral trust in order to begin prepaying for funeral costs.
FAQs About Cardiac Dysrhythmia
1. Does having a cardiac dysrhythmia always lead to needing a pacemaker?
No. Many types of cardiac dysrhythmia do not cause any harmful effects. Even in more serious cases, lifestyle changes and medications will likely be tried first. Sometimes a pacemaker is also placed on a temporary basis. This may be done until medications have time to help the heart resume a healthy, normal rhythm.
2. Can a cardiac dysrhythmia cause a heart attack?
Certain cardiac dysrhythmias increase a person’s risk of sudden cardiac arrest. A sudden cardiac arrest is often confused with a heart attack, however, they are not the same. During a heart attack, a blood clot stops the flow of blood to the heart resulting in damage to heart tissue, or heart failure. In a sudden cardiac arrest, heart failure occurs as the heart stops beating completely resulting in sudden cardiac death.
3. Can a cardiac dysrhythmia cause a stroke?
Yes. Some kinds of cardiac dysrhythmia such as atrial fibrillation may cause blood clots. These blood clots may travel to the brain resulting in a stroke. Patients with atrial fibrillation have a stroke risk that is five times higher than in those without atrial fibrillation.
4. What are the risks of having a pacemaker placed?
- Damage to the blood vessels or nerves around the pacemaker
- Infection at the site of the pacemaker
- A collapsed lung
- An allergic reaction to chemicals and drugs used in the procedure (such as dyes or anesthesia)
- Bruising, swelling, or bleeding around the pacemaker site
If the doctor feels an individual is at a higher risk for any of these complications, they will discuss this with the person before surgery.
The battery life of an average pacemaker is about 15 years. The leads of a pacemaker may also wear out over time. If the battery or the leads wear out, they will need to be replaced. These replacement procedures are generally quick and do not require much recovery.
5. Can a pacemaker be turned off if a person is at the end of their life?
Yes. If a person is receiving end-of-life care or hospice care, they may not want a pacemaker or ICD device to shock their heart if it falls into an abnormal rhythm. In these situations, a pacemaker or ICD may be turned off. The individual or their family should speak to the doctor about turning the pacemaker or ICD off in this situation. This does not usually require additional surgery.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.