Acute Cardiac Care: A Practical Guide for Nurses

by Editor: Angela Kucia (Department of Cardiology, The Lyell McEwin Hospital ); Editor: Tom Quinn (Faculty of Health and Medical Sciences, University of Surrey )

• ISBN13: 9781444309836
• ISBN10: 1444309838
• Format: eBook
• Copyright: 2009-08-01
• Publisher: Wiley-Blackwell

Summary

Acute Cardiac Care provides nurses with a comprehensive understanding of the current practice and principles underlying the care and management of acute cardiac conditions. It addresses the management of acute coronary syndromes (ACS) with an emphasis on evidence based pharmacological management, cardiac emergencies (cardiac arrest, arrhythmia, acute pulmonary oedema, cardiogenic shock), current diagnostic and interventional modalities for the management of ACS, including risk stratification, and the ethical, political, social and economic factors that impact upon the provision of acute cardiac services in Australia and the UK. Edited by renowned academics & clinicians in the field, this practical text will encourage nurses to think critically about evidence and management of acute coronary conditions, and provide a guide on how and where to look for up-to-date evidence and guidelines. KEY FEATURES: A comprehensive and practical guide to the current practice and principles underlying the nursing care of acute cardiac conditions Edited by leading authorities in the field with a wealth of experience in acute cardiac care and resuscitation Has an emphasis on evidence-based practice, encouraging nurses to critically think about their practice Contains learning objectives, key points and activities and further reading guidelines

Table of Contents

Contributors

Foreword

Preface

Mechanics of the Cardiovascular System

Overview

Basic heart anatomy

The cardiac cycle

Cardiac output

Conclusion

Regulation of Cardiac and Vascular Function

Overview

Central nervous system regulation of the cardiovascular system

Vasomotor control

Baroreceptors

Chemoreceptors

Humoral control

Electrolytes

Conclusion

Cardiac Electrophysiology

Overview

Cardiac cells

The action potential

The action potential in non-pacemaker cells

The cardiac conduction system

The electrocardiogram

Conclusion

The Coronary Circulation

Overview

The coronary circulation

The left main coronary artery

The LAD artery

The LCX or CX artery

The right coronary artery

Collateral circulation

Microvascular circulation

Coronary venous circulation

Risk Factors for Cardiovascular Disease

Overview

Classification of risk factors for CVD

Biomedical risk factors

Behavioural risk factors

Psychosocial risk factors

Conclusion

Populations at Risk

Overview

Risk factors for CVD

Clarifying risk

Risk assessment tools

Populations at increased risk

Targeting treatment

Using what we know

Conclusion

Evidence-Based Practice

Overview

The need for change

Evidence-based practice

Barriers to the evidence

Conclusion

Ethics of Research in Acute Cardiac Care

Overview

Evidence-based medicine and clinical trials

Informed consent for trial participation

What is an ethical dilemma?

Genetic research

Considering an offer for the unit to participate in a clinical trial

Ethical issues in marketing and pricing of new pharmaceutical agents

Conclusion

Cardiovascular Assessment

Overview

Health history

Physical examination

Conclusion

Electrocardiogram Interpretation

Overview

Normal sequence of depolarisation and repolarisation

Theoretical basis of electrocardiography

Determining the cardiac axis

Determination of heart rate and electrocardiographic intervals

Chamber enlargement

Bundle branch block

ECG changes related to myocardial ischaemia and infarction

Obtaining a 12-lead ECG

Conclusion

Cardiac Monitoring

Overview

ECG monitoring systems and lead formats

Indications for arrhythmia monitoring

Nursing considerations in the care of the patient with ECG monitoring

Laboratory Tests

Overview

Generic laboratory tests

Electrolytes

Renal function

Glucose measurement

Lipid profiles

Complete blood examination

Clotting screen

Biochemical markers

Markers of myocardial necrosis

Cardiac natriuretic peptides

C-reactive protein

Conclusion

Diagnostic Procedures

Overview

Chest X-ray

Cardiac catheterisation (angiogram)

Echocardiography

Stress testing

Magnetic resonance imaging

Computerised tomography

Electrophysiology studies

Conclusion

Sudden Cardiac Death

Overview

Definitions

Burden of disease and risk factors for SCD

Sudden death in the young including athletes

Structural abnormalities

Cardiomyopathies and SCD

Genetic syndromes and SCD

Conclusion

Out-of-Hospital Cardiac Arrest and Automated External Defibrillation

Overview

Out-of-hospital cardiac arrest

Hazards to the victim and rescuer

Recognition of cardiac arrest and BLS

Automated external defibrillation

Conclusion

Ethical Issues in Resuscitation

Overview

Guiding ethical principles in resuscitation

Futility

Rights of the individual versus the needs of society

Patient perceptions of resuscitation

Introducing the DNR conversation

Witnessed resuscitation

Withdrawal of treatment

Organ donation

Training and research with the newly dead

Pathogenesis of Acute Coronary Syndromes

Overview

Acute coronary syndrome

Atherosclerosis

Endothelial dysfunction

Plaque disruption

Inflammation

Thrombosis

Vasoconstriction

Conclusion

Presentations of Acute Coronary Syndromes

Overview

Angina pectoris

Stable angina

The acute coronary syndromes

Global trends in ACS presentations

Clinical history in ACS

Physical examination in ACS patients

The 12-lead electrocardiogram in ACS

Cardiac markers in ACS

Clinical assessment and risk stratification in ACS

Conclusion

Risk Stratification in Acute Coronary Syndromes

Overview

Introduction

Risk stratification

Risk stratification guidelines

Risk scores

Chest pain units

Conclusion

Reducing Time to Treatment

Overview

Benefits of early reperfusion

Identifying and addressing delays

Conclusion

Reperfusion Strategies

Overview

Pathogenesis of STEMI

Principles of reperfusion strategies

Options for reperfusion

Strategies for reducing treatment time delays

Detecting and managing failed reperfusion

Preventing and detecting re-occlusion

Conclusion

Adjunct Pharmacological Agents in Acute Coronary Syndromes

Overview

Anti-ischaemic therapies

Antiplatelet and anticoagulant therapy

Inhibitors of the renin-angiotensinaldosterone system

Statins

Conclusion

Arrhythmias

Overview

Basic electrophysiology

Mechanisms of arrhythmia generations

Cardiac monitoring

Rhythm interpretation

Determining the rhythm

Tachyarrhythmias

Asystole

Treatment of arrhythmias

Conclusion

In-Hospital Resuscitation

Overview

Introduction

Prevention: systems for identifying patients at risk of cardiac arrest

Early recognition and management of critically ill patients

In-hospital resuscitation

Working within your scope of practice

Audit and data collection

Conclusion

Acute Heart Failure

Overview

Introduction

Establishing the diagnosis

Management specifics

Refractory AHF

Dignity, communication and preventing complications: back to basics

Managing chronic heart failure better to reduce the need for re-hospitalisation

Conclusion

Convalescence

Overview

Introduction

Assessment and identification of patient needs

High risk groups

Promoting self-management in the convalescent phase

Particular concerns of spouses and family members

Accommodating convalescence and discharge planning following an acute cardiac event

Models of intervention to facilitate convalescence and secondary prevention

Nursing strategies to promote convalescence

Palliative care

Conclusion

Discharge Planning and Secondary Prevention

Overview

Discharge planning

Secondary prevention

Provision of secondary prevention

Components of secondary prevention

Cardio-protective drug therapy

Challenges in secondary prevention

Conclusion

Index

Table of Contents provided by Publisher. All Rights Reserved.