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Textbook of Cardiovascular & Thoracic Nursing
P Hariprasath
SECTION 1: CARDIAC NURSING
1:
Anatomy and Physiology of Heart
HEART AND ITS LOCATION
CARDIAC TISSUE
Epicardium and Pericardium
Myocardium
Endocardium
CONDUCTION TISSUES
CHAMBERS OF THE HEART (FIG. 1.5)
Right Atrium
Right Ventricle
Left Atrium
Left Ventricle
HEART VALVES (FIG. 1.6)
Atrioventricular Valves
Semilunar Valves
CORONARY CIRCULATION
Left Coronary Artery
Left Anterior Descending Artery
Circumflex Artery
Right Coronary Artery
Conus Branch
Sinus Node Artery
Right Ventricular Branches
Right Atrial Branch
Acute Marginal Branch
AV Nodal Branch
Posterior Descending Branch
Left Ventricular Branch
Left Atrial Branch
Coronary Veins (Fig. 1.11)
PHYSIOLOGY OF CORONARY CIRCULATION
Control of Coronary Blood Flow
Local Muscle Metabolism is the Primary Controller of Coronary Flow
Oxygen Demand as a Major Factor in Local Coronary Blood Flow Regulation
Nervous Control of Coronary Blood Flow
Direct Effects of Nervous Stimuli on the Coronary Vasculature
Hemodynamics
Factors Affecting Blood Flow
Vascular Resistance
Size of the Blood Vessel Lumen
Blood Viscosity
Total Blood Vessel Length
Venous Return
Velocity of Blood Flow
CONDUCTION SYSTEM
Action Potential and Contraction of Contractile Fibers
Depolarization
Plateau
Repolarization
Electrocardiogram (Fig. 1.13)
Correlation of ECG Waves with Atrial and Ventricular Systole (Fig. 1.14)
CARDIAC CYCLE (FIG. 1.15)
Pressure and Volume Changes During the Cardiac Cycle (Fig. 1.16)
Atrial Systole
Ventricular Systole
Relaxation Period
Heart Sounds
Cardiac Output
Regulation of Stroke Volume
Preload Effect of Stretching
Contractility
Afterload
2:
Assessment and Diagnostic Evaluation
INSPECTION
PALPATION
Apical Impulse
Site
Arterial Pulse
Arterial Pulse is Palpated for
JUGULAR VENOUS PULSATIONS
Abnormalities of Jugular Vein Waveforms
Elevated a wave
Absent a Wave
Cannon a wave (Giant a Wave)
Prominent x Descent
Prominent y Descent
Blunted x Descent
Blunted y Descent
Jugular Venous Pressure (Table 2.1)
Anatomy
Measurement of JVP (Fig. 2.19)
Abdominal Jugular Reflex
Causes of Elevated JVP
Thrills
AUSCULTATION
Auscultatory Areas (Fig. 2.21)
Heart is Auscultated for
Heart Sounds
First heart Sound (S1)
Second Heart Sound S2
Third heart Sound S3
Fourth Heart Sound S4
Quadruple Rhythm
Summation Gallop
Opening Snap
Ejection Clicks
CAUSES OF MURMUR
Systolic Murmur
Diastolic Murmurs
Continuous Murmurs
CHARACTERISTICS OF HEART MURMUR
Location
Timing
Systolic Murmur (Figs 2.31 and 2.32A to D)
Diastolic Murmur (Figs 2.33A to C)
Continuous Murmur (Fig. 2.34)
Intensity of Murmur (Table 2.2)
Pitch
Quality
Radiation
SHAPE OF MURMUR (FIGS 2.35A TO E)
The Shape of Murmur may be
ARTERIAL BRUITS
RESPIRATION
VALSALVA MANEUVER
POSITION
ISOMETRIC EXERCISE
PHARMACOLOGIC AGENTS
BLOOD SPECIMEN COLLECTION (TABLE 2.3)
Patient Preparation
Blood Sample Collection
Hemolysis
Interpretation of Results
CARDIAC MARKERS
Cardiac-specific Troponin
Myoglobin
SERUM LIPIDS
Ratios
Apolipoproteins
Lipoprotein-Associated Phospholipase A2
C-Reactive Protein (CRP)
Homocysteine (HCY)
Cardiac Natriuretic Peptide Markers
COMPLETE BLOOD COUNT
RED BLOOD CELLS
WHITE BLOOD CELLS
PLATELET COUNT
ERYTHROCYTE SEDIMENTATION RATE
PLATELET COUNT
PROTHROMBIN TIME
Partial Thromboplastin Time and Activated Partial Thromboplastin Time
ACTIVATED CLOTTING TIME
FIBRINOGEN LEVEL
THROMBIN TIME
INTRODUCTION
PURPOSE
CONTRAINDICATIONS
COMPLICATIONS
INTERPRETATION OF ABG VALUES
Acid-base Balance (Fig. 2.36)
The Respiratory (Lungs) Buffer Response
The Renal (Metabolic) Buffer Response
ACID BASE DISORDERS
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
COMPONENTS OF THE ARTERIAL BLOOD GAS
pH
Remember
Partial Pressure
PO2
SaO2
PaCO2
HCO3 (Bicarbonate)
Base Excess
STEPS TO AN ARTERIAL BLOOD GAS INTERPRETATION
Examples
Example 1:
Example 2:
Compensation
Example 3:
Example 4
Principles of Invasive Pressure Monitoring
Referencing and zeroing
Types of Invasive Pressure Monitoring
Arterial Waveform (Fig. 2.38)
Referencing
Complications
Pulmonary Artery Flow-Directed Catheter
Pulmonary Artery Catheter Insertion (Fig. 2.39)
Invasive Cardiac Output Measurement Techniques
Noninvasive Hemodynamic Monitoring
Venous Oxygen Saturation
Pulse Oximetry
NURSING MANAGEMENT
THE CARDIAC CONDUCTION SYSTEM (FIG. 2.44)
Sinus Node
Atrioventricular Node
Bundle of His
Bundle Branches
Purkinje Fibers
Origin and Spread of the Electrical Impulse through the Heart
Velocity of Conduction of Impulses
ECG WAVES (FIG. 2.45)
Cardiac Action Potential
Rapid Depolarization
Plateau
Slow Repolarization
BASIC ELECTROCARDIOGRAPHY
The 12-Lead Electrocardiogram (Table 2.7)
Bipolar Leads
Unipolar Leads
Right Chest and Posterior Leads
Axis Determination
Methods of Axis Determination
ECG Interpretation
Rate
Regularity
P Waves
PR Interval
QT Interval
Dropped Beat
Pause
QRS Complex
Heart Rate Calculation
Method 1
Method 2
Method 3
Intraventricular Conduction Disturbances
Left Bundle-branch Block (Fig. 2.63)
Right Bundle-branch Block (Fig. 2.64)
Diagnosis of Left Bundle and Right Bundle Branch Block
Atrial Enlargement
Left Atrial Enlargement
Right Atrial Enlargement
Biatrial Enlargement
Ventricular hypertrophy
Left Ventricular Hypertrophy
Right Ventricular Hypertrophy
EXERCISE TESTING
Indications
Contraindications
Absolute
Relative
Pretest Considerations
Preparation for Electrocardiogram
Exercise Test Selection (Table. 2.8)
Bruce Treadmill Protocol
Balke Treadmill Protocol
Naughton Treadmill Protocol
Ramp Testing
Interpretation of Exercise Test Responses
Heart Rate
Blood Pressure
Exercise Capacity
Electrocardiographic Responses (Fig. 2.72)
Subjective Responses
Test Termination
Indications for Stopping an Exercise Test
Recovery Period
ECHOCARDIOGRAPHY
Modes
Real-Time Two-Dimensional Echocardiography
Three-dimensional Echocardiographic
Two-dimensional Echocardiography (Fig. 2.75)
Doppler (Fig. 2.84)
Modes
Normal Echocardiographic Values
Ventricular and Atrial Dimensions (ID, Internal Dimension)
Aorta and Aortic Valve
Mitral valve
Ventricular Function
Assessment of LV systolic Function
Fractional Shortening
Ejection Fraction
Stroke Volume
Cardiac Output
Regional LV Wall Motion
Valve Assessment
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
Mitral Regurgitation
Mitral Valve Prolapse
INDICATIONS
Class I
Class II
Class III
CONTRAINDICATIONS
Relative Contraindications
PATIENT PREPARATION
PROCEDURE
CATHETERIZATION APPROACH
Percutaneous Femoral Approach
Direct Brachial Approach (Figs 2.106A and B)
Right Heart Catheterization
Left Heart Catheterization
POSTPROCEDURE CARE
COMPLICATIONS
CORONARY ARTERIOGRAM
Techniques
Percutaneous Approach/Judkins Technique (Fig. 2.107)
Direct Approach/Sones and Shirey Technique
Drugs Used During Coronary Arteriography
Analgesics
Anticoagulants
Contrast Agents
Anatomy of Coronary Arteries (Figs 2.111 to 2.115, Table 2.14)
Angiographic Views
Left Coronary Artery (Fig. 2.116)
Right Coronary Artery
Left Coronary Angiographic Views
Right Coronary Artery Angiographic Views (Fig. 2.117)
Interpretation of Data
Lesion-specific Characteristics
DIAGNOSTIC ELECTROPHYSIOLOGY STUDIES
Indications
Patient Preparation
Techniques
Complications
INTERVENTIONAL ELECTROPHYSIOLOGY AND CATHETER ABLATION
Indications
Radiofrequency Catheter Ablation (Figs 2.120A and B)
Techniques
NURSING CARE OF THE PATIENT UNDERGOING ELECTROPHYSIOLOGY PROCEDURES
INTRODUCTION
NORMAL ANATOMY
Left Subclavian Artery
Aorta
Pulmonary Vasculature
Heart
Left Atrium
Left Ventricle
Right Atrium
Right Ventricle
Azygos Vein
SPECIFIC ABNORMALITIES
Abnormal Pulmonary Blood Flow and Pulmonary Edema
Valvular Heart Disease
Ischemic Heart Disease
Pericardial Disease
3:
Pharmacology of Heart
INOTROPES
Epinephrine
Dopamine
Dobutamine
PHOSPHODIESTERASE INHIBITORS
Amrionone
Heart Failure
Milrinone
Digoxin
ANTIANGINAL DRUGS
Isosorbide Dinitrate
Isosorbide Mononitrate
Nicorandil
ADRENERGIC INHIBITORS
Central-Acting α-Adrenergic Antagonists
FEW COMMONLY USED CENTRAL-ACTING α-ADRENERGIC ANTAGONISTS
Clonidine
Guanfacine
Methyldopa
Intravenous
PERIPHERAL-ACTING α-ADRENERGIC ANTAGONISTS
Guanethidine
Reserpine
α1-ADRENERGIC BLOCKERS
Parozosin
Terazosin
β-ADRENERGIC BLOCKERS
Mechanism of Action
Side Effects
Nursing Considerations
FEW COMMONLY USED β-ADRENERGIC BLOCKERS
Atenolol
Mechanism of Action
Indication and Dosage
Propranolol
Intravenous
Metoprolol
DIRECT VASODILATORS
Hyrdralazine
Minoxidil
Nitroglycerin
Sodium Nitroprusside
ANGIOTENSIN INHIBITORS
Angiotensin-converting Enzyme Inhibitors
FEW COMMONLY ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
Benazepril
Enalapril
Captopril
Ramipril
ANGIOTENSIN II RECEPTOR BLOCKERS
FEW COMMONLY USED ANGIOTENSIN II RECEPTOR BLOCKERS
Telmisartan
Losartan
Valsartan
Olmesartan
CALCIUM CHANNEL BLOCKERS
FEW COMMONLY USED CALCIUM CHANNEL BLOCKERS
Amlodipine
Nifedipine
Verapamil
Diltiazem
DIURETICS
Thiazide Diuretics
FEW COMMONLY USED THIAZIDE DIURETICS
Hydrochlorothiazide
Chlorothiazide
Trichlormethiazide
FEW COMMONLY USED LOOP DIURETICS
Furosemide
Torsemide
POTASSIUM-SPARING DIURETICS
Amiloride
ALDOSTERONE RECEPTOR BLOCKERS
Spironolactone
ANTILIPEMICS
HMG-CoA Reductase Inhibitors (Statins)
FEW COMMONLY USED STATINS
Simvastatin
Atrovastin
Niacin
FIBRIC ACID DERIVATIVES
Fenofibrate
Bile Acid Sequestrants
CHOLESTEROL ABSORPTION INHIBITOR
Ezetimibe (Zetia)
ANTIARRHYTHMIC
Class I (Sodium Channel Blockers)
Class I A (Prolong Repolarization)
Class I B (Shorten Repolarization)
Class I C (Little Effect on Repolarization)
Class II (β Adrenergic Blockers) – Reduce Sympathetic Tone
Class III (Potassium Channel Blockers)—Prolong Repolarization
Class IV (Calcium Channel Blockers)—Prolong Conduction and Refractoriness in SA and AV Nodes
COMMONLY USED ANTIARRHYTHMIC DRUGS
Amiodarone
Indication and Dosage
Oral
Lidocaine
Thrombolytics
First Generation
Second Generation
Alteplase
Streptokinase
Urokinase
Reteplase
Anistreplase
Tenecteplase
ANTICOAGULANTS
Fast acting
Heparin
Enoxaparin (Low Molecular Weight Heparin)
COUMARIN DERIVATES
Warfarin
INDANDIONE DERIVATES
Phenindione
ANTIPLATELETS
Aspirin
Ticlopidine
Clopidogrel
Tirofiban
Dipyridamole
Abciximab
Eptifibatide
4:
Nursing Management of Patients with Hypertension
TYPES OF HYPERTENSION
RISK FACTORS FOR HYPERTENSION
CAUSES
Primary Hypertension
Secondary Hypertension
NORMAL REGULATION OF BLOOD PRESSURE
Sympathetic Nervous System
Vascular Endothelium
Renal System
PATHOPHYSIOLOGY OF PRIMARY HYPERTENSION
PATHOPHYSIOLOGY OF SECONDARY HYPERTENSION
Renal Parenchymal Disease
Renovascular Disease
Primary Hyperaldosteronism
Pheochromocytoma
CLASSIFICATION
CLINICAL MANIFESTATIONS
COMPLICATIONS
HYPERTENSIVE HEART DISEASE
Coronary Artery Disease
Left Ventricular Hypertrophy
Heart Failure
Cerebrovascular Disease
Peripheral Vascular Disease
Nephrosclerosis
Retinal Damage
ASSESSMENT AND DIAGNOSTIC STUDIES
History Collection
Physical Assessment
Diagnostic Studies
MANAGEMENT OF HYPERTENSION
Nursing Management
5:
Nursing Management of Patients with Coronary Artery Disease
CORONARY ARTERY DISEASE
Non-Modifiable Risk Factors
Age, Gender, and Ethnicity
Family History and Genetics
Modifiable Major Risk Factors
Elevated Serum Lipids
Hypertension
Tobacco Use
Physical Inactivity
Obesity
Modifiable Contributing Risk Factors
Diabetes Mellitus
Metabolic Syndrome
Psychologic States
Homocysteine
Clinical Manifestations
Vascular
Cardiac
Diagnostic Tests
Pathophysiology
Management
Life Style Changes
Nursing Management
Relieving pain
Maintaining Cardiac Output
Health Education
ANGINA PECTORIS
Pathophysiology
Types of Angina
Canadian Cardiovascular Society Angina Grading Scale
Clinical Manifestations
Assessment and Diagnostic Findings
Medical Management
Drug Therapy
Antiplatelet
Anticoagulants
Nursing Management
MYOCARDIAL INFARCTION
Risk Factors
Non-modifiable Risk Factors
Modifiable Risk Factors
Contributing Factors
Classification of Myocardial Infarction
Left Ventricular Myocardial Infarction
Anterior Myocardial Infarction
Inferior/Posterior Myocardial Infarction
Lateral Myocardial Infarction
Right Ventricular Myocardial Infarction
Q Wave and Non Q Wave Infarction
Non ST Segment Vs ST Segment Elevated Myocardial Infarction
Healing Process of Myocardial Infarction
Clinical Manifestations of Myocardial Infarction (Box 5.1)
Pain
Sympathetic Nervous System Stimulation
Cardiovascular Manifestations
Nausea and Vomiting
Fever
Complications of Myocardial Infarction
Assessment and Diagnostic Findings
Patient History
Electrocardiogram
Echocardiogram
Laboratory Tests
Cardiac Enzymes for MI
Management
Drug Therapy
Nutritional Therapy
Primary Percutaneous Transluminal Coronary Angioplasty
Coronary Atherectomy
Coronary Artery Stents
Myocardial Revascularization–Coronary Artery Bypass Graft
Transmyocardial Laser Revascularization
Enhanced External Counter Pulsation (EECP)
Nursing Management of Patients with Myocardial Infraction
6:
Nursing Management of Patients with Dysrhythmia
INTRODUCTION
Sites of Origin of Dysrhythmia
Mechanism of Conduction
Common Causes of Dysrhythmia
Cardiac Conditions
Other Conditions
RHYTHMS ORIGINATING IN SINOATRIAL (SA) NODE
Sinus Bradycardia
Electrocardiogram (ECG) Characteristics
Treatment
Sinus Tachycardia
ECG Characteristics
Treatment
Sinus Arrest
ECG Characteristics
Treatment
RHYTHMS ORIGINATING IN ATRIA
Premature Atrial Contraction
ECG Characteristics
Treatment
Atrial Tachycardia
ECG Characteristics
Treatment
Paroxysmal Supraventricular Tachycardia
ECG Characteristics
Treatment
Supraventricular Tachycardia
ECG Characteristics
Treatment
Atrial Flutter
ECG Characteristics
Treatment
Atrial Fibrillation
ECG Characteristics
Treatment
RHYTHMS ORIGINATING IN THE ATRIOVENTRICULAR JUNCTION
ECG Characteristics
Premature Junctional Complexes
ECG Characteristics
Treatment
Junctional Rhythm and Junctional Tachycardia
ECG Characteristics
Treatment
RHYTHMS ORIGINATING IN VENTRICLES
Premature Ventricular Contractions
ECG Characteristics
Treatment
Ventricular Tachycardia
Different forms of Ventricular Tachycardia Depending on QRS Configuration
Ventricular Tachycardia may be Sustained or Nonsustained
ECG Characteristics
Treatment (Table 6.2)
Others
Ventricular Fibrillation
ECG Characteristics
Treatment
Asystole
ECG Characteristics
Treatment
CONDUCTION ABNORMALITIES
First Degree Atrioventricular Block
ECG Characteristics
Treatment
Second Degree AV Block Type I
ECG Characteristics
Treatment
Second Degree AV Block Type II
ECG Characteristics
Treatment
Third Degree AV Block
ECG Characteristics
Treatment
MANAGEMENT OF ARRHYTHMIA
Cardioversion
Radiofrequency Catheter Ablation Therapy
Nursing Management
7:
Nursing Management of Patients with Heart Failure
HEART FAILURE
Causes of Heart Failure
Types of Heart Failure
Classification of Heart Failure (New York Heart Association Functional Classification of Heart Disease)
ACC/AHA (American College of Cardiology/American Heart Association) Stages of Heart Failure
Pathophysiology (Flowchart 7.1)
Compensatory Mechanisms
Clinical Manifestations (Table 7.1)
Left-sided Heart Failure
Right-Sided Heart Failure
Complications
Assessment and Diagnostic Studies
Physical Assessment
Diagnostic Studies (Framingham Criteria for Diagnosis of Congestive Heart Failure)
Medical Management
General Measures for the Management of Heart Failure
Nursing Management
Maintaining Adequate Cardiac Output
Improving Oxygenation
Restoring Fluid Balance
Improving Activity Tolerance
Health Education
Surgical Management
Implantable Cardiac Defibrillators and Resynchronization Therapy
Revascularization
Heart Transplantation
Ventricular Assist Devices
CARDIOMYOPATHY
Causes
Causes of Secondary Cardiomyopathy
Types of Cardiomyopathy (Fig. 7.1)
Signs and Symptoms
Diagnostic Tests
Medical Management
Nursing Management
Improving Cardiac Output
Reducing Fatigue
Health Education
Surgical Management
8:
Nursing Management of Patients with Inflammatory Heart Disease
RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE
Causes
Pathophysiology of Rheumatic Heart Disease (Flowchart 8.1)
Major Criteria
Carditis
Assessment and Diagnostic Studies
Physical Examination
Diagnostic Studies
Others
Management
Nursing Management
Reducing Fever
Maintaining Adequate Cardiac Output
Maintaining Activity
INFECTIVE ENDOCARDITIS
Causes
Bacteria
Fungi
Viruses
Predisposing Conditions for Infective Endocarditis
Cardiac Conditions
Non-cardiac Conditions
Classification of Infective Endocarditis
Types
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Studies
Diagnosis of Infective Endocarditis (Modified Duke Criteria)
Major Criteria
Minor Criteria
Diagnostic Studies
Management
Cardiac Conditions Requiring Antibiotic Prophylaxis to Prevent Infective Endocarditis
High-Risk
Moderate Risk
Low Risk
Nursing Management
Maintaining Adequate Cardiac Output
Maintaining Tissue Perfusion
Maintaining Normal Temperature
Improving Nutritional Status
MYOCARDITIS
Causes
Viral (Most Common)
Bacterial
Fungal
Parasitic
Toxins
Hypersensitivity
Autoimmune Activation
Pathophysiology (Flowchart 8.3)
Clinical Manifestations
Assessment and Diagnostic Studies
Physical Examination
Diagnostic Studies
Expanded Criteria for Diagnosis of Myocarditis
Category I: Clinical Symptoms
Category II: Evidence of Cardiac Structural or Functional Perturbation in the absence of Regional Coronary Ischemia
Category III: Cardiac Magnetic Resonance Imaging
Category IV: Myocardial biopsy—Pathologic or Molecular Analysis
Management
Nursing Management
Reducing Fever
Maintaining Cardiac Output
Reducing Fatigue
PERICARDITIS
Classfication of Pericarditis
Clinical Classification
Etiologic Classification
Pericarditis Presumably Related to Hypersensitivity or Autoimmunity
Postcardiac Injury
Pathophysiology (Flowchart 8.4)
Clinical Manifestations
Assessment and Diagnostic Studies
Management
Complications of Pericarditis
Nursing Management
9:
Nursing Management of Patients with Valvular Disorders
MITRAL STENOSIS
Causes
Pathophysiology (Flowchart 9.1)
Clinical Manifestations
Symptoms
Signs
Assessment and Diagnostic Studies
Physical Assessment
Other Findings
Diagnostic Studies
Medical Management
MITRAL VALVE PROLAPSE (BARLOW SYNDROME, MYXOMATOUS VALVE SYNDROME, CLICK-MURMUR SYNDROME)
Causes
Pathophysiology (Flowchart 9.2)
Clinical Manifestations
Assessment and Diagnostic Studies
Physical Assessment
Diagnostic Studies
Medical Treatment
MITRAL REGURGITATION
Causes
Acute
Chronic
Pathophysiology (Flowchart 9.3)
Clinical Manifestations
Symptoms
Signs
Assessment and Diagnostic Studies
Physical Assessment
Diagnostic Studies
Medical Management
AORTIC STENOSIS
Causes
Pathophysiology (Flowchart 9.4)
Clinical Manifestations
Symptoms
Signs
Assessment and Diagnostic Studies
Physical Assessment
Diagnostic Studies
Medical Management
AORTIC REGURGITATION
Causes
Pathophysiology (Flowchart 9.5)
Clinical Manifestations
Symptoms
Signs (Table 9.1)
Assessment and Diagnostic Studies
Physical Assessment
Diagnostic Studies
Medical Management
NURSING MANAGEMENT OF PATIENTS WITH VALVULAR HEART DISORDERS
SURGICAL MANAGEMENT OF VALVULAR DISORDERS (FOR FURTHER DETAILS REFER CHAPTER 15)
10:
Nursing Management of Patients with Congenital Heart Disease
CIRCULATORY CHANGES AT BIRTH
INCREASED PULMONARY BLOOD FLOW (LEFT TO RIGHT SHUNTS)
Atrial Septal Defect
Types
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Findings
Management
Ventricular Septal Defect
Types
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Findings
Management
Patent Ductus Arteriosus (Fig. 10.6)
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Atrioventricular Canal Defect
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Findings
Management
OBSTRUCTION TO BLOOD FLOW FROM VENTRICLES
Coarctation of Aorta
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Aortic Stenosis
Types
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Studies
Management
Pulmonic Stenosis
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Studies
Management
DECREASED PULMONARY BLOOD FLOW WITH RIGHT TO LEFT SHUNTS
Tetralogy of Fallot (TOF) (Fig. 10.13)
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Findings
Management
Tricuspid Atresia (Fig. 10.14)
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Studies
Management
MIXED BLOOD FLOW WITH RIGHT TO LEFT SHUNTS
Transposition of Great Arteries (TGA)
Pathophysiology
Clinical Manifestations
Assessment and Diagnostic Studies
Management
Total Anomalous Pulmonary Venous Connection (Fig. 10.16)
Types
Pathophysiology
Clinical Manifestations
Obstructed Pulmonary Veins
Management
Unobstructed Pulmonary Blood Flow
Management
Truncus Arteriosus
Types
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
NURSING MANAGEMENT OF PATIENTS WITH CONGENITAL HEART DISEASE
Relieving Respiratory Distress
Improving Cardiac Output
Improving Oxygenation
Nutrition
For the Infant
For the Child
Preventing Infection
Health Education
Instruct the Family About the Necessary Measures to Maintain the Child's Health
Teach the Family About the Defect and its Management
11:
Interventional Cardiology
INTERVENTIONAL PHARMACOLOGY
Thrombolytics
Indications
Contraindications
Procedure
Nursing Considerations
INTERVENTIONAL DEVICES
PTCA (Percutaneous Transluminal Coronary Angioplasty)
Indications
Procedure
Complications
Coronary Artery Stent
Bare Metal stents (Fig. 11.2)
Balloon-expandable Stents
Self-expanding Stents
Drug-Eluting Stents
Sirolimus-Eluting Stents
Paclitaxel-Eluting Stents
Zotarolimus-Eluting Stents
Everolimus-Eluting Stent
Post-Procedure Care
Complications
Coronary Atherectomy
Directional coronary atherectomy
Rotational Ablation (Fig. 11.7)
Transluminal Extraction Atherectomy
Complications
Transmyocardial Revascularization
12:
Pacemaker
PACEMAKER
Indications for Pacing
Temporary
Permanent
Types of Pacemakers
Temporary Pacemaker
Pacemaker Rhythms (Fig. 12.5)
Pacing Modes
Others Pacing Modes
Basics of Pacemaker Operation
Components of A Pacing System
Bipolar Pacemaker Operation
Unipolar Pacemaker Operation (Fig. 12.11)
Asynchronous (Fixed-Rate) Pacing Mode
Demand Mode
Capture
Sensing
Initiating Temporary Pacing
Transvenous Ventricular Pacing
Epicardial Pacing
Dual-Chamber Temporary Pacing
NURSING CONDSIDERATIONS
Permanent Pacemakers
Temporary Pacemakers
Complications of Pacemaker Use
Patient Education
13:
Defibrillators
DEFIBRILLATORS
Defibrillation
Synchronized Cardioversion
Indications for Defibrillation
Indication for Synchronized Cardioversion
TYPES OF DEFIBRILLATOR
Monophasic Defibrillator
Biphasic Defibrillator
Transthoracic Impedance
Electrode Placement
Standard Electrode Placement
Anteroposterior Electrode Placement
Posterior—Apex
Defibrillation Procedure
Precautions
Procedure
Post-Defibrillation Care
Complications
IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) (FIG. 13.6A)
Components
Pulse Generator
Battery
Capacitors
Sensing and Amplification System
Indications
Sudden Cardiac Death Survivors
Sustained Ventricular Tachycardia
Syncope of Unknown Origin
Functional Characteristics
Sensing and Detection
Modes of Operation
Ventricular Fibrillation Therapy
Ventricular Tachycardia Therapy
Bradycardia Pacing
Device Implantation
Complications
14:
Mechanical Circulatory Assistive Devices
INTRA-AORTIC BALLOON PUMP (IABP)
Components of an IABP
Insertion of an IABP
Goals of IABP Therapy
Indications and Contraindications of IABP Therapy
Indications
Contraindications
Physiology of Balloon Function
Effects of Inflation During Diastole
Effects of Deflation During Systole
Timing
Timing Errors
Early Inflation of the Balloon
Late Inflation of the Balloon
Early Deflation of the Balloon (Fig. 14.8)
Late Deflation of the Balloon (Fig. 14.9)
Terms Related to IABP Therapy
Complications of IABP Therapy
Weaning from IABP Therapy
Stable Hemodynamic Parameters
SHORT TERM DEVICES
Abiomed Pumps
Tandem Heart Percutaneous Transeptal Left Ventricular Assist (PTVA)
Extracorporeal Membrane Oxygenation (ECMO)
Long-Term Mechanical Circulatory Support
Ventricular Assist Devices (VAD)
VAD Selection Criteria
Types of VADs
Total Artificial Heart
Postoperative Complications
Requirements for Being Discharged with an LVAD
Precautions at Discharge Safety
15:
Nursing Care of Patient Undergoing Cardiac Surgery
CARDIOPULMONARY BYPASS
Different types of Cannulation (Fig. 15.1)
Components of Cardiopulmonary Bypass Circuit (Fig. 15.2)
Complications
MYOCARDIAL PROTECTION
Types of Cardioplegia
Techniques (Fig. 15.3)
Temperature of Cardioplegia
INDICATIONS FOR CARDIAC SURGERY
ACC/AHA Indications for CABG
Asymptomatic or Mild Angina
Stable Angina
Unstable Angina/NSTEMI
Segment Elevation Myocardial Infarction (STEMI)
Presence of Poor LV Function
Presence of Life-Threatening Ventricular Arrhythmias
Failed PCI
Previous CABG
INDICATIONS AND CONTRAINDICATIONS FOR CARDIAC TRANSPLANTATION
Indications
Diseases
Contraindications and Excluded Etiologies
HEART–LUNG TRANSPLANT RECIPIENT CRITERIA AND CONTRAINDICATIONS
Recipient Criteria
Disease Processes
Absolute Contraindications
Relative Contraindications
INDICATIONS FOR AORTIC VALVE REPLACEMENT IN AORTIC STENOSIS
Class I
Class IIa
Class IIb
Class III
INDICATIONS FOR AORTIC VALVE REPLACEMENT IN AORTIC REGURGITATION
Class I
Class IIa
Class IIb
Class III
INDICATIONS FOR MITRAL VALVE REPAIR OR REPLACEMENT IN MITRAL STENOSIS
Class I
Class IIa
Class IIb
Class III
INDICATIONS FOR SURGERY FOR MITRAL REGURGITATION
Class I
Class IIa
Class IIb
Class III
PREOPERATIVE CARE
INTRAOPERATIVE CARE
POSTOPERATIVE CARE
Patient Arrival
Initial Postoperative Assessment
Cardiovascular Status
Respiratory Status
Neuromuscular Status
Genitourinary Status
Integumentary Status
Gastrointestinal Status
Ongoing Assessment
Ongoing Patient Care
Respiratory
Cardiovascular
Nutrition
Neurology
Fluid/Electrolytes
Pain Management
Wound Care
Postoperative complications
Cardiac Complications
Pulmonary Complications
Gastrointestinal Complications
Renal Complications
Neurological Complications
CORONARY ARTERY BYPASS GRAFT SURGERY
Patient Preparation
Premedication
Anesthesia
Positioning
Monitoring
Harvesting of Conduit
Saphenous Vein
Internal Mammary Artery
Coronary Artery Bypass
Cardiopulmonary Bypass
Placement of Graft
Techniques of Anastomosis
Distal anastomosis Technique
Proximal Anastomosis Technique (Fig. 15.10A and B)
Weaning from Cardiopulmonary Bypass
Early Complications
Late Complications
Postoperative Management
VALVE SURGERY
Valvuloplasty
Types of Valvuloplasty
Valve Replacement
Types of Valve Prostheses
Tissue or Biologic Valve or Bio Prostheses
SELECTION OF AN ARTIFICIAL VALVE
Children
In Adults Younger than 70 Years
In Patients Older than 70 Years
Pregnancy
COMPLICATIONS OF ARTIFICIAL VALVE
Postoperative Care
Patient Education
CARDIAC TRANSPLANTATION
Selection of Heart Donors
Selection of Recipient
Preoperative Check-list
Procedure
Postoperative Care
Monitor for Bleeding
Management of Bleeding
Monitor for Hypovolemia
Monitor for Heart Failure
Monitor for Pulmonary Hypertension
Monitor for Arrhythmias
Monitor for Rejection (Table 15.1)
Immunosuppression
Prevention of Infection
Transplant Vasculopathy
MINIMALLY INVASIVE CARDIAC SURGERY
Types of Minimally Invasive Cardiac Surgery
Minimally Invasive Direct CABG (MIDCAB)
OPCAB (Off Pump Coronary Artery Bypass Grafting)
Procedure
Robotically Assisted Heart Surgery
Benefits of Robotically Assisted Heart Surgery
Types of Robotically Assisted Heart Surgeries
Procedure
Port Access Coronary Artery Bypass Graft
NOTE
NOTE
SECTION 2: VASCULAR NURSING
16:
Anatomy and Physiology of Vascular System
BASIC STRUCTURE OF A BLOOD VESSEL (FIG. 16.1A TO C)
ARTERIES
Arterioles
CAPILLARIES
VENULES
Veins
ANASTOMOSES
BLOOD DISTRIBUTION
EXCHANGES IN CAPILLARIES
17:
Assessment and Diagnostic Evaluation
COMMON SYMPTOMS OF PERIPHERAL ARTERIAL DISEASE
Limb Symptoms
Classification of Lower Limb Ischemia
Asymptomatic Ischemia
Intermittent Claudication
Night/Rest Pain
Tissue loss (Ulceration/Gangrene)
Neurological Presentations
Abdominal presentations
Visceral Ischemia
Abdominal Aortic Aneurysm
Vasospastic Presentations
COMMON ABNORMALITIES OF PERIPHERAL ARTERIES
Chronic Lower Limb Ischemia
Acute Limb Ischemia
VENOUS DISEASE
Common Symptoms of Venous Disease
Common Abnormalities of Venous Disease
Superficial Venous Thrombosis
Chronic Venous Insufficiency
Chronic Leg Ulceration
Varicose Veins
PHYSICAL EXAMINATION FOR ARTERIES
Arteries
Examination of Pulses
Measurement of Ankle—Brachial Pressure Index (Fig. 17.2)
Bruits
Aneurysms
The Allen Test/Test for Collateral Circulation
Buerger's Test
Exercise Testing
Examination of the Skin
PHYSICAL EXAMINATION FOR VEINS
Venous
Trendelenburg Test
Homan's Sign
DIAGNOSTIC EVALUATION
Ultrasound Studies
Ultrasound (Conventional)
Doppler Ultrasound
Duplex Scan
Arterial Examination
Venous Examination
Advantages and Disadvantages of Color Doppler Ultrasound
Advantages
Disadvantages
COMPUTED TOMOGRAPHY
18:
Nursing Management of Patients with Arterial Disorders
PERIPHERAL ARTERIAL DISEASE
Causes and Risk Factors
Types
Peripheral Arterial Disease of the Lower Extremities
Peripheral Arterial Disease of the Upper Extremities
Nursing Management of Peripheral Artery Disease
Promoting Tissue Perfusion
Protecting Lower Extremities
Preventing Infection
Health Education
THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE)
Clinical Manifestations
Diagnostic Studies
Management
RAYNAUD'S DISEASE
Clinical Manifestations
Management
Nursing Management
Minimizing Sensory Alteration
Relieving Pain
Health Education
AORTIC ANEURYSM
Causes
Risk Factors
Classification
Clinical Manifestations
Complications
Diagnostic Studies
Management
Medical Management
Surgical Management
Nursing Management
AORTIC DISSECTION
Causes and Risk Factors
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Initial Management
Conservative Management
Surgical Management
Nursing Management
19:
Nursing Management of Patients with Venous Disorders
VENOUS THROMBOSIS
Types
Causes
Risk Factors
Venous Stasis
Endothelial Damage
Hypercoagulability of Blood
Pathophysiology
Clinical Manifestations
Superficial Thrombophlebitis
Deep Vein Thrombosis
Diagnostic Studies
Non-invasive Venous Studies
Duplex Scanning
Venogram
Complications of Venous Thrombosis
Management
Superficial Thrombophlebitis
Deep Vein Thrombosis
Surgical Management
Venous Thrombectomy
Vena Cava Interruption Devices
Nursing Management
Relieving Pain
Prevention of Bleeding
Monitoring Clotting Profiles
Preventing Hazards of Immobility
Health Education
VARICOSE VEINS
Predisposing Factors
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Doppler Examination
Duplex Ultrasound Imaging
Varicography
Venography
Prevention
Management
Nursing Management
CHRONIC VENOUS INSUFFICIENCY
Causes
Pathophysiology
Clinical Manifestations
Complications
Management
LEG ULCERS
Causes
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Removing Devitalized Tissue
Stimulating Formation of Granulation Tissue
Preventing Recurrence
Nursing Management
Restoring Tissue Integrity
Reducing Pain
Health Education
SECTION 3: THORACIC NURSING
20:
Anatomy and Physiology of Lungs
EMBRYOLOGY OF LUNGS
LOCATION OF LUNGS
ANATOMY OF LUNGS
Surfaces of the Lungs
Borders of Lungs
Fissures and Lobes of the Lungs (Fig. 20.4)
SEGMENTS OF LUNGS (Figs 20.5A to F)
Left Lung Segments
Right Lung Segments
Alveoli (Fig. 20.7)
Blood Supply, Nerve Supply and Lymphatic Drainage of Lungs
Lymphatic Drainage
Nerve Supply
PHYSIOLOGY OF LUNGS
Mechanism of Respiration (Fig. 20.8)
Inhalation
Exhalation
Factors Affecting Respiration
Pulmonary Ventilation
Alveolar Ventilation
Ventilation-perfusion Ratio
Lung Volumes and Capacities (Fig. 20.10)
Lung Volumes
Lung Capacities
Exchange of Gases (Fig. 20.11)
Diffusion of Gases -partial Pressures
Transport of Gases
21:
Assessment and Diagnostic Evaluation
COUGH
Causes of Cough
Types of Cough
SPUTUM PRODUCTION
Amount
Types of Sputum
Smell
Solid Material
HEMOPTYSIS
Amount and Appearance
Duration and Frequency
Causes of Hemoptysis
CHEST PAIN
Types
Pleural Pain
Chest Wall Pain
Mediastinal Pain
Causes of Chest Pain
BREATHLESSNESS
Causes of Breathlessness
Mode of Onset, Duration, Progression of Breathlessness
Variability, Aggravating/Relieving Factors of Breathlessness
Associated Symptoms
WHEEZE
GENERAL EXAMINATION
Breathing Patterns
Use of Accessory Muscles
Stridor
Hoarseness
Cyanosis
Blood Pressure
Skin Appearances
Hands
Finger Clubbing
Discoloration of the Fingers and Nails
Tremor
EXAMINATION OF THORAX
Inspection
Chest Configuration
Thoracic Palpation
Respiratory Excursion (Fig. 21.5)
Tactile Fremitus (Fig. 21.6)
Thoracic Percussion (Fig. 21.7)
Percussion Sounds
Diaphragmatic Excursion
Auscultation
Normal Breath Sounds
Adventitious Breath Sounds
Fine Crackles
Coarse Crackles
Rhonchi
Wheezes
Stridor
Absent Breath Sounds
Pleural Friction Rub
DIAGNOSTIC EVALUATION
Blood Studies
Oximetry
Principle
Applications of Pulse Oximetry
Limitations of Pulse Oximetry
Skin Test
Procedure
Interpretation
False-Negative Reactions
False-Positive Reactions
Sputum Studies
Collection of Sample
Bronchoscopy
Suction
After a Sample is Collected
Culture and Sensitivity
Results
Gram Stain
Gram-Positive Bacteria
Gram-Negative Bacteria
Acid-fast Smear
Cytology
Purpose
Result
Pulmonary Ventilation/Perfusion Scan
Purpose
Results
Pulmonary Angiography
Bronchoscopy
Complications
Nursing Care
Thoracoscopy
Lung Biopsy Procedures
Techniques
Nursing Care
Mediastinoscopy and Mediastinotomy
Nursing Care
Thoracentesis (Fig. 21.9)
Indications
Contraindications
Preparation of the Patient
General Instructions to the Nurse
Procedure
After Care
Analysis of Pleural Fluid
Pulmonary Function Test (PFT)
Indications
Preparation of the Patient
Pulmonary Function Testing Methods
Interpretation of the Test
Normal values of PFT
Step by Step Interpretation of PFT Values
22:
Respiratory Therapies
OXYGEN THERAPY
Indications
METHODS OF ADMINISTRATION OF OXYGEN
Nasal Cannula (Fig. 22.1)
Simple Face Mask (Fig. 22.2)
Partial Rebreathing Mask (Fig. 22.3)
Non-Rebreathing Mask (Fig. 22.4)
Transtracheal Catheter (Fig. 22.5)
Venturi Mask (Fig. 22.6)
CPAP Mask (Fig. 22.7)
BiPAP Mask (Fig. 22.8)
ARTIFICIAL AIRWAYS
Endotracheal Tubes (Fig. 22.9)
Endotracheal Intubation Procedure
Indications
Procedure
Followup Phase
Nursing Care of Patients with Endotracheal Intubation
Complications of Endotracheal Intubation
Tracheostomy
Indications
Procedure
Components of Tracheostomy Tube (Fig. 22.10)
Features of Tracheostomy Tube
Speaking Tracheostomy Tube (Fig. 22.13) with Cuff, two External Tubings
Nursing care of Patients with Tracheostomy
Changing Tracheostomy Dressings
Skin Care
Complications of Tracheostomy
INCENTIVE SPIROMETRY
Indications
Procedure
CHEST PHYSIOTHERAPY
Indications
Percussion
Vibration (Fig. 22.18)
Postural Drainage (Fig. 22.19)
Breathing Retraining
CHEST DRAINAGE
Chest Drainage Systems
Water Seal Chest Drainage Systems (Fig. 22.20)
Single-bottle Water-seal System
Two-bottle Water-seal System
Three-bottle Water-seal System
Dry Suction with a One-Way Valve System
Care of Patient with Chest Drainage
NEBULIZATION
Purpose
Types of Nebulizers
Commonly Used Drugs Used in Nebulization
Procedure
Complications
MECHANICAL VENTILATION
Indications for Mechanical Ventilation
Classification of Ventilators
Negative-Pressure Ventilators
Positive-Pressure Ventilators
Cycles of Mechanical Ventilators
Settings of Mechanical Ventilator
VENTILATOR GRAPHICS (FIGS 22.21 TO 22.26)
MODES OF MECHANICAL VENTILATOR (FIG. 22.27)
Volume Modes
Controlled Mandatory Ventilation (Fig. 22.28)
Assist-control Mechanical Ventilation (Fig. 22.29)
Synchronized Intermittent Mandatory Ventilation
Pressure Modes
Pressure Control Ventilation (Fig. 22.31)
Pressure Support Ventilation (Fig. 22.32)
Positive End-expiratory Pressure
Advantages
Disadvantages
Continuous Positive Airway Pressure (Fig. 22.33)
Bilevel Positive Airway Pressure
Weaning from the Ventilator
Indicators for Weaning
Weaning Readiness
Indices for Weaning
Complications Mechanical Ventilation
Nursing Management of Patients Mechanical Ventilation
23:
Nursing Management of Patients with Thoracic Disorders
BRONCHIAL ASTHMA
Stimuli that can Incite Asthma
Allergen Inhalation
Air Pollutants
Drugs
Occupational Exposure
Food Additives
Pathophysiology
Clinical Manifestations
Classification of Asthma
Diagnosis of Asthma
Management of Asthma
Goals of Asthma Management
Oxygen
High Doses of Inhaled Bronchodilators
Systemic Corticosteroids
Intravenous Fluids
Subsequent Management
Monitoring of Treatment
Drugs Used in Asthma
Antiinflammatory Agents
Mast Cell Stabilizers
Anticholinergics
Leukotriene Modifiers
β2-Adrenergic Agonists
Methylxanthines
Stepwise Approach for Managing Asthma
Quick Relief Medications
Nursing Management of Patients with Asthma
Avoidance of Triggers
Patient Education
BRONCHIECTASIS
Causes
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Medical Management
Nursing Management
PNEUMONIA
Risk Factors
Types of Pneumonia
Bacterial Pneumonia
Viral and Mycoplasmal Pneumonia
Pneumocystis Carinii Pneumonia (PCP)
Legionella Pneumonia
Aspiration (Inhalation) Pneumonia
Hypostatic Pneumonia
Lipid Pneumonia
Lobar Pneumonia
Bronchopneumonia (Lobular Pneumonia)
Pathogenesis
Pathophysiology
Congestion
Red Hepatization
Gray Hepatization
Resolution
Clinical Manifestations
Complications
Diagnostic Studies
Management
Uncomplicated Community Acquired Pneumonia
Severe Community Acquired Pneumonia
Hospital Acquired Pneumonia
Nursing Interventions
Improving Gas Exchange
Enhancing Airway Clearance
Relieving Pleuritic Pain
Promoting Rest and Conserving Energy
Promoting Fluid Intake
Maintaining Nutrition
LUNG ABSCESS
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Drug Therapy
Nursing Management
TUMORS OF LUNGS
Types of Lung Tumors
Epithelial Tumors
Soft Tissue Tumors
Pleural Tumors
Miscellaneous Tumors
Bronchogenic Carcinoma
Causes
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Medical Management
Surgical Management
Radiation Therapy
Chemotherapy
Nursing Management
Managing Symptoms
Relieving Breathing Problems
Reducing Fatigue
PULMONARY TUBERCULOSIS
Mode of Transmission
Risk Factors
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Tuberculin Skin Test
Chest X-ray
Bacteriologic and Other Studies
Medical Management
Treatment Schedule
Drug Regimen
Nursing Management
Improving Breathing Pattern
Preventing Transmission of Infection
Improving Nutritional Status
Improving Compliance
Health Education
PLEURISY
Clinical Manifestations
Diagnostic Studies
Medical Management
Nursing Management
PLEURAL EFFUSION
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Medical Management
Nursing Management
PNEUMOTHORAX
Simple Pneumothorax
Traumatic Pneumothorax
Clinical Manifestations
Medical Management
Hemothorax
Open Pneumothorax
EMPYEMA/PYOTHORAX
Clinical Manifestations
Diagnostic Studies
Medical Management
INTERSTITIAL LUNG DISEASE
Types
Causes
Clinical Manifestations
Diagnostic Studies
Management
Antibiotics
Nursing Management
Improving Breathing Pattern
Promoting Gas Exchange
Health Education
CYSTIC FIBROSIS
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Medical Management
Nursing Management
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Causes
Pathophysiology
Morphologic Types of COPD (Figs 23.3 and 23.4)
Clinical Manifestations
Classification of Severity COPD
Complications
Diagnostic Studies
Medical Management
Risk Reduction
Pharmacologic Therapy
Breathing Exercise
Management of Exacerbation
Oxygen Therapy
Surgical Management
Lung Volume Reduction Surgery
Lung Transplantation
Pulmonary Rehabilitation
Nursing Management
Improving Airway Clearance
Improving Breathing Pattern
Controlling Infection
Improving Gas Exchange
Improving Nutrition
Increasing Activity Tolerance
ACUTE RESPIRATORY FAILURE
Types
Causes
Respiratory System
Central Nervous System
Chest Wall
Cardiac System
Neuromuscular System
Pathophysiology
Mechanisms of Hypoxemic Respiratory Failure
Shunt
Diffusion Limitation
Alveolar Hypoventilation
Mechanisms of Hypercapnic Respiratory Failure
Clinical Manifestations
Hypoxemia
Hypercapnia
Diagnostic Studies
Management
Respiratory Therapy
Drug Therapy
Nursing Management
ACUTE RESPIRATORY DISTRESS SYNDROME
Causes
Direct Lung Injury
Indirect Lung Injury
Pathophysiology
Clinical Manifestations
Diagnostic Criteria
Management
Oxygen Administration
Mechanical Ventilation
Positioning Strategies
Maintenance of Cardiac Output and Tissue Perfusion
Maintenance of Nutrition and Fluid Balance
Nursing Management
PULMONARY EMBOLISM
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Emergency Management
General Management
Surgical Management
Nursing Management
PULMONARY HYPERTENSION
Types
Causes of Pulmonary Hypertension
Primary or Idiopathic
Secondary
Pathophysiology
Clinical Manifestations
Diagnostic Studies
Management
Nursing Management
24:
Nursing Management of Patients Undergoing Thoracic Surgery
PREOPERATIVE CARE
History
Important Components of History in Preoperative Evaluation
Duke Activity Status Index
Physical Examination
Laboratory Studies
Imaging Studies
Pulmonary Function Testing
Arterial Blood Gas Measurements
INTRAOPERATIVE CARE
Ventilation
Monitoring
Body Temperature
Positioning
Fluid Administration
POSTOPERATIVE CARE
Fluid Management
Blood Administration
Medications
Nutrition
Respiratory Therapy
Wound Care
Management of Drainage Tubes
Physical Therapy
Complications
Early Complications
Late Complications
THORACIC SURGERY
Thoracic Incisions
Posterolateral Thoracotomy
Axillary Thoracotomy (Fig. 24.2)
Anterior Thoracotomy (Fig. 24.3)
Thoracoabdominal Incision (Fig. 24.4)
Median Sternotomy Incision (Fig. 24.5)
Transverse Thoracosternotomy (Clamshell)
Thoracosternotomy (Hemi-clamshell)
PULMONARY RESECTIONS
Pneumonectomy (Fig. 24.8)
Lobectomy (Fig. 24.9)
Sleeve Lobectomy (Fig. 24.10)
Segmentectomy (Fig. 24.11)
Wedge Resection (Fig. 24.12)
Bullectomy (Fig. 24.13)
Lung Volume Reduction Surgery (Fig. 24.14)
VIDEO-ASSISTED THORACIC SURGERY (VATS) (FIG. 24.15)
ROBOTIC THORACIC SURGERY (FIG. 24.16)
SECTION 4: MISCELLANEOUS
25:
Intensive Coronary Care Unit/Cardiothoracic Unit
QUALITY ASSURANCE
Purposes/Need
Approaches
STANDARDS
Characteristics of Standard
Purposes of Standards
Sources of Nursing Care Standards
Classification of Standards
Normative and Empirical Standards
Ends and Means Standards
Structure, Process and Outcome Standards
Structure Standard
Process Standard
Outcome Standards
INFECTION CONTROL IN CCU/ICTU
Sources of Infection in CCU/ICTU
Strategies to Reduce Infection Risk
Hand Hygiene
Procedures Requiring Aseptic Technique
IV Care Practices
Respiratory Care—Patient-Based Interventions
Personal Protective Equipment for Routine Patient Care
Environment Factors and Design Issues for the CCU/ICTU
Space
Ventilation
Traffic Flow
Visitors
Non-CCU/ICTU Staff
Environmental Cleaning
Daily
Terminal
Scheduled
STANDARD SAFETY MEASURES
Handwashing/Hand Hygiene
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health and Blood Borne Pathogens
Patient Placement
Protocols and Procedures
Nursing Audit
Characteristics
Objectives
Types of Audit
Methods of Audit
Advantages
Disadvantages
Organization of CCU/ICTU
Cardiac Team Members
Burnout Syndrome
Causes of Burnout
Warning Signs and Symptoms of Burnout
Preventing Burnout
Coping with Job Burnout
NURSING MANAGEMENT OF PATIENTS IN CCU/ICTU
MOBILE CORONARY CARE UNIT
26:
Cardiovascular and Thoracic Conditions—a Major Health Problem
CARDIOVASCULAR PROBLEMS
Top Ten Causes of Mortality
Epidemiological Transition of NCDs
Indian Healthcare Overview (Fig. 12.1)
India – Transition to NCDs
Economic Impact of CVDs
Factors for Increase in Incidence of Heart Diseases in India
Factors Contributing to Rise of CVD Incidence in India
Cardiac Care Cycle (Fig. 26.2)
Stages in the Cardiac Care Cycle
THORACIC PROBLEMS
Chronic Obstructive Pulmonary Disease
Burden of COPD
Role of WHO
Tuberculosis (TB)
Incidence, Prevalence and Mortality Rate of Tuberculosis in 2011 in India
Burden of Tuberculosis
WHO Response
Asthma
Global Statistics
The Human and Economic Burden
Reducing the Asthma Burden
WHO Strategy for Prevention and Control of Asthma
27:
National Health Programs Related to Cardiovascular and Thoracic Conditions
CARDIOVASCULAR PROGRAM
Prevention and Control of Cardiovascular Diseases
Strategic Priorities
CVD in Developing Countries
Social and Economic Consequences
Key Areas of Work
THORACIC PROGRAM
RNTCP (Revised National Tuberculosis Control Program)
Objectives:
Components of DOTS
Treatment Schedule
Category 1
Category 2
Category 3
Drug Regimen
Global Alliance against Chronic Respiratory Diseases (GARD)
Objectives
GARD Strategic Objectives to Support up to Technical Work
28:
Trends and Issues in Cardiothoracic Nursing
PREVENTION
Corporates
Healthcare Providers
Government
Pharmaceutical Companies
Intervention
Advances in Medical Technology
Public Private Partnerships
Innovation in Service Delivery
Telemedicine
TRENDS IN CARDIAC SURGERY
Minimally Invasive Heart Surgeries
Robotically Assisted Heart Surgery
Advantages of Minimally Invasive Heart Surgeries
TRENDS IN THORACIC SURGERY
Minimally Invasive Thoracic Surgery
Advantages of Minimally Invasive Thoracic Surgery
ISSUES IN CARDIOTHORACIC CARE
Low Availability
Low Accessibility
Low Affordability
Lack of Concerted Policies
29:
Legal and Ethical Issues
LEGAL ISSUES
Sources of Law
Classification of Law
Legal Issues in Nursing
Informed Consent
Fraud
Medication Errors
TORTS
Classification of Torts
Intentional Torts
Quasi-intentional Torts
Unintentional Torts
Legal Safe Guards and Nursing Practice
Institutional Policies
Licensure
Standards of Care
Standing Orders
List of Do's and Don'ts as Guidelines for Safe Practice
Do's
Don'ts
ETHICS
Code of Ethics
Ethical Principles
Professional Conduct
Professional Responsibility and Accountability
Nursing Practice
Communication and Interpersonal Relationships
Management
Professional Advancement
ICN Code of Ethics for Nurses
Elements of the Code
American Nurses Association Code of Ethics for Nurses
Canadian Nurses Association Code of Ethics for Nursing
30:
Alternate System of Medicine and Complementary Therapies
DEFINITIONS
ALTERNATIVE MEDICAL SYSTEMS
Traditional Chinese Medicine
Ayurveda
Siddha
Native American Healthcare
Hispanic Healthcare
Homeopathy
Naturopathy
MIND-BODY INTERVENTIONS
Relaxation Breathing
Prayer
Meditation
Biofeedback
Imagery
Hypnosis
Music Therapy
Art Therapy
Journaling
BIOLOGIC-BASED THERAPIES
Herbal Therapy
Nutraceuticals
Nutritional Therapy
Aromatherapy
MANIPULATIVE AND BODY-BASED METHODS
Chiropractic Therapy
Massage Therapy
Energy Therapies
COMPLEMENTARY AND ALTERNATIVE MEDICINE IN CARDIOVASCULAR DISEASE
COMPLEMENTARY AND ALTERNATIVE MEDICINE IN LUNG DISEASE
Nutrients
Herbal
NOTE
Appendix I
NANDA NURSING DIAGNOSIS 2012–14
Health Promotion
Nutrition
Elimination and Exchange
Activity/Rest
Perception/Cognition
Self-Perception
Role Relationships
Sexuality
Coping/Stress Tolerance
Life Principles
Safety/Protection
Comfort
Growth/Development
Appendix II
CARDIOPULMONARY RESUSCITATION
Adult One-Rescuer Cardiopulmonary Resuscitation (CPR)
Assess
Activate Emergency Medical Services (EMS) System
Circulation
Begin Compressions
Airway
Breathing
Defibrillation
Adult Two-Rescuer Cardiopulmonary Resuscitation (CPR)
One Rescuer
Other Rescuer
Circulation
Compression-Ventilation Cycle (Fig. 8)
One Rescuer/Compressor
Other Rescuer/Ventilator
Switching
Defibrillation
Appendix III
CARDIAC ARREST
Cardiac Causes
Noncardiac Causes
Management
Appendix IV
CARDIAC REHABILITATION
Broad Aims of Cardiac Rehabilitation
Specific Aims of Cardiac Rehabilitation
Indications
Contraindications
Phases of Cardiac Rehabilitation
Phase I (Inpatient Cardiac Rehabilitation)
Phase II (Outpatient Cardiac Rehabilitation)
Phase III (Long Term Cardiac Rehabilitation)
INDEX
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