Textbook of Cardiovascular & Thoracic Nursing P Hariprasath
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1Textbook of Cardiovascular and Thoracic Nursing
(As per INC Syllabus for MSc Students)
P Hariprasath MSc (Nursing) (Cardiovascular and Thoracic Nursing) Assistant Professor Department of Medical Surgical Nursing Panna Dhai Maa Subharti Nursing College Swami Vivekanand Subharti University Meerut, Uttar Pradesh, India Formerly Lecturer Department of Medical Surgical Nursing Rajasthan College of Nursing Sikar, Rajasthan, India
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Textbook of Cardiovascular and Thoracic Nursing
First Edition: 2016
Printed at
This book is dedicated
my dear nursing students4
Cardiovascular disease is one of the major health problems in India. Nearly 100 million people are affected with cardiovascular disease, the prevalence of the cardiovascular diseases increasing among the youth of India and nearly 25% of the victims are below 40 years of age. The most indigestible fact is our country is set to be the heart disease capital of the world in next few years.
All of these things motivated me to write a book on cardiac nursing in order to prevent and manage cardiovascular disease. In this book all the essential concepts of cardiac nursing are explained in simple and student-friendly way with tables, images and schematic representation of pathophysiology. I hope this book will serve the purpose of the nursing community.
P Hariprasath6
First, I praise and thank Almighty for the abundant grace, strength and blessings for me to complete this book.
This book would not have been possible without the endeavor of my parents Mr Pandurangan and Mrs Latha. Hearty thanks to my sister, Mrs Vidhya (Advocate), Cuddalore, Tamil Nadu for providing her con amore support to complete this book. My uncle, Mr Ravikumar encouraged me constantly to fulfil this book. My nephew, Master Srikanth and my niece, Ms Shreya for showing love and affection throughout the work.
Dr Srinivas BNYS, MD, Director ARS Hospital, Villupuram Tamil Nadu fended me to complete this book. Dr Anuradha BHMS, Medical Officer (Homeopathy) Government General Hospital, Villupuram, Tamil Nadu for her vehement support to complete this book. I show my gratitude to Mrs Titi Mangalathil MSc (N), Principal and all faculty members of Rajasthan College of Nursing, Sikar, Rajasthan for condescend support to finish this book.
Last but not least, I would like to especially thanks Mr Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Payal Bharti (Project Manager) Jaypee Brothers Medical Publishers (P) Ltd., for accepting and publishing my book.
Placement: II year
Hours of Instruction
Theory: 150 hours
Practical: 950 hours
Total: 1100 hours
Course Description
This course is designed to assist students in developing expertise and indepth understanding in the field of cardiovascular and thoracic nursing. It will help a student to develop advanced skills for nursing intervention in various cardio medical and surgical conditions. It will enable the student to function as cardiovascular and thoracic nurse practitioners/specialist. It will further enable the student to function as educator, manager and researcher in the field of cardiovascular and thoracic nursing.
At the end of the course, the student will be able to:
  • Appreciate trends and issues related to cardiovascular and thoracic nursing.
  • Describe the epidemiology, etiology, pathophysiology and diagnostic assessment of cardiovascular and thoracic conditions.
  • Participate in national health programs for health promotion, prevention and rehabilitation of patients with cardiovascular and thoracic conditions.
  • Perform physical, psychosocial and spiritual assessment.
  • Assist in various diagnostic, therapeutic and surgical procedures.
  • Apply nursing process in providing comprehensive care to patients with cardiovascular and thoracic conditions.
  • Demonstrate advance skills/competence in managing patients with cardiovascular and thoracic conditions including "advance cardiac life support".
  • Describe the various drugs used in cardiovascular and thoracic conditions and nurse's responsibility.
  • Demonstrate skill in handling various equipment/gadgets used for critical care of cardiovascular and thoracic patients.
  • Appreciate teamwork and coordinate activities related to patient care.
  • Practice infection control measures.
  • Identify emergencies and complications and take appropriate measures.
Unit I
  • Historical development, trends and issues in the field of cardiology
  • Cardiovascular and thoracic conditions—major health problem
  • Concepts, principles and nursing perspectives
  • Ethical and legal issues
  • Evidence-based nursing and its application in cardiovascular and thoracic nursing (to be incorporated in all the units).
Unit II
  • Risk factors—hereditary, psychosocial factors, hypertension
  • Smoking, obesity, diabetes mellitus, etc.
  • Health promotion, disease prevention, lifestyle modification
  • National health programs related to cardiovascular and thoracic conditions
  • Alternate system of medicine
  • Complementary therapies.
Unit III
Review of anatomy and physiology of cardiovascular and respiratory system
  • Review of anatomy and physiology of heart, lung, thoracic cavity and blood vessels. Embryology of heart and lung
  • Coronary circulation
  • Hemodynamics and electrophysiology of heart
  • Biochemistry of blood in relation to cardiopulmonary function.
Unit IV
Assessment and diagnostic measures
  • History taking
  • Physical assessment
  • Heart rate variability (HRV): Mechanisms, measurements, pattern, factors, impact of interventions on HRV.
  • Diagnostic tests
    • Hemodynamic monitoring: Technical aspects, monitoring, functional hemodynamic indices, ventricular function indices, output measurement (arterial and Swan-Ganz monitoring). Blood gas and its significance, oxygen supply and demand.
    • Radiologic examination of the chest: Interpretation, chest film findings.
    • Electrocardiography (ECG): Electrical conduction through the heart, basic electrocardiography, 12-lead electrocardiogram, axis determination. ECG changes in intraventricular conduction abnormalities—arrhythmias, ischemia, injury and infarction, atrial and ventricular enlargement, electrolyte imbalance.
    • Echocardiography: Technical aspects, special techniques, echocardiography of cardiac structures in health and disease, newer techniques.
    • Nuclear and other imaging studies of the heart: Magnetic resonance imaging (MRI).
    • Cardioelectrophysiology procedures: Diagnostic studies, interventional and catheter ablation, nursing care.
    • Exercise testing: Indications and objectives, safety and personnel, pretest considerations, selection, interpretation, test termination, recovery period.
    • Cardiac catheterization: Indications, contraindications, patient preparation, procedure, interpretation of data.
    • Pulmonary function test: Bronchoscopy and graphics.
    • 11Interpretation of diagnostic measures
    • Nurse's role in diagnostic tests.
  • Laboratory tests using blood: Blood specimen collection, cardiac markers, blood lipids, hematologic studies, blood cultures, coagulation studies, arterial blood gases, blood chemistries, cardiac enzyme studies, serum concentration of selected drugs.
Unit V
Cardiac disorders and nursing management
Etiology, clinical manifestations, diagnosis, prognosis, related pathophysiology, treatment modalities and nursing management of:
  • Hypertension
  • Coronary artery disease
  • Angina of various types
  • Cardiomegaly
  • Myocardial Infarction, congestive cardiac failure
  • Heart failure, pulmonary edema, shock
  • Rheumatic heart disease and other valvular diseases
  • Inflammatory heart diseases, infective endocarditis, myocarditis, pericarditis
  • Cardiomyopathy—dilated, restrictive, hypertrophic
  • Arrhythmias, heart block.
Unit VI
Altered pulmonary conditions
Etiology, clinical manifestations, diagnosis, prognosis, related pathophysiology, treatment modalities and nursing management of:
  • Bronchitis
  • Bronchial asthma
  • Bronchiectasis
  • Pneumonias
  • Lung abscess, lung tumor
  • Pulmonary tuberculosis, fibrosis, pneumoconiosis, etc.
  • Pleuritis, effusion
  • Pneumo, haemo and pyothorax
  • Interstitial lung disease
  • Cystic fibrosis
  • Acute and Chronic obstructive pulmonary disease (conditions leading to cor pulmonale, acute respiratory failure, adult respiratory distress syndrome, pulmonary embolism)
  • Pulmonary hypertension.
Unit VII
Vascular disorders and nursing management
Etiology, clinical manifestations, diagnosis, prognosis, related pathophysiology, treatment modalities and nursing management of:
  • Disorders of arteries
  • Disorders of the aorta
  • Aortic aneurysms
  • Aortic dissection
  • Raynaud's phenomenon
  • 12Peripheral arterial disease of the lower extremities
  • Venous thrombosis
  • Varicose veins
  • Chronic venous insufficiency and venous leg ulcers
  • Pulmonary embolism.
Cardiothoracic emergency interventions
  • Cardiopulmonary resuscitation (CPR)—basic life support (BLS) and advanced life support (ALS)
  • Use of ventilator, defibrillator, pacemaker
  • Postresuscitation care
  • Care of the critically ill-patients
  • Psychosocial and spiritual aspects of care
  • Stress management; intensive care unit (ICU) psychosis
  • Role of a nurse.
Unit IX
Nursing care of a patient with obstructive airway
  • Assessment
  • Use of artificial airway
  • Endotracheal intubation, tracheostomy and its care
  • Complication, minimum cuff leak, securing tubes
  • Oxygen delivery systems
  • Nasal cannula
  • Oxygen mask, venturi mask
  • Partial rebreathing bag
  • Positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) masks
  • Uses, advantages, disadvantages, nursing implications of each.
Mechanical ventilation
  • Principles of mechanical ventilation
  • Types of mechanical ventilation and ventilators
  • Modes of ventilation, advantages, disadvantages, complications
  • Positive end-expiratory pressure (PEEP) therapy, indications, physiology, and complications. Weaning off the ventilator
  • Nursing assessment and interventions of ventilated patient.
Unit X
Congenital heart diseases
Etiology, clinical manifestations, diagnosis, prognosis, related pathophysiology, treatment modalities and nursing management of:
  • Embryological development of heart
  • Classification—cyanotic and acyanotic heart disease
  • Tetralogy of Fallot
  • Atrial septal defect, ventricular septal defect, eisenmenger's complex
  • Patent ductus arteriosus, aortopulmonary window
  • Truncus arteriosus
  • Transposition of great arteries
  • Total anomaly of pulmonary venous connection
  • Pulmonary stenosis, atresia
  • Coarctation of aorta
  • 13Ebstein's anomaly
  • Double outlet right ventricle, single ventricle, hypoplastic left heart syndrome.
Unit XI
  • Review
  • Pharmacokinetics
  • Analgesics/anti-inflammatory agents
  • Antibiotics, antiseptics
  • Drug reaction and toxicity
  • Drugs used in cardiac emergencies
  • Blood and blood components
    • Antithrombolytic agents
    • Inotropic agents
    • Beta-blocking agents
    • Calcium channel blockers
    • Vasoconstrictors
    • Vasodilators
    • Angiotensin-converting-enzyme (ACE) inhibitors
    • Anticoagulants
    • Antiarrhythmic drugs
    • Antihypertensives
    • Diuretics
    • Sedatives and tranquilizers
    • Digitalis.
Unit XII
Nursing care of patient undergoing cardiothoracic surgery
  • Indications, selection of patient
  • Preoperative assessment and preparation; counselling
  • Intraoperative care—principles of open heart surgery, equipment, anesthesia, cardiopulmonary bypass.
  • Surgical procedures for coronary artery bypass grafting, recent advances and types of grafts, valve replacement or reconstruction, cardiac transplant, palliative surgery and different stents, vascular surgery, other recent advances.
  • Thoracic surgery—lobectomy pneumonectomy, tumor excision, etc.
  • Immediate postoperative care—assessment postoperative problems and interventions; bleeding, cardiac tamponade, low cardiac output, infarction, pericardial effusion, pleural effusion, pneumothorax, hemothorax, coagulopathy, thermal imbalance, inadequate ventilation/perfusion, neurological problems, renal problems, psychological problems
  • Chest physiotherapy
  • Nursing interventions—lifestyle modification, complementary therapy/alternative systems of medicine.
  • Intermediate and late postoperative care after coronary artery bypass graft (CABG), valve surgery, others.
Cardiac rehabilitation
  • Process
  • Physical evaluation
  • Lifestyle modification
  • Physical conditioning for cardiovascular efficiency through exercise
  • Counseling
  • Follow-up care.
Unit XIV
Intensive coronary care unit/intensive cardiothoracic unit
  • Quality assurance
    • Standards, protocols, policies, procedures
    • Infection control; standard safety measures
    • Nursing audit
    • Design of intermediate coronary care unit (ICCU)/intermediate cardiothoracic unit (ICTU)
    • Staffing; cardiac team
    • Burnout syndrome.
  • Nurse's role in the management of ICCU and ICTU
  • Mobile coronary care unit
  • Planning inservice educational program and teaching.1516