Acute Cardiac Care. a Practical Guide for Nurses

Description

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 and 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.

1 Mechanics of the Cardiovascular System (B. Greaney & A.M. Kucia) Overview.
Basic heart anatomy.
The cardiac cycle.
Cardiac output.
Conclusion.

2 Regulation of Cardiac and Vascular Function (B. Greaney & A.M. Kucia). Overview.
Central nervous system regulation of the cardiovascular system.
Vasomotor control.
Baroreceptors.
Chemoreceptors.
Humoral control.
Electrolytes.
Conclusion.

3 Cardiac Electrophysiology (B. Greaney & A.M. Kucia).
Overview.
Cardiac cells.
The action potential.
The action potential in non-pacemaker cells.
The cardiac conduction system.
The electrocardiogram.
Conclusion.

4 The Coronary Circulation (B. Greaney & A.M. Kucia).
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.

5 Risk Factors for Cardiovascular Disease (A.M. Kucia & E. Birchmore).
Overview.
Classification of risk factors for CVD.
Biomedical risk factors.
Behavioural risk factors.
Psychosocial risk factors.
Conclusion.

6 Populations at Risk (T. Wachtel, R. Webster & J. Smith).
Overview.
Risk factors for CVD.
Clarifying risk.
Risk assessment tools.
Populations at increased risk.
Targeting treatment.
Using what we know.
Conclusion.

7 Evidence-Based Practice (D. Evans & T. Quinn).
Overview.
The need for change.
Evidence-based practice.
Barriers to the evidence.
Conclusion.

8 Ethics of Research in Acute Cardiac Care (B.F. Williams & A.M. Kucia).
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.

9 Cardiovascular Assessment (A.M. Kucia & S.A. Unger).
Overview.
Health history.
Physical examination.
Conclusion.

10 Electrocardiogram Interpretation (A.M. Kucia & C. Oldroyd).
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.

11 Cardiac Monitoring (A.M. Kucia & C. Oldroyd).
Overview.
ECG monitoring systems and lead formats.
Indications for arrhythmia monitoring.
Nursing considerations in the care of the patient with ECG monitoring.

12 Laboratory Tests (D. Barrett, L. Jesuthasan & A.M. Kucia).
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.

13 Diagnostic Procedures (L. Belz, K. Mishra, S.A. Unger & A.M. Kucia).
Overview.
Chest X-ray.
Cardiac catheterisation (angiogram).
Echocardiography.
Stress testing.
Magnetic resonance imaging.
Computerised tomography.
Electrophysiology studies.
Conclusion.

14 Sudden Cardiac Death (T. Quinn & P. Gregory).
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.

15 Out-of-Hospital Cardiac Arrest and Automated External Defibrillation (P. Gregory & T. Quinn).
Overview,
Out-of-hospital cardiac arrest,
Hazards to the victim and rescuer,
Recognition of cardiac arrest and BLS,
Automated external defibrillation,
Conclusion,

16 Ethical Issues in Resuscitation (A.M. Kucia & B.F. Williams).
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.

17 Pathogenesis of Acute Coronary Syndromes (A.M. Kucia & J.D. Horowitz).
Overview.
Acute coronary syndrome.
Atherosclerosis.
Endothelial dysfunction.
Plaque disruption.
Inflammation.
Thrombosis.
Vasoconstriction.
Conclusion.

18 Presentations of Acute Coronary Syndromes (A.M. Kucia & J.F. Beltrame).
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.

19 Risk Stratification in Acute Coronary Syndromes (A. Day, C. Ryan & T. Quinn).
Overview.
Introduction.
Risk stratification.
Risk stratification guidelines.
Risk scores.
Chest pain units.
Conclusion.

20 Reducing Time to Treatment (T. Quinn & A. Day).
Overview.
Benefits of early reperfusion.
Identifying and addressing delays.
Conclusion.

21 Reperfusion Strategies (C.J. Zeitz & T. Quinn).
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.

22 Adjunct Pharmacological Agents in Acute Coronary Syndromes (A.M. Kucia & J.D. Horowitz).
Overview.
Anti-ischaemic therapies.
Antiplatelet and anticoagulant therapy.
Inhibitors of the renin-angiotensinaldosterone system.
Statins.
Conclusion.

23 Arrhythmias (C. Oldroyd & A.M. Kucia).
Overview.
Basic electrophysiology.
Mechanisms of arrhythmia generations.
Cardiac monitoring.
Rhythm interpretation.
Determining the rhythm.
Tachyarrhythmias.
Asystole.
Treatment of arrhythmias.
Conclusion.

24 In-Hospital Resuscitation (C. Oldroyd, K. Lewis & P. Whiston).
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.

25 Acute Heart Failure (T. Quinn).
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.

26 Convalescence (P. Davidson & R. Webster).
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.

27 Discharge Planning and Secondary Prevention (R. Webster & P. Davidson).
Overview.
Discharge planning.
Secondary prevention.
Provision of secondary prevention.
Components of secondary prevention.
Cardio-protective drug therapy.
Challenges in secondary prevention.
Conclusion.
Index.

Author Information

Angela M. Kucia is a Clinical Practice Consultant in Acute Cardiac Assessment at the Queen Elizabeth and Lyell McEwin Hospitals in Adelaide, South Australia. Angela also lectures in postgraduate cardiovascular nursing at the University of South Australia and has been involved in acute cardiac nursing for twenty years.

Tom Quinn is Professor of Clinical Practice at the University of Surrey and also Visiting Professor of Cardiac Nursing at Coventry University, UK. Tom has extensive clinical experience both in and out of hospital, and was closely involved in developing and implementing the National Service Framework for Coronary Heart Disease and related policies in England.