Cardiac Care E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1010

Veröffentlichungsjahr: 2022

Beschreibung

In the newly revised Second Edition of Cardiac Care: A Practical Guide for Nurses, a team of dedicated and widely recognised nursing medical experts from around the world deliver an invaluable and practical guide for nurses who practice in cardiac care environments.

This latest edition includes brand new chapters on structural heart disease, takotsubo syndrome, and non-obstructive coronary artery disease. While also covering the essential topics necessary for the proper provision of cardiac care, this practical guide for nurses provides:

• A thorough introduction to cardiac practice, including the mechanics of the cardiovascular systems and the regulation of cardiac and vascular function
• Comprehensive exploration of cardiovascular disease assessment, including risk factors for cardiovascular disease, laboratory tests, and diagnostic procedures
• Practical discussions of the detection and management of heart rhythm disturbances, including ECG interpretation, cardiac monitoring, and arrhythmias
• In-depth examinations of the detection and management of acute coronary syndromes, including chest pain assessment and discharge planning
• Chapter overviews, key concepts, learning objectives and activities, with critical points intermingled throughout

Perfect for practicing nurses who care for patients with cardiac conditions, Cardiac Care: A Practical Guide for Nurses will also earn a place in the libraries of other allied health professionals in cardiac care settings.

Leseprobe

Cardiac Care

A Practical Guide for Nurses

Second Edition

Edited by

Angela M. Kucia

Adjunct Senior Lecturer, UNISA Clinical and Health Sciences

University of South Australia

South Australia, Australia

Clinical Nurse Consultant, Acute Cardiac Assessment

Lyell McEwin Hospital

South Australia, Australia

Ian D. Jones

Professor of Cardiovascular Nursing, School of Nursing and Allied Health

Liverpool John Moores University

Liverpool, UK

This edition first published 2022© 2022 John Wiley & Sons Ltd

Edition HistoryBlackwell Publishing Ltd (1e, 2010)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Angela M. Kucia and Ian D. Jones to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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Library of Congress Cataloging‐in‐Publication Data applied for

Paperback ISBN: 9781119117780

Cover Image: © Stocktrek Images/Getty ImagesCover Design by Wiley

List of Contributors

Barrett, David I.Department of ParamedicalPerioperative and Advanced PracticeFaculty of Health ScienceUniversity of HullHull, UK

Beltrame, John F.Discipline of MedicineThe Queen Elizabeth HospitalAdelaide, Australia

Faculty of Health and Medical SciencesUniversity of AdelaideAdelaide, Australia

Translational Vascular Function Research CollaborativeBasil Hetzel Institute for Translational Health ResearchAdelaide, Australia

Davidson, Patricia M.Vice Chancellor UnitUniversity of WollongongWollongong, New South Wales, Australia

Gloster, Annabelle S.Faculty for Advancing PracticeHealth Education EnglandManchester, UK

Greaney, BrendanDepartment of NursingMidwifery and HealthFaculty of Health & Life SciencesCoventry UniversityCoventry, UK

Gregory, PeteSchool of Allied Health and MidwiferyUniversity of WolverhamptonWalsall, UK

Hartley, AngelaHealthy HeartiesEast MoleseySurrey, UK. https://healthyhearties.co.uk/

Hassan, SalimahCardiology DepartmentAintree University HospitalLiverpool Foundation NHS TrustLiverpool, UK

Horowitz, John D.Cardiovascular Pathophysiology and Therapeutics GroupBasil Hetzel Institute for Translational Health ResearchAdelaide, Australia

Jones, Ian D.Cardiovascular NursingLiverpool John Moores University and Liverpool Centre for Cardiovascular SciencesLiverpool, UK

Keenan, JanCardiology WardOxford Heart CentreOxford University HospitalJohn Radcliffe HospitalHeadington, Oxford, UK

Kucia, Angela M.Department of CardiologyLyell McEwin HospitalElizabeth, Australia

UniSA Clinical and Health SciencesUniversity of South AustraliaAdelaide, Australia

Board of Directors, Her Heart Ltd., Melbourne, Australia

Lotto, RobynFaculty of Health and Life SciencesLiverpool John Moores University and Liverpool Centre for Cardiovascular SciencesLiverpool, UK

Nicholson, ChristopherCardiology and Respiratory DirectorateEast Lancashire Hospitals NHS TrustRoyal Blackburn Hospital, UK

Faculty of HealthSocial Care and MedicineEdge Hill UniversityOrmskirk, UK

Oldroyd, CarolFaculty of Health and Life SciencesCoventry UniversityCoventry, UK

Rabasse, PrabaFaculty of Health and Life SciencesLiverpool John Moores University and Liverpool Centre for Cardiovascular SciencesLiverpool, UK

Rushton, MelanieSchool of Health & SocietyUniversity of SalfordManchester, UK

Ryan, CassandraHome Hospital, SA HealthAdelaide, Australia

Shepherd, Carolyn E.Bristol Heart InstituteUniversity Hospitals Bristol and Weston NHSBristol, UK

Tagney, JennyBristol Heart InstituteUniversity Hospitals Bristol and Weston NHSBristol, UK

Department of Nursing and MidwiferyUniversity of the West of EnglandBristol, UK

Thompson, David R.School of Nursing and MidwiferyQueen's University BelfastBelfast, UK

School of NursingAnhui Medical UniversityHefei, People’s Republic of China

School of NursingMidwifery and Health SystemsUniversity College DublinDublin, Ireland

Department of PsychiatryUniversity of MelbourneMelbourne, Australia

School of Public HealthMonash UniversityMelbourne, Australia

School of Nursing and MidwiferyUniversity of QueenslandBrisbane, Australia

School of Nursing and MidwiferyLa Trobe UniversityMelbourne, Australia

Unger, Steven A.Nuclear MedicineThe Queen Elizabeth Hospital and the Lyell McEwin HospitalAdelaide, Australia

Faculty of Health and Medical SciencesUniversity of AdelaideAdelaide, Australia

Webster, Rosemary A.Cardio‐respiratory DirectorateLeicester Royal InfirmaryLeicester, UK

Williamson, KarenCardiology DepartmentRoyal Bolton HospitalBolton, UK

Wright, DeborahDepartment of CardiologyThe Queen Elizbeth HospitalWoodville, South AustraliaAustralia

Zeitz, Christopher J.Department of CardiologyThe Queen Elizabeth HospitalAdelaide, Australia

Faculty of Health and Medical SciencesUniversity of AdelaideAdelaide, Australia

Translational Vascular Function Research CollaborativeBasil Hetzel Institute for Translational Health ResearchAdelaide, Australia

Foreword

It is my pleasure to write this Foreword for the follow up edition to Acute Cardiac Care, which has become an important seminal text and resource for Cardiovascular nurses. It is edited by two leading authorities in the field (Dr Angela Kucia and Prof Ian Jones) plus a series of other global experts from across the disciplines (nursing, medicine, psychology and others). The breadth and depth of each of the chapters is to be commended, plus the accessibility and readability of each chapter. I believe this allows nurses who work in diverse roles such as Nurse Practitioners, clinicians and managers to continue to remain up to date. The information supports evidence‐based practice and can be used to inform clinical practice guidelines and policy.

As the roles of nurses expand so does the complexity of the technology that they face. There have also been unprecedented challenges such as the Pandemic and nurses have been at the forefront of this change. As Cardiovascular disease continues to be a leading cause of death, nurses who work in this area require up to date resources such as this invaluable text.

The areas covered are practical (from assessment through to knowledge implementation), they explore different aspects from assessing risk, detection and management including discharge planning and secondary prevention. There are also important sections divided into Acute as well as Chronic. The chapters around Non‐obstructive coronary artery disease (MINOCA/INOCA) and risk assessment, plus Takotsubo Syndrome are important as they relate particularly to women. Globally we lose 1 in 3 women to heart disease and in Australia, that’s one woman every hour. The literature around gender differences consistently show that women are under‐diagnosed, under treated and have significantly worse outcomes than men. Cardiac nurses are in a unique position to raise awareness of these issues plus make a difference in assessment, intervene with any treatment and follow up care ‐ not only with the patient but their carer.

Professor Linda Worrall‐CarterPhD, MEd(Prelim), BEd, R.N.,Coron Care Cert., FCSANZMFounder & CEO Her HeartJuly 2022

Preface

The development of the coronary care unit in the 1960s is often regarded as the foundation upon which modern‐day cardiology was built. However, these specialist units that relied on highly skilled nurses to prevent and manage patients at risk of cardiac arrest also became one of the cornerstones of modern‐day advanced nursing practice. The knowledge and skills gained in this specialist setting equipped nurses to lead care and has since led to the development of several specialist and advanced nursing roles in a plethora of cardiovascular settings. From prevention to end of life care, nurses are undertaking increasingly complex roles supporting patients and families.

Most aspects of cardiac care are guided by clinical guidelines that are based on good evidence from clinical trials. Cardiac care guidelines continually evolve as new evidence becomes available. We have included many links to resources and guidelines in this book. The guidelines and links will be updated over time, but we have included them to bring to your attention the organisations that have a role in producing guidelines that guide cardiac care. Although weblinks may be superseded over time, you will be able to find these organisations in a web search where updated guidelines will be available in the future. Likewise, we have included links to some available resources such as YouTube videos that can enhance your learning. There is a great deal of information online that is useful, especially for visual learners, though caution must be taken in ensuring the sources are credible. As two cardiac nurses who have contributed to some of these developments over several decades, we are committed to advancing the profession whilst remaining true to our underpinning nursing principles. Ann Townsend, one of the leading figures in the early years of coronary care nursing one stated that “technical expertise without compassionate application is futile”. It is upon this ethos that we present this text.

We would like to thank the authors of the chapters within the book whose knowledge and expertise shines through on every page. Finally we would like to thank our families and colleagues who have travelled with us upon our journey, and the patients who have helped us to understand how best to serve them over our long careers.

Part IKnowledge for Practice

2Regulation of Cardiac and Vascular Function

Brendan Greaney and Angela M. Kucia

Overview

The regulation of cardiac and vascular function is complex, involving neural (autonomic) and humoral (circulating or hormonal) factors. You will hear this referred to as ‘neurohumoral control of the cardiovascular system’. These mechanisms control cardiac output, blood pressure and local control of blood flow in response to physiological requirements and in the setting of adverse clinical events such as trauma, disease or stress. In turn, neurohumoral control is influenced by sensors that monitor blood pressure (baroreceptors), blood volume (volume receptors), blood chemistry (chemoreceptors) and plasma osmolarity (osmoreceptors). These sensors work together to maintain arterial pressure at a level that is adequate for organ perfusion (Klabunde 2021a). This chapter reviews the mechanisms involved in neurohumoral controls of the cardiovascular system.

Learning Objectives

After reading this chapter, you should be able to:

Describe the components of the autonomic nervous system that relate to cardiac function.

Describe the effects of sympathetic and parasympathetic stimulation on the cardiovascular system.

Discuss the function of baroreceptors in the regulation of arterial pressure.

Discuss the function of chemoreceptors in the regulation of respiratory activity and arterial pressure.

List the chemicals that can stimulate the heart and cardiovascular system and describe their negative and positive effects.

Key Concepts

Neurohumoral control; sympathetic and parasympathetic nervous system; baroreceptors; chemoreceptors; blood pressure regulation

Central Nervous System Regulation of the Cardiovascular System

The central nervous system (CNS) controls the autonomic regulation of cardiovascular function. Autonomic refers to functions of the nervous system that are not under voluntary control (such as regulation of heart rate). The heart is innervated by both parasympathetic and sympathetic nerve fibres. These fibres together play a vital role in the control of heart rate and contractility, as well as regulation of blood pressure. Nervous system regulation of the heart originates in the medulla oblongata. This region of the brain stem, termed the cardiovascular centre, receives input from a variety of sensory receptors (Totora and Derrickson 2009). Parasympathetic innervation is associated with the cardioinhibitory centre of the cardiovascular centre, and sympathetic innervation is associated with the cardioacceleratory centre (also known as cardiostimulatory centre) of the cardiovascular centre.

The cardioinhibitory centre sends signals via parasympathetic fibres in the vagus nerve to the sino‐atrial (SA) and atrio‐ventricular (AV) nodes, conduction pathways, myocytes and coronary vasculature. The right vagus nerve predominantly innervates the SA node, and the left vagus nerve innervates the AV node and ventricular conduction system. Nerve fibres in the parasympathetic nervous system are cholinergic, which means they release acetylcholine. Acetylcholine binds to muscarinic receptors that are specifically associated with vagal nerve endings in the heart, resulting in negative chronotropy (decreased heart rate), negative inotropy (decreased contractility, more so in the atria than the ventricles) and negative dromotropy (decreased conduction velocity).

The cardioacceleratory centre sends signals by way of the thoracic spinal cord and sympathetic cardiac accelerator nerves to the SA node, AV node and myocardium. These nerves secrete norepinephrine, which binds to β‐adrenergic receptors in the heart. The term ‘pressor’ is sometimes used to describe the responses associated with sympathetic stimulation on the heart, which are positive chronotropy (increased heart rate), positive inotropy (increased contractility, more so in the atria than the ventricles) and positive dromotropy (increased conduction velocity).

Key Point

The SA and AV nodes are autorhythmic: they fire at their own intrinsic rate. Therefore, if parasympathetic and sympathetic nerve fibres to these nodes were severed, the heart would continue to beat at its own intrinsic rate.