Cardiac Surgery Essentials for Critical Care Nursing

Cardiac Surgery Essentials for Critical Care Nursing (Hardin, Cardiac Surgery Essentials for Critical Care Nursing)

Cardiac Surgery Essentials for Critical Care Nursing is an evidence-based foundation for care of the patient during the vulnerable period immediately following cardiac surgery. A comprehensive resource, this text serves as a foundation for nurses beginning to care for cardiac surgery patients, as well as a source of advanced knowledge for nurses who have mastered the essential basic skills necessary to care for this patient population. It addresses significant changes in cardiac surgery and the nursing responsibilities to meet the needs of these acutely ill patients, as well as advances and strategies to optimize patient outcomes in this dynamic field. The perfect study aid for those readers preparing for the AACN's Cardiac Surgery Certification, this book features critical thinking questions, multiple choice self-assessment questions, web resources, clinical inquiry boxes, and case studies.

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Cardiac Surgery Essentials for Critical Care Nursing (Hardin, Cardiac Surgery Essentials for Critical Care Nursing)

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Cardiovascular Care Made Incredibly Visual! (Incredibly Easy! Series®)

Master essential cardiovascular anatomy and physiology - as well as assessment techniques, diagnostic tests, treatments, emergency procedures - through detailed visual aids and concise, clear information that brings complex concepts to life. Based on the well-known "Incredibly Easy" series, Cardiovascular Care Made Incredibly Visual, Second Edition, combines images and clear, concise text to make complex cardiovascular concepts easy to understand. A valuable reference or review book, it employs hundreds of detailed photographs, diagrams, charts and images to clarify essential cardiovascular anatomy and physiology physical assessment techniques, diagnostic tests, treatments, emergency procedures, cardiac monitoring methods, and more.

This NEW edition includes:

NEW! Addition of congenital cardiac disorders, new diagnostic tests and treatments, and noninvasive cardiac output monitoring
NEW! Current ACLS algorithms
NEW! Review and update of all content
Special sections that reinforce key points:
--Come Equipped: Lists the equipment required for procedures
--Photo Op: Highlights procedures that are detailed in text with photos
--Memory Board: Visual mnemonics that help nurses understand and remember difficult concepts
Puzzles that test your comprehension

Foster a quick and thorough understanding of cardiovascular care the Incredibly Visual way - with clear, logical content, written in conversational style, highly-detailed visual aids, and key highlights that help you recall what you've learned.

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Cardiovascular Care Made Incredibly Visual! (Incredibly Easy! Series®)

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NCP - 5 Nursing Diagnosis for Coronary Heart Disease

Coronary Heart Disease (CHD) is a heart disease that is mainly caused by narrowing of the coronary arteries due to atherosclerosis or spasm or a combination of both. CHD is a disease that is very scary. It is recognized that the recent developments in the field of heart disease found many new facts about CHD. However, control of traditional risk factors, particularly dyslipidemia, obesity, smoking, and hypertension is still quite relevant in reducing morbidity and mortality of CHD and other cardiovascular diseases.

Definition

Coronary Heart Disease (CHD) is the circumstances in which there is an imbalance between the needs of the heart muscle with oxygen supply that is provided by the coronary arteries (Mila, 2010).


Etiology

Coronary heart disease can be caused by several things:

• Narrowing (stenosis) and contraction (spasm) of coronary arteries, but gradually narrowing will allow the development of adequate collateral as a replacement.
• Atherosclerosis, causes about 98% of cases of CHD.
• Narrowing of the coronary arteries in syphilis, Takayasu aortitis, arteritis that the various types of coronary arteries, etc..

Risk Factors

1. Smoke

Smoking can stimulate the process of atherosclerosis due to a direct effect on the arterial wall, carbon monoxide causes arterial hypoxia, nicotine causes mobilization of catecholamines that cause platelet reaction, glycoprotein tobacco can cause hypersensitivity reactions arterial wall.

2. Hyperlipoproteinemia

Diabetes Mellitus, obesity and hyperlipoproteinemia associated with fat deposition.

3. Hypercholesterolemia

Cholesterol, fat and other substances can cause thickening of the artery walls, so that the lumen of the blood vessels constrict and the process is called atherosclerosis.

4. Hypertension

Increased blood pressure is a heavy burden to the heart, causing left ventricular hypertrophy or enlargement of the left ventricle. As well as high blood pressure which cause direct trauma to the coronary arteries, thus facilitating the occurrence of coronary atherosclerosis (coronary factor).

5. Diabetes mellitus

Intolerance to glucose, known as vascular disease predisposition.

6. Obesity and metabolic syndrome

Obesity is the excess amount of body fat is more than 19% in men, and more than 21% in women. Obesity can also increase levels of cholesterol and LDL cholesterol. Risk of Coronary Heart Disease will obviously increase when the weight began to exceed 20% of ideal body weight.


Pathophysiology

If too many foods that contain cholesterol, the cholesterol levels in the blood can be excessive (called hypercholesterolemia). Excess cholesterol in the blood will be stored in the lining of the arteries, known as plaque, or atheroma (plaque major source, derived from LDL-cholesterol. While HDL carry excess cholesterol back to the liver, thus reducing the buildup of cholesterol in the vessel wall blood).

If the longer plaque increases, there will be a thickening of the artery walls, causing narrowing of the arteries. This incident is referred to as atherosclerosis (aterom presence in arterial walls, contains cholesterol and other fatty substances). This leads to atherosclerosis (thickening of the arterial wall and loss of flexibility of the artery walls). If the atheroma, which formed the thicker, can tear the artery wall lining, and a blood clot occurs (thrombus) that can block blood flow in the arteries.

This can lead to reduced blood flow and the supply of essential substances, such as oxygen to a particular area or organ, like the heart. When the coronary arteries, which supply blood to the functioning heart muscle (myocardium medical term), then the blood supply is reduced and causes of death in the region (known as a myocardial infarction).

The consequence is the occurrence of heart attacks and cause symptoms such as severe chest pain (known as angina pectoris). This condition is called coronary heart disease (CHD).


Clinical Manifestations

Symptoms of CHD:

• A few days or weeks, before the body was not powered, chest feels uncomfortable, during exercise or move hard heart beat, shortness of breath, sometimes accompanied by nausea, vomiting, and a lot of body sweat.
• Chest pain. Left chest pain (angina) and felt pain coming from inside. Patients felt chest pain, also an assortment of tingling, burning, crushed by heavy objects, slashed, hot. Chest pain is felt in the left chest with spreading to the left arm, pain in the pit of the stomach, right chest, chest pain which penetrates to the back, even to the jaw and neck.
• Heart palpitations (rapid pulse).
• cold sweat
• Energy and mind become weak, fear no reason, feeling wanted to die.
• Low blood pressure or stroke.

Signs of CHD:

• Usually high fat content, does not cause symptoms. Sometimes, if the level is very high, fatty deposits will form a buildup of fat, called xanthomas in the tendons and in the skin.
• Fever, body temperature is usually around 38 ° C.
• Nausea and vomiting, upper abdominal bloating and pain.
• Pale face.
• Skin becomes wet and cold, sweaty bodies.
• Movements became sluggish (less enthusiasm).
• Shortness of breath.
• Anxious and restless.
• Fainting.

Diagnostic Tests

Depending on the needs, various types of checks can be performed to establish the diagnosis and determine the degree of CHD. From the simple to the invasive.

1. Electrocardiographic (ECG)

Examination of the heart's electrical activity or picture electrocardiogram (ECG), is the examination support to provide indication of coronary heart disease. With this examination we can see if there is signs. Can a previous heart attack, or a narrowing of a new heart attack occurs, each of which gives a different picture.

2. Chest X-ray

From x-rays, the doctor can assess heart size, presence or absence of enlargement. In addition, it can also be seen picture of lungs. Abnormalities in coronary can not be seen in X-rays. From the size of the heart can be assessed whether a patient already in advanced coronary heart disease. Perhaps, long coronary heart disease which has continued at heart trouble. The picture usually looks enlarged heart.

3. Laboratory examination

Conducted to determine triglyceride levels as a risk factor. Of blood examination also known presence or absence of an acute heart attack to see a rise in cardiac enzymes.


5 Nursing Diagnosis for Coronary Heart Disease

1. Acute Pain related to cardiac tissue ischemia, or blockages in the coronary arteries.

2. Activity Intolerance related to imbalance between oxygen supply and demand, and the presence of necrotic tissue in myocardial ischemia.

3. Risk for Decreased Cardiac Output related to changes in the rate, rhythm, cardiac conduction, decrease preload or increased SVR, miocardial infarction.

4. Risk for Ineffective Tissue Perfusion related to decreased blood pressure, hypovolemia.

5. Risk for Fluid Volume Excess related to decreased organ perfusion (renal), increased sodium retention, decreased plasma protein.

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Nursing Care Plan for Aortic Insufficiency (Regurgitation)

Definition

Aortic insufficiency (AI), also known as aortic regurgitation (AR) is the return of blood to the left ventricle from the aorta during diastole (relaxation). Aortic insufficiency is a condition where there is reflux (backflow) of blood from the aorta into the left ventricle during relaxation. This causes backward flow of blood from the aorta (the largest blood vessel) into the left ventricle.


Etiology

Most common cause is rheumatic fever. Abnormalities of the aortic valve and the base could also lead to aortic insufficiency. On chronic aortic insufficiency seen fibrosis and retraction leaves or without valvular calcification, which is generally a sequela of rheumatic fever.

1. Rheumatic Fever

Rheumatic fever is a condition that results from infection by group A streptococcal bacteria that are not treated. Damage to the valve petals of rheumatic fever causes increased turbulence across the valve and more damage. Narrowing of rheumatic fever occurs from fusion of the edges (commissures) of the petals of the valve.

Under normal circumstances, the aortic valve closes to prevent blood in the aorta, from flowing back into the left ventricle. In aortic regurgitation, the valve that allows pain behind the leak of blood into the left ventricle when the ventricle relaxes muscles after pumping. These patients also have some degree of damage in rheumatic mitral valve.

2. Congenital Abnormalities

Congenital abnormalities which brought the baby from birth, such as valve disease which can not be shut down completely while in the womb, causing blood flow from the left ventricle can not flow properly.

3. The Aging Process

With aging, protein collagen of the valve petals destroyed, and calcium is deposited on the petals. Upheaval across the valves increase causes scarring and thickening. Progressive disease that causes aortic calcification had nothing to do with lifestyle choices are healthy, do not like to precipitate calcium in the coronary arteries to cause heart attacks.


Pathophysiology

Aortic insufficiency caused by inflammatory lesions that distort the shape of the aortic valve blade, so that each blade can not close the lumen of the aorta during diastole and consequently causes backflow of blood from the aorta into the left ventricle.

Because diastole when the aortic valve leaks, some blood in the aorta, which is usually high pressure, the left ventricle will flow, so that the left ventricle must cope with both the blood that normally sends received blood from the left atrium and the back of the aorta. Then dilated left ventricle and hypertrophy to accommodate the increased volume, as well as pushing the power due to more than normal to pump blood, causing blood pressure systolic increased. Cardiovascular system trying to compensate through reflex dilation of blood vessels and peripheral arterial limp, so the decreased peripheral resistance and diastolic pressure dropped drastically.

Hemodynamic changes in acute circumstances, can be distinguished with chronic conditions. Acute damage arising in patients without a history of previous insufficiency. The left ventricle did not have enough time to adapt to aortic insufficiency. Sudden increase of left ventricular end-diastolic pressure could arise with little ventricular dilatation.


Clinical Manifestations

Clients come with a complaint by a real carotid artery pulsation and pulsation at the apex when the client lying to the left. On the client chronic aortic insufficiency may develop symptoms of heart failure, including dypsnea during activity, orthopnea, paroxysmal nocturnal dyspnea, pulmonary edema and fatigue. Angina tends to arise only breaks the onset of bradycardia and longer disappear from the angina caused by coronary disease.

On physical examination found the carotid artery pulse rapid and substantial differences in blood pressure that can result in a hyperdynamic state with pulsus bisferiens. If severe insufficiency, arising noticeable effect on peripheral arterial pulsation. If severe heart failure, diastolic pressure may be normal due to the increase in left ventricular diastolic pressure. Can be normal-sized heart, if it when chronic mild aortic insufficiency or if acute insufficiency. In clients with moderate or severe insufficiency, heart looks enlarged, the apex impulse shifts to the inferolateral and is hyperdynamic.


Examination Support

1. Electrocardiogram

ECG is rarely normal in chronic aortic regurgitation and often exhibit significant changes in repolarization. On acute aortic regurgitation ECG may be normal. Visible image of left ventricular hypertrophy, increased amplitude QRS, ST-T-shaped type of diastolic overload, meaning that the average vector showed that ST is great, and and T wave vector parallel to the average of the QRS complex. Figure shows the P-R interval lengthening.

2. Thorax Radiography

Shows a progressive enlargement of the heart. Namely an enlarged left ventricle, left atrium, and aortic dilatation. The shape and size of the heart was unchanged in acute insufficiency but looks pulmonary edema.

3. Transthoracic Echocardiography

Exposing the base of the proximal aorta on imaging.

4. Aortography.

5. Increased cardiac isoenzyme (CPK and ck mb)

6. Cardiac catheterization

7. Transesophageal Echocardiography (TEE)

Visualize the entire aorta.

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