Cardiac Nursing

, by Woods, Susan L.; Froelicher, Erika S. Sivarajan (CON)

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ISBN: 9780397550685 | 0397550685
Cover: Hardcover
Copyright: 3/1/1995

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Now thoroughly updated with current, evidence-based material, Cardiac Nursing is recognized as "The Red Reference Book" for nurses caring for patients who have, or are at risk for developing, cardiac diseases. Organized within the framework of the nursing process, this comprehensive clinical reference provides complete information on the assessment, pathophysiology, management, and prevention of heart diseases and details the rationale and evidence for interventions. This edition has seven brand-new chapters on inflammation, atherosclerosis, genetics, heart rate variability, complementary and alternative medicine, disease management models, and nuclear and other scans. Boxes of evidence-based content have been added within chapters where appropriate.

Anatomy and Physiology	p. 1
Cardiac Anatomy and Physiology	p. 3
General Anatomic Description	p. 3
Cardiac Structures	p. 6
Cardiac Tissue	p. 9
Coronary Circulation	p. 12
Cardiac Innervation	p. 16
Myocardial Cell Structure	p. 16
Myocardial Cell Electrical Characteristics	p. 17
Cardiac Action Potential	p. 22
Sarcolemmal Ionic Currents	p. 26
Factors Modifying Electrophysiologic Function	p. 28
Propagation of the Cardiac Impulse	p. 29
Mechanical Characteristics of Cardiac Cells	p. 32
Mechanical Properties of the Myocardium	p. 35
Myocardial Metabolism	p. 41
Physiology of the Coronary Circulation	p. 41
The Cardiac Cycle	p. 43
Systemic Circulation	p. 49
Structural Characteristics of the Vasculature and Lymphatics	p. 49
Local Regulation	p. 53
Neurohumoral Stimulation	p. 58
Calcium	p. 60
Volume and Flow Distribution	p. 61
The Arterial System	p. 63
The Venous System	p. 64
Microcirculatory Exchange	p. 65
The Lymphatic System	p. 67
Pulmonary Circulation and Gas Transport	p. 71
Structural/Anatomic	p. 71
Physiology	p. 72
Gas Transport	p. 75
Oxygen Delivery, Consumption, Extraction and Cardiac Output	p. 77
Oxygen Consumption-Delivery Relationship	p. 78
Monitoring Oxygenation	p. 78
Regulation of Cardiac Output and Blood Pressure	p. 81
Afferent Input and Receptor	p. 81
Central Nervous System Regulation	p. 83
Autonomic Nervous System Regulation	p. 84
Systemic Hormones	p. 89
Heart Rate	p. 92
Intrinsic Cardiac Control	p. 93
Extrinsic Control: Pericardial Limitation	p. 94
Long-Term Control of Blood Pressure	p. 94
Local Regulation of Systemic Microvascular Beds	p. 96
Venous System	p. 98
Models of Cardiac Performance	p. 99
Additional Effects of Respiration	p. 102
Overall Control	p. 102
Physiologic and Pathologic Responses	p. 109
Genetics	p. 111
DNA	p. 111
DNA and Human Diversity	p. 113
Genetic Variation	p. 113
Gene Testing	p. 114
The Human Genome Project	p. 114
Pharmacogenomics	p. 114
Biochemical Basis of Genetic Disease	p. 115
Overview: Heart Disease	p. 115
The Genetics of Cardiovascular Disease	p. 116
Evidence for a Genetic Basis of Coronary Artery Disease	p. 118
Diagnosis and Risk Assessment: Application of Genetic Susceptibility Information in the Prevention of Coronary Artery Disease	p. 120
Ethical Considerations	p. 121
Summary	p. 121
Inflammation	p. 127
Introduction	p. 127
Overview of the Pathophysiology of Cardiovascular Disease	p. 128
Brain Natriuretic Peptide	p. 129
Circulating Adhesion Molecules	p. 129
Fibrinogen	p. 130
High Sensitivity C-Reactive Protein	p. 130
Homocysteine	p. 131
Interleukin 6	p. 132
Serum Amyloid A	p. 133
Tumor Necrosis Factor Alpha	p. 133
von Willebrand Factor	p. 134
Conclusion	p. 134
Atherosclerosis	p. 139
American Heart Association Lesion Classification System	p. 139
Cells and Extracellular Matrix of Lesions	p. 143
Vascular Surface Defects and Hematoma	p. 145
Lesion Types and Morphology: Correlation with Clinical Syndromes	p. 146
Conclusion	p. 146
Hematopoiesis, Coagulation, and Bleeding	p. 150
Hematopoietic Cells	p. 150
Hemostasis	p. 154
Coagulation-Inflammation Link	p. 157
Bleeding Disorders	p. 158
Clotting Disorders	p. 162
Fluid and Electrolyte Balance and Imbalance	p. 173
Principles of Fluid Balance	p. 173
Extracellular Fluid Volume Balance	p. 175
Osmolality Balance	p. 176
Principles of Electrolyte Balance	p. 177
Electrolyte Imbalances	p. 179
Summary	p. 186
Acid-Base Balance and Imbalances	p. 189
Principles of Acid-Base Balance	p. 189
Acid-Base Imbalances	p. 191
Summary	p. 195
Sleep	p. 197
Normal Sleep	p. 197
The Regulation of Sleeping and Waking	p. 202
Physiology During Sleep	p. 202
Impaired Sleep, Sleep Disorders, and Excessive Daytime Sleepiness	p. 204
Sleep in Patients with Cardiovascular Disease	p. 205
Cardiac Events in Sleep	p. 208
Sleep-Related Disordered Breathing	p. 209
Sleep-Related Adverse Outcomes in Patients with Cardiovascular Disease	p. 210
Nursing Management	p. 211
The Health Care Providers' Sleep	p. 213
Summary	p. 213
Physiologic Adaptations with Aging	p. 220
General Physiologic Changes	p. 221
Cardiovascular Changes	p. 222
Respiratory Changes	p. 223
Renal Changes	p. 224
Hepatic Changes	p. 225
Effects of Aging on Pharmacokinetics	p. 225
Summary	p. 225
Assessment of Heart Disease	p. 227
History Taking and Physical Examination	p. 229
Cardiovascular History	p. 229
Physical Assessment	p. 234
Laboratory Tests Using Blood	p. 265
Blood Specimen Collection	p. 265
Cardiac Markers	p. 269
Blood Lipids	p. 276
Additional Laboratory Tests Associated with Cardiac Disease	p. 278
Hematologic Studies	p. 281
Blood Cultures	p. 283
Coagulation Studies	p. 283
Arterial Blood Gases	p. 286
Blood Chemistries	p. 286
Selected Chemistries	p. 288
Serum Concentration of Selected Drugs	p. 291
Radiologic Examination of the Chest	p. 296
How X-Rays Work	p. 296
Interpretation of Chest Radiographs	p. 297
Chest Film Findings in Acute Care Determining Line, Tube, and Catheter Placement	p. 297
Chest Film Findings in Cardiovascular Disease	p. 297
Echocardiography	p. 307
Technical Aspects	p. 308
Special Techniques	p. 309
Echocardiography of Cardiac Structures in Health and Disease	p. 312
Newer Techniques	p. 317
Conclusion	p. 318
Nuclear and Other Imaging Studies	p. 319
Nuclear Studies of the heart	p. 319
Electrocardiography	p. 326
Electrical Conduction Through the Heart	p. 326
Basic Electrocardiography	p. 328
The 12-Lead Electrocardiogram	p. 330
Axis Determination	p. 336
Intraventricular Conduction Abnormalities	p. 337
Ischemia, Injury, and Infarction	p. 342
Atrial and Ventricular Enlargement	p. 349
Electrolyte Imbalances	p. 353
Wellens Syndrome	p. 356
Brugada Syndrome	p. 357
Arrhythmias and Conduction Disturbances	p. 361
Mechanisms of Arrhythmias	p. 361
Basic Arrhythmias and Conduction Disturbances	p. 365
Complex Arrhythmias and Conduction Disturbances	p. 391
Cardiac Electrophysiology Procedures	p. 425
Diagnostic Electrophysiology Studies	p. 425
Interventional Electrophysiology and Catheter Ablation	p. 430
Nursing Care of the Patient Undergoing Electrophysiology Procedures	p. 436
Exercise Testing	p. 439
Indications and Objectives	p. 439
Safety and Personnel	p. 439
Pretest Considerations	p. 440
Exercise Test Selection	p. 442
Interpretation of Exercise Test Responses	p. 445
Test Termination	p. 450
Recovery Period	p. 452
Assessing Test Accuracy	p. 452
Ancillary Methods for the Detection of Coronary Artery Disease	p. 453
Gas Exchange Techniques	p. 454
Prognosis	p. 455
Exercise Testing in Special Populations	p. 455
Summary	p. 456
Cardiac Catheterization	p. 459
Indications	p. 459
Contraindications	p. 460
Patient Preparation	p. 461
Procedure	p. 463
The Nurse in the Cardiac Catheterization Laboratory	p. 472
Interpretation of Data	p. 474
Hemodynamic Monitoring	p. 478
Technical Aspects of Invasive Pressure Monitoring	p. 478
Direct Arterial Pressure Monitoring	p. 483
Central Venous Pressure Monitoring	p. 488
Pulmonary Artery Pressure Monitoring	p. 489
Functional Hemodynamic Indices	p. 500
Cardiac Output Measurement	p. 503
Ventricular Function Curves	p. 505
Continuous Cardiac Output	p. 506
Less Invasive Methods for Cardiac Output Monitoring	p. 507
Oxygen Supply and Demand	p. 512
Heart Rate Variability	p. 527
Mechanisms of Heart Rate Variability	p. 527
Heart Rate Variability Measurement	p. 527
HRV Patterns in Common Cardiovascular Conditions	p. 530
Factors Influencing Heart Rate Variability	p. 532
Impact of Interventions on HRV	p. 535
Summary	p. 536
Pathophysiology and Management of Heart Disease	p. 539
Pathophysiology of Acute Coronary Syndrome	p. 541
Introduction	p. 541
Mechanisms That Regulate Coronary Blood Flow	p. 542
Causes of Myocardial Ischemia and Infarction	p. 542
Risk Factors for Coronary Artery Disease	p. 543
Incidence of Myocardial Ischemia	p. 543
Incidence of Myocardial Infarction	p. 545
Implications for Nurses	p. 547
Acute Coronary Syndromes	p. 550
Angina Pectoris	p. 550
Myocardial Infarction	p. 556
Interventional Cardiology Techniques	p. 585
Percutaneous Coronary Interventions	p. 585
Percutaneous Coronary Procedures	p. 587
Complications Associated with PCI	p. 592
Late Complications of PCI	p. 594
Adjuctive Modalities	p. 595
Anticoagulation Options for PCI	p. 596
Noncoronary Devices	p. 596
Nursing Management	p. 597
Heart Failure	p. 601
Etiologies and Definitions	p. 601
Pathophysiology and Pathogenesis	p. 603
Clinical Manifestations	p. 610
Classification	p. 612
Medical Management	p. 613
Nursing Management	p. 621
Cardiac Surgery	p. 628
Evolving Trends in Cardiac Surgery	p. 628
Properative Assessment and Preparation	p. 628
Surgical Techniques	p. 629
Cardiac Surgery Procedures for Coronary Artery Revascularization	p. 631
Cardiac Surgery Procedures for Acquired Structural Heart Disease	p. 634
Cardiac Transplantation	p. 642
Acute Heart Failure and Shock	p. 659
Database for Nursing Management	p. 659
Nursing Management Plan for the Patient in Shock	p. 674
Sudden Cardiac Death and Cardiac Arrest	p. 689
Definition of Sudden Death	p. 689
Pathophysiology and Cause of Sudden Cardiac Arrest	p. 689
Management of Sudden Cardiac Arrest	p. 691
Survivors of Cardiac Arrest	p. 704
Summary	p. 707
Pacemakers and Implantable Defibrillators	p. 709
Pacemakers	p. 709
Implantable Cardioverter Defibrillators	p. 738
Conclusion	p. 754
Acquired Valvular Heart Disease	p. 756
Database for Nursing Management	p. 756
Pericardial, Myocardial, and Endocardial Disease	p. 776
Pericardial Disease	p. 776
Cardiomyopathies	p. 782
Endocardial Disease	p. 787
Congenital Heart Disease	p. 794
Incidence and Prevalence	p. 794
Congenital Heart Defects	p. 794
Normal Pulmonary Blood Flow-Impairment or Obstruction to Ventricular Outflow	p. 794
Left-to-Right Shunts with Increased Pulmonary Blood Flow	p. 798
Cyanotic Right-to-Left Shunts with Decreased Pulmonary Blood Flow	p. 800
Cyanotic Congenital Heart Defects with Increased Pulmonary Blood Flow	p. 801
Medical Management Plan	p. 803
Health Promotion and Disease Prevention	p. 807
Coronary Heart Disease Risk Factors	p. 809
Demographic Characteristics	p. 810
Family History of Cardiovascular Disease	p. 810
Cigarette Smoking	p. 811
Hypertension	p. 812
Serum Lipids and Lipoproteins	p. 812
Physical Activity	p. 813
Diabetes Mellitus	p. 815
Body Weight	p. 817
Reproductive Hormones	p. 818
Folate and Homocysteine	p. 819
Antioxidants	p. 820
Conclusions	p. 820
Psychosocial Risk Factors: Assessment and Management Interventions	p. 825
Psychosocial Risk Factors and CHD	p. 825
Mechanisms for Psychosocial Risk Factors and CHD	p. 828
Assessment of Psychosocial Risk Factors	p. 829
Management Interventions for Psychosocial Risk Factors	p. 830
Pharmacological Interventions	p. 834
Summary	p. 835
Smoking Cessation: A Systematic Approach to Managing Patients with Coronary Heart Disease	p. 838
Harmful Effects of Smoking	p. 839
Benefits of Smoking Cessation	p. 840
Theoretical Framework for Smoking Cessation	p. 840
Smoking Cessation Interventions in the Coronary Heart Disease Population	p. 840
General Trends in Smoking Cessation Interventions	p. 841
Treating Tobacco Use and Dependence: Clinical Practice Guideline	p. 841
Special Areas on Which to Focus	p. 849
Summary	p. 852
Hypertension	p. 856
Database for Management	p. 856
Management of High BP	p. 867
Lipid Management and Coronary Heart Disease	p. 897
Blood Lipids: Structure and Functions	p. 897
Lipid Metabolism and Transport	p. 898
Reverse Cholesterol Transport	p. 899
Low-Density Lipoprotein Variants	p. 900
Cholesterol and Endothelial Function	p. 900
Dyslipidemic Disorders	p. 901
Hypercholesterolemia	p. 901
The Management of High Blood Cholesterol	p. 902
Evaluation of the Patient with Elevated Cholesterol	p. 905
Lipoprotein Measurement	p. 905
Dietary Management of Hyperlipidemia	p. 905
Weight Control and Lipid Management	p. 908
Alcohol and Lipoproteins	p. 909
Physical Activity and Lipoproteins	p. 909
Hormones and Lipoproteins	p. 909
Pharmacologic Management of Hyperlipidemia	p. 910
Exercise and Activity	p. 916
Role of Exercise in Cardiovascular Health	p. 916
Cardiac Rehabilitation	p. 921
Closing Comment	p. 933
Obesity: An Overview of Assessment and Treatment	p. 937
Identification and Assessment of the Overweight or Obese Patient	p. 938
Clinical Evaluation	p. 939
Treatment of Overweight and Obesity	p. 941
Components of the Treatment	p. 942
Summary	p. 945
Diabetes Mellitus	p. 948
Definition and Diagnosis	p. 948
Prevalence and Consequences of Diabetes	p. 948
Pathophysiology of Diabetes Mellitus	p. 949
Complications of Diabetes Mellitus	p. 951
Pathophysiology of Complications	p. 952
Nursing Management of Diabetes	p. 953
Health Screening and Monitoring	p. 958
Summary	p. 958
Adherence to Cardiovascular Treatment Regimens	p. 961
Significance of Nonadherence	p. 961
Methods of Measurement	p. 962
Determinants of Adherence	p. 965
Models of Behavior Change	p. 966
Adherence-Enhancing Strategies	p. 966
Educational Strategies to Improve Adherence	p. 969
Questionnaires Relevant to Adherence-Enhancing Interventions	p. 969
Building a Therapeutic Relationship with the Patient	p. 970
Summary	p. 971
Complementary and Alternative Medicine in Cardiac and Vascular Disease	p. 974
CAM Definitions and Characteristics	p. 974
CAM Domains	p. 974
Prevalence of CAM	p. 975
Alternative Medical Systems	p. 975
Mind-Body Interventions for Cardiovascular Disease	p. 976
Biologically Based Treatments	p. 978
Manipulative and Body-Based Methods and Energy Therapies	p. 982
Legal Aspects of CAM	p. 982
Integration of CAM into Nursing Assessment and Clinical Management	p. 982
Summary	p. 983
Disease Management Models for Cardiovascular Care	p. 986
Disease Management: Definition and Models	p. 987
Various Models of Disease Management in Cardiovascular Care	p. 987
Components of Disease Management Systems	p. 988
Training and Job Qualifications for Disease Management	p. 992
The Unresolved Issues for Disease Management	p. 992
Index	p. 997
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Cardiac Nursing

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