Updates and Advances in Cardiovascular Nursing

Contents

Foreword: The New Edge of Cardiovascular Care xiii

Benjamin Smallheer

Preface: Tackling Cardiovascular and Stroke Disease in 2023 and Beyond xv

Leslie L. Davis

Focus on Cardiovascular and Stroke Conditions

Hypertensive Emergencies: Implications for Nurses 271
Leslie L. Davis
An acute elevation of blood pressure (BP) greater than 180/120 mm Hg as-
sociated with target organ damage is considered a hypertensive emer-
gency. Patients with a hypertensive emergency need intravenous
medications and close monitoring in the intensive care unit. Whereas an
acute elevation of BP greater than 180/120 mm Hg without evidence of tar-
get organ damage is a hypertensive urgency. Patients with a hypertensive
urgency are treated with oral medications and generally discharged home
with outpatient follow-up. Patients with either condition need a thorough
evaluation to determine cause of the acute increase in BP and education
to optimize the treatment regimen long-term.

Heart Failure: Priorities for Transition to Home 283

Margaret T. Bowers and Tonya Carter
Nurses play a key role in promoting successful transitions of patients with
heart failure (HF) from the hospital to the ambulatory setting. Engaging pa-
tients and caregivers in discharge teaching early in the hospitalization can
enhance their understanding of HF as a clinical syndrome and identify pre-
cipitants of decompensation. Effective transitional care interventions for
patient with HF include a phone call within 48 to 72 hours and a follow-
up appointment within 7 days. Early symptom identification and treatment
are key aspects of HF care to improve quality of life and minimize risk of
hospitalization.
Dyslipidemia Update 295
Jennifer Ballard-Hernandez and James Sall
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality
in the United States. The development and progression of atherosclerotic
CVD are largely dependent on a multitude of modifiable and nonmodifiable
risk factors. Current therapeutic strategies involve risk factor modification,
especially dyslipidemia. The treatment of dyslipidemia continues to be dy-
namic, and in this paper, we review the current strategies for risk assess-
ment, diagnosis, and treatment. As treatments for the management of
dyslipidemia continue to evolve with ever-increasing options for therapeutic
targets, an understanding of lipid-lowering therapies remains an essential
topic of understanding for all health care providers.
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Stroke: Hospital Nursing Management Within the First 24 Hours 309

Susan E. Wilson and Susan Ashcraft
Within the United States, someone will have a stroke approximately every
40 seconds. Eighty-five percent of strokes are ischemic, with 15% classi-
fied as either intracranial or subarachnoid hemorrhage. Stroke care is
complex, and nurses play a critical role in identification, assessment, man-
agement, and coordination throughout the stroke continuum of care. This
article will explore the nursing care of the patient with ischemic and hem-
orrhagic stroke during the first 24 hours.

Evaluation of Wide Complex Tachycardia 325

Anthony M. Angelow and Jennifer Coates
When a patient develops wide complex tachycardia, it is important to de-
termine the cause quickly and accurately. This article will help the bedside
nurse understand different causes, determine the most probable cause,
and provide appropriate first-line treatment.

Updates and Advances in Cardiovascular Nursing: Peripheral Arterial Disease 337

Debra Kohlman-Trigoboff
This article focuses on peripheral arterial disease (PAD) of the lower extrem-
ities. There is a higher incidence of myocardial infarction, stroke, and cardi-
ovascular death, resulting in higher rates of all-cause mortality compared
with patients without PAD. Thus, the presence of PAD is a marker for sys-
temic atherosclerotic disease and can lead to the early detection and treat-
ment of coronary artery disease or cerebrovascular disease. This article
reviews the latest information about the prevalence, symptoms, classifica-
tion, diagnosis, and treatment of PAD. Monitoring and detection of PAD
are also discussed, including implications for nursing care.

Update on Valvular Heart Disease for Registered Nurses 357

Janet F. Wyman, Crystal Cusin, and Dayna Gjurovski
Over the last few decades, there have been dramatic advances in the
understanding of the mechanisms of valvular heart disease and develop-
ment of percutaneous treatment options. These innovations have resulted
in the need for a multidisciplinary heart team approach for quality patient
outcomes, a team in which nursing is an integral member. This update pro-
vides an overview of the major valve diseases, current guideline recom-
mendations, catheter-based treatment options and key elements of
nursing care: physical examination, diagnostic testing, pre- and post-pro-
cedure care protocols, and patient education elements.

Focus on Treatment (Drug and Device Updates)

Anticoagulation for Stroke Prevention in Atrial Fibrillation 379
Carrie Palmer
Cardioembolic stroke from atrial fibrillation causes substantial death and
disability in the United States. Treatment with oral anticoagulants provides
safe and effective stroke prevention for high-risk patients. This article
 Contents ix

reviews strategies for the use of anticoagulation and highlights the nurse’s
role in patient education.

A Pharmacologic Update: New Treatments for Patients with Cardiovascular Disease 389
Elizabeth Radchik, Leslie L. Davis, and Ciantel A. Blyler
Pharmacologic agents are a key part of the medical armamentarium aimed
at reducing the significant morbidity and mortality caused by cardiovascu-
lar disease (CVD). In recent years, the landscape of CVD treatment has
evolved with the development of new medication classes and the repur-
posing of existing medications for new indications. This article provides
nurses with a pharmacologic update on new and emerging therapies for
the treatment of hypertrophic cardiomyopathy, familial hypercholesterole-
mia, and heart failure. The authors review clinical indications, pharmacol-
ogy, practical considerations for the safe and appropriate use of these
medications, and implications for nurses.

A Primer on Pacemakers and Defibrillators for Nurses 405

T. Jennifer Walker and Anderson Bradbury
Although the concepts of pacing have been around for more than half a
century, technological advances in cardiac implantable electronic devices
(CIEDs) have changed the landscape for patients in need of pacing support
or sudden death prevention. Nurses encounter patients with CIEDs in all
aspects of the health care setting. Because exciting CIED therapies are
on the horizon, nurses must stay up-to-date to promote optimal outcomes
for CIED patients. This essential guide provides nurses with a comprehen-
sive overview of the principles of pacing and implantable cardioverter de-
fibrillators (ICDs), as well as innovative technologies such as leadless
cardiac pacemakers and subcutaneous ICDs.

Mechanical Circulatory Support Therapy in the Cardiac Intensive Care Unit 421
Sarah E. Schroeder
Mechanical circulatory support (MCS) includes temporary and durable
mechanical devices used for two sets of indications: 1. acute heart failure
(HF) secondary sepsis, a myocardial infarction, or pulmonary emboli, and
2. for chronic end-stage HF secondary to worsening cardiomyopathy de-
spite guideline driven medical treatment. This article is to aide cardiac in-
tensive care unit (ICU) nurses in understanding the history of MCS therapy,
the care of the MCS patient in the cardiac ICU, the critical and collabora-
tive role of transplant teams with MCS therapy, educational needs for a
successful discharge, and implications for education and shared deci-
sion-making when placing these devices.

Special Populations
Cardiovascular Disease in Women: An Update for Nurses 439
John R. Blakeman and Ann L. Eckhardt
Cardiovascular disease (CVD) is the leading cause of death in women but is
often underrecognized and undertreated. Women are more likely to experi-
ence delay in treatment and worse outcomes, even though they experience
similar symptoms as men. Women are more likely to experience ischemia
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related to microvascular dysfunction, which is not readily diagnosed by com-

monly used diagnostic tests. Nurses are ideally positioned to be patient ad-
vocates and use evidence-based guidelines to encourage primary
prevention and ensure prompt treatment. This paper provides an update
on CVD in women for clinical nurses based on the latest research evidence.

Caring for Sexual and Gender Minority Adults with Cardiovascular Disease 461
Danny Doan, Yashika Sharma, David López Veneros, and Billy A. Caceres
This article summarizes existing evidence on cardiovascular disease (CVD)
risk and CVD diagnoses among sexual and gender minority adults and
provides recommendations for providing nursing care to sexual and gen-
der minority adults with CVD. More research is needed to develop evi-
dence-based strategies to care for sexual and gender minority adults
with CVD.

Pediatric Murmurs 475

Rémi M. Hueckel and Christy Leyland
Many healthy children may be found to have a murmur on physical exam.
Whether this murmur is discovered at a routine health maintenance visit or
as a result of a focused exam on a child with illness, it is just one finding
and must be considered in the context of the child’s history and other
physical exam findings. Murmurs associated with heart defect or dysfunc-
tion occur most often in infancy. Most murmurs discovered in children, es-
pecially after infancy, between ages 3 to 6 and in young-adulthood, are
innocent or benign murmurs and less likely a symptom of cardiac dysfunc-
tion or defect.