Coronary Artery Disease - Research Paper Example

? Coronary Artery Disease This paper focuses on the problem of the nursing role in the coronary artery disease treatment, mainly in the coronary artery bypass surgery. Firstly, it discusses the general background of the problem: coronary art disease and how it is treated. Secondly, it outlines the compatibility of the Helen Fuld School of Nursing conceptual framework with the values of the coronary artery bypass surgery nursing. Thirdly, it explores the role of the nurse in detail during different phases of the surgery. Next, it reports the findings of an evidence-based study into the problem. Finally, it concludes with the summary of what has been provided in the paper. Identification of the Concept: Coronary Art Disease Coronary art disease (abbreviated as CAD) may be defined as the end result of the specific process which sees accumulation, within the walls of those arteries that supply the myocardium, of atheromatous plaques (Kasliwal, 2009). The chronic systemic process of this disease is atherosclerosis. Normally, arteries’ inside walls are rather smooth and flexible, which allows easy blood flow. Plaques, which are fatty deposits, can build up in the wall of artery. This plaque will then narrow the artery and consequently stop or just reduce the blood flow. Atherosclerosis affects all body vascular beds and evolves due to a range of factors (Kasliwal, 2009). Manifested in various representations and involving numerous blood vessels in a body, when atherosclerosis reaches coronary arteries, it leads to coronary art disease; it also causes cerebrovascular disease (this is linked to the transient ischemic attack and stroke); aortic aneurysms; intestinal ischemia; and peripheral vascular disease (Homoud, 2008). Simply put, coronary art disease (CAD) results from the hardening of coronary arteries that are found on the heart surface. Atherosclerosis-related cardiovascular disease accounts for a half of all deaths in the developed countries and one-fourth of deaths in the countries of the developing world (Homoud, 2008). In the USA, it is the leading cause of women and men mortality: in case of women it accounts for over 250, 000 deaths each year. The number is even greater in men. Charney (1999, p.3) provides data that by the age of 60 one in five U.S. males have had a coronary event whereas this has been experienced by just one in seventeen females. In the age group 29-44, the number of heart attacks due to coronary art disease is 32, 000 in men and 9, 000 in women; in the age group 45-64, the number of affected males is 218, 000 and females 74, 000; in the group aged older than 65, the occurrences are 418, 000 for men, and 356, 000 for women (Charney, 1999, p.4). Treatment of coronary artery disease depends on the case severity. The options include medical therapy, stenting and angioplasty, and coronary artery bypass surgery (Michaels & Chatterjee, 2002). If patients’ coronary narrowings do not hinder the flow of blood, they are prescribed medications and modification of lifestyle. This is done to prevent the disease progression. In case the patient is diagnosed with atherosclerosis which clearly limits the flow blood to the arteries, he or she undergoes balloon angioplasty; also, stenting is sometimes offered. In the most severe cases, when the patient has numerous narrowings of the coronary arteries or their blockages, the surgery (coronary artery bypass graft surgery) is typically advised (Michaels & Chatterjee, 2002). Coronary Artery Bypass Surgery and the Helen Fuld School of Nursing Conceptual Framework Coronary artery bypass surgery nurses who are skilled, compassionate, and knowledgeable are essential for achieving the positive outcome in patients in the post-operative phase. This is explained by the fact that care for these patients is rather complex and intense, yet rewarding. Coronary artery bypass surgery nurses are an important part of the surgery team that enable, through their efforts, the patient to restore health and go on living. The foregoing idea of the coronary artery bypass surgery nursing role is compatible with the Helen Fuld School of Nursing conceptual framework. In particular, the latter views nursing as a humanistic, interactive, as well as purposeful process, on which the survival of the patient depends to a large extent. Just as the role of the nurse is to cater for the client’s physical and psychological well-being, as stated in the scholarly research, the Helen Fuld School of Nursing emphasizes the importance of treating the client as a whole (HFSON Undergraduate Handbook). Just as nurses are required to demonstrate qualitative and relentless care in the post-operative phase, the concept of integrity promoted by the Helen Fuld School of Nursing is helpful to develop. It is stated that this integrity should be three-fold: structural, social, and personal. Thus, the values stated in the framework should be implemented in the coronary artery bypass surgery nursing practice. Nursing Role in Coronary Artery Bypass Grafting Coronary artery bypass grafting (or coronary artery bypass surgery) is recommended for patients who have been diagnosed with coronary artery disease in order to relieve the existing symptoms, improve life quality, as well as prolong their life. In the United States, the number of people undergoing coronary artery bypass grafting exceeds 300,000 annually, with the initial cost of hospital care about 30,000 per one patient. Each year more and more patients are advised to undergo coronary artery bypass grafting. With the advancement of perioperative care and enhancement of operative techniques, the complexity of cases increases, too. Therefore, it gets even more crucial with each year that effective collaboration is maintained among the surgeon, the perfusionist, the anaesthesiologist, and the perioperative nurses (Eagle et al., 2004). In this respect, it has to be mentioned that coronary artery bypass nurse specializes majorly in patient care before and after the main heart surgery. During the preoperative phase, patients undergo the preparation for the surgery. While this is an established protocol in the majority of hospitals, special attention should be given to the patient’s education before the surgery. This has been found to assist in the process of better recovery, contribute to the patient’s contentment, as well as decrease the complications that may occur in the post-operative phase. It is critical for the nurse to respond to the learning needs of the patient and inform him/her in a timely manner about the open heart surgery. This should be done 5-14 days before the operation, when the anxiety levels are lower in patients (Cupples, 1991). The information may include the account of possible sights and sounds that may be experienced during the surgery, information about those invasive lines that are going to be inserted, length of the surgical intrusion, and possible sensations. The nurse should also emphasize the effectiveness of management pain with medications and reassure that it will be done quickly (Martin & Turkelson, 2006). During the intraoperative phase, the nurse’s role is minimal. Sometimes, nurses trained in coronary artery bypass graft assist during the surgery when in the operating room. Thus, they are required to have been trained to help conduct medical procedures and operate the equipment utilized during the surgery, which is done open-heart. They know the medications which are typically used during the surgery and are able to recognize possible complications resultant from these medicines in the recovery room. Comprehensive nursing care takes place right after the operation, typically in a unit of cardiac intensive care. Coronary artery bypass grafting nurses are responsible for monitoring the breathing, pain, heart rate, and neurological consequences in patients that have just undergone the operation. Besides, they are to watch for both internal and external bleeding, which may be an indicator of an emergency. These nurses are obliged to evaluate the patient in the period of several hours after the operation relentlessly and constantly. Specifically, 30%-60% of patients develop pulmonary dysfunction as well as hypoxemia, so the nurse should watch out for these. When the patient is mechanically ventilated, the nurse should support the effective gas exchange maintenance as well as stable breathing patterns (Kjaergaard et al., 2004). As Martin & Turkelson (2006) sum up, nurses role in postoperative management encompasses physical assessment done in an accurate and frequent manner, continuous oximetery of the patient’s pulse, analysis of gas in arterial blood, pulmonary care (e.g. suctioning during the period when the patient gets intubated and is coughing; also, post-extubation intensive spirometry), early mobilization, shivering control, and pain management. Pain control is typically done through intravenous narcotics during the time when the patient is intubated. After extubation, both oral and intravenous narcotics can be given. The role of the nurse is to balance the patient’s need for control of pain without having respiratory depression with his or her need to get pain maximally suppressed so that an effective cough is allowed. Besides, the nurse is obliged to do the assessment of the patient for being ready for having an early extubation. The latter ought to be considered once the patient becomes arousable, capable of following the given commands, stable in hymodynamic sense, and, finally, initiating his or her own spontaneous efforts of ventilation avoiding excessive strain (Martin & Turkelson, 2006). The nurse should also provide the post-operative management of the patient’s hemodynamics. It is critical that the nurse watches for the need to reconnect equipment if the movement of the patient to the recovery room or intensive care unit has caused hemodynamic instability. The nurse should watch for the blood pressure and heart rate to be maintained according to the ordered parameters. If hypothermia after the surgery persists, the nurse should rewarm the patient. This may be achieved by the use of warm blankets, convective air mattresses, as well as warm humidified oxygen (Urden et al., 2002). Overall, the hemodynamic parameters ought to be checked every half an hour/every hour. Also, the nurse is responsible for the management of patient’s bleeding in the post-operative phase. The latter may be complicated by too much bleeding, so the nurse’s role is to assess the existing potential for bleeding; monitor the patient for the signs of bleeding (Martin & Turkelson, 2006). Also, nurses measure the output of the urine, watch for the stroke which is thought to be a complication for coronary artery bypass grafting, provide wound care, watch for inflammation signs in the chest area, and monitor the count of blood cells. Coronary Artery Bypass Grafting: Evidence-Based Practice In this section of the paper, the results of the study published in Circulation are discussed. The article “Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data.” is based on the report of evidence-based research findings. It was found in the course of CASS that the difference between the mortality rate in patients who were assigned to the surgery and the mortality rate in patients who were assigned medical therapy (in a randomized trial of 780 patients) were insignificant statistically. Within the period of 5 years, the former had the average rate of mortality 1.1% whereas the latter – 1.6%. That led the researchers to the conclusion that “patients similar to those enrolled in this trial can safely defer bypass surgery until symptoms worsen to the point that surgical palliation is required.” (American Heart Association, 1983) Conclusion To sum up, the role of the nurse in the coronary artery bypass surgery is very important. It is critical in the pre-operative and especially in the post-operative phase when the nurse is responsible for monitoring the patient’s condition and watches out for possible signs of malfunction. Working in accordance with the best values found in the Helen Fuld School of Nursing framework, coronary artery bypass surgery nurses will effectively deliver medical care which will help their clients restore health. References American Heart Association (1983). Coronary artery surgery study (CASS): A randomized trial of coronary artery bypass surgery. Survival data. Circulation, vol.68, 939-950. Cupples, S. (1991). Effects of timing and reinforcement of preoperative education on knowledge and recovery of patients having coronary artery bypass surgery. Heart Lung, vol. 20, 654-660. Charney, P. (1999). Coronary artery disease in women: What all physicians need to know. ACP Press. Eagle, K., Guyton, R., Davidoff, R., et al.. (2004). ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. American Heart Association. Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=9181. Homoud, M. (2008) Coronary artery disease. Retrieved from http://ocw.tufts.edu/data/50/636849.pdf. Kasliwal (2009) Coronary artery disease – ECAB. Elsevier Health Sciences. Kjaergaard, S., Rees S., Gronlund, J., et al.. (2004). Hypoxemia after cardiac surgery: Clinical application of a model of pulmonary gas exchange. Eur J Anaesthesiol, vol.21, 296-301. Martin, C. & Turkelson, S. (2006). Nursing care of the patient undergoing coronary bypass grafting. Journal of Cardiovascular Nursing, vol. 2, No.2, 109-117. Michaels, A. & Chatterjee, K. (2002). Angioplasty versus bypass surgery for coronary artery disease. Circulation, vol. 106, e187-e190. Urden, L., Stacy, K., Lough, M. (2002). Thelen's critical care nursing diagnosis and management. St. Louis, Mo: Mosby. Read More