Cardiac/Vascular Nurse Exam Secrets Study Guide (34 page)

Assess pain and instruct patient and family about expected pain levels and locations during recovery. Review expected progression of activity levels.

Review what constitutes an emergency and how to contact help in the event of an emergency. Provide clear written instructions.

Review all medications with clear written instructions and follow-up care plans, as well as referrals to other institutes that promote further wellness interventions.

Cardiovascular disease and depression

Depression is a major risk factor for developing cardiovascular disease, particularly myocardial infarction. Depression affects the patient’s decision-making ability, his/her interest in self-care and motivation toward healing and rehabilitation. If depression is caught and treated it can help prevent disease development and improve quality and length of life in those with active disease processes. The first line of treatment is stress management and counseling for anxiety. Medications are carefully considered after taking into account the patient’s condition, other medications and treatments. Signs and symptoms of depression should be discussed with every cardiovascular patient before discharge from a healthcare setting. You should be particularly aware of symptoms of depression in postmenopausal women.

Recovering coronary artery bypass graft (CABG) patient

Notify doctor of signs and symptoms of infection at the incision sites (leg and chest) or postpericardiotomy syndrome (fever, muscle and joint pain, weakness and chest discomfort).

Seek medical care immediately if the patient experiences symptoms of heart failure or myocardial infarction.

Monitor weight and notify the doctor if there is a sudden gain.

Verbalize explanations and tips for following prescribed diet, activity, rest and exercise programs including cardiac rehabilitation.

Obtain written and verbal instructions regarding all medications including purpose, dose, frequency and common side effects.

Accept referrals and information for lifestyle modifications such as smoking cessation and other support organizations.

Percutaneous coronary intervention (PCI)

Preoperative: Information regarding the procedure, including who will be present in the room and his/her function, what sights and sounds are typical, sensations and amount of discomfort during and after the procedure, and an estimate of the amount of time required for the procedure.

Review consents and other documentation including advanced directives.

Postoperative: Review the procedure and its outcomes, provide visual documentation of the procedure including before and after images of the lesions.

Assess pain and instruct patient and family about expected pain levels and locations (chest, back, insertion site) during recovery.

Review what constitutes an emergency and how to contact help in the event of an emergency. Provide clear written instructions.

Review all medications (aspirin, antiplatelets, beta-blockers, antihypertensives, antilipids and nitrates) with clear written instructions.

Review diet and activity expectations and progression including referrals to consultations for diet or lifestyle modifications and cardiac rehabilitation.

Define follow-up care plans as well as referrals to other institutes that promote further wellness interventions.

Pacemaker placement

Preoperative: Information regarding the procedure, including who will be present in the room and his/her function, what sights and sounds are typical, sensations and amount of discomfort during and after the procedure, and an estimate of the amount of time required for the procedure.

Review consents and other documentation including advanced directives.

Postoperative: Expected and unexpected pain levels and locations (chest, insertion site) during recovery.

Review what constitutes an emergency and how to contact help in the event of an emergency. Provide clear written instructions.

Review all medications (including antibiotics) with clear written instructions and follow-up care plans, as well as referrals to other institutes that promote further wellness interventions.

Review activity expectations and progression including referrals to consultations for diet or lifestyle modifications and cardiac rehabilitation.

Review lifestyle modifications, including carrying a pacemaker identification card and informing all healthcare providers (including dentists) of the pacemaker. Include safety precautions: may safely operate microwaves and cell phones, but should avoid high-strength radiation fields such as MRI.

Carotid endarterectomy

Preoperative: Information regarding the procedure, including who will be present in the room and his/her function, what sights and sounds are typical, sensations and amount of discomfort during and after the procedure, and an estimate of the amount of time required for the procedure.

Review consents and other documentation including advanced directives.

Postoperative: Review the procedure and its outcomes, provide visual documentation of the procedure.

Assess pain and instruct patient and family about expected pain levels and locations (chest, back, insertion site) during recovery.

Review what constitutes an emergency (including neurological impairment) and how to contact help in the event of an emergency. Provide clear written instructions.

Review all medications (aspirin, clopidogrel) with clear written instructions and follow-up care plans, as well as referrals to other institutes that promote further wellness interventions.

Review diet and activity expectations and progression including referrals to consultations for diet and weight loss or lifestyle modifications for hypertension, cholesterol, diabetes management and smoking cessation.

Heart failure

Disease process: Heart failure causes and disease progression should be covered. This teaching should include signs and symptoms of worsening conditions and self-monitoring techniques such as daily weights.

Life expectancy: The patient should have a clear understanding of the length and quality of life he/she will experience as part of the disease process. End-of-life choices should be discussed and advanced directives should be reviewed.

Activity levels: Based on the current stage of the disease and diagnostic testing, parameters are set for all activities of daily life.

Diet: Detailed instruction on what constitutes a low-sodium diet is generally required; fluid restriction may also be needed.

Medications: Education regarding medications should include clear and written instructions regarding dosage, timing and frequency of each administration as well as what the expected treatment result will be, common side effects, interactions and negative reactions.

Therapeutic support: Every effort should be made to encourage compliance with treatment plans and acceptance of referrals to other health and education resources for top priority health needs such as smoking cessation and mental health.

Acute or chronic illnesses

Diagnosis: Establish a basic understanding of the disease process, including areas of body affected, causes, prognosis and whether or not it is contagious.

Complications: Clarify possible signs and symptoms, early warning signs and signals of disease progression and healing.

Management: Define what the patient can expect from his/her care and recovery, including treatments, diet, activity levels and medications.

Aggravating factors: Help the patient understand what behaviors or triggers may increase his/her symptoms and what can be done to avoid or control them.

Prognosis: Patients need both an immediate idea as well as a long-term picture of what to expect.

Prevention: Establish self-care habits that can help prevent recurrence of the problem.

Resources: Make sure the patient is informed of all available resources for help on his/her healthcare journey.

Crisis

A crisis is a change in well-being that has a definite beginning and end. It is marked by an inability to cope either because of exhaustion of normal coping mechanisms or sudden and dramatic change in circumstances. A nurse’s role during times of crisis is to first ensure the safety of the individual, then improve coping strategies and assist the patient in returning to a stable level of functioning. This can be done by use of medication, therapies, controlling environmental influences, offering reassurance, suggestions for change and support in decisions and actions toward crisis resolution.

Benefits of a learning contract

A learning contract establishes a formal agreement that learning will take place. Learning contracts are a concrete indication of a learner’s willingness to begin the learning and change process. It spells out expectations of both teacher and learner to maintain a positive and productive relationship. Goals are set and ways to evaluate progress are outlined so that both parties know what will be expected of them. Goals should be centered on patient needs and wishes and decided upon with his/her input. Learning contracts can be employed in a number of healthcare settings and provide measurable outcomes for intervention evaluation.

Professional Role Performance

Legal regulation of nursing practice

Legal regulation of nursing practice protects the health, safety, and welfare of patients. All states require nurse licensing and most states require additional accreditation for advanced nursing practice. Nursing practice acts are state laws that grant the right to practice nursing to individuals who meet predetermined standards. Regulatory boards are responsible for determining eligibility for licensing and relicensing, approving and supervising educational programs, enforcing statutes, and writing rules and regulations. Licensing requirements, state statutes and monitoring, advisory boards, and guidelines effectively protect patients and aim to ensure optimum care by nurses.

Code of ethics for nurses as defined by the American Nurses Association

1. Practice with compassion and respect for each patient as a unique individual.

2. Maintain the patient as highest priority.

3. Support practices that promote patient safety.

4. Maintain a high level of individual accountability.

5. Utilize practices that will promote the health and well-being of the nurse as a practitioner and individual.

6. Establish and maintain environments of high quality care.

7. Actively participate in the advancement and improvement of the profession.

8. Coordinate care efforts with other healthcare and community resources.

9. Maintain integrity and set a public example of the values and excellence of the profession.

Patient rights as identified by the American Hospital Association

• Right to considerate and respectful care.
  
• Right to information about diagnosis, treatment and prognosis.
  
• Right to make decisions about the plan of care.
  
• Right to have advance directives.
  
• Right to privacy.
  
• Right to confidentiality.
  
• Right to review clinical records.
  
• Right to responsible care and services, including the right to transfer institutions, and payors that might influence care and treatment.
  
• Right to reasonable continuity of care.
  
• Right to be informed of hospital policies and procedures that regulate patient care, treatment and responsibilities; includes the right to grievance and dispute resolution.
  

(American Hospital Association, Patients’ Bill of Rights, 1990)

Differences between licensure and certification

Licensure is the meeting of legal parameters established by government to identify that an individual has met a minimum standard of competence and safety in his/her profession. No one is allowed to practice in that profession without qualifying to do so under the laws of the state in which he/she is intending to practice.

Certification is a step above and beyond licensure that is pursued by the individual nurse or required by an institution for employment in specialty areas. Guidelines and testing for certification are established by the profession with the backing of independent agencies to ensure standards of quality. Certification implies a higher level of competency within a specialized area of care.

N
egligence and malpractice

Negligence and malpractice are classified as unintentional torts (wrongful acts). Negligence refers to harm caused by carelessness or failure to act. Malpractice is a specific form of negligence that results from harm caused by not meeting reasonable standards of care set within the profession of nursing. Malpractice cases can be pursued if the wronged party is able to prove that the nurse in question was responsible for performing, or not performing, an intervention within his/her scope of practice. It must be reasonably proven that this action by the nurse was directly related to the harm and suffering of the patient.