CARDIOVASCULAR I

FOUNDATION OF CARDIOVASCULAR NURSING

INTRODUCTION

Habtamu (Msc in Cardiovascular N.)

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Learning Objectives

At the completion of this introductory part, students are

expected to:
 Describe Historical development, trends, and issues in
the field of cardiology.
 Identify Cardiovascular conditions – a major health
problem
 Explain Concepts, principles, and nursing perspectives
 Know Ethical and legal issues
 Apply Evidence-based nursing and its application in
cardiovascular Nursing care
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Historical development, trends and issues in the
field of cardiology.

• Cardiology field includes medical diagnosis and

treatment of congenital heart defects, coronary artery
disease, heart failure, valvular heart disease and
electrophysiology
• Einthoven, a professor of physiology in the small
Dutch town of Leiden, first recorded a human
electrocardiogram ,and the first string galvanometer
to record the electrical activity of the heart won a
Nobel Prize in 1924 for his contributions to the field
of electrocardiography.
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Conti..
• Einthoven himself described various arrhythmias,
including bigeminy, atrial flutter and fibrillation, and
“P mitrale,” as well as left and right ventricular
hypertrophy.
• First catheterization of the living human heart was
performed by a young surgeon, Werner Forssman, (on
himself!) in 1929 in Eberswald

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 Conti..
• Modern cardiovascular surgery was first applied in
1938, by Robert Gross at Harvard and Boston's
Children's Hospital successfully closed a patent
ductus arteriosus In 1953, John Gibbon at Thomas
Jefferson Hospital in Philadelphia performed the first
open-heart operation using cardiopulmonary bypass .
• He successfully closed an atrial septal defect in an
18-year-old girl Gibbon’s design led to the
construction of the heart-lung machine .

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 Conti..
• In 1842 ,Johann Christian Doppler discovers the
Doppler sound effects – begins the premise for
sonographic imagery. 1881 – Jacques and Pierre
discover the principle of piezoelectricity – another
stepping stone to creating the ultrasound.
• In 1978 , J Roelandt introduce the first hand held
echo machine.
• In 1959, Elmquist and Senning at the university of
zurich reported on the first successful use of an
internal pacemaker
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 Conti..

• In 1970, Michel Mirowski, an Israeli cardiologist

with training in electrical engineering working at
Sinai Hospital in Baltimore, invented the implanted
cardioverter-defibrillator.
• In 1927,The technique of angiography itself was first
developed by the Portuguese physician Egas Moniz at
the University of Lisbon for cerebral angiography .

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 Conti..
• The use of a balloon-tipped catheter for the treatment
of atherosclerotic vascular disease was first described
in 1964 by two interventional radiologists, Charles
Dotter and Melvin Judkins to treat a case of
atherosclerotic disease in the superficial femoral
artery of the left leg
• Andreas Gruentzig performed the first successful
PTCA or percutaneous coronary intervention (PCI))
on a human on September 16, 1977 at University
Hospital.
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Cardiovascular conditions and Major health
Problems.
• Myocardial infarction
• Stroke
• Heart Failure
• Anemia
• Hypertension

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Myocardial infarction(MI)
• MI is defined as a diseased condition which is caused
by reduced blood flow in a coronary artery due to
atherosclerosis & occlusion of an artery by an
embolus or thrombus.
• MI or heart attack is the irreversible damage of
myocardial tissue caused by prolonged ischemia &
hypoxia.

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TYPES OF INFARCTS
According to degree of thickness of ventricular wall
involved
• Transmural (full thickness)
• Laminar (subendocardial)

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 Transmural
• Full thickness
• Superimposed thrombus in atherosclerosis
– total, prolonged occlusion
– EKG - ST elevation
– Rx - Thrombolytic Therapy or PCI or CABG

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 Non-transmural / Sub-endocardial
• Inner 1/3 to half of ventricular wall
• Non-occlusive thrombus or spontaneous re-perfusion
– EKG – ST depression
– Some enzymatic release – troponin I
– Rx-majority with medical treatment
• Minority treated via PCI or CABG

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According to ST Elevation/ECG abnormality.
• ST Elevation MI
• Non St elevation MI
• Development of pathologic Q wave on ECG

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• Based on anatomic involvement of the coronary
artery
• Proximal LAD ( Proximal Left anterior desending): ST elevation V1-
V6, I, aVL and fascicular or bundle branch block
• Mid LAD( left anterior desending artery): ST elevation V1-V4, I, aVL
• Distal LAD and diagonal: ST elevation V1-V2 or I, aVL, V5, V6
• Proximal RCA and LCX branch(Left circumflex artery): ST elevation
II, III, AVF
• LBBB: indicate large anterior MI acute MI involving the proximal left
anterior descending coronary artery
• RBBB: challenging interpretation of STEMI in lead V1 through V3

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General Measures

• Anti –ischemic therapy

-Nitrates
-BB
• Antiplatelet monotherapy
• Revascularization therapy : PCI Vs CABG
-For high risk patients

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 Stroke

• Occurs when a clot blocks the blood supply to the

brain or when a blood vessel in the brain bursts.

• Stroke can cause death or significant disability, such as

paralysis, speech difficulties, and emotional problems.

• Some new treatments can reduce stroke damage if

patients get medical care soon after symptoms begin. 

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 Types of Stroke
• Ischemic Stroke. About 85% of all strokes are
ischemic, in which blood flow to the brain is blocked
by blood clots or fatty deposits called plaque in blood
vessel linings.
• Hemorrhagic Stroke. A hemorrhagic stroke occurs
when a blood vessel bursts in the brain. Blood
accumulates and compresses the surrounding brain
tissue. There are two types of hemorrhagic stroke
• Intracerebral hemorrhage is the most common type
of hemorrhagic stroke. It occurs when an artery in the
brain bursts, flooding the surrounding tissue with
blood.
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Conti..

• Subarachnoid hemorrhage is bleeding in the area

between the brain and the thin tissues that cover it.
• Transient ischemic attack (TIA) is a "warning
stroke" or a "mini-stroke" that results in no lasting
damage. Recognizing and treating TIAs immediately
can reduce your risk of a major stroke

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 Stroke Symptoms

The five most common signs and symptoms of stroke are:

– Sudden numbness or weakness of the face, arm, or
leg
– Sudden confusion or trouble speaking or
understanding others
– Sudden trouble seeing in one or both eyes
– Sudden dizziness, trouble walking, or loss of balance
or coordination
– Sudden severe headache with no known cause

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 Stroke Treatment

• Emergency treatment Get to the hospital within

three hours of the first symptoms of an ischemic
stroke, a doctor may give you medications, called
thrombolytics, to break up blood clots
• Preventing another stroke. If you have had a stroke,
you are at high risk for another one. At least one in
every eight stroke survivors has another stroke within
5 years. Important to treat the underlying causes,
including heart disease, high blood pressure, atrial
fibrillation, high cholesterol, or diabetes.
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Conti..
• Rehabilitation. Rehabilitation often involves
physical therapy to help you relearn skills you may
have lost because of the stroke

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Other treatments for Stroke

• Other treatments are given in the hospital depend on the cause

of the stroke:
–Blood thinners such as heparin, warfarin (Coumadin), aspirin,
or clopidogrel (Plavix)
–Medicine to control symptoms such as high blood pressure
–Special procedures or surgery to relieve symptoms or prevent
more strokes
–Nutrients and fluids 
–A feeding tube in the stomach (gastrostomy tube)
–Physical therapy, occupational therapy, speech therapy, and
swallowing therapy
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Heart Failure(HF)

• The current American Heart Association (AHA)

guidelines define HF as a complex clinical
syndrome that results from structural or
functional impairment of ventricular filling or
ejection of blood, which in turn leads to the cardinal
clinical symptoms of dyspnea and fatigue and signs
of HF.

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Types of HF

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The most useful index of LV function is the EF
(EF=stroke volume /end-diastolic volume).

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Classification of HF AHA HF Stage and NYHA
Functional Class
A At high risk for heart failure but without
structural heart disease or symptoms
of heart failure (eg, patients with
hypertension or coronary artery disease)

B Structural heart disease but without

symptoms of heart failure I Asymptomatic

II Symptomatic with moderate exertion

C Structural heart disease with prior or
current symptoms of heart failure
III Symptomatic with minimal exertion

D Refractory heart failure requiring

IV Symptomatic at rest
specialized interventions

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Pathophysiology of HF

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Clinical Manifestation

The cardinal Sxs of HF are

 dyspnea and fatigue
○ which may limit exercise tolerance, and
 Both abnormalities can impair the functional capacity and
quality of life
• Signs of circulatory congestion
– Pulmonary rales, neck vein distension
– peripheral/lower extremity edema and s3 gallop
rhythm.
– Hepatomegaly and ascites causing RUQ pain and
abdominal fullness, nausea and vomiting
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• Evidence of left ventricular dilation and
reduced systolic function
– MVR, TVR,
– laterally displaced apical impulse,
– and a palpable ventricular gallop(S3)
– Narrow pulse pressure

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IX

• Cbc
• Serum electrolytes
• RFT
• OFT
• RBS
• LIPID PROFILE
• Cardiac biomarkers-BNP,NT-proBNP, Troponin,
ceratine kinase.
• CXR
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Goals of Heart Failure Therapy

 Relieve HF symptoms
 Make patients feel better
 Improve overall clinical status
 Stabilize acute episodes of decompensation

 Decrease morbidity and mortality

 Slow and/or reverse disease progression
 Identify and treat reversible causes of
LV dysfunction

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Components of Treatment

– General measures

– Medical therapy
• Guided by functional class

– device options

– Surgical therapy

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How Do We Make Heart Failure Patients
Feel Better?

 With hemodynamic interventions

 Salt restriction
 Diuretics
 Digoxin
 Vasodilators
 Positive inotropic agents
 Mechanical interventions that improve hemodynamics
(e.g., CRT, LVADs)

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 Hypertension
• Is a force exerted by circulating blood
against the walls of the body’s arteries, the
major blood vessels in the body.
Hypertension is diagnosed if, when it is
measured on two different days, the systolic
blood pressure readings on both days is
≥140 mmHg and/or the diastolic blood
pressure readings on both days is ≥90
mmHg.
 Classification of HTN

• Essential HTN or Primary HTN– cause not

known and is constitute more than
95% of hyperextension.
• Secondary HTN---there is underlying
etiology
for the development of HTN.
• HTN Emergency, urgency..
Cont..
 Complication of HTN
• LVH---IHD---Angina---ACS
• Heart failure
• Stroke---Ischemic/Hemorrhagic
• CKD
• PAD
• Blindness
 Lifestyle Modification

Modification Approximate SBP reduction

(range)

Weight reduction 5–20 mmHg / 10 kg weight loss

Adopt DASH eating 8–14 mmHg

plan
Dietary sodium 2–8 mmHg
reduction
Physical activity 4–9 mmHg

Moderation of alcohol 2–4 mmHg

consumption
 Algorithm for
Treatment of Hypertension
Lifestyle Modifications

Not at Goal Blood Pressure (<140/90 mmHg)

(<130/80 mmHg for those with diabetes or chronic kidney disease)

Initial Drug Choices

Without Compelling With Compelling

Indications Indications

Stage 1 Hypertension Stage 2 Hypertension Drug(s) for the compelling

(SBP 140–159 or DBP 90–99 mmHg) (SBP >160 or DBP >100 mmHg) indications
Thiazide-type diuretics for most. 2-drug combination for most (usually Other antihypertensive drugs (diuretics,
May consider ACEI, ARB, BB, CCB, thiazide-type diuretic and ACEI, ARB, BB, CCB)
or combination. ACEI, or ARB, or BB, or CCB) as needed.

Not at Goal
Blood Pressure

Optimize dosages or add additional drugs

until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
Anemia

• Hemoglobin concentration (HGB) measures the

concentration of the major oxygen-carrying pigment in
whole blood. Values may be expressed as grams of
hemoglobin per 100 mL of whole blood (g/dL) or per
liter of blood (g/L)
• Hematocrit (HCT) is the percent of a sample of whole
blood occupied by intact red blood cells.
• RBC count is the number of red blood cells contained
in a specified volume of whole blood, usually expressed
as millions of red blood cells per microL of whole blood.

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CLASSIFICATION OF CAUSES OF ANEMIA

• Two approaches

– Underling causes and RBC Kinetic;

Pathophysiologic classification

– Peripheral blood smear morphological and MCV;

Morphologic classification

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• Three Categories according to
morphologic(size) approach
– Macrocytic
– Microcytic
– Normocytic

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 Macrocytic Anemia

• MCV > 100fL(femtoliter)

• Not all macrocytosis is necessarily associated with
anemia
– AZT,(zidovudine, Retrovir) alcohol, dyslipidemia
• Other features are sometimes seen
• Typical example
– Megaloblastic anemias
• Folate deficiency
• Vitamin B12 deficiency

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Microcytic Anemia

• MCV < 80fL

• Always associated with hypochromia
• Typical examples
– IDA
– Thalassemias

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Normocytic Anemia

• Normocytic & Normochromic cells

• Vast and heterogeneous group
• Of little diagnostic significant
• Kinetic approach more important for Dx in
NN anemias(normocytic normochromic
anemia)
• Typical examples
– Aplastic anemia
– Early IDA
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CLASSIFICATION OF ANEMIA

• Functional classification of anemia has three

major categories.

1) Marrow production defects(hypoproliferation)

2) Red cell maturation defects (ineffective
erythropoiesis)
3) Decreased red cell survival (blood
loss/hemolysis).

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Iron deficiency anemia

• Free iron is toxic to cells, and the body has

established an elaborate set of protective
mechanisms to bind iron in various tissue
compartments.

• Within cells, iron is stored complexed to

protein as ferritin or hemosiderin.

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• Under steady-state conditions, the serum ferritin level
correlates with total body iron stores;

– Thus, the serum ferritin level is the most

convenient laboratory test to estimate iron
stores.

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• The normal value for ferritin varies according to the age and
gender of the individual .

• Adult males have serum ferritin values averaging 100

mcg/L, while adult females have levels averaging 30 mcg/L.

• As Iron stores are depleted, the serum ferritin falls to <15

mcg/L.

• Such levels are diagnostic of absent body iron stores.

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Treatment

Oral preparaton Tablet(iron content,

• Ferrous Sulfate mg)
• Ferrous Fumerate • 325(65)
• Ferrous Gluconate • 325(107)
• Polysaccharid iron
• 325(39)
Should be taken on empty
stomach • 150(150)
S/E-GI disturbance,
abd.pain
N,V ,constipation
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Hypertension

• Is a force exerted by circulating blood against the

walls of the body’s arteries, the major blood vessels
in the body.
• Hypertension is when blood pressure is too high.
• Hypertension is diagnosed if, when it is measured on
two different days, the systolic blood pressure
readings on both days is ≥140 mmHg and/or the
diastolic blood pressure readings on both days is ≥90
mmHg

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Classification of HTN

• Essential HTN or Primary HTN– cause not

known and is constitute more than
95% of hyperextension.
• Secondary HTN---there is underlying etiology
for the development of HTN.
• BP= CO*SVR

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Complication of HTN

• LVH---IHD---Angina---ACS
• Heart failure
• Stroke---Ischemic/Hemorrhagic
• CKD
• PAD
• Blindness

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Concepts, principles, and nursing perspectives

Nursing care of patient with Heart Failure in

older adult.
• Heart failure is common in older adults, affecting
nearly 10% of people over the age of 75 years.
• Aging affects cardiac function. Diastolic filling is
impaired by decreased ventricular compliance. With
aging, the heart is less responsive to SNS stimulation.

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• As a result, maximal heart rate, cardiac reserve, and
exercise tolerance are reduced.
• Concurrent health problems such as arthritis that
affect stamina or mobility often contribute to a more
sedentary lifestyle, further decreasing the heart’s
ability to respond to increased stress.

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Assessing for Home Care

• The older adult with heart failure may not be

dyspneic, instead presenting with weakness and
fatigue, somnolence, confusion, disorientation, or
worsening dementia.
• Dependent edema and respiratory crackles may or
may not indicate heart failure in older adults.
• Assess the diet of the older adult. Decreased taste
may lead to increased use of salt to bring out food
flavors. Limited mobility or visual acuity may cause
the older adult to rely on prepared foods that are high
in sodium such as canned soups and frozen meals.
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Discuss normal daily activities and assess sleep and rest
patterns. It is also important to assess the environment
for the following:
• Safe roads or neighborhoods for walking
• Access to pharmacy, medical care, and assistive
services such as a cardiac rehabilitation program or
structured exercise programs designed for older adults.

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Patient and Family Teaching
• Teaching for the older adult with heart failure focuses
on maintaining function and promptly identifying and
treating episodes of heart failure.
Teach patients how to adapt to changes in
cardiovascular function associated with aging, such as
the following:
• Allowing longer warm-up and cool-down periods
during exercise
• Engaging in regular exercise such as walking five or
more times a week

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• Resting with feet elevated (e.g., in a recliner)
when fatigued
• Maintaining adequate fluid intake
• Preventing infection through pneumococcal
and influenza immunizations.

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Nursing care of patient with pulmonary edema

• Pulmonary edema is an abnormal accumulation of

fluid in the interstitial tissue and alveoli of the lung.
Both cardiac and noncardiac disorders can cause
pulmonary edema.
• Cardiac causes include acute myocardial infarction,
acute heart failure, and valvular disease.
• Cardiogenic pulmonary edema, is a sign of severe
cardiac decompensation in which increased pressure
in the LV unable to pump enough blood.

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Noncardiac causes of pulmonary edema

• Include primary pulmonary disorders, such as

aute respiratory distress syndrome (ARDS),
trauma, sepsis, drug overdose, or neurologic
sequelae.
• Cardiogenic pulmonary edema is a severe
form of heart failure.

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• Risk factors are those associated with heart failure,
and treatment focuses on maintaining oxygenation
and improving cardiac function.
• Noncardiogenic pulmonary edema is a primary or
secondary lung disorder. It usually occurs secondarily
to a critical event such a major trauma, shock, or DIC.
Treatment focuses on maintaining oxygenation and
the primary, underlying disorder.

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 Pathophysiology

• In cardiogenic pulmonary edema, the contractility of

the left ventricle is severely impaired. The ejection
fraction falls as the ventricle is unable to eject the
blood that enters it, causing a sharp rise in end-
diastolic volume and pressure.
• Pulmonary hydrostatic pressures rise, ultimately
exceeding the osmotic pressure of the blood. As a
result, fluid leaking from the pulmonary capillaries
congests interstitial tissues, decreasing lung
compliance and interfering with gas exchange.
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 Manifestation of Pulmonary edema

• MANIFESTATIONS OF PULMONARY EDEMA

Respiratory
• Tachypnea

• Labored respirations
• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Cough productive of frothy, pink sputum
• Crackles, wheezes
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Conti..
Cardiovascular
• Tachycardia
• Hypotension
• Cyanosis
• Cool, clammy skin
• Hypoxemia
• Ventricular gallop
Neurologic
• Restlessness
• Anxiety
• Feeling of impending doom 72
Nursing Care of patient with Pulmonary edema.

• Nursing care of the patient with acute pulmonary

edema focuses on relieving the pulmonary effects of
the disorder. Interventions are directed toward
improving oxygenation, reducing fluid volume, and
providing emotional support.

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Assessment

• See the Manifestations and Interprofessional Care

sections for the assessment of the patient with acute
pulmonary edema.
• The nurse often is instrumental in recognizing early
manifestations of pulmonary edema and initiating
treatment. As with many critical conditions, emergent
care is directed toward the ABCs: airway, breathing,
and circulation.
Priorities of Care
• Collaborating with the interprofessional team to
ensure adequate 74
Conti..

• Treatment of the underlying process while

providing care that supports the physical and
psychologic responses to the disorder is a
priority of nursing care.

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 Diagnoses, Outcomes, and Interventions

• Promoting effective gas exchange and restoring an

effective cardiac output are the priorities for nursing
and interprofessional care of patients with
cardiogenic pulmonary edema.
• The experience of acute dyspnea and shortness of
breath is terrifying for the patient. The nurse is
instrumental in providing emotional support and
reassurance.

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Nursing Care of the Patient with Rheumatic Fever and Rheumatic
Heart Disease

• Rheumatic fever is a systemic inflammatory disease

caused by an abnormal immune response to
pharyngeal infection by group A beta hemolytic
streptococci. Rheumatic fever usually is a self-
limiting disorder, although it may become recurrent
or chronic.
• Although the heart commonly is involved in the
acute inflammatory process, only about 10% of
people with rheumatic fever develop rheumatic heart
disease.
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Conti..

• Rheumatic heart disease frequently damages the heart

valves and is a major cause of mitral and aortic valve
disorders.
• Endocardial inflammation, however, causes swelling
and erythema of valve structures and small vegetative
lesions on valve leaflets. As the inflammatory process
resolves, fibrous scarring occurs, causing deformity.
• Rheumatic heart disease (RHD) is a slowly
progressive valvular deformity that may follow acute
or repeated attacks of rheumatic fever.
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Conti..
• Valve leaflets become rigid and deformed;
commissures (openings) fuse, and the chordae
tendineae fibrosis and shorten. This results in stenosis
or regurgitation of the valve. In stenosis, a
narrowed, fused valve obstructs forward blood flow.
• Regurgitation occurs when the valve fails to close
properly (an incompetent valve), allowing blood to
flow back through it.
• Valves on the left side of the heart are usually
affected; the mitral valve is most frequently involved.
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81
 Assessment

• See the Manifestations and Interprofessional Care

sections for the assessment of the patient with
rheumatic fever/rheumatic heart disease.
• Assess patients at risk for rheumatic fever (prolonged,
untreated, or recurrent pharyngitis) for possible
manifestations.
• Health history: complaints of recent sore throat with
fever, difficulty swallowing, and general malaise;
treatment measures; previous history of strep throat or
rheumatic fever; history of heart murmur or other
cardiac problems; current medications.
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• Physical assessment: vital signs including
temperature; skin color, presence of rash on the trunk
or proximal extremities; mental status; evidence of
inflamed joints; heart and lung sounds.

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 Diagnoses, Outcomes, and Interventions

• The nursing care focus for the patient with RHD is on

providing supportive care and preventing
complications. Teaching to prevent recurrence of
rheumatic fever is extremely important.
• Pain and Activity Intolerance are priority nursing
diagnoses for the patient with rheumatic fever and
RHD.

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Ethical and Legal issues

Definition of Ethics
• It is a branch of philosophy which is concerned with
human character and conduct. Ethics are defined as
the science of moral in human conduct.
• Morals are ‘oughts’ and ‘shoulds’ of society whereas
ethics are the principles behind the ‘shoulds’, the
‘whys’ of moral codes are statements.
• The term ‘law’ refers to those standards of human
conduct established, and enforced by the authority, of
an organised society through its Government .
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Conti..

Legal Responsibility
• Legal responsibility refers to the ways in which a
nurse is expected to follow the rules and regulations
prescribed for nursing practice. These responsibilities
are described by State,
• Central Government through service conduct rules
based on standards developed by State Nursing
Council and National Nursing Council.

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 Malpractice

• Professional misconduct; negligence

performed in professional practice; any
unreasonable lack of skill in professional
duties or illegal or immoral conduct that result
in injury or death to the client/consumer.
.

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 Negligence

• Negligence is described as lack of proper care

and attention; carelessness; An act of
carelessness
• The few examples of common areas of
negligence in which nurse will be held
responsible are:

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Conti..

• harmful objects left near the patient with suicidal

ideation
• not following Five ‘R’ (Rights) and causing harm to
the patient by giving wrong medicine
• causing thermal, chemical, physical injuries to the
patient
• fall of patient, under sedation, after operation
recovering from anesthesia, semi conscious state, and
person suffering from dizziness

89
 Conti..
• Failure to observe and take appropriate action
• Failure to inform to the team members about
untoward effect observed in patient
• Absconding of patient
• Loss/damage of patient’s property
• Foreign object left in patient’s body during the
surgery due to wrong counting
• Delay in obtaining help for patient

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 Intentional Torts

• Intentional torts are, when others interfere in

individual’s privacy, mobility, property or personal
interests. These rights of the individual should be
protected. Intentional torts can be Assault, Battery,
False imprisonment or defamation.
• Assault: It is the unjustifiable threat or attempt to
inflict offensive physical contact or body harm on a
person that puts the person in a immediate danger of
or in apprehension.

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Conti..

• Battery: It involves an intentional act that is harmful

or offensive – touching another person without that
person’s consent.
• False Imprisonment: It is an intentional act which
prevents an individual from moving about where s/he
wants to be.
• Defamation: Publication of a false statement about
an individual made either verbally or in some other
form to the third person, which damages his/her
reputation.
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 Informed Consent
• All patients should be given opportunity to grant informal
consent. Informed consent implies to when patient is given
the complete knowledge and understanding about any
treatment/procedure and agrees to sign for
treatment/procedure.
• For any procedure/treatment consent is required according
to the institutional policies.
• Nurse must witness while doctor gives explanation of a
procedure/treatment in detail before taking the consent.
• Sometimes an information leaflet/pamphlet can be prepared
for patient to read.
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 Conti..
Nursing Personnel must keep in mind the following point:
• Patient can consent for herself/himself or legally authorize
someone to consent for her/him.
• If a patient is below 18 years of age, then the legal guardian
has to give the consent.
• Consent should be taken from the spouse or legal guardian if a
person has mental disorder or mental incompetence.
• Consent of husband and wife should be obtained for legal
abortion.
• Legal policy need to be followed for the consent for an orphan
according to the State.

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 Ways to Avoid Malpractice

Know your own strengths and weaknesses

Evaluate your assignment
Delegate carefully
Exercise caution when assisting procedures
Document the use of restraints
Take steps to prevent falls
Comply with laws about advance directives
Follow hospital policies and procedures
Keep policies and procedures up to date
Provide a safe environment

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 Responsible & Accountable

You are responsible and accountable for your actions

based on:
Your clinical training
Your title
Scope of practice
Standard of care guidelines
Policies and procedures of your health care facility

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 Evidence-based nursing and its application in
cardiovascular Nursing care
• DEFINITIONS Evidence: It is something that
furnishes proof or testimony or something legally
submitted to ascertain the truth of the matter.
• Evidence based nursing- it is a process by which
nurses make clinical decisions using the best
available research evidence, their clinical expertise
and patient preferences

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Conti..

• EBP in nursing is a way of providing nursing care

that is guided by the integration of the best available
scientific knowledge with nursing expertise. This
approach requires nurses to critically assess relevant
scientific data or evidence and to implement high
quality interventions for their nursing practice.

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 NEED FOR EBP

• For making sure that each client get the best possible
services.
• Update knowledge and is essential for lifelong
learning.
• Provide clinical judgement.
• Improvement care provided and save lives.

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Conti..

• There are five steps in the process of

implementing evidencebased medicine practice.4 Also
known as the “five A’s of evidence-based
practice” in health science, these steps include:
1. Ask: Formulate answerable clinical questions about a
patient, problem, intervention, or outcome.
2. Acquire: Search for relevant evidence to answer
questions.

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3.Appraise: Determine whether or not the evidence is
high-quality and valuable.
4.Apply: Make clinical decisions utilizing the best
available evidence.
5.Assess: Evaluate the outcome of applying the
evidence to the patient’s situation.
Some healthcare organizations choose to add a sixth
step, “disseminate,” to the cycle.5 When you share your
own research and evidence with colleagues, this
supports the widespread use of evidence-based practice
in nursing.

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