Cardiac Disease - Essay Sample

Introduction

Cardiac Disease has become the second leading cause of death worldwide, with its incidence increasing every year. According to the Centers for Disease Control and Prevention, one in every four deaths in the United States every year is caused by heart disease (Heart Disease, 2017). There are many different heart diseases, but the most common one is Coronary Artery Disease (CAD) (Heart Disease, 2017). "CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body" (Heart Disease, 2017). Over time, the buildup of the fatty plaques causes narrowing in the coronary arteries, leading to partial or total occlusion of blood flow to the heart.

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Heart Attack

If the heart's blockage is complete, some areas of the muscle may be severely damaged or die, leading to a heart attack (Carson-DeWitt, 2014). The most common invasive procedure used for revascularization of the heart muscle is a coronary angiogram. Angiograms have "become a routine diagnostic tool in cardiology departments worldwide, and has a substantial role in the management of coronary artery diseases" (Sa’aleek, Nader, Saleh, & Darawad, 2016, p. 10). However, as with any invasive procedure, there are many risks associated with this method. One of the most common vascular-associated problems with angiograms is hematoma formation at the puncture site. This could lead to decreased hemoglobin, hypotension, pain, and increased length of stay in the hospital (Mohammady, Heidari, Sari, Zolfaghari, & Janani, 2014, p. 40).

Nursing Management

Nursing management of the access site post sheath removal is extremely important in preventing these access-related complications that can prolong hospitalization and exacerbate patient discomfort. Nurses play a vital role in monitoring puncture-related complications and promoting patient comfort. To avoid these possible complications, patients are required to be on strict bed rest for a few hours after Percutaneous Coronary Intervention following sheath removal (Mohammady et al., 2014, p. 40). However, the prolonged need for immobilization and bed rest can be very uncomfortable for the patient. The majority of them who have this procedure have many difficulties laying flat, especially those with a history of back problems and those who have dementia and cannot remember to keep their leg straight. Due to the potential severity of complications that can occur with angiograms and the need for immobilization after sheath removal, it is important to assess the length of immobilization that patients have to endure to prevent these problems. This research paper will discuss early ambulation's efficacy compared to late ambulation in reducing hematoma formation and back pain after cardiac catheterization.

Elderly Populations

The growing number of elderly populations in our society equates with more people who suffer from cardiovascular disease and the increased need for coronary interventions. The gold standard to date in diagnosing and treating coronary artery disease is cardiac angiogram and percutaneous coronary intervention (PCI). "Percutaneous coronary intervention procedures require an arterial access to reach coronary arteries and cardiac chambers and that is performed by insertion of device called a sheath in the selected artery" (Sa’aleek et al., 2016, p. 10). The most common access site used in coronary angiograms is the femoral artery. After the procedure is completed, manual or mechanical compression has to be applied to the artery to achieve hemostasis (Robertson, Andras, Colgan, & Jackson, 2016, p. 3). Manual compression over the access site usually requires 15 – 20 minutes of pressure to obtain hemostasis, followed by additional bed rest (Bechara, Annambhotla, & Lin, 2010). When the patients have completed their required bed rest time, they can get up and ambulate with an aide from their nurse. Decreasing the bed rest requirement and allowing the patient to ambulate earlier may increase patient comfort and decrease back pain. However, there are still vascular complication risks that need to be considered. Identifying the optimal length of bed rest without compromising patient safety is lacking in current literature.

Cardiac Catheterizations

Following cardiac catheterizations, it is necessary to lie in bed for a few hours to prevent access site bleeding or other complications. "Because of the use of compression bandages on puncture sites and long durations of bed confinement, hip and leg mobility become restricted, causing common complaints such as back soreness and related problems" (Wu, Dai, Kao, Chang, & Lou, 2015). Patients who have musculoskeletal issues, orthopnea, or dementia will have a particularly difficult time complying with prolonged bed rest. Therefore, it is important to do this review because vascular complications and extended bed confinement increase patient distress and discomfort. It is also responsible for increased morbidity and length of stay in the hospital (Sa’aleek et al., 2016). This increase in the number of days spent in the hospital necessitates more resources and, consequently, decreases patient satisfaction overall. Even though back pain is the most common complaint from prolonged bed rest, another important issue is patient voiding after the procedure. The strict bed rest requirement does not particularly go well when it comes to patients having to urinate. And with the use of IV fluids to flush out the dye used during the procedure, patients tend to want to void right after their cardiac catheterizations.

This, in turn, can make them very uncomfortable and increase their tendency to move in bed, putting them at risk for bleeding or hematoma. However, many female patients verbalize their embarrassment with using a bedpan to urinate. Another issue is that some male patients have difficulty urinating in a supine position, especially those with Benign Prostatic Hyperplasia (BPH). Although one could argue that insertion of a Foley catheter would prevent these problems, it is preferable to use a non-invasive method to empty the bladder as urinary catheterization increases the risk of developing a urinary tract infection (Augustin, de Quadros, & Sarmento-Leite, 2010, p. 944).

Conclusion

Therefore, reducing bed rest time and allowing early ambulation could help promote patient comfort and counter these problems. However, there are many differences in the mandated duration of bed rest following coronary angiograms. The number of hours of required bed rest time obtained from different studies ranged from as short as 2 hours to as long as 24 hours of immobility. Therefore, this lack of consensus and standardization of protocol necessitates the need to implement a change and explore the different durations of bed rest to enhance patient comfort and prevent vascular complications after cardiac catheterizations (Mohammady et al., 2014, p. 40).