Nursing Management of Patients with Respiratory and Cardiac Issues

This report provides a detailed overview of nursing management for patients with respiratory and cardiac conditions. It begins with an introduction to the roles of nursing staff in patient care, emphasizing the importance of therapeutic environments. The report then delves into the pathophysiology of both respiratory and cardiac systems, discussing conditions like obstructive and restrictive respiratory diseases, and coronary artery disease (CAD). A literature review explores nursing management principles relevant to these systems, covering topics such as pulmonary edema, pneumonia, asthma, acute respiratory distress syndrome (ARDS), and the use of bronchoscopy. The review highlights the importance of patient monitoring, interventions, and the challenges nurses face in providing comprehensive care. The report also touches upon pulmonary cancer and melanoma, discussing treatment modalities like chemotherapy, immunotherapy, and surgery, and addresses the management of cardiovascular issues like hypertension and diabetes. The report concludes by emphasizing the need for nurses to provide holistic care, including physical and emotional support to ensure patient well-being.

PRINCIPLES OF NURSING
MANAGEMENT OF
PATIENTS/CLIENTS WITH
MEDICAL-SURGICAL CONDITIONS
RELEVANT TO RESPIRATORY AND
CARDIAC SYSTEMS

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Respiratory and cardiac systems' patho-physiology...............................................................1
LITERATURE REVIEW................................................................................................................3
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
The nursing management is done for the patients by nursing staffs to make them cure and
be healthy. The patients who are brought to hospitals are more likely in need of physical help and
emotional support. A dynamic and personal relationship is maintained between patients and
nursing staffs. A patient is fully depended on nursing staffs with their core trust and faith.
Nursing staffs always try to make patients feel better with their support. All skills and knowledge
are used by them to ensure patient's wellbeing in order to achieve good health and self-
dependency. Nursing professionals always try to assets necessary therapeutic environment for
patients related to respiratory and cardiac medical surgical conditions. Various issues and
problems are found every day with respect to respiratory and cardiac disorders.
Respiratory and cardiac systems' pathophysiology
Respiratory problems may be obstructive and restrictive. Obstructive diseases are
characterised by reduction in airflow and its limitations. There are various diseases that are
associated with this like asthma, chronic bronchitis, chronic obstructive pulmonary diseases and
emphysema. When there is a reduction or increase in size of lungs, stiffness causes problem
while intake of air so that maximum amount of air volume within lungs can be decreased.
Restrictive disorders also occurred due to respiratory muscles weakness and abnormalities of
chest wall. Furthermore, the use of certain drugs like methotrexate, amiodarone and others also
cause abnormalities within lungs.
Following lung dysfunction may arise like:
Respiratory Disorder-Fibrosis, oedema, congestive heart failure, pleural disease
Airway disease- Asthma
Pleural cavity- Effusion, enlarged heart, tumour
Chest wall disorders- Scleroderma, pregnancy, obesity,
Muscles disorders- Nero muscular diseases, polio, diaphragmatic paralysis
It is hereby to demonstrate the pathophysiology of cardiac system of patients with medical
or surgical conditions, several number of cardiovascular disorders have been found. This is for
instance to consider the most common complaint of coronary artery disease, also termed as
CAD. It is basically a condition in which, the patient is suffering from a defective coronary
artery that obstructs a sufficient supply of blood into the heart muscles. This in turn results in an
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unfulfilled demand of the tissue. It is empirically considered as a deteriorating condition of the
patients whose vessel lumen completely gets obstructed. It is also known to associate with
several other risk factors that states a foremost requirement of educating patients regarding its
effective management.
It is therefore on discoursing upon the pathophysiology of CAD, it has been found to build
up from a rich depository of cholesterol as well as plaques inside patient’s artery. These are also
known as atheromatous plaques that in turn results in thickening of the arterial wall. This
resultantly blocks the artery wall and narrow down the scope of blood flow as a major
obstruction in the supply of sufficient amount of blood. Such existence of atheromas
consequently results in the reduction of oxygen level in the body with reduced nutrient content.
Below are the points summarizing the pathophysiology of CAD-
 Development of atheromas from a damage or injury in the endothelium as the inner lining
of artery.
 High absorption of low density lipoprotein (LDL) enters the damaged endothelium by
together enduring oxidation as a part of a chemical procedure and results in the formation
of fatty streaks.
 The developed fatty streaks then tend to develop with assistance of collagen and
proteoglycan as an extracellular matrix forming an atherosclerotic plaque and resulting in
a fibrous plaque.
 The fibrous plaque turns into the state of angiogenesis that helps the plague in calcifying
themselves.
 Finally, the arteries get narrowed leading to cause a sense of pain in the chest, also known
as angina.
 This is a stage in which the heart muscles get completely deprived of oxygen by
increasing the narrowness and obstruction that results in heart attack. It is also termed as
myocardial infarction.
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LITERATURE REVIEW
Principles of nursing management relevant to respiratory and cardiac systems
As per Ruscic and et.al., 2017, nursing management are aware to serve their services to
patients for many injures and major disease like respiratory. Moreover, the most important
surgery is pulmonary edema, pneumonia, acute respiratory failure etc. and all these major
surgeries are considered as the respiratory diseases. It is difficult to handle respiratory patients
because they want proper air transportation. These patients have to go under major treatment
procedures and they can be time consuming as well. In this respiratory system, many
complications can occur like respiratory muscle dysfunction or disease of the airway.
Respiratory patient should have treatment for about 24 hours so that it can be easy enough for the
nurse to analyse whether the patient is being provided proper airway or not. The respiratory
patients should have separate rooms from the others so that they are far away from the dust and
another infection because it throws a negative impact on the respiratory system of the patient. In
the respiratory patients' treatment nurse have to take care on a regular basis and ensure to change
the air pump on a timely basis. As per Kim and Choi, 2016, the respiratory patients face the
major condition in this disease because patients can go in commas and it can also have a further
impact on other health functions as well. In this disease, the main risk is heart attack and
respiratory patients have serious complications in the treatment. This is associated with airway
and intubation of an obstructive sleep apnea patient or pulmonary, pulmonary edema. In this
disease major complication can be that the respirators can collapse and the same is called upper
airway and pulmonary disorder. It means upper and internal part in respiratory system have been
damaged which effects the person to a huge extent and it can also lead to death or any serious
condition like they have to give oxygen through ventilator in order to provide oxygen. In this
disease nurses are providing proper care to the patient so that the patient can be able to recover as
soon as possible. The research determines an upper airway in the anatomical region the soft
palate, epiglottis, in geniousness muscle and soft tissue anterior to the spinal column and its
collapse can lead to desaturation, atelectasis, and respiratory failure.
Apart from that, nurse management in respiratory patients should ensure they are
handling all the service of the patient like bathing, providing medicine and other kind of services.
For improving these respiratory patients to these disease, nurse have to clean the room where
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patient is admitted and take care about the patients' treatment that whether it is being provided on
time.
According to Lipopincott and Wilkins (2007), Acute respiratory distress syndrome is
described as a severe form lung injury which is occurred when lungs are not capable of
maintaining the oxygen-carbon dioxide balance. The respiratory is inflamed, alveolar edema is
developed. A ventilation perfusion is occurred at that time. Vital sign measurements increase
blood flow; tachycardia and tachypnea like symptoms are occurred as well during it. ABG
analysis, Chest X-RAYS, and Electrocardiography are the diagnoses that are done for acute
respiratory distress. Nursing interventions can be for patients’ vital signs; pulse oximetry
readings and ECG are monitored. Prescribed drugs are being administered by nursing staffs. ,
Humidified and supplemental oxygen is being administered before giving it to the patient and the
fact is to be ensured that the Patients airway is maintained.
Asthma is a chronic reactive airway disorder in which episodic, reversible airway
obstruction causes bronchospasm, increased mucous secretions and mucosal oedema. Diagnosis
and specific treatment can be done for this disorder and it is referred as is the ABG analysis
which helps in providing the best indication of an attack's severity. Signs and symptoms which
are observed as follows: bronchial airway obstruction, asthma attack may begin drastically,
sudden allergy is caused due to environmental exposure, an attack may be occurred during night
and in morning, tachycardia, tachypnea, mild systolic hypertension, and pulse paradoxn may
occur.
As per Ibrahim (2018), Bronchoscopy is a technique through which air-carrying airways
are visual enough from trachea or windpipe and it can help in the diagnostic purposes. It is a thin
tube which is inserted through nose and mouth through tracheostomy. It is usually performed by
pulmonologist and a thoracic surgeon. There are two types of bronchoscopes – a flexible
bronchoscope and rigid bronchoscope. Depending upon the indication, bronchoscope can be
chosen by examiner. This can be further used to make diagnosis in a more persistent manner. It
is also used for the treatment in removal of foreign bodies in airways, to remove a mass or
growth that blocks the airway. Complications are raised due to use of bronchoscopy that is nose
bleeding, vocal cord injury, irregular heartbeats, lack of oxygen to the body, heart injuries due to
lack of oxygen. Squirts of salt water are injected through the bronchoscope into the area of
injection. Needle aspiration is done in which a small needle is inserted in a small airway to get
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the samples outside the airway. Forceps biopsy is also performed to visualise the lesion in airway
or lungs. Abnormal tissue which is there in the way of forceps biopsy is easily visualised.
Specimens which are obtained are sometimes sent to the pathologist for inspection. Patients are
taken for an observation in which they are being provided the monitoring assess for about two or
three hours and until that time, no sort of medication is given to the patient. Nowadays this
bronchoscope is being used with lasers to remove and destroy tumours. Probes are passed to
freeze the bleeding which occurs during diagnosis process.
According to Miller, Siege and Jemal (2016), a number of cancer survivors are trying to
continue their live. The American Cancer Society is trying to collaborate with the National
Institute of Cancer for the wellbeing of patients. Pulmonary cancer is mainly caused to those
people who smoke. Lung cancer is another common problem. Most of the patients who are
dealing with lung cancer are treated through chemotherapy. Different types of chemotherapy
treatment are given to the patient of different stages. Immunotherapy drugs are currently used as
a therapy and are given to the patients to strengthen their immunity. In this, the immunotherapy
drugs act by targeting the programmed cell death receptor that is called T cells that has been
further approved to treat some types of NSCLC. Lung cancer survivals may develop the
impaired pulmonary function.
The lung cancer patients are those who are either current smokers or former ones. The parts of
lungs which are affected are mainly neck, oesophageal part of the respiratory tract. Several other
health problems take place due to smoking.
Malenoma is also a type of respiratory disorder. About more than 1.2 million malenoma patients
live in United States of America. Surgery is the primary treatment for this disease. Patients with
stage III are offered adjuvant immunotherapy with infection or anticytoxic T- lymphocyte –
associated with protein antibody. Many side effects can be caused by these types of therapy
which is given to patients. In recent times, the patient with malenoma stage IV is now treated
with immunotherapy (ipilimumab, pembrolizumab) or by targeted therapy drugs. A large number
of patients take immunotherapy also goes for radiation therapy. There exists a large set of
population of both males and females suffering from malenoma due to several number of skin
related issues along with some other behavioural risk factors.
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As per Kaplow (2015.) the patient with cardiovascular issues have large number of
problems related to blood pressure, diabetes, hypertension and many more including pain that is
usually being felt in the arm, jaws, irregular heartbeat, palpitations, shortness of breath,
weakness, fatigue, cough and dizziness, etc. The patients suffering from this disease are mostly
found to have the history of diseases related to hypertension and diabetes. If this problem is
occurred in a woman, then there exists some additional concerns of using contraceptives and
birth control pills, etc.
Ascultatory sequences are related with heart sounds. In this diagnosis process, the
stethoscope is placed at four different valve sites and at Erb's point. The same ausculation is
repeated during every cardiovascular assessment. After this, physical assessments are done by
nurse.
During this, the patients' general appearance is observed. Skin colour, edema and skin
lesions are noticed. Palpation is used by nurse in which precordium is examined for heaves and
the point of maximum impulse is recorded. The palpate pulses are recorded in extremities for
strong and rhythmic pulses. Then percusses of the heart is done at the left border of the heart and
sound change is noticed. Ausculating is continued by checking nerves and vessels. The
stethoscope is used to check the movement activity of diaphragm to hear mitral or apical area for
one minute and heart rate and rhythm is recorded. This process should be repeated sequentially
and this is called Auscultatory sequences. This is noted in form of S1, S2, S3 and so on.
Now according to Timmis (2015) Acute Coronary Syndrome is a disease of heart
disorder. In this disorder, three major thrombotic effects of CAD and myocardial ischemia are
occurred. Unstable angina, Non- ST- segment elevation myocardial infarction (STEMI) are
observed. Acute coronary syndrome is occurred when a rapture or erosion of plaque is occurred
in one or more coronary arteries that cause platelet adhesions and activation of thrombin is found
to exist. Due to this, the blood clot formation and reduction of myocardial blood flow takes
place. This complication may cause heart failure, mitral valve insufficiency blood supply,
cardiogenic shock arrhythmias and finally it may lead to death. Signs and symptoms may include
abdominal pulsations, dull lower back pain, nausea, vomiting, shot of breathing, muscles
weakness due to insufficient supply of blood. Electrocardiogram is done to measure the
Electrical activity of heart via electrode that is attached to the skin.
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Blood tests are performed where enzymes are detected in blood cells that may result in
damage of heart tissues. Coronary angiogram is a process in which x-ray imagination is done to
see the blood vessels. A long tube called catheter is threaded with an artery which is found in the
arm or groin region of body. Moreover, this is passed to the arteries of heart. A liquid dye is sent
through the tube to the arteries and this dye is detected by X-Ray that in turn results in blockages
narrowing down the arteries.
According to Morton Fontaine,and Gallo,(2017) in Arrhythmias abnormal electrical
conduction or automatically changes in heart rate and rhythm are occurred. This disease has
many forms like mild form and severe form. In mild form, this is called sinus arrhythmia in
which there is no treatment because heart rate is increased or decreased with respirations. This is
originated due to atrial and ventricular valve. The impulse which is generated by the nodes in the
heart does not work properly and results causing alterations in the cardiac output and blood
pressure. Congenital heart disease, degeneration of conduction system, effects of drugs, stress
alcohol uptake may be the cause of arrhythmia.
Signs and symptoms may include chest pain, dizziness, weakness, fatigue and feelings of
impending doom. Other life threatening symptoms may occur like low pulse rate, absence of
respirations and light blood pressure can be felt. Nursing interventions are done in which
irregular or abnormal impulse rate is observed. Medicines are administered as it is needed.
Adequate oxygen is provided to full fill oxygen supply to heart and to reduce heart workload. If
this problem is caused due to drug toxicity, electrolytes would be given to prevent toxicity
accumulation in body.
This is to discourse upon the nursing management measures of coronary artery disease or
CAD, it has been found that an immediate use of nitro-glycerine is a must where the nurse
should together refer monitoring the heart rate and blood pressure on continual basis. It is with a
special consideration of anginal episodes. Although, it is in accordance to NGUYEN, QUANG
and HA, PHUONG (2016), it is important to record the length of pain along with its other
associated signs and symptoms with proper medication that is needed to release the patient.
Herein, use of a scale to determine the exact level of pain can also be used by together asking the
patient to themselves grade the severity from a scale of 1 to 10.
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Morton, Fontaine, Hudak & Gallo (2017) with a distinct consideration have hereby stated
about the importance of patient education. In whose accordance, the patient should be taught
about cardiac catheterization where if the patient is scheduled for a surgery, then also he or she
must be explained the events and procedures by the nurse. It is with a foremost concern of
assisting the patient to cope up with stress and refer a prescribed diet chart with regular yet
moderate exercise. The basic forte of the medical management of cardiac systems as in case of
coronary artery diseases, is to minimize the overall rate of the requirement of oxygen inside
myocardium.
There are various types of interventions that can be applied to such diseases associated with
the coronary arteries and other related complications such as nursing interventions, surgical
interventions etc. Surgical interventions are considered as one of the effective ways to make
modifications and some well-known ways of surgical interventions may include bypass grafting
or replacement of intracoronary stent in accordance to (Kaplow, 2015). There are various
medications as well that can be provided to the person dealing with coronary artery diseases and
some common examples of these medications include nitrates, calcium channel blockers etc.
These can actually provide a sort of relief to the person dealing with the coronary artery issues
and complications.
CONCLUSION
Medical assessment with nursing principles and practices are one of the most important
parts of medical surgery. In this context, different types of diseases with their sign and symptoms
are described including nurse assessment and practices care. The patho-physiology of respiratory
diseases and cardiac disorders are mentioned with diagnosis assessment. This literature is taken
from different journals articles including books. So much knowledge and information related to
health and diseases can be gained. Complications of coronary heart disease and pulmonary
cancer are mainly focused to reveal the literature's content.
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REFERENCES
Books and Journals
Miller, K.D., Siegel, R.L., & Jemal, A., (2016). Cancer treatment and survivorship statistics,
2016. CA: a cancer journal for clinicians, 66(4), pp.271-289.
Kaplow, R., (2015). Cardiac surgery essentials for critical care nursing. Jones & Bartlett
Publishers.
Timmis, A., (2015). Acute coronary syndromes. BMJ: British Medical Journal (Online), 351.
Morton, P.G., Fontaine, D., Hudak, C.M. & Gallo, B.M., (2017). Critical care nursing: a holistic
approach (p. 1056). Lippincott Williams & Wilkins.
Kim, J.S. & Choi, J.S., (2016). Factors influencing emergency nurses' burnout during an
outbreak of Middle East respiratory syndrome coronavirus in Korea. Asian nursing
research. 10(4). pp.295-299.
Ruscic, K. J., & et.al., (2017). Prevention of respiratory complications of the surgical patient:
actionable plan for continued process improvement. Current opinion in
anaesthesiology. 30(3). p.399.
Online
Ibrahim., 2018. [Online]. Available through: <https://www.omicsonline.org/pulmonary-
respiratory-medicine.php>.
NGUYEN, QUANG and HA, PHUONG. 2016. Cardiovascular and respiratory monitoring in
critical nursing care. [PDF]. Available through:
<https://www.theseus.fi/bitstream/handle/10024/107989/Nguyen_Quang_Ha_Phuong.pdf?
sequence=3>.
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