SUB SPECIALITY – CARDIO VASCULAR AND THORACIC NURSING
Theory : 150 hours.
Practical : 950 hours.
Total : 1100 hours.
Course DescriptionThis course is designed to assist students in developing expertise and indepth
understanding in the field of cardiovascular and thoracic nursing. It
will help students to develop advanced skills for nursing intervention in
various cardio medical and surgical conditions. It will enable the student to
function as Cardio vascular and Thoracic Nurse practitioner/specialist. It
will further enable the student to function as educator, manager and
researcher in the field of cardio vascular and thoracic nursing.
Objectives
At the end of the course the students will be able to:
1. Appreciate trends and issues related to cardio vascular and thoracic
Nursing.
2. Describe the epidemiology, etiology, pathophysiology and diagnostic
assessment of cardio vascular and thoracic conditions
3. Participate in national health programs for health promotion,
prevention and rehabilitation of patients with cardio vascular and
thoracic conditions
4. Perform physical, psychosocial & spiritual assessment
5. Assist in various diagnostic, therapeutic and surgical procedures
6. Apply nursing process in providing comprehensive care to patients
with cardio vascular and thoracic conditions
7. Demonstrate advance skills/competence in managing patients with
cardio vascular and thoracic conditions including Advance Cardiac
Life Support.
8. Describe the various drugs used in cardio vascular and thoracic
conditions and nurses responsibility
9. Demonstrate skill in handling various equipments/gadgets used for
critical care of cardio vascular and thoracic patients
10. Appreciate team work & coordinate activities related to patient care.
11. Practice infection control measures.
12. Identify emergencies and complications & take appropriate measures
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13. Discuss the legal and ethical issues in cardio vascular and thoracic
nursing
14. Assist patients and their family to cope with emotional distress, grief,
anxiety and spiritual needs.
15. Appreciate the role of alternative system of medicine in care of patient
16. Incorporate evidence based nursing practice and identify the areas of
research in the field of cardio vascular and thoracic nursing
17. Identify the sources of stress and manage burnout syndrome among
health care providers.
18. Teach and supervise nurses and allied health workers.
19. Design a layout of ICCU and ICTU and develop standards for cardio
vascular and thoracic nursing practice.
Content Outline
Unit Hours Content
I 5 Introduction
Historical development, trends and issues in the field of cardiology.
Cardio vascular and thoracic conditions – major health problem.
Concepts, principles and nursing perspectives
Ethical and legal issues
Evidence based nursing and its application in cardio vascular and
thoracic nursing( to be incorporated in all the units)
II 5 Epidemiology
Risk factors: hereditary, psycho social factors, hypertension,
smoking, obesity, diabetes mellitus etc
Health promotion, disease prevention, Life style modification
National health programs related to cardio vascular and thoracic
conditions
Alternate system of medicine
Complementary therapies
III 5 Review of anatomy and physiology of cardio vascular and
respiratory system
Review of anatomy and physiology of heart, lung, thoracic cavity
and blood vessels. Embryology of heart and lung.
Coronary circulation
Hemodynamics and electro physiology of heart.
Bio-chemistry of blood in relation to cardio pulmonary function.
IV 20 Assessment and Diagnostic Measures:
History taking
Physical assessment
• Heart rate variability: Mechanisms , measurements, pattern,
factors, impact of interventions on HRV
Diagnostic tests
• Hemodynamic monitoring: Technical aspects, monitoring,
functional hemodynamic indices, ventricular function indices,
output measurements (Arterial and swan Ganz monitoring).
Blood gases and its significance, oxygen supply and demand
• Radiologic examination of the chest: interpretation, chest film
findings
• Electro cardiography(ECG) : electrical conduction through the
heart, basic electrocardiography, 12 lead electrocardiogram, axis
determination
- ECG changes in: intraventricular conduction abnormalities-
Arrhythmias, ischemia, injury and infarction, atrial and
ventricular enlargement, electrolyte imbalance,
• Echocardiography: technical aspects, special techniques,
echocardiography of cardiac structures in health and disease,
newer techniques
• Nuclear and other imaging studies of the heart: Magnetic
Resonance Imaging.
• Cardio electrophysiology procedures: diagnostic studies,
interventional and catheter ablation, nursing care
• Exercise testing: indications and objectives, safety and
personnel, pretest considerations, selection, interpretation, test
termination, recovery period
• Cardiac catheterization: indications, contraindications, patient
preparation, procedure, interpretation of data
• Pulmonary function test: Bronchoscopy and graphies
• Interpretation of diagnostic measures
• Nurse’s role in diagnostic tests
Laboratory tests using blood: Blood specimen collection, Cardiac
markers, Blood lipids, Hematologic studies, Blood cultures,
Coagulation studies, Arterial blood gases, Blood Chemistries,
cardiac enzyme studies, Serum Concentration of Selected drugs.
Interpretation and role of nurse
V 25 Cardiac disorders and nursing management:
Etiology, clinical manifestations, diagnosis, prognosis, related
pathophysiology, treatment modalities and nursing management of:
• Hypertension
• Coronary Artery Disease.
• Angina of various types.
• Cardiomegaly
• Myocardial Infarction, Congestive cardiac failure
• Heart Failure, Pulmonary Edema, Shock.
• Rheumatic heart disease and other Valvular Diseases
• Inflammatory Heart Diseases, Infective Endocarditis,
Myocarditis, Pericarditis.
• Cardiomyopathy, dilated, restrictive, hypertrophic.
• Arrhythmias, heart block
Associated illnesses
Unit Hours Content
VI 10 Altered pulmonary conditions
Etiology, clinical manifestations, diagnosis, prognosis, related
pathophysiology, treatment modalities and nursing management of:
• Bronchitis
• Bronchial asthma
• Bronchiectasis
• Pneumonias
• Lung abscess, lung tumour
• Pulmonary tuberculosis, fibrosis, pneumoconiosis etc
• Pleuritis, effusion
• Pneumo, haemo and pyothorax
• Interstitial Lung Disease
• Cystic fibrosis
• Acute and Chronic obstructive pulmonary disease (conditions
leading to)
• Cor pulmonale
• Acute respiratory failure
• Adult respiratory distress syndrome
• Pulmonary embolism
• Pulmonary Hypertension
VII 10 Vascular disorders and nursing management
Etiology, clinical manifestations, diagnosis, prognosis, related
pathophysiology, treatment modalities and nursing management of:
• Disorders of arteries
• Disorders of the aorta
• Aortic Aneurysms,
• Aortic dissection
• Raynaud’s phenomenon
• Peripheral arterial disease of the lower extremities
• Venous thrombosis
• Varicose veins
• Chronic venous insufficiency and venous leg ulcers
• Pulmonary embolism
VIII 10 Cardio thoracic emergency interventions
CPR- BLS and ALS
Use of ventilator, defibrillator , pacemaker
Post resuscitation care.
Care of the critically ill patients
Psychosocial and spiritual aspects of care
Stress management; ICU psychosis
Role of nurse
IX 10 Nursing care of a patient with obstructive airway
Assessment
Use of artificial airway
Endotracheal intubation, tracheostomy and its care
Complication, minimum cuff leak, securing tubes
Oxygen delivery systems.
Nasal Cannula
Oxygen mask, Venturi mask
Partial rebreathing bag
Bi-PAP and C-PAP masks
Uses, advantages, disadvantages, nursing implications of each.
Mechanical Ventilation
Principles of mechanical ventilation
Types of mechanical ventilation and ventilators.
Modes of ventilation, advantage, disadvantage, complications.
PEEP therapy, indications, physiology, and complications. Weaning
off the ventilator.
Nursing assessment and interventions of ventilated patient.
X 10 Congenital Heart Diseases,
Etiology, clinical manifestations, diagnois, prognosis, related
pathophysiology, treatment modalities and nursing management of:
• Embryological development of heart.
• Classification – cyanotic and acyanotic heart disease.
• Tetralogy of Fallots.
• Atrial Septal Defect, Ventricular Septal Defect., Eisenmenger’s
complex.
• Patent ductus arteriosus, AP window
• Truncus Arteriosus.
• Transposition of great arteries.
• Total Anomaly of Pulmonary Venous Connection.
• Pulmonary stenosis, atresia.
• Coarctation of aorta.
• Ebstein’s anomaly
• Double outlet right ventricle, Single ventricle, Hypoplastic left
heart syndrome.
XI 10 Pharmacology
Review
Pharmacokinetics
Analgesics/Anti inflammatory agents
Antibiotics, antiseptics
Drug reaction & toxicity
Drugs used in cardiac emergencies
Blood and blood components
• Antithrombolytic agents
• Inotropic agents
• Beta-blocking agents
• Calcium channel blockers.
• Vaso constrictors
• Vaso dilators
• ACE inhibitors.
• Anticoagulents
• Antiarrhythmic drugs.
• Anti hypertensives
• Diuretics
• Sedatives and tranquilizers.
• Digitalis.
• Antilipemics
Principles of drug administration, role and responsibilities of
nurses and care of drugs
XII 20 Nursing Care of patient undergoing cardio thoracic surgery
Indications, selection of patient
Preoperative assessment and preparation; counselling.
Intraoperative care: Principles of open heart surgery, equipment,
anaesthesia, cardiopulmonary by pass.
Surgical procedures for Coronary Artery Bypass Grafting, recent
advances and types of grafts, Valve replacement or reconstruction,
cardiac transplant, Palliative surgery and different Stents, vascular
surgery, other recent advances.
Thoracic surgery: lobectomy, pneumonectomy, tumour excision etc
Immediate postoperative care : assessment, post operative problems
and interventions : Bleeding, Cardiac tamponade, Low cardiac
output, Infarction, Pericardial effusion, Pleural effusion,
Pneumothorax, Haemothorax, Coagulopathy, Thermal imbalance,
Inadequate., ventilation/perfusion, Neurological problems, renal
problems, Psychological problems.
Chest physiotherapy
Nursing interventions- life style modification, complementary
therapy/alternative systems of medicine.
Intermediate and late post operative care after CABG, valve surgery,
others.
Follow up care
XIII 5 Cardiac rehabilitation
Process
Physical evaluation
Life style modification
Physical conditioning for cardiovascular efficiency through exercise
Counseling
Follow up care
XIV 5 Intensive Coronary Care Unit/intensive cardio thoracic unit:
Quality assurance
• Standards, Protocols, Policies, Procedures
• Infection control; Standard safety measures
• Nursing audit
• Design of ICCU/ICTU
• Staffing; cardiac team
• Burn out syndrome
Nurse’s role in the management of I.C.C.U and ICTU.
Mobile coronary care unit.
Planning inservice educational programme and teaching
Practicals
Total – 960 Hours
1 Weeks = 30 Hours
S.No. Deptt/ Unit No. of Week Total Hours1 Cardio thoracic -Medical 4 120 Hours
-Surgical 4 120 Hours
2. OTs (Cardiac and thoracic) 4 120 Hours
3. Casualty 2 60 Hours
4. Diagnostic labs including cath lab 2 60 Hours
5. ICCU 4 120 Hours
6. ICU 4 120 Hours
7. CCU 4 120 Hours
8. Paediatric Intensive 2 60 Hours
9. OPD 2 60 Hours
Total 32 Weeks 960 Hours
Essential Nursing Skills
Procedures Observed
1. Echo cardiogram
2. Ultrasound
3. Monitoring JVP , CVP
4. CT SCAN
5. MRI
6. Pet SCAN
7. Angiography
8. Cardiac cathetrisation
9. Angioplasty
10. Various Surgeries
11. Any other
I. Procedures Assisted
1. Arterial blood gas analysis
2. Thoracentesis
3. Lung biopsy
4. Computer assisted tomography (CAT Scan)
5. M.R.I.
6. Pulmonary angiography
7. Bronchoscopy
8. Pulmonary function test
9. ET tube insertion
10. Tracheostomy tube insertion
11. Cardiac catheterisation
12. Angiogram
13. Defibrillation
14. Treadmill test
15. Echo cardiography
16. Doppler ultrasound
17. Cardiac surgery
18. Insertion of chest tube
19. CVP Monitoring
20. Measuring pulmonary artery pressure by Swan-Ganz Catheter
21. Cardiac Pacing
II. Procedures Performed
1. Preparation of assessment tool for CT client (Cardiac, thoracic and
vascular).
2. ECG – Recording, Reading, Identification of abnormalities
3. Oxygen therapy – Cylinder, central supply,
Catheter, nasal canula, mask, tent
Through ET and Tracheostomy tube
Manual resuscitation bag
4. Mechanical ventilation
5. Spirometer
6. Tuberculen skin test
7. Aerosal therapy
8. Nebulizer therapy
9. Water seal drainage
10. Chest physiotheray including – Breathing Exercises
Coughing Exercises
Percussion & Vibration
11. Suctioning – Oropharyngeal, nasotracheal, Endotrachieal
Through tracheostomy tube
12. Artificial airway cuff maintenance
13. CPR
14. Care of client on ventilator
15. Identification of different – Arrhythmias
Abnormal pulses, respirations
B.P. Variation
Heart sounds
Breath sounds
16. Pulse oxymetry
17. Introduction of intracath
18. Bolus I.V. Injection
19. Life line
20. Maintenance of “Heplock”
21. Subcutaneous of Heparin
22. Obtaining leg measurements to detect early swelling in
thrombophlebetes
23. Identification of Homans signs
24. Buergen – Allen exercises
