Caring for patients under cardiac arrest

Though there has been a significant decline in the number of deaths related to cardiac arrest in the last decade, this disease still represents a major health problem in America. It has been reported that cardiac arrest “is a leading cause of death in the United States, accounting for more than 400,000 deaths each year” (“Sudden Cardiac Death,” 2010). Sudden cardiac death can happen to a person with no heart or health problems. The research indicates that as many as 95% of those who suffer from cardiac arrest die before reaching the emergency room. The goal of this paper is to explore the research findings in order to learn about the pathophysiology, psychosocial, medical treatments, alternative therapies, nursing care and critical care technology used to treat patients who suffer from sudden cardiac arrest, and to discuss the possible causes of this disorder and outcomes as they relate to a specific patient.

Case Study

A 62-year-old African-American male was brought to the hospital emergency care unit at 8:50 a.m. on Oct. 19, 2010. EMS workers were rushed to the patient’s home where they found him lying on the floor next to his bed, where he had fainted. He was discovered by his son who was alarmed after knocking on his door and did not get a response. The patient has no history of hypertension, high-cholesterol, heart disease or diabetes. Since the passing of his wife seven years ago, he spends his days around the house watching television. His son also stated that the patient complained of mild dizziness from time to time in the last three months, but he refused to see his doctors. The patient engages in a 30-minute walk around the house on a daily basis fallowing his doctor’s order that he needed to get daily exercise to maintain a healthy heart. The patient was a heavy smoker for most of his life, but he quit smoking six years ago. The patient suffered a sudden cardiac arrest twenty-four hours after he was admitted.

Pathophysiology

When a person experiences a cardiac arrest, the heart stops beating abruptly. This disorder is not the same as a heart attack, also referred to as myocardial infraction (MI). A heart attack is caused by “plumbing problems,” or blockages of the major blood vessels. Cardiac arrest is caused by “electrical problems” or abnormal heart rhythms also known as arrhythmias (“Sudden Cardiac Death,” 2010). A patient who develops arrhythmias may experience heart beats that are disorganized, irregular or maybe too fast or too slow resulting in ventricular fibrillation (collapsed of the lower chambers of the heart) which is marked by uncoordinated contractions of the heart muscles in the ventricular chambers of the heart. This is because the electrical system responsible for maintaining steady and orderly beats malfunctions and causes the heart to stop abruptly with a loss of blood supply throughout the body. Severe brain damages and death can occur within minutes of the onset of this disorder (Friedewald, 2010, Jones et al, 2006).

Psychosocial Aspects

It was found that survivors of cardiac arrest generally experience long-term emotional consequences. This is because sudden cardiac arrest is a physically traumatic experience that causes the individual to develop post-traumatic stress syndrome (PTSD). These patients will experience intrusive thoughts and develop avoidant behavior that can lead to anxiety and depression. Patients may also experience brain injuries that cause cognitive impairments which negatively affects their quality of life (O’Reilly, Grub & O’Carroll, 2004; Moulaert et al, 2007). In addition to high levels of anxiety, depression and stress, survivors may experience profound anger and confusion. However, these symptoms decline over a period of 6 months to one year following discharge (Arawwawala &Brett, 2007).

Medical Treatments

There are many types of medical treatments available today. However, treatment for each patient depends on the patient’s medical history, current health status and lifestyle. After a cardiac arrest, basic and advanced life suport are required to restore the heart to its normal state. The use of a defibrillator, a device which is used to send electrical shocks through the heart is the most common used treatment for patients who suffer from a cardiac arrest. Lee, Gelder, Burns & Cone (2008) observe that cardiopulmonary resuscitation (CPR) is the patient’s only chance of surviving a cardiac arrest. In fact, it was found that when CPR is performed within four minutes of the incident, it doubles the patient’s chance of survival. When a patient experiences cardiac arrest, it becomes very difficult to detect a pulse. For this reason trained medical personnel must use an automated external defibrillator (AEDs) to revive the patient. The AED is a device that detects and interprets cardiac rhythm (Gullo, 2002; O’Reilly et al, 2004).

Following resuscitation, the patient must undergo a number of tests to determine the extent of the damage and to find out what methods of care is needed to restore and maintain normal cardiac function (O’Reilly, 2004). There are several treatment modalities designed to ensure patients’ survival after a cardiac arrest. These include: medication, implantable cardioverter defibrillators (ICDs) and catheter ablation (CA). Physicians may recommend ACE inhibitors, beta blockers, calcium channel blockers and other medicines that can be used to control abnormal heart rhythms. Astropine sulfate is used to increase heart rate in some patients who suffers form low heart beats. In addition to using a variety of medications the physician may

use ICDs devices to monitor the heart rhythms on an ongoing basis. This device is used to slow heart beats by delivering shocks to the heart. The CA technique is used to destroy muscles responsible for causing abnormal electrical signals that leads to rapid or irregular heart rhythms (Sudden Cardiac Death, 2010).

Patients who have pulseless electrical activity even though they have satisfactory electrocardiogram (ECG) readings receive continuous ECG monitoring and receive 500-1000-mL infusion of 0.9% saline and epinephrine and atropine. Once the cardiopulmonary system is stabilized, or after CPR has resulted in a rewarming of the body to 34…C in hypothermia patients, post-resuscitative care begins. Post-resuscitative care for cardiac arrest patients include the use of electrolytes, glucose, BUN, creatinine and cardiac markers. Patients also receive blood pressure support, which includes maintaining a mean arterial pressure (MAP) of less than 80 mm Hg for older patients and less than 60 mm Hg for younger and healthier patients. Patients with lower maps or who have sights of left ventricular failure may receive pulmonary artery catheter monitoring. In cases where there is neurological damage, patients will receive neurological support, which include maintaining oxygenation and cerebral perfusion pressure. The goal of this is to reduce cerebral complications (Respiratory and Cardiac Arrest, 2010).

Alternative Therapies

Alternative therapies can help cardiac arrest patients maintain a healthy heart. This includes lifestyle changes such as following a healthy diet, engaging in regular exercise and pursuing healthy lifestyle practices, such as using alcoholic beverages in moderation and refraining from smoking. Coronary artery disease (CAD) has also been cited as a risk factor for sudden cardiac arrest. A healthy diet involves eating a variety of fruits, vegetables, and whole

grain products. Survivors are also advised to select foods low in saturated fats, trans fat and cholesterol. This means selecting meats that are lean, and having fat-free or low-fat milk, beans, fish, and chicken without the skin. Maintaining a low sodium diet is also important because too much salt can cause the patient to develop high blood pressure, which is a risk factor for CAD. Maintaining a healthy body weight is another way to keep the heart healthy. Patients who suffer a cardiac arrest should also engage in adequate physical exercise (Sudden Cardiac Arrest, 2010).

Nursing Care and Critical Care Technology

Gilligan et al (2005) observe that cardiac arrest patients have a better chance of survival when they are cared for by specially trained nurses. In fact, it was found that patients were approximately four times more likely to survive if they were cared for by a nurse with Advance Life Support (ALS) training. These nurses are trained to use special technological devices such as the AED monitor. The specialized nurse is also trained to make appropriate referrals to specialized care when necessary (Moulaert, 2007). More importantly, specialize nurses are skilled in working with patients with critical care needs such as clearing the patient’s airway, assessing breathing, carrying out effective pulse check, and compression; and using the AED (Lucia, 2008).

Conclusion/Discussion

Based on the research, the patient can maintain a healthy heart by increasing his activity level. Walking-around the house for 30-minute a day may not be adequate to maintain the level of cardiovascular fitness necessary to have a healthy heart. For this reason, he should reduce sedentary activities such as watching TV and spend more time exercising. In addition, lifestyle changes such as proper nutrition has been found to play a significant role in decreasing the risk

factors for cardiac arrest. For this reason, the patient should eat balanced and nutritious meals that include proper servings of fruits and vegetables and avoid high consumption of fatty foods. Once the patient engages adheres to the above recommendations, his prognosis is good.