New cardiac nurses, look no further! I am here to ease your heart and soul with a little education, some encouragement, and possibly a pun or two.
Let’s chat about a few important concepts to know as a beginner cardiac nurse.
Understand Where the Heart Issues are Originating
If you can separate in your mind the difference between electrical issues and structural issues with the heart, this will make more sense overall. As many of us are aware, our hearts beat constantly. On average, your heart likely beats anywhere from 60-100 times per minute. The heart is pushing freshly oxygenated blood all over your body, which is imperative to keep your beautiful self 100% alive.
There are multiple aspects of this process that can become compromised, but let’s break it down into two basic issues.
Electrical Heart Issues
The way your heart knows to beat is because it receives an electrical impulse that goes through a very specific pattern. (I talk about it in depth in this post). There are essentially five steps the impulse goes through to successfully cause reliable and smooth contractions of all four chambers of the heart.
Patients could have something wrong with this process, which would be an electrical issue and result in bad heart rhythms. Bad rhythms can prevent the heart from contracting correctly, which means that precious blood isn’t get circulated. Depending on which one it is specifically, it can be an emergent situation (where you’d call a code), more of an urgent situation (we need to do this very soon, but not this second), or more of a long-term issue that we’ll work to resolve and prevent complications.
As a cardiac nurse, you’ll be responsible for monitoring the electrical status of their heart with continuous cardiac monitoring. This provides a glimpse into part of their heart health.
Fun tip: Doctors who focus solely on the electrical conductivity of the heart are called electrophysiologists.
Structural Heart Issues
Your patient could also have an issue with heart itself. A very common issue is with their heart valves. They could have a valve that leaks, one that’s too narrow, or even on that has part of it bulging back. These all prevent normal blood flow through the heart itself.
Other issues can involve the large blood vessels that bring blood to the heart, carry it to and from the lungs, and the large vessel that carries it away from the heart to the rest of the body.
You could also see issues with the heart muscle itself. The heart is a muscle, and if muscle doesn’t get the oxygen it needs, it can get damaged. If it’s damaged, it doesn’t pump correctly. The most common reason the heart muscle itself isn’t getting enough blood is due to an issue with the coronary arteries.
Coronary arteries are much smaller blood vessels that bring blood to the heart muscle. But, if these are clogged up, then blood isn’t getting to the heart effectively, and a heart attack (myocardial infarction) can ensue.
Your Job as a Cardiac Nurse
You will need to be keenly aware of their cardiac history and how that will impact your current nursing care. I discuss more about different things to check out in their medical history and patient chart in this post.
Your patient may also have a structural issue. These structural issues can be a minor issue, but often when patients are in the hospital because of them, it’s a pretty serious situation.
Often, patients have a degree of both structural and electrical issues and you’ll be responsible for being knowledgeable about both, monitoring, anticipating complications, and educating the patient about what the heck is going on.
Additionally, as a cardiac nurse you will be responsible for facilitating many diagnostics and procedures to ensure your patient has the correct diagnosis, checking the heart to see how it’s responding, and to actually fix certain issues. You’ll need to know why it’s necessary, what they do during, how to prepare a patient, and how to recover them.
To be knowledgeable about cardiac nursing is to the top disease processes than land patients in the cardiology unit of a hospital and how to care for them appropriately.
The Most Common Cardiac Disease Processes of Hospitalized Patients
Let’s go over some of the most situations you’ll find yourself in as an acute care cardiac nurse. While there are many cardiac issues that patients could have, only some will actually make patients sick enough to be cared for in the hospital. Therefore, let’s focus our prioritization there in the beginning.
Now, this isn’t a formal research study that dictated this list. It’s based off of my own experience, and that of three other colleagues when we put our heads together and thought about what was most common. Please keep in mind that multiple conditions listed below involve the pulmonary and/or vascular systems. The cardiac system is closely intertwined with these systems and therefore, in an acute cardiac nursing situation you will find yourself dealing with them!
- STEMI and NSTEMI
- Coronary Artery Bypass Graft (CABG)
- Valve Replacements (mitral and aortic)
- Congestive Heart Failure
- Pericardial Effusions
- Atrial Fibrillation
- Heparin-Induced Thrombocytopenia
- Blood Clots – PEs, DVTs
- Carotid Endarterectomies
- Pleural Effusions
- Pneumothorax and Hemothorax
- Lung surgeries
- Anoxic brain injuries
As a cardiac nurse, you’ll be responsible for having an intimate knowledge of these situations and before you know it, you’ll be a pro. (And if you want to get a jump on it, just check out our comprehensive cardiac review course here.)
Your Job as You Manage Your Cardiac Patients
The cardiologist, electrophysiologist, cardiac surgeon, or cardiac interventionalist may come see your patient once during a shift, but you will be there with the patient the whole time. You are the physician’s eyes and ears. You will see what orders you have for your patient, implement them, and monitor the patient’s response.
For example, your physician likely will order for you to keep their vital signs within a specific range. They may write an order that says, “Keep Systolic Blood Pressure Less Than 160”. These are called “blood pressure parameters”. It will be your job to ensure their blood pressure is taken on a regular basis, and if the systolic blood pressure is higher than 160, it will be your responsibility to intervene. Likely, if the physician has ordered these blood pressure parameters, they’ve also ordered medications for you to give as needed (called PRN meds) so that you can give a medication first before calling the physician to let him or her know.
You’ll be working to monitor their vital signs, telemetry monitor, and overall condition and intervene as needed. You’ll check meds before giving them to ensure they’re appropriate, and educate the patient on them.
Learn Your Basics First
As you can tell, cardiac nursing gets complex quickly. When you start getting into 12-lead EKGs and different kinds of murmurs, it gets really confusing. But as a brand new cardiac nurse, you shouldn’t start there. That’s like learning how to dunk before you know how to dribble.
Learn your foundational baseline information first.
Getting ready to have patients on telemetry, but need a little refresher first?
Telemetry Basics Brush-Up from FreshRN is a self-paced mini-course where we walk through the basics of cardiac electrical conductivity and how that is reflected on your telemetry strips, discuss rhythms based on the level of urgency you should have, go over insider tips and tricks, and more.
Before you learn different kinds of blocks, you need to know this basic knowledge first:
- Normal sinus rhythm
- Sinus tachycardia
- Sinus bradycardia
You should also be familiar with the different heart sounds too. First note the difference between normal and abnormal heart sounds. You don’t need to be able to know all the different murmurs at first, you just have to be able to identify if something is abnormal.
I want to reassure you: As nurses, it is not our jobs to diagnose. It is our job as nurses to assess and then communicate to the physician when something is abnormal and needs attention.
I became a nurse in 2010 and earned my critical care certification in 2015. I didn’t even learn about 12-lead EKGs and what they mean until 5 years into my career as a nurse. I had 2 years of cardiac step-down and 3 years of neuro ICU before I became accustomed to the really complex world of the heart.
Thinking a new nurse will master all of this right away is not an appropriate learning curve. We need to understand the foundations first and have reasonable expectations.
Check out this video I made about realistic basics that cardiac nurses should know.
I hope these cardiac nursing for beginners tips help you out as you embark on this exciting career. Learn the foundations of nursing and the basics of the heart before you expect yourself to grasp the more complex issues in cardiac care.
It might be overwhelming, but you’ve got this!
More Resources for Cardiac Nursing for Beginners:
- Top Tips for a New Cardiac Nurse
- Cardiac Nurse – A Typical Day
- 5-Lead ECG Interpretation – Tips For Nurses
- Cardiac Confidence: A Crash Course for New Cardiac Nurses – self-paced online course (11.0 contact hours)