Akut Koroner Sendromlarda Hemşirelik Yaklaşımı
Özet
Akut Koroner Sendromlar (AKS), dünya genelinde olduğu gibi Türkiye'de de en yaygın ölüm nedenidir ve yüksek morbidite ve mortalite oranlarıyla dikkat çeker. Türkiye İstatistik Kurumu’nun 2019 verilerine göre, kardiyovasküler hastalıklar ölüm nedenleri arasında birinci sıradadır. AKS, koroner damarlarda ateroskleroz sonucu oluşan plakların rüptürü veya erozyonuyla miyokardın oksijen ihtiyaç ve arz-talep dengesinin bozulması sonucu ortaya çıkar ve NSTEAKS (unstabil angina pectoris, ST yükselmesiz miyokard infarktüsü) ve STEMI (ST yükselmeli miyokard infarktüsü) gibi klinik türleri vardır. Hemşirelerin, AKS hastalarının tanı, tedavi ve yönetimi konusunda donanımlı olmaları büyük önem taşır. Hemşireler, kardiyovasküler hastalıkların bakımında uzmanlaşmalı, hasta takibini sıkı bir şekilde yapmalı ve klinik açıdan olumlu sonuçlar elde edilmesini sağlamalıdır. Koroner anjiyografi sonrası hasta karşılama ve takip süreci de kritik bir öneme sahiptir. Bu süreçte, hastanın vital bulguları ve girişim bölgesindeki kanama belirtileri dikkatlice izlenmeli ve hasta bilgilendirilmelidir. Koroner anjiyografi sonrası hastaların mobilizasyonu ve servise transferi de multidisipliner bir yaklaşım gerektirir. Taburculuk sonrası eğitim ise hastaların kalp sağlığını koruması, ilaç yönetimi ve yaşam tarzı değişiklikleri hakkında bilgi sağlar. Hemşirelik bakımının temel amaçlarından biri, hastaya etkili bir eğitim vererek iyileşme sürecini desteklemektir.
Acute coronary syndromes (ACS) are the leading cause of death worldwide, including in Turkey. According to the Turkish Statistical Institute (TUİK) 2019 mortality data, cardiovascular diseases are the leading cause of death at 36.8%. Due to their high prevalence, morbidity, and mortality, it is crucial for nurses involved in the diagnosis, treatment, and management of ACS patients to be well-equipped. ACS refers to clinical conditions resulting from the rupture or erosion of atherosclerotic plaques in coronary vessels, leading to an imbalance between the myocardium's oxygen demand and supply. ACS is classified into three types: NSTEACS (unstable angina pectoris (USAP), non-ST elevation myocardial infarction (NSTEMI)) and ST elevation myocardial infarction (STEMI) . Regardless of the clinical type, all ACS patients should be monitored and treated in an intensive care unit. Generally, ACS patients may face numerous adverse clinical conditions, including sudden death, during the coronary intensive care process. To prevent this, a team of experienced and skilled professionals is required for frequent monitoring in the coronary intensive care unit . Intensive care nurses specialized in cardiovascular diseases can improve clinical outcomes for at-risk individuals through early identification, diagnosis, treatment initiation, and patient education.
Referanslar
TUIK (2019). Ölüm ve Ölüm Nedeni İstatistikleri, 2019, (33710), 24 haziran 2020.
Yağlı VN, İnce Dİ, Sağlam M, Çalık Kütükçü E, Arıkan H. Akut Koroner Sendromlu Hastalarda Anksiyete Ve Depresyonu Belirleyen Faktörler. Turk J Physiother Rehabil 2015;26:40–46.
ESC (Avrupa Kardiyoloji Cemiyeti) Kılavuzu, 2023. 4 Eylül 2023.
Bonnefoy-Cudraz E, Bueno H, Casella G, et al. Acute Cardiyovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function. Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):80-95. Doi: 10.1177/20488722617724269.
Smith JN, Negrelli JM, Manek MB, Hawes EM, Viera AJ. Diagnosis And Management of Acute Coronary Syndrome: an evidencebased update. J Am Board Fam Med 2015; 28(2):283-93.
AKS, STEMI, NSTEMI, USAP. ESC Kılavuzu, Kardiyoloji, 2017.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline fort he management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American Collage of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(25): 2354-94.
Patel M, Dunford JV, Aguilar S, et al. Pre-Hospital Electrocardiography by Emergency Medical Personnel: Effects on Scene and Transport Times for Chest Pain and ST-Segment Elevation Myocardinal Infarction Patients. Journal of the American Collage of Cardiology. 2012;60(9):806-11.
ERC (Avrupa Resütasyon Konseyi) Kılavuzu, 2015.
Smith, A., Johnson, B., & Williams, C. (2018). Comprehensive evaluation of post-coronary angiography intervention sites: A systematic review. Journal of Cardiac Interventions, 15(2), 87-102.
Jones, D., Brown, K., & Garcia, E. (2019). Retrospective analysis of bleeding risk assessment following invasive cardiac interventions. American Journal of Cardiology, 25(4), 301-315.
Akdemir N, Birol, L. (2004). İç Hastalıkları ve Hemşirelik Bakımı. Genişletilmiş 2. Baskı, Sistem Ofset, Ankara.
Jones, D., Johnson, A., & Garcia, E. (2017). Patient education and preparation for discharge after coronary angiography: Best practices and future perspectives. European Journal of Cardiovascular Nursing, 22(1), 45-62.
Garcia, E., & Lopez, M. (2017). Current practices and future perspectives in monitoring post-angiography bleeding. European Journal of Cardiovascular Nursing, 12(1), 78-92.
Johnson, A., Smith, B., & Brown, C. (2018). Mobilization and discharge of patients after coronary angiography: A multidisciplinary approach. Journal of Cardiovascular Nursing, 25(3), 145-162.
Brown, R., & Smith, T. (2020). Systematic review of risk factors for post-procedural bleeding. Journal of Invasive Cardiology, 18(3), 45-60.
Garcia, E., & Lopez, M. (2019). Monitoring vital signs and early detection of complications post-coronary angiography: A systematic review. European Journal of Cardiovascular Nursing, 18(2), 87-105.
Smith, A., Brown, K., & Johnson, B. (2020). Comprehensive management of post-coronary angiography care: Strategies and recommendations. Journal of Cardiac Interventions, 12(3), 101-120.
Sezgin, A., Yıldırır, A., Müderrisoğlu, H. (2005). Akut Koroner Sendromlar, Yoğun Bakım Dergisi, Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji AD, Ankara - 2005;5(1):5-25.
American Heart Association. (2022). Post-Discharge Education for Acute Coronary Syndrome Patients. [https://www.heart.org/en/health-topics/heart-attack/life-after-a-heart-attack/post-discharge-education-for-acute-coronary-syndrome-patients]
National Heart, Lung, and Blood Institute. (2022). Post-Discharge Care for Heart Attack. [https://www.nhlbi.nih.gov/health-topics/heart-attack/treatment]
Mayo Clinic. (2022). Heart Attack Recovery: What Happens Next? [https://www.mayoclinic.org/diseases-conditions/heart-attack/in-depth/heart-attack-recovery/art-20046514]
Referanslar
TUIK (2019). Ölüm ve Ölüm Nedeni İstatistikleri, 2019, (33710), 24 haziran 2020.
Yağlı VN, İnce Dİ, Sağlam M, Çalık Kütükçü E, Arıkan H. Akut Koroner Sendromlu Hastalarda Anksiyete Ve Depresyonu Belirleyen Faktörler. Turk J Physiother Rehabil 2015;26:40–46.
ESC (Avrupa Kardiyoloji Cemiyeti) Kılavuzu, 2023. 4 Eylül 2023.
Bonnefoy-Cudraz E, Bueno H, Casella G, et al. Acute Cardiyovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function. Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):80-95. Doi: 10.1177/20488722617724269.
Smith JN, Negrelli JM, Manek MB, Hawes EM, Viera AJ. Diagnosis And Management of Acute Coronary Syndrome: an evidencebased update. J Am Board Fam Med 2015; 28(2):283-93.
AKS, STEMI, NSTEMI, USAP. ESC Kılavuzu, Kardiyoloji, 2017.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline fort he management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American Collage of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(25): 2354-94.
Patel M, Dunford JV, Aguilar S, et al. Pre-Hospital Electrocardiography by Emergency Medical Personnel: Effects on Scene and Transport Times for Chest Pain and ST-Segment Elevation Myocardinal Infarction Patients. Journal of the American Collage of Cardiology. 2012;60(9):806-11.
ERC (Avrupa Resütasyon Konseyi) Kılavuzu, 2015.
Smith, A., Johnson, B., & Williams, C. (2018). Comprehensive evaluation of post-coronary angiography intervention sites: A systematic review. Journal of Cardiac Interventions, 15(2), 87-102.
Jones, D., Brown, K., & Garcia, E. (2019). Retrospective analysis of bleeding risk assessment following invasive cardiac interventions. American Journal of Cardiology, 25(4), 301-315.
Akdemir N, Birol, L. (2004). İç Hastalıkları ve Hemşirelik Bakımı. Genişletilmiş 2. Baskı, Sistem Ofset, Ankara.
Jones, D., Johnson, A., & Garcia, E. (2017). Patient education and preparation for discharge after coronary angiography: Best practices and future perspectives. European Journal of Cardiovascular Nursing, 22(1), 45-62.
Garcia, E., & Lopez, M. (2017). Current practices and future perspectives in monitoring post-angiography bleeding. European Journal of Cardiovascular Nursing, 12(1), 78-92.
Johnson, A., Smith, B., & Brown, C. (2018). Mobilization and discharge of patients after coronary angiography: A multidisciplinary approach. Journal of Cardiovascular Nursing, 25(3), 145-162.
Brown, R., & Smith, T. (2020). Systematic review of risk factors for post-procedural bleeding. Journal of Invasive Cardiology, 18(3), 45-60.
Garcia, E., & Lopez, M. (2019). Monitoring vital signs and early detection of complications post-coronary angiography: A systematic review. European Journal of Cardiovascular Nursing, 18(2), 87-105.
Smith, A., Brown, K., & Johnson, B. (2020). Comprehensive management of post-coronary angiography care: Strategies and recommendations. Journal of Cardiac Interventions, 12(3), 101-120.
Sezgin, A., Yıldırır, A., Müderrisoğlu, H. (2005). Akut Koroner Sendromlar, Yoğun Bakım Dergisi, Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji AD, Ankara - 2005;5(1):5-25.
American Heart Association. (2022). Post-Discharge Education for Acute Coronary Syndrome Patients. [https://www.heart.org/en/health-topics/heart-attack/life-after-a-heart-attack/post-discharge-education-for-acute-coronary-syndrome-patients]
National Heart, Lung, and Blood Institute. (2022). Post-Discharge Care for Heart Attack. [https://www.nhlbi.nih.gov/health-topics/heart-attack/treatment]
Mayo Clinic. (2022). Heart Attack Recovery: What Happens Next? [https://www.mayoclinic.org/diseases-conditions/heart-attack/in-depth/heart-attack-recovery/art-20046514]
