What does a nurse need to know when working in the Coronary Care Unit (CCU)?

From the Guidelines

Nurses working in the Coronary Care Unit (CCU) need to be highly skilled in cardiac care and critical thinking, with a strong foundation in medical knowledge, patient care, and procedural skills, as outlined in the 2020 ACC clinical competencies for nurse practitioners and physician assistants in adult cardiovascular medicine 1. To provide optimal care, nurses should focus on key areas, including:

• Advanced cardiac monitoring: Be proficient in interpreting ECGs, recognizing arrhythmias, and responding to changes in cardiac output.
• Medication management: Know common cardiac drugs (e.g., nitroglycerin, heparin, beta-blockers) and their dosages, administration methods, and side effects.
• Emergency response: Be prepared for cardiac emergencies like cardiac arrest, requiring immediate CPR and defibrillation skills.
• Ventilator management: Understand mechanical ventilation basics and troubleshooting.
• Hemodynamic monitoring: Interpret data from central lines, arterial lines, and pulmonary artery catheters.
• Post-procedure care: Be familiar with care after cardiac procedures like angioplasty or CABG surgery.
• Patient education: Provide information on lifestyle changes, medication adherence, and follow-up care.
• Emotional support: Offer compassionate care to patients and families during stressful situations.
• Infection control: Maintain strict adherence to protocols to prevent hospital-acquired infections.
• Interdisciplinary communication: Effectively collaborate with physicians, specialists, and other healthcare team members. Additionally, nurses should be knowledgeable about:
• Critical care cardiology competencies, including the management of patients with heart failure, cardiogenic shock, and acute coronary syndromes 1.
• The pathophysiology of acute heart failure, including the role of neurohormonal activation and left ventricular remodeling in heart failure progression 1.
• The indications, contraindications, and management strategies for mechanical circulatory support, including intra-aortic balloon counterpulsation, percutaneous and surgical ventricular assist devices, and extracorporeal membrane oxygenation 1.
• The importance of staying updated on the latest cardiac care guidelines and technologies, as outlined in the 2020 ACC clinical competencies for nurse practitioners and physician assistants in adult cardiovascular medicine 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Key Knowledge Areas for Nurses in the Coronary Care Unit (CCU)

• Pharmacological knowledge is a prerequisite for the proper administration of drugs and for the clinical evaluation of the effects on the patient 2
• Nurses should have knowledge about the preparation and administration of intravenous medications, as well as the use of high alert medications (HAMs) 2, 3
• Physical assessment skills are essential for detecting patients at risk of deterioration and responding to changing health status 4
• Nurses should be aware of the importance of using checklists to help eliminate deficiencies in daily care and treatment in the intensive care unit 5

Barriers to Effective Nursing Practice in the CCU

• Reliance on others and technology can be a barrier to physical assessment practice 4
• Ward culture and specialty area can also be barriers to effective nursing practice 4
• Lack of knowledge and training on HAMs can result in medication errors 3
• Interruptions during medication administration can increase the risk of medication errors 6

Strategies for Improving Nursing Practice in the CCU

• Providing training and education on pharmacology and medication administration 2, 3
• Implementing evidence-based strategies to limit interruptions during medication administration 6
• Using checklists to guide daily patient care and evaluation 5
• Encouraging nurses to prioritize physical assessment and use their skills to detect patients at risk of deterioration 4