Cardiac Assessment - EXAM 4 Flashcards
What are the reasons why a cardiac catheterization procedure would be performed?
- Acute MI
- Angina
- Prior to valve replacement surgery
What is the cardiac catheter procedure?
- Puncture into radial OR femoral artery
- Insertion of a catheter that is advanced into the heart
- Contrast dye injected to provide information on the status of the coronary arteries, ventricular function, valvular disease, and intracardiac pressures
- Anti-anixety and pain meds used pre-procedure
- Bedrest post procedure for 4-12 hours per order
What is important to tell the patient about the contrast dye that is injected during cardiac catheterization?
Will feel warm when the dye is injected
Should patients’ routine medications be given on the day of a cardiac catheter?
Check with the cardiologist
Special caution with diabetics, patients on cardiac meds, or anticoagulants
What should the nurse be assessing post cardiac catheterization?
- VS
- Monitor insertion site for bleeding, hematoma
- Assess distal pulses
- Maintain IV fluid (usually NS 1L over 4-8 hours)
- Apply pressure on femoral puncture during turning, eating, coughing, or bedpan use
How does nursing care differ if the radial artery is used VS femoral artery for cardiac catherization?
- CMS checks of involved hand
- BP on alternate arm
- Increased mobility as ambulation will not be restricted
- Shorter recovery time
What is Holter Monitoring (Ambulatory ECG)?
Recording EKG for 24-48 hours and correlating rhythm changes with symptoms recorded in a diary
What are the nursing responsibilities of Holter Monitoring (Ambulatory ECG)?
Normal activity is encouraged. Explain the importance of keeping a diary of symptoms. No bathing or showering during monitoring.
What is the Exercise Treadmill Test?
Evaluates the effect of exercise tolerance on myocardial function. Includes continuous monitoring of VS and EKG for ischemic changes.
What are the three types of echocardiogram?
- Transthoracic Echo (TTE)
- Transesophageal Echo (TEE)
- Stress Echo
What is a Transthoracic Echo (TTE)?
Involves an ultrasound of the heart that records direction and flow of blood through the heart.
What is a Transesophageal Echo (TEE)?
What is a stress echo?
What is Nuclear Cardiology?
IV injection of a radioactive isotope used to evaluate myocardial contractility perfusion and for acute injury.
What are the nursing responsibilities for nuclear cardiology?
Light meal between scan , all caffeine and theophylline products are held
What are biochemical markers?
Enzymes that are released following a MI
What are nursing responsibilites for biochemical markers?
Serial levels to be assessed q8 hours X 3 sets
What is electrophysiology study?
Records intracardiac electrical activity using catheters inserted into the femoral vein. Catheters are advanced into the right side of the heart. Dysrhythmias can be induced by this procedure.
What are the nursing responsibilties for electrophysiology study?
Ensure written consent is completed
Anti-arrhythmic meds may be held
Keep patient NPO 6-8 hours before procedure
Premedicate for relaxation
Why are serum lipid levels checked?
Elevated lipid levels are considered a risk factor for development of coronary artery disease (CAD)
Why are cholesterol levels checked?
Elevated cholesterol is a risk factor for ASHD
Why are triglycerides checked?
Elevated triglycerides are a risk factor for CV disease
Why are lipoproteins checked?
High density lipoproteins (HDL) protects heart against development of CAD
Low density lipoprotein (LDL) increases risk of CAD development
What should be assessed for cardiac patients?
- Cardiac rhythm
- Assess heart sounds - regular/irregular
- Auscultate heart sounds
- Assess for orthostatic BP and HR changes
- Assess for apical-radial pulse deficit
- Assess peripheral pulses
- Assess color, temperature, cap refill
- Dyspnea
Where and when is S1 heard?
S1 is heard at the apex of the heart.
S1 is associated with the closing of the mitral and tricuspid valves
End of diastole, beginning of systole
Where and when is S2 heard?
Best heard at the base of the heart.
Associated with the closing of the aortic and pulmonic valves.
End of systole, beginning of diastole