Cardiac Procedures Flashcards
Cardiac catheterization
Requires a signed consent form.
Patient must be NPO for 6-8 hr before test.
allergy to iodine, shellfish, or contrast dye.
Have patient void before giving preoperative medication.
Record baseline vital signs and mark location of pedal pulses.
Inform patient that procedure involves being on a narrow table with a camera that rotates around to different angles, patient will have an IV, and must lie still during test. Procedural sedation is used.
ECG leads, BP cuff, O2 saturation monitor, CO2 monitor will be in place during the test.
Patient may be asked to cough or turn head during the procedure.
Assess peripheral pulses with vital signs and question patient about numbness or tingling.
Inspect insertion site for bleeding or sign of hematoma. If femoral insertion site was used, keep patient flat and leg extended for ordered time. If a closure device was used at the arterial puncture site, patient may be able to ambulate within 2 hr.
Encourage fluids unless contraindicated to flush contrast from body.
Transesophageal echocardiogram (TEE)
Patient must be NPO for 4-6 hr before test.
Initiate IV access before test for sedation.
Apply ECG leads for monitoring during test.
Monitor pulse oximetry, end tidal CO2, and BP.
Observe patient after test until sedation has worn off.
Stress echocardiogram
Explain the procedure and the importance of returning to the examining table immediately after exercising.
Instruct patient not to consume heavy meal beforehand and to abstain from using tobacco or caffeine for 6-8 hr before test.
Tell patient to wear walking shoes.
Echocardiography
Inform patient that there is no discomfort, although conduction jelly may feel cool.
Normal finding: no abnormalities of size or location of heart structures; normal wall movement.
Chemical stress test
with dipyridamole, adenosine, or dobutamine
Used for those who cannot exercise for an ECG stress test. Continuous 12-lead ECG monitoring is performed and the drug is administered.
Blood pressure and pulse are taken and recorded q15min. The drug effect increases cardiac workload to identify whether cardiac ischemia results.
The patient is NPO during the test.
Unavoidable risk factors for heart
Age, sex, race, hereditary
Modifiable risk factors for heart disease
Obesity, lack of exercise, smoking, HTN, diabetes, alcohol, stress
Cardiotonic
Digoxin
Digoxin level
0.5-2
With digoxin you want to check
Apical pulse for 60sec/ 1 min hold med if less then 60bpm monitor potassium level (3.5-5.5)
S/s dig toxicity
NV anorexia yellowing
Anti arrhythmic: lidocain, propanol(beta blocker), amiodonine cordarone these meds have what action?
Restore rhythmic movement slow HR and BP… check before giving
Thiazides, HCTZ, loop and potassium sparing are all
Diuretics. Thiazides, HCTZ, and loop have sulfa allergies.
Check I &O, monitor daily weights, BP
Potassium Sparing watch potassium level avoid salt
Prevent clots. Watch for bleeding
Anticoagulant
Heparin: aptt/ptt antagonist prothamine sulfate
Coumadin: pt/inr antagonist vitamin k
Dialate or enlarge blood vessels, relieve angina pain
Vasodilator
Check BP hold systolic <100
Nitroglycerin SL, patch, spray wear gloves. After first dose if not relieved by pain in 5min,call911
Can administer 1 every 5 min. Max of 3
Patch take off at night
Majority of these medications end in pine
Ca channel blockers
Analgesics
Morphine and dilaudid decrease demand for oxygen antagonist nalaxone/ narcan
Cause contractions of muscles
Vasopressors
Norepinephrine
BP increases
Beta blockers
End in olol Hold HR<50 BP systolic<100 Contraindicated pt with asthma or wheezing Mask symptoms hypoglycemia
PQRST
Provokes, quality, radiates, severity, time
Protein specific to the heart. Elevates first when heart muscle damage
Tropinin
Lipid panel consist of
Cholesterol <200
LDL <100 more than 2 factors<70
HDL >40 men >50 women
Triglycerides <150
Laser assisted angioplasty
Laser heat vaporizes plaque
Ballon stent inserted to open blocked arteries
Coronary artery stent
