Cardiac Tx Flashcards
oxygen administration, pharmacology therapy, cardioversion/defibrillation; primary focus is to relieve ischemia
non invasive interventions
Pt is not coding- HAS A PULSE, is having some difficulty, can’t breathe, HR too fast, BP too low—need to slow HR- electric shock to slow it down- less energy than normal defibrillator
synchronized cardioversion
rhythms that require cardioversion
Afib with rapid ventricular response (170 bpm) esp if symptomatic- resets cycle
Usually elective procedure, can be emergency; versed is used
cardioversion consent; conscious sedation
chance of going back to previous rhythm; need to watch: airway, clot formation, rhythm, achy pain
cardioversion post procedure
NOT synchronized; vfib- emergency
defibrillation
AICD- chronic long periods of Vtac, or rhythms that compromise
Pacemakers
Percutaneous Transluminal Coronary Interventions –angioplasty
Invasive procedures
detects life-threatening changes in the cardiac rhythm
Single, dual or biventricular chambered
AICD: Automatic internal cardiac defibrillator
pulse generator used to provide an electrical stimulus to the heart.- can do override pacing if tachy- to outpace it and slow it down
Pacemaker
bradycardia, SA node problems, tachy or atrial arhthmias
pacemaker indications
bleeding- quickclot dressing; generators need to be replaced q10 yrs
pacemaker post procedure complications
catheter ablation, Percutaneous Transluminal Coronary Interventions,
temporary pacemakers
Destroys, removes, or isolates using heat to pass through tissue
catheter ablation
SVT, Afib, and/or aflutter
indications for catheter ablation
started on anti-coagulants
post procedure catheter ablation
restores blood flow; most common temp pacemaker
PTCI: Percutaneous Transluminal Coronary Interventions
chronic stable angina, unstable angina, acute MI, stemi code
indications for PTCI
up to 50% occulusion of coronary vessel- complication- plaque breaks off- stroke
balloon angioplasty
body response- body wants to attack, most pts with no health insurance receive this
bare metal stenting
coating on stent that prevents WBC and thrombin from sticking
drug eluting stenting
Informed consent Assess for allergies- dye is used- friendlier on kidneys but can still cause problems- will look at pts creatinine Offer educational videos (CVT) Perform complete assessment Assess for CP Baseline VS Check allergies Peripheral pulses- very often- will mark an X on pulse before Administer medications – Valium (on call to Cath Lab) – Benadryl (on call to Cath Lab) – BP and cardiac medications
pre procedure nursing interventions for PTCI
Monitor VS & cardiac rhythm as ordered
Observe appropriate activity orders ( flat or up to 30 degrees if closure device) according to access site
Assess cath site –hematoma, bleeding, bruising & pulses per protocol
Maintain any IV infusions such as Nitroglycerin, Angiomax and/or Integrillin
PO Plavix, Effient, or Brilinta
Continue IVF to flush contrast
Encourage PO fluids
Monitor for arrythmias
post procedure nursing care for PTCI
Bleeding and hematomas Anaphylactic contrast reactions Pseudoaneurysms Embolization Vessel dissection Restenosis Dysrhythmias
potential complications for PTCI
normal 0-100, over 100 technically in HF (fluid overload),
BNP
Prep for CABG- coronary artery bypass graft
EKG Chest X-RAY Labs T&C for blood Some will require PFT’s (pulmonary function tests)
Vital Signs
Closely monitor I & O
Monitor CT output- bc they are kept “dry”
Monitor H&H and electrolytes
IVF, Blood and Albumin common- volume expanders
IV Dopamine, Dobutamine, Nitroglycerin, & Nipride
Monitor for arrhythmias
Care of post CABG
cool to 92 degrees right before heart stops, arctic sun-dec myocardial o2 demand and saves brain- warm back up 24-36 hours afterwards
protocols for MI
Hypothermia, Acute Pain, Decreased Cardiac Output, Ineffective Airway clearance, Disturbed Thought Processes, Risk for Infection
Common CABG Nursing Dx
Hypovolemia Hypotension and/or hypertension Hypothermia Arrythmias Infection
CABG complications
Medications Teaching Cardiac rehab- 3 levels Diet Activity Incisional care Follow up appts
Discharge of the CABG pt
– Usually begins while still in the hospital. Supervised walking in the halls.
Phase 1 cardiac rehab
– Early outpatient phase of cardiac rehabilitation
– 2-6 weeks after released from hospital
Phase 2 cardiac rehab
– Improve functional capacity and endurance
– Provide education of lifestyle changes
– Reduce fear and anxiety
– Assist in making optimal and social adjustments
Goals for Phase 2 cardiac rehab
– 6 weeks
Phase 3 cardiac rehab
– Provide an ongoing exercise program
– Offer support necessary to make lifestyle changes
– Achieve the desired goal, such as independent lifestyle or return to work
– Prevent progression of heart disease
Goals for Phase 3 cardiac rehab
