CV Labs and Dx pt.2 (Exam 1) Flashcards
Invasive Procedures and CV Disease
Trans-esophageal echocardiogram (TEE)
Cardiac catheterization
Electrophysiology study (EPS)
Transesophageal Echocardiogram Procedure
A probed with ultrasound transducer is placed down the throat with the end near the heart
Done in vascular lab
TEE looks at
Posterior part of the heart
Does Transesophageal Echocardiogram use contrast dye?
Yes
Check patient BUN / Cr
Force fluids (nephrotoxic)
Before TEE what labs should we look at?
BUN - Cr
Contrast dye is nephrotoxic
Post TEE
Force fluids
NPO until gag reflex returns
TEE: Requires
IV
Local anesthetic
Conscious sedation
Patient should be NPA for 6 hours
NPO until gag reflex returns
Electrophysiology Study (EPS)
Evaluate the elterical health of the heart;
induces dysrhythmias on purpose to confirms the root of the suspected electrical problem of the heart
Inducing dysrhythmias on purpose in controlled environment
If patient is going for electrophysiology study they should
d/c their antidysrhythmics several days before procedure
be NP 8 hours before test
Nursing care Post EPS procedure
Frequent V.S after procedure
EPS stands for
Electrophysiology Study
Cardiac Catheterization with Angiography
Heart Cath - Dye Test
Putting dye in the patient and taking pictures
Cardiac Catheterization with angiography provides information about
Heart muscles
blood vessels
valves
Heart Cath is done when needing to
confirm the location / extent of CAD (diagnostic)
perform an interventions, such angioplasty / stent placement (therapeutic)
Left Heart Cath: How does one get there?
You have to enter an artery: femoral - radial - brachial
Go through the ascending aorta to get through the coronary arteries
5 main places looked at with Left Heart Cath
- Aorta
- Right Coronary Artery
- Left Descending Coronary Artery
- Circumflex Coronary Artery
- Left Main Coronary Artery
Right Heart Cath: How does one get there?
You enter via the venous system through the superior vena cava
Reasons for Right sided Heart Cath
Measure EF
Look at pressure
(can not look at coronary arteries)
Left Heart Cath: Procedure
Catheter is inserted into an artery, and guided into the heart.
The heart muscle,valves, and vessels are evaluated
Local anesthesia is used
Heart Cath: Pre Procedure
NPO or meds may be allowed with sips of water (HCP orders)
Permit signed
Patient family teaching
Little pain as blood vessels have no nerve fibers
Will experience a “hot flash” when dye is injected
Pre-procedure checklist commonly used
Check: BUN / Cr (dye)
Empty bladder
Local anesthesia and IV sedation likely
Heart Cath: Post Procedure
Care will occur in cath lab or special observation area (recover in cardiac cath lab)
Heparin drip will be d/c and clotting time will be closely monitored before sheath is pulled
Sheath is removed and pressure is maintained for 20 min
Once patient returns from heart cath they will be put on
Best rest for 6 hours with affected leg straight and HOB below 30 degrees
What should the nurse assess and check frequently post Heart Cath
Circulation of extremity used
Assess for:
Pulses
Color
Sensation
Heart Cath: Potential Complication
Bleeding
Emboli (stroke)
Infection
Dysrhythmias
Damage to heart (cardiac tamponade)
Allergic to dye
Renal failure (2nd to contrast nephrotoxicity)
Heart Cath Complication: Bleeding
IV heparin gtt is used during the procedure to decrease risk for clots. Monitor puncture site closely for hematoma
Contrast nephrotoxicity
AKI occurring within 3 days of contrast dye injection
What patients are at increase risk for contrast nephrotoxicity?
Pre Existing renal impairment
Diabetic
Volume depleted
Contrast Nephrotoxicity: Prevention
Sodium Bicarb IV and acetylcysteine po before and after procedure
These drugs are thought to decrease the formation of free radicals in renal tissue thus limiting kidney damage
FORCE FLUIDS AFTER
