CVD 2 Flashcards
What is cardiac catheterization used for?
to identify and diagnose arterial blockages
What will happen during cardiac catheterization?
- long thin catheter is inserted into an artery in the groin or wrist and threaded to heart
- dye is injected so that heart structures and patency can be visualized via x-ray
- patient is awake but given medicine to relax
What medications are often given during heart cath?
Versed and Fentanyl
Balloon Angioplasty
-catheter has a small balloon on tip that is inflated at site of blockage
How does the balloon angioplasty restore blood flow?
Balloon flattens or compresses the plaque against the artery wall opening up the vessel
Stent Placement
- stent is replaced around the balloon, once the balloon has inflate, it expands against the vessel wall
- balloon is removed but the stent remains in place
Pre-procedure for Heart Cath Care
- vascular status of extremity used
- Allen’s test
- ensure patient is NPO for at least 8 hrs
- shave area
Allen’s Test
done prior to using the radial artery for angioplasty to assess the arterial blood supply of the hand
Modified Allen’s Test
- locate the radial and ulnar artery of hand to be used
- ask patient to clench fist then occlude arteries
- have patient open hand and relax
- release pressure on ulnar artery while still occluding radial artery
- color should return in about 7 seconds
If it takes longer than 7 seconds for color to return to hand what would that mean?
Allen test is positive and the radial artery should not be used (poor collateral blood flow)
Radial Artery Benefits
- reduced risk of bleeding, vascular complications, and death
- improved patient comfort
Femoral Artery Use
- operator experience
- higher vascular complications
- bedrest is necessary
How often should you assess Heart Cath site for bleeding after procedure?
q 15 minutes for the first hour then per protocol
If a hematoma occurs what should be done?
Notify provider immediately then apply direct pressure
How long should the patient be on continuous cardiac monitoring and have vitals taken?
q 15 mins for first hour then q 30 minutes the next hour
How long should the extremity used be kept straight?
4 hours
How long could the patient be on bedrest?
2-8 hours
Post Cath Procedure care
- assess for bleeding
- educate patient to report bleeding or chest pain immediately
- IV fluids x 2 hrs then increase oral fluids
- assistance will be needed first time OOB
How is the heart catheter inserted?
inserted through a plastic introducer sheath (long hollow tube)
Sheath Care
- sometimes patient returns to unit w/ sheath in place
- bending affected limb is contraindicated
- HOB at least 30 degrees or less
- removed by trained cardiac nurse and patient remain on bedrest for 6 hrs
Patient Education after Heart Cath
- no bending at the waist, heavy lifting, or straining for 24 hrs
- no heavy exercise for 4-6 weeks
- no driving for 24-48 hours
- showers only
- monitor for numbness/tingling
When should the patient call the doctor after Heart Cath?
- bleeding
- swelling
- new bruising
- pain at site
- fever > 101.5
If the radial artery was used you should avoid what?
Sleeping on hand and repetitive movement for 24-48 hours
Risks after having Femoral Heart Cath
- hematoma
- pseudoaneurysm
- loss of pulse distal to insertion site
- acute kidney failure
- allergic reaction
- cardiac tamponade
- chest pain
What happens during a Coronary Artery Bypass Graft (CABG)?
A blood vessel is grafted to the occluded artery, improving blood flow to the heart
When would a patient qualify for a CABG?
When they have at least 70% occlusion
What veins are often used for a CABG?
Greater and Lesser Saphenous veins
Why are the Greater and Lesser Saphenous veins often used and how are the grafted?
- Easier to retrieve by one surgeon while another works on the chest
- grafted to ascending aorta and distal to occluded portion of coronary artery
Nursing Care Post-Op CABG
- monitor patient
- incision care
- assess for infection
- cardiac rehab
What is Cardiac Rehab?
- medically supervised program designed to improve your cardiovascular health
- exercise training, heart healthy living, stress reduction
What is a Myocardial Infarction?
“Heart Attack”
myocardial death secondary to rupture of atherosclerotic plaque leading to complete obstruction of one or more arteries
Time line of a MI
infarction (arterial obstruction)-tissue ischemia-muscle injury-cell death which occurs over minutes to hours
S/S of MI
- acute onset of pressure, tightness, pain, or a squeezing/aching sensation in chest, arms, neck, back. or jaw
- n/v, indigestion, heartburn, abdominal pain
- SOB
- cold sweat/extreme diaphoresis
- extreme fatigue/lightheaded, dizzy
- feeling of impending doom
Elderly patients may experience what when having a MI?
“silent ischemia” or no symptoms
EKG
- determines amount of ischemia and degree of injury
- identifies location
- follows progression and resolution of MI
- should be done soon after admit or after chest pain begins
- monitor for V-fib
Ventricular Fibrillation (V-fib)
lethal arrhythmia that often results after a STEMI that can result in death
An elevation in what may be significant for skeletal or cardiac muscle injury?
Total Creatinine Kinase
CK-MB
specific to cardiac cells; increases only when there has been damage to the myocardium
When does CK-MB increase and peak?
increases w/in 4-8 hours of cardiac injury and peaks w/in 24 hours
If CK-MB is negative for more than 48 hours you should what?
look for source other than cardiac
Myoglobin
- found in cardiac and skeletal muscle
- elevated level is not specific to an MI, but normal level will rule out MI
Troponin (I&T)
- specific to myocardium
- remains elevated for up to 3 weeks
- detects acute injury or recent injury
When does troponin increase and peak
Increases w/in 3-4 hours of injury and peaks w/in 24 hours
What is a critical level of troponin?
1.5
Goal for MI
- minimize damage to heart
- preserve heart function
- reduce O2 demand while increasing meds
- increase blood flow to heart
At discharge it must be documented that the patient was discharged on what?
- statin
- ACE or ARB
- Aspirin
- Beta blocker
Chronic Meds for patients Post-MI
- statin
- aspirin
- ACE/ARB
- Beta blocker
Phase 1 Cardiac Rehab (Acute)
- at diagnosis of atherosclerosis
- light exercise and education
- lifestyle changes, s/s probs, when to call 911, control hypertension/diabetes, weight loss etc..
Phase 2 Cardiac Rehab (Recovery)
- after discharge/lasts up to 6 months
- supervised exercise w/ cardiac monitor
- individualized based on stress test results
Phase 3 Cardiac Rehab
- supervised program/cardiac monitoring no longer needed
- maintain healthy heart long-term
Nursing Management Post MI
- administer ASA & MSO4
- assess for bleeding w/ thrombolytic therapy
- administer O2 to assist w/ oxygen supply
- VS q 15 mins/bedrest
- semi-fowlers to decrease dyspnea
- monitor for hypervolemia
- reduce anxiety
- neuro checks q 4
