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capstone > Nursing care of patients requiring cardiac interventions > Flashcards

Nursing care of patients requiring cardiac interventions Flashcards

1
Q

What is coronary heart disease?

A

A reduction or complete obstruction of blood flow through the coronary arteries due to narrowing from atherosclerosis

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2
Q

How does coronary heart disease present?

A

Usually presents as chest pain

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3
Q

How is coronary heart disease diagnosed?

A 
• History
• Physical assessment
• Diagnostic and Imaging Studies
– Electrocardiogram (ECG) and/or stress test 
– Echocardiogram
– Angiogram
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4
Q

What is the treatment of coronary heart disease?

A 
• Lifestyle moderation
• Pharmacologic therapy
• Risk factor management
• Surgical management
– Angioplasty and stent implantation
– Bypass surgery
– Implantable cardiac defibrillators (ICD)
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5
Q

What can be done for the treatment of lifestyle moderation in people with coronary heart disease?

A

cessation of smoking
exercise
weight control
cardiac educator

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6
Q

What pharmacological treatments are used for coronary heart disease?

A
  • Antiplatelet Agents
  • Antianginal Agents
  • Risk factor management
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7
Q

When doing a physical assessment for the heart what do we do?

A

vital signs
pulses
deformities and or discomfort
auscultation

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8
Q

What is a coronary angiogram?

A
  • A specialised x-ray which looks for disease in the blood vessels
  • The catheter tube will be inserted into either the groin (femoral) artery or the upper arm (brachial) artery
  • Contrast reveals any blockages or narrowing of blood vessels
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9
Q

What is angioplasty?

A

a procedure which can follow an angiogram

a deflated balloon can be inflated into the artery to widen narrowing

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10
Q

What is a stent?

A

happens during an angioplasty
a stent is a small metal mesh pipe placed in the blocked or narrowed blood vessel that expands permanently to keep the area open allowing more blood to flow

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11
Q

How do you prepare the patient for an angiogram?

A 
• Prepare skin and site – bilateral groin shave
• Fasting
• Allergies – contrast medium
• Neurovascular assessment
• Educate
– Darkened room at times – Cold
– Equipment
– Hard table
– Hot flush with dye
– Palpitations
– Pain during procedure
• Pre-medication
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12
Q

Where can they approach the heart?

A

Femoral or brachial

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13
Q

What nursing care happens after the procedure?

A 
• Keep the extremity straight and immobilised 6-8 hours (varies between institutions)
• Frequent vital signs 
puncture site observations
– 15 minutely first hour
• Pressure to puncture site if coughing,
laughing
• Neurovascular assessment
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14
Q

What are possible complications of angioplasty?

A 
• Bruising to puncture site
• Allergic reaction to contrast 
• Loss of kidney function
• dysrhythmias
• perforation
• CVA, MI
– thrombosis
– embolism
– Aneurysm
• Haemorrhage 
• Infection
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15
Q

What is a bypass graft

A

often referred to as open heart surgery
• Requires a sternotomy
• Cardiopulmonary Bypass
• Is being done “off pump”

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16
Q

What are the 3 main coronary arteries that are used?

A
  • Left anterior descending artery
  • Circumflex artery
  • Right coronary artery
17
Q

What do they use for the graft?

A 
• Vein grafts
– saphenous vein 
– cephalic, basilic
• Arterial grafts
– internal mammary arteries (IMA) 
• accustomed to pressure
• similar size
• longer patency
18
Q

What is a valve repair surgery?

A

• Resize the valve by removing extra tissue
• Remove calcium deposits that may have built up around the valve leaflets
• Repair the cords that control the movement
of the valve
leaflets
• Reattach the valve to its
cords

19
Q

What is the pre-op management for a heart procedure?

A 
• Pre-admission clinic
– Physical assessment 
• ECG, CXR
• Respiratory function tests 
• Height, weight
– MRSA screening
– Education
– Blood tests
– Stop aspirin / warfarin / smoking
20
Q

What intra-operative management needs to happen?

A
  • Monitoring
  • Cardio-pulmonary bypass
  • Haemodilution
  • Hypothermia
  • Cardioplegia
21
Q

What are the complications of heart procedures? explain each

A

Haemorrhage - bleed
Cardiac Tamponade - Blood / Fluid in pericardial sac, Blocked chest drains
Emboli - clot

22
Q

What post-op care happens for people what have had heart surgery?

A

• Continuous monitoring
• Assessment of body systems
– physical assessment parameters – ‘listening’ to the monitors

23
Q

What is the nursing management for altered tissue perfusion?

A
  • Apply oxygen
    – Monitor cardiac readings
    – Administer medications
    – Administer fluids – crystalloids and colloids
    – Monitor pH, urine output, ABG’s, peripheral perfusion, weight and fluid balance
24
Q

What is the mobilisation regime?

A

only an example - may change between hospital
• Day 1: sit out of bed
• Day 2: walk to toilet with assistance
• Day 3: short walks
• Day 4: walk length of ward
• Day 5: independent, double length of ward
• Day 6: independent, triple lengths, stairs
• Day 7: independent, stairs, discharge

25
Q

What types of chest drains are used?

A
  • Intercostal Chest (ICC) drain

* Underwater Seal Drain (UWSD)

26
Q

What is the indication for a chest drain?

A 
To drain air and/or fluid from the pleural space, chest cavity or pericardium
• Pneumothorax 
• Haemothorax
• Pleural Effusion 
• Empyema
27
Q

What is the nursing management for a chest drain?

A
  • Respiratory assessment
  • Palpate skin around tube insertion site for subcutaneous emphysema
  • If patient is on suction, turn off the suction for evaluation
  • Observe for swinging in the tubing
  • Observe of air leak (bubbling, continuous or intermittent)
  • Amount of drainage
  • Ensure there are no kinks in the tubing
  • Ensure all connections site are secure and have insulate adhesive
  • Ensure the tubing is secure and that insertion dressing is intact
  • Record and document finding of each UWSD hourly, report abnormal finding
  • Dressings are changed as per policy

capstone (19 decks)

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