Nursing care of patients requiring cardiac interventions Flashcards
What is coronary heart disease?
A reduction or complete obstruction of blood flow through the coronary arteries due to narrowing from atherosclerosis
How does coronary heart disease present?
Usually presents as chest pain
How is coronary heart disease diagnosed?
• History • Physical assessment • Diagnostic and Imaging Studies – Electrocardiogram (ECG) and/or stress test – Echocardiogram – Angiogram
What is the treatment of coronary heart disease?
• Lifestyle moderation • Pharmacologic therapy • Risk factor management • Surgical management – Angioplasty and stent implantation – Bypass surgery – Implantable cardiac defibrillators (ICD)
What can be done for the treatment of lifestyle moderation in people with coronary heart disease?
cessation of smoking
exercise
weight control
cardiac educator
What pharmacological treatments are used for coronary heart disease?
- Antiplatelet Agents
- Antianginal Agents
- Risk factor management
When doing a physical assessment for the heart what do we do?
vital signs
pulses
deformities and or discomfort
auscultation
What is a coronary angiogram?
- 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
What is angioplasty?
a procedure which can follow an angiogram
a deflated balloon can be inflated into the artery to widen narrowing
What is a stent?
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
How do you prepare the patient for an angiogram?
• 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
Where can they approach the heart?
Femoral or brachial
What nursing care happens after the procedure?
• 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
What are possible complications of angioplasty?
• Bruising to puncture site • Allergic reaction to contrast • Loss of kidney function • dysrhythmias • perforation • CVA, MI – thrombosis – embolism – Aneurysm • Haemorrhage • Infection
What is a bypass graft
often referred to as open heart surgery
• Requires a sternotomy
• Cardiopulmonary Bypass
• Is being done “off pump”
What are the 3 main coronary arteries that are used?
- Left anterior descending artery
- Circumflex artery
- Right coronary artery
What do they use for the graft?
• Vein grafts – saphenous vein – cephalic, basilic • Arterial grafts – internal mammary arteries (IMA) • accustomed to pressure • similar size • longer patency
What is a valve repair surgery?
• 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
What is the pre-op management for a heart procedure?
• Pre-admission clinic – Physical assessment • ECG, CXR • Respiratory function tests • Height, weight – MRSA screening – Education – Blood tests – Stop aspirin / warfarin / smoking
What intra-operative management needs to happen?
- Monitoring
- Cardio-pulmonary bypass
- Haemodilution
- Hypothermia
- Cardioplegia
What are the complications of heart procedures? explain each
Haemorrhage - bleed
Cardiac Tamponade - Blood / Fluid in pericardial sac, Blocked chest drains
Emboli - clot
What post-op care happens for people what have had heart surgery?
• Continuous monitoring
• Assessment of body systems
– physical assessment parameters – ‘listening’ to the monitors
What is the nursing management for altered tissue perfusion?
- Apply oxygen
– Monitor cardiac readings
– Administer medications
– Administer fluids – crystalloids and colloids
– Monitor pH, urine output, ABG’s, peripheral perfusion, weight and fluid balance
What is the mobilisation regime?
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
What types of chest drains are used?
- Intercostal Chest (ICC) drain
* Underwater Seal Drain (UWSD)
What is the indication for a chest drain?
To drain air and/or fluid from the pleural space, chest cavity or pericardium • Pneumothorax • Haemothorax • Pleural Effusion • Empyema
What is the nursing management for a chest drain?
- 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
