PCM 2 Extra book/article stuff need for key points Flashcards
When are Catheter Alblation procedures indicated?
Indicated for:
- Supraventricular tachycardia
- AV nodal reentrant pathways
- Atrial fibrillation and flutter
- and certain types of ventricular tachycardia
What is the Purpose of the Ablation Procedure?
Attempts to remove or isolate ectopic foci in an attempt to reduce the resultant rhythm disturbance
- Radio frequency ablation uses low-power, high frequency alnternating current to destroy cardiac tissue and is the most affective technique for ablation
- After the ectopic foci are located that ablation catheter is is positioned at the site to deliver a current for 10-60 seconds
What are the typical Guidelines Post-Alblation Procedure?
- The leg used for access (Venous puncture site) Must remain straight and immobile for 3 to 4 hours. If an artery was used, the time increases to 4 to 6 hours.
- Most of the post-intervention care is geared toward monitoring for complications. Possible complications include bleeding from site, cardiac tamponade from perforation and arrythmias
- After a successful procedure (and initial immobility to prevent vascular complications), usually activity is not restricted
What is a Pulmonary Embolism?
The partial or full occlusion of the pulmonary vasculature from thromboembolism from LE, air entering the venous system through catheterization, fat droplets from traumatic origin or tumor fragments
What should happen if a patient has S/S of a pulmonary embolism during treatment?
PT intervention should be discontinued
- Ensure the patient is secure on a stable surface and call for help immediately
What does a Pulmonary Embolism Result in?
- Decreased blood flow to the lungs distal to the occlusion
- Atelectasis and focal edema
- Bronchospam from the release of humeral agents
- Possible parenchymal infarction
- Possible right heart strain
What does Prothrombine Time measure?
Measurement of the time it takes for a clot to form when exposed to tissue factor in the extrinsic and common pathways. This measure is used to determine the efficacy of the anticoagulant Coumadin (warfarin)
What is the normal Prothrombine Time for an adult?
11 - 12.5 seconds
With Prothrombine Time, what is the Therapeutic range for effectiveness of anticoagulant (in seconds)?
1.5 - 2.5 times normal
With Prothrombine Time, in seconds, what is considered a high risk for bleeding into tissues?
> 20 seconds; utilize caution and discuss with interprofessional team
What are the Clinical Implications with Prothrombine Time?
Due to increased risk of bleeding:
- Provide fall prevention screening and intervention as needed due to increased risk of injury with falls.
- Apply prolonged pressure to the site if bleeding occurs.
- Examine skin for bruising, petechiae, or blood in urine.
–Bruising may result from blood pressure cuff or other medical
devices.
- Monitor for changes in neurological condition due to increased risk of intracranial bleeding.
TS-Spinal Precautions
What are the Spinal Fusion safety measures?
- NO hip flexion past 90°
- NO trunk rotation
- NO traction (dont pull person by the arms)
- NO sidebending
TS-Spinal Precautions
How can someone with a Spinal Fusion Stand up without breaking precautions?
- Slide to the edge of the chair/bed
- Place feet flat on floor
- Hand at your sides
- Keeping your back straight, PUSH UP with your hands and legs, Do Not Bend Forward
TS-Spinal Precautions
How can someone with a Spinal Fusion Log Roll without breaking precautions?
- Bend your knee on the opposite side of the body and point it in the direction you want to turn
- Reach with your arm on the opposite side of the body and lay it across your chest in the direction you want to turn
- Allow your bent knee to roll across your body at the same time you reach with your arm. Roll together, keeping your shoulders and hips together
- Once you are laying on your side, bend your knees slightly. Take your arm and place it on the bed in front of your body. Your arms are ready to push up
- Slide your legs off the bed at the same time Your arms push up. This helps prevent trunk-side bending
What are the Conservative or Standard Sternal Precuations?
DO NOT
- lift arms above 90°
- push through or pull your amrs
AVOID
- lifting objects more than 2kg
- reach backwards or place your arms behind back
ALWAYS
- Support chest with both arms when coughing
What are the Modified Sternal Precautions?
What are the most common sternal precautions for infants following cardiac surgery?
- Prone restictions
- No lifting at the axillae
- No pulling of arms to sit
