cardiac methods to make better

  1. cardiac cath
    • detailed info about structure & performance of heart valves, coronary circulation
    • L sided- cath enters through radial, brachial, or femoral artery, advanced to L side of heart
    • - area used most
    • - looking for narrowing or total occulusion of coronary arteries
    • - used for people who fail stress test or MD has a good reason to skip step
  2. Cardiac cath 2 Complications, nursing
    • Complications- bleeding, occlussion, dysrhythmias (v. fib), allergy (shellfish or iodine), dehydration
    • Nursing- before
    • - explain procedure- little/no pain, lie still @ 2 hrs, flushed feeling with dye, report CP, NPO 8 hrs)- awake for this
    • - note iodine/shellfish allergies
    • - mark peripheral pulses, note quality
    • - establish IV access
    • - lie still
    • - osmotic diuresis- gives lots of fluids
    • baseline-
    • - CSM- before mark how good pulses are good and color
    • during and after
  3. Cardiac cath- nursing during
    • monitor VS
    • continous EKG
    • monitor for signs allergy- itchy, rask
    • monitor for CP
  4. cardiac cath- types
    • PTCA angioplasty- balloon
    • - Percutaneous transluminal coronary angioplasty
    • - thru the skin into the center of blood vessels thru heart

    • DCA
    • - direct coronary arthoectomy
    • - direct removal of plaque with spinning razor blade
    • - spins and scrapes off plaque
    • Intracoronary stents AHA stents
    • - stents helps to keep vessels open. metal piece of support- go plavix dec clot
  5. Cardiac Cath nursing after
    • assessment prevention/early detection of complication
    • - VS q 30mins x 2 hrs then q 1hr check insertion side- bandaide no bleeding, no hematoma
    • - keep extremities straight xx 4-6 hrs- arm board
    • - BR x 2hrs if leg, log roll, HOB 15 degrees
    • - CSM extremity w/VS**
    • - monitor cardiac rhythm
    • bedpan- fractured pan
    • femoral 4-6hrs leg str8
    • bedrest
  6. Cardiac cath after cont nx care
    • encourage po fluids will have IVF as well
    • monitor for hypersensitivity reaction
    • emotional support
    • encouraging fluid to flush the dye which can cause renal failure
  7. Angina or MIjQuery110106793467170048932_1488402156653
    • check bp before giving med each time
    • relieve acute attack, prevent future attacks
    • nitrates- SL, po, translingual spray- vasodilate
    • Antiplatelets
    • - ASA
    • - Dypyridamole (Persantine)
    • - Gllbllla inhibitors- Reopro, aggrastat, plavix
    • 2nd nitroglycerin- call ems
  8. Angina or MI??2
    • opiates- dec preload & afterload too- morphine- vasodilation
    • O2- o2 stat esp with orientation
    • antilipidemics- helps with plaque formation?
    • antioxidants- Vit E, C, folic acid
    • B-blocker- cardiac specific- dec workload
    • ca channel blocker
    • Ace-I
  9. Angina or MI? nx management
    • assess and teach s&s duration, risk factors
    • cardiac monitoring and 12 lead EKG
    • ASA
    • SL NTG (sublingual nitro)
    • MS04- morphine
    • O2
    • calm , quiet environment
  10. Angina or MI? Educate pt
    • avoid precipitating factors
    • sit with onset
    • NTG q 5min x3, EMS
    • control HTN- damage endothelilium
  11. home care
    • controlled exercise- FITT
    • smoking cessation- no passive smoking
    • proper diet, wt loss PRN (high fiber diet)
    • stress management
    • med compliance
  12. what is a core measure?
    • evidence based, scientifically researched standard of care
    • CMS (Centered for Medicare & Medicaid Services) establisjed the core measure in 2000 and began publically reporting data in 2003
    • currently SHBH collects data on 28 core measures in 4 areas: Heart Failure, Heart Attack, Pne (CAP), and surgical care infection prevention
    • gold standard things we do for people who have certain dx
  13. Nursing responsiblities for acute MI
    • door to service goal is 90 mins
    • time starts the minute the pt arrives at the hospital
    • obtain EKG within first 10mins of arrival and have physician read the EKG
    • activate the cath lab team as soon as there is possibility your pt is going to the cath lab (the team would rather be canclled than no called timely)
  14. Nursing responsibilities for acute MI 2
    • admin ASA other meds as prescribed by physician (pt must received ASA within 24 hours of arrival unless contraindicated and contraindication must be documented by physician)
    • document vitals
    • in there is a delay in going to the cath lab, has the physican documented this delay(eg has the pt refused, unstable, is there any testing needed prior to cath lab.l there are valid reason for a delay but these must be documented by the physician
  15. nx responsibilities acute MI? 3
    • at d/c, has the physician prescribed ASA and Beta Blocker? if not, the physician must document reason for not prescribing these meds
    • If EF documented as less than 40% pt is also a candidate for ACE/ARB; physician must clearly document reason for not putting pt on ACE/ARB
    • has your pt smoked cigarettes at any timein the past 12 months? If so, pt needs smoking cessation counseling. a brief note stating "I advised the pt to quit smoking will be good
  16. Angina or MI?? 4 treatment
    • PTCA or thrombolytic therapy- immediate revascularization
    • ASA** core measure
    • nitrates
    • analgesics- morphine
    • O2 depends
  17. Angina or MI? 5 meds
    • Heparin- dec risk
    • GllBlla inhibitors
    • b-blockers** core measure
    • ace inhibitor** core measure
    • stool softners
  18. Thrombolytic therapy
    • Clot busters
    • Activase, Reteplase
    • Ideally within 3-6 hours, 12 hr max of S&S
    • +/- Heparin- dec formation of new clots
    • complication- ** bleeding (brain, GI), allergic rx
  19. Nursing management Cardiac rehab phase I
    • In hospital- LOS 5-7d
    • ease pt heart back to normal
    • - pain control 72 hrs monitor
    • - prevent BR complications, manage psychosocial (job, money etc), pt education
    • - educate @ recovery, risk factors, meds, diet, activity, leg and chest wound care, smoking cessation
    • at BR:
    • - pain control
    • - passive ROM
    • - DB, cough, T
    • - boots
    • - log roll pt
  20. Phase I cardiac rehab
    • freq VS
    • continous EKG
    • ** qd wt, q2h I&O, physical exam
    • monitor labs- lytes- K, mg
    • 2g NA diet
    • fluid balance is important, can develop HF
  21. MI complications
    • Dysrhythmias- major cause of death
    • - maintain proper O2 and lytes
    • - +/- antidysrhythmics- individuals situations/decision
    • Cardiogenic shock- 80% mortality
    • - hypotension, diaphoresis, tachycardia, restlessness, cold, clammy skin
    • - HD support, dopamine, dobutamine (+ isotopes)- strengthen heart/strengthen beat
    • HF and pulmonary edema
    • pericarditis
  22. Phase I cardiac rehab-
    • slowly increase activity
    • - passive ROM
    • - BR x 24 hrs
    • - commode
    • Anxiolytics- can develop catecholamines (In HR, BP)
    • low level ETT- to move to phase II
    • - check HR, BP, and pain
    • - check before and after
  23. phase II cardiac rehab
    • outpatient, supervised, monitored
    • 10-14 days after d.c
    • restore approriate and desirable ADL's, lifestyle, occupation
    • reinforce lifestyle changes- diet, no smoking
    • psychosocial support- help them get thru hurdles
    • pt can tolerate low level activity
  24. Phase II cardiac rehab
    • treadmill- 3x/wk x2-3 months- inc as tol (monitor heart rate and bp before and after)
    • ETT- to progress to phase III
    • intercourse- when 2 flights of stairs w/no s&s
    • return to work after 8 wks
    • gradual inc speed on treadmill- cont monitor
  25. Phase III cardiac rehab
    • community- scattered
    • long term follow up behavior changes
    • responsibility shifts to client for lifelong changes
    • be able to cont activity w/ a group of pts who have experienced this similar things- teach each other
  26. surgical management caBG
    • CABG- coronary artery bypass graft
    • median sternotomy, cardioplegia, cardiopulmonary bypass pump
    • females- less short, similar long term benfits
    • - for some pts cardiac cath doesnt work
    • - cut sternum separate ribs, freeze heart with, bypass machine- stop heart (get vessels for leg)
  27. surgical management nursing care
    • average- los 4-5 d
    • d/c planning and education of pt and fam begins at admission
    • cardiac rehab on discharge
    • VNA services- worry about sternum
    • pain tx
    • chest leg and wound- think of co mordities
  28. surgical management- postop nursing
    • routine post op care
    • VS, heart sounds, EKG, I&O, ** renal function, ** neuro check
    • intubated (when off this get pt up?), PA line, epicardial pacer, CT
    • rewarming after surgery- watch for hypotension- remember heart gets chilled so needs to rewarm- vasodilate- watch bp
    • wound care
  29. Surgical management d/c teaching
    • no lifting more than 5lbs and no driving @ 6 wks
    • wound care- infection, healing, watch
    • cardiac rehab
    • diet- dec na, inc fiber,
    • exercise- low moderate
    • medications- pain
    • smoking cessation
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cardiac methods to make better
not always better