ATI CH27: Cardiovascular Diagnostic & Therapeutic Procedures – Flashcards
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What do cardiovascular diagnostic procedures evaluate ?
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Functioning of the heart--enzymes Ultrasound--visualization Response to exercise Catheters--blood volume, perfusion, fluid status, pumping, artery blockage
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When are cardiac enzymes released?
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When the heart muscle suffers ischemia
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What are cardiac enzymes specific markers for ?
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MI
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Why are cardiovascular diagnostics & procedures done?
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Angina MI Heart disease Hyperlipidemia
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An ultrasound of the heart used to diagnose valve disorders and cardiomyopathy
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Echocardiogram
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What are ECHOs used for ?
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Cardiomyopathy Heart failure Angina MI
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What should you explain to the pt before an ECHO
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Reason Noninvasive 1hr long
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What side should the pt lay on during an ECHO?
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Left side & stay still
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When the client exercises the cardia muscle by walking on a treadmill Determines the workload of the heart
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Stress Test
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Why do they need a stress test?
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Angina Heart failure MI Dysrhythmias
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Considerations for stress tests
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Consent form Comfortable shoes and clothing Fast 2-4hr before No alcohol or tobacco or caffeine Get rest
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What meds are given during a pharmacological stress test?
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Dipyridamole Adenosine Dobutamine
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What should the nurse monitor during a stress test?
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12-lead ECG to monitor dysrhythmias & HR BP
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What should the pt report during a stress test?
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Chest pain SOB Dizziness
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What does hemodynamic monitoring provide info on?
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Blood volume & perfusion Fluid status Pumping of heart
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What parameters are associated w hemodynamics?
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Central venous pressure (cvp) Pulmonary artery pressure (pap) Pulmonary artery wedge pressure (pawp) Cardiac output (CO) Intra-arterial blood pressure
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What does mixed venous oxygen sat indicate ?
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Balance between oxygen supply and demand Measured by pulmonary artery cath w fiberoptics
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What do you need for hemodynamic monitoring
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Pressure transducer Pressure tubing Monitor Pressure bag and flush
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Why do they use arterial lines for HDM?
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Provide continuous info about ch ages in BP and permit withdrawal of samples Intraarterial pressure differes from cuff
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Can you use an arterial like for IV?
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No
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An invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage
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Angiogram
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What is an angiogram done in the lower extremities for ?
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To determine blood flow and areas of blockage
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Involves the insertion of a cath into a femoral or brachial vessel and threading it into the heart
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Angiogram
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What does the injection of contrast media under fluoroscopy show?
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Coronary artery narrowing & occlusions
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What are angiograms used for ?
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Unstable angina ECG changes -- T wave inversion, ST elevation, depression) Confirm and determine location and extent of heart disease
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What allergies do you have to assess before angiogram?
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Shellfish and iodine
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How long do you have to be NPO for angiogram?
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8hr
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What should you assess before angiogram?
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VS, peripheral pulse, heart & lungs Consent Understanding Renal function
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What should you educate the pt about regarding angiogram ?
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Awake & sedated Local anesthetic & small incision Feel warm when dye is inserted Must keep affected leg or arm straight after procedure Sandbag can be put on incision to prevent bleeding
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What does the nurse do during an angiogram?
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Admin sedatives & analgesia Monitor VS & heart rhythm Intervene during dysrhythmias Have resuscitation equipment & emergency meds readily available
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How often do you take vitals for an angiogram? & check incisor site
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Every 15 x4 Every 30 x2 Every hour x4 Every 4 hr
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What do you assess at groin site?
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Bleeding & hematoma Thrombosis (pedal pulse, color, temp)
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What can be used to hasten hemostasis following heart cath removal?
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Vascular closure device
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Older pt w arthritis might experience Pain if laying in bed for 4-6 hr. What should nurse do?
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Ask provider for analgesia
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What anti platelet or thrombolitic agents are prescribed to prevent clots and restinosis?
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Aspirin Clopidogrel, ticlopidine Heparin Enoxaparin Eptifibatide
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What does the contrast act as ?
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Osmotic diuretic
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What should be monitored after angiogram ?
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I&O Heart--dysrhythmias Pain
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How does the nurse assist w sheath removal from the vessel after an angiogram ?
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Apply pressure to arterial/venous sites Observe vagal response (bradycardia or hypotension) from compression of nerves Apply pressure dressing
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How long after an angiogram does a pt have to leave the dressing?
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24 hrs
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Angiogram & physical activity
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Avoid strenuous exercise Restrict lifting to less than 10 lbs
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What should the pt immediately report ?
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Bleeding from site SOB Chest pain Change in color or temp of extremity
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For a pt w stent replacement, how long will they receive anticoagulation therapy?
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6-8 weeks
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For pt w stent replacement & on anticoagulants what should the nurse educate them on?
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Take meds at the same time each day Have regular labs done to determine therapeutic levels Avoid activities that could cause bleeding (wear shoes around house & use a soft tooth brush)
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What lifestyles changes should be implemented for those after an angiogram ?
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Manage weight Low fat/ low sodium diet Exercise No smoking Less alcohol
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What are possibly complications regarding an angiogram?
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Cardiac Tamponade Hematoma Formation Restinosis of treated vessel Retroperitoneal
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How does cardiac tamponade occur ?
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Fluid accumulation in the pericardial Sac
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What are manifestations of cardiac tamponade ?
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Hypotension Jugular vein distention Muffled heart sounds Paradoxical pulse Intracardiac & PAP are similar & elevated
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What should the nurse do if cardiac tamponade occurs?
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Notify provider Admin IV Fluids -- hypotension Chest x Ray or ECHO to confirm diagnosis Prep for pericardiocentesis (consent, materials, meds) Monitor hemodynamic pressures Monitor heart rhythm -- change means needle in wrong spot Monitor for reoccurrence
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What is hematoma formation ?
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When blood clots form around insertion site
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What should the nurse do of hematoma formation occurs ?
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Assess groin at prescribed intervals Hold pressure for uncontrolled bleeding Monitor peripheral circulation Notify provider
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What is restinosis of treated vessel?
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When clot reformation in the coronary artery can occur
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What should the nurse do if restinosis occurs ?
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Assess ECG patterns & for chest pain Notify dr Prep for cath lab
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What is retroperitoneal bleeding ?
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When there is bleeding in the retroperitoneal space (abdominal cavity behind peritoneum) due to femoral artery puncture
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What should the nurse do if retroperitoneal (abdominal cavity) bleeding occurs?
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Assess for flank pain & hypotension Notify provider Admin IV & blood
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Why are types of vascular access?
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Central Intravenous Therapy: 1. Nontunneled percutaneous central venous catheter (CVC) 2. Peripherally inserted central catheter (PIC)
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Before using central IV what should you do?
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Check placement via x Ray
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How are central IV inserted & by who?
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Sterile technique Provider, PA, specially trained nurse
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What central IV require surgical removal?
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Tunneled & implanted
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Why are central IV Fluids appropriate for all Fluids ?
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Rapid demodulation in superior vena cava
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Types of central IVs
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1. Nontunneled percutaneous venous catheter (CVC) 2. PICC 3. Tunneled 4. Implanted port
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What does a Nontunneled percutaneous venous catheter (CVC) look like?
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18-25 cm w 1-5 lumens
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How long can you use a Nontunneled percutaneous venous catheter (CVC)?
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Short term
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Where do you insert a Nontunneled percutaneous venous catheter (CVC)
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Subclavian vein Jugular vein Tip in the distal 3rd of the superior vena cava
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What are Nontunneled percutaneous venous catheter (CVC) used for?
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Admin of blood Long term chemo Antibiotics Total parenteral nutrition
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What does a PICC look like ?
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45-74 cm w single or multiple linens
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How long can you use a PICC?
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12 months
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Where is a PICC inserted?
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Basilica or cephalon vein at least 1 finger below or above antecubital fossa Advance until tip is in lower 1/3 of SVC
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What is a PICC used for?
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Blood admin Long term chemo Antibiotics Total parenteral nutrition
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Consideration for PICC
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Insert early in the course of therapy before veins exposed to repeated venipuncture
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What should the nurse do prior to insertion of PICC or untunneled CVC
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Prep site w chlorhexidine Ensure sterility Put stop sign outside of door
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After a PICC or nontunneled CVC what should you assess ?
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Redness Swelling Drainage Tenderness Condition of dressing
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How long should you clean insertion port w alcohol ? Valve disinfection caps 1 time use
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15 sec Let dry before using
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What kind of dressing do you use for untunneled CVC & PICC
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Clear dressing for visualization Change every 7 days or when wet, loose, soiled
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What should you educate pt w Untunneled CVC & PICC about?
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Do not emerge in water Do not have venipuncture or BP taken on side w PICC
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INS Practices for Flushing PICC
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10mL syringe -- do not apply force if resistant Flush before, between & after meds Flush w 20mL NS after blood Flush w 5mL heparin w not in use
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How long can you use a tunneled percutaneous central venous catheter ?
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Long term use
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Where do you insert tunneled percutaneous central venous catheter?
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Portion of cath lies in a subQ tunnel separating the point where the cath enters the vein from where it entered the skin w a cuff Tissue granulated into cuff to provide a mechanical barrier to organisms and an anchoring for cath
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What is a tunneled percutaneous central venous catheter used for ?
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Frequent & long term need for vascular access
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Why isn't dressing needed for tunneled percutaneous central venous catheter?
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Entrance into skin and vein are separate and tissue granulated into cath cuff, providing barrier
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What do Groshog caths have pressure sensitive valves to prevent ?
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Prevents blood reflux and do not require a clamp
