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PTCA is performed when?
when there is greater than 50% occlusion of one to two coronary arteries
PTCA with stent placement is to?
prevent artery reocclusion, to dilate the left main coronary artery (which supplies blood folw to a large area of the heart
What are some of the subjective finding in a client with coronary artery disease?
chest pain with or without exertion
- pain radiating to the jaw, left arm, through the back, or to the shoulder
What would occur on the ECG of a client with coronary artery disease?
ST segment would be elevated or depressed or even nonspecific. Other signs include bradycarda, tachycardia, hyptension, elevated BP, vomitting and metal disorentation
Name nursing actions for a client who is going to have a PTCA done?
- ensure client signed a consent form
- mantain NPO status for at least 8 hrs to reduce the risk of aspiration when lying flat for the procedure
- assess the client and family understands the procedure
- assess the client for an iodine/shellfish allergy
- assess renal function prior to introduction of contrast dye
What premeds do you give a client undergoing PTCA?
During the PTCA procedure what are nursing actions?
- Administer sedations such as Midazolam (Versed) and analgesia such as Fentanyl (Sublimaze) as prescribed
- Monitor chest pain
- monitor vitals and heart rhythm
- have resuscitation equip ready
How often should you assess tthe client who under went PCTA
- vital signs are assessed every 15 mins x 4
- every 30 mins x 2
- every 4 hrs x 4
- every 4 hrs
What medication is prescribed to the PTCA client post procedure?
- Antiplatelets or thrombolytic agents
complications of PTCA
perforation of an artery by the cath may cause cardiac tamponade or require emergency bypass surgery
What can occur as a result from fluid accumulation in the pericardial sac?
Cardiac tamponade. S/S include hyptension, jugular venous distention, muffled heart sounds and parodoxical pulse
an invasive surgical procedure that aims to restore vasculaturization of the myocardium
Coronary artery bypass graft (CABG)
What is the indication for CABG?
over 50% blockage of the left main coronary artery with anginal episodes (blockage inaccessible to angioplasty and stenting
What education should the nurse provide for the client to do postoperative (CABG)?
Inform the client of the importance of coughing and deep breathing after the procedure ot prevent complication. Client should splint the incision when coughing and deep breathing.
What is a primary complication of CABG?
Atelectasis is a primary complication of GABG. Other complications include pneumonia and pulmonary edema
results from bleeding while chest tubes are occluded, causing fluid to build up in the pericardium. Increased pericardial fluid compresses the heart chambers and inhibit effective pumping
Why is pericadiocentesis avoid if client has cardiac tampnade?
Blood may have clots so treatment is emergency strnotomy wiht drainage
What are the indications for Peripheral Bypass Grafts. A bypass graft surgery aims to restore adequate blood flow to the areas affected may be temporary artery disease
acute circulatory compromise in limb
severe pain at rest that interferes with ability to work
Nursing interventions immediately postoperative period following peripheral bypass graft surgery?
- Assess the incision for bleeding
- Rationale: arteries were involved in the bypass graft. An arterial bleed is life threatening
- Assess distal pulse
- Rationale: Distal pulse is an indicator of adequate circulation
- Place an X on the site of the pulse
- Rationale: this allows for easier assessment of distal pulse
Why does the nurse discourage the client who had just had a peripheral bypass graft surgery sitting for prolonged period of time?
sitting puts pressure on vessels and increases the risk of venous stasis and edema
Encourage the client who just had a peripheral bypass graft surgery to walk in order to achieve what?
improvement in blood circulation
Which of the following client findings pose an immediate concern? (select all that apply)
1 Trace of bloody drainage on the first dressing change
2 Capillary refill of affected limb of 6 seconds
3 Mottled appearance of the limb
4 Throbbing pain of affected limb tht is decreased with Morphine Sulfate
5 Pulse of 2+ in the affected limb
capillary refill greater than 3 secs and a limb that appears mottled indicates decreased circulation and may indicate graft occlusion.
Why would you advice the client to not smoke?
Nicotine causes vasoconstriction, which will decrease perfusion and delay healing. Smoking will also increase progession of atherosclerosis
Why do advice the client to have activity restrictions?
This will prevent disruption of sutures
Skin remain fragile. Wounds will not heal will if circulation is compromised
An appropriate diet will slow the progression of atherosclerosis
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