When a client with angina is scheduled to have a cardiac catheterization?
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Denise M. McEnroe-Petitte is an assistant professor of nursing at Kent State University-Tuscarawas in New Philadelphia, Ohio. Adapted and updated from Ayers DM. Preparing a patient for cardiac catheterization. Nursing. 2002;32(9):82. The author has disclosed that she has no financial relationships related to this article. Show
Nursing 41():p 14-15, Fall 2011. | DOI: 10.1097/01.NURSE.0000407702.97427.8f
COMMONLY PERFORMED AND HIGHLY accurate, diagnostic cardiac catheterization reveals defects in the heart chambers, the valves, and coronary arteries. Using fluoroscopy, the cardiologist inserts catheters into one or both sides of the heart and measures pressures and cardiac output. The cardiologist also may obtain blood specimens for oxygen saturation testing. By injecting contrast media, the cardiologist can further define cardiac structures, including the coronary arteries, and assess cardiac wall motion. Depending on the facility and the patient's condition, cardiac catheterization may be performed as either an inpatient or an outpatient procedure. Indications for cardiac catheterization include definitive or suspected myocardial ischemia, syncope, valvular heart disease, and acute myocardial infarction (MI). It also may be indicated after an MI, coronary artery bypass graft surgery, or percutaneous transluminal coronary angioplasty in patients having recurring symptoms, and after a heart transplant to monitor for rejection. To prepare the patient, teach him about the procedure and answer his questions. Provide booklets, videos, or other educational tools to reinforce learning. The cardiologist will discuss benefits and risks, such as dysrhythmias, bleeding, stroke, or MI. Make sure the patient has provided informed consent. Assess for allergies, especially significant allergies such as a previous anaphylactic reaction to one or more allergens, including contrast media. Ask if he has a history of asthma, which is associated with an increased likelihood of a contrast reaction. Also note if he's allergic to medications—including lidocaine, the local anesthetic commonly used for vascular access. The patient may be instructed to fast for 3 to 8 hours before the procedure and withhold or decrease the dosages of scheduled medications (including insulin, antihypertensive drugs, and diuretics). The physician may prescribe pretreatment prophylaxis for the patient with a history of contrast media allergy. Establish two peripheral venous access sites and infuse I.V. fluids as ordered to prevent dehydration. Obtain specimens for lab tests (complete blood cell count, electrolytes, blood urea nitrogen, creatinine, coagulation studies, cardiac biomarkers, and urinalysis). Also obtain a chest X-ray and an ECG. The femoral and brachial arteries are common catheter insertion sites, although the radial artery also is an option. Assess and mark pulses on the extremity that will be used. Have the patient void. (He may wear his dentures and eyeglasses during the test.) Administer analgesics and sedatives as directed. During the procedureThe test itself lasts 30 minutes to 1 hour, but the entire procedure, including precatheterization and postcatheterization care, may take up to 4 hours. Tell the patient what to expect, including the following points:
Follow-up careAssess the patient for nausea or pain (including back pain from lying still) and provide medication as indicated. Assess the catheter insertion site for bleeding or hematoma with vital signs as ordered. Instruct him to inform you immediately if he experiences chest discomfort or other anginal symptoms. Review the discharge orders with the patient and family, including activity restrictions, and educate them about signs and symptoms of complications, including MI, stroke, and insertion-site bleeding or infection. If indicated, inform the patient that he may need blood urea nitrogen and creatinine monitoring after discharge. Finally, instruct him to follow up with his primary care provider. Which symptom should the nurse teach the patient with stable angina to report immediately to her physician?The most common symptom is chest pain that occurs behind the breastbone or slightly to the left of it. The pain of stable angina most often begins slowly and gets worse over the next few minutes before going away. Typically, the chest pain feels like tightness, heavy pressure, squeezing, or a crushing feeling.
Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider?Features of unstable angina include pain at rest that lasts over 30 minutes and does not relieve with sublingual nitroglycerine. Pain associated with sweating, nausea, and vomiting may suggest myocardial infarction (MI).
How should the nurse instruct the client with angina pectoris to take sublingual nitroglycerine when chest pain occurs?Nitroglycerin comes as a sublingual tablet to take under the tongue. The tablets is usually taken as needed, either 5 to 10 minutes before activities that may cause attacks of angina or at the first sign of an attack.
Which action would the nurse take when performing external cardiac compression?A nurse is performing external cardiac compression. Which action should the nurse take? Extend the fingers over the sternum and chest with the heels of each hand side by side.
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