Heart Catheterization
The patient is as risk for this after a left heart catheterization (LHC).
What is an acute kidney injury- intrarenal due to the IV iodine? Get a good medical history before the procedure and monitor labs after the procedure.
A number derived from the blood pressure that tells us about perfusion.
What is MAP (mean arterial pressure)?
SBP+2(DBP)/3
If you see Sinus Tachycardia (ST) on the monitor, you should do this.
What is assess the patient and figure out why they're tachycardic? Then treat the why (pain, anxiety, fever, meds like albuterol or too much caffeine, etc).
Frequency of monitoring the chest tubes for output/color/consistency?
What is hourly? Report output greater than 150mL/hr to the surgeon.
The most frequent and life threatening complication of an aneurysm.
What is rupture?
It leads to abrupt and massive hemorrhagic shock.
If the LHC is unable to provide intervention and the patient has multi-vessel disease, the patient requires this surgery.
What is a coronary artery bypass graft (CABG)?
The normal range for central venous pressure.
What is 2-5mmHg?
CVP tells us about fluid status. If the CVP is above 5, there is Fluid Volume Excess. If it is below 2, Fluid Volume Deficit.
Priority action when you see Sinus Bradycardia (SB) on the monitor.
What is assess? If assessment is done (the patient states SOB or they're diaphoretic or show signs of hemodynamic instability) then you should give atropine and pace if they do not improve.
Symptoms of a life threatening complication after CABG that must be reported IMMEDIATELY.
What are JVD with clear lung sounds, distant, muffled heart sounds, hypotension? Also sudden cessation of previously heavy chest tube drainage, pulsus parodoxus, cardiovascular collapse. (All signs of tamponade)
The msot common cause of aneurysms.
What is atherosclerosis?
Also hypertension, hyperlipidemia, and cigarette smoking.
The most commonly accessed site for a LHC.
What is the femoral artery? The radial and brachial approach can also be used.
The pressure the ventricles have to push against to get blood out of the heart.
What is afterload?
What medications decrease OR increase afterload?
This is what you should do first when you see PVC's on the monitor.
What is assess? (For palpitations, chest pain, dizziness, do vitals, etc.) Next, look at labs, specifically potassium and magnesium. Then, call the MD if it's new and they have symptoms.
Frequency to check neurologic status after a CABG.
What is q30-60 minutes until awakened from anesthesia, then q2-4 hours, depending on agency policy.
If rupture of abdominal aortic aneurysm is suspected, assess for these signs and symptoms, then notify the physician immediately.
What are severe sudden pain in the lower back or abdomen, that can radiate to the groin, buttocks, or legs; hematoma on the flanks; abdominal distension; oliguria; diaphoresis; hypotension; loss of peripheral pulses; dysrhythmias?
These are things you should monitor AFTER the LHC.
What is monitor the access site for bleeding or hematoma, monitor the vitals (q15m for 1 hour, q 30 for 1 hour, q 1h for 4 hours, etc), monitor the peripheral pulse on the affected side along for color, cap refill, and temperature, monitor for flank/abdominal pain, abnormal rhythms).
Normal ranges for pulmonary artery pressure (PAP).
What is 15-26mmHg systolic/5-15mmHg diastolic?
You should do this if the patient is in Ventricular Tachycardia (VT) and is telling you they are feeling like they will die.
What is call a RRT, stay with the patient, have someone bring in a crash cart, and then provide synchronize cardioversion?
Essential to control to prevent heart failure and leakage from suture lines.
What is blood pressure? Hypertension after CABG is dangerous because it can cause bleeding and it increases the workload of the heart. Hypotension reduces cardiac output to the rest of the body.
The most common symptoms for an aortic dissection.
What is "sharp", "stabbing", "ripping", "tearing" pain that can move from its point of origin?
Diaphoresis, nausea, vomiting, faintness, and apprehension are also common.
Commonly, aortic regurgitation, which is characterized by a murmur heard along the right sternal border, can be auscultated.
If the patient has a stent, they should be discharged on these medications.
What is dual antiplatelet therapy (DAT)?
Aspirin with Plavix (clopidogrel) or Brillinta (ticagrelor) or Effient (prasugrel).
Normal range for cardiac output.
What is 4-7L/min?
This is the first intervention (after assessing) that you should do for you patient in atrial fibrillation (AF).
What is diltiazem drip if the blood pressure is stable and synchronized cardioversion if it is not?
A common problem after CABG that should be addressed before hypertension and vasoconstriction begin.
What is hypothermia?
Warming blankets and monitoring of the temperature are essential to prevent complications. However, rewarming should not be done too quickly because it can cause shivering which leads to metabolic acidosis and hypoxia. The temp should be raised no faster than 1 degree Celsius per hour.
Interventions for emergency care in the patient with aortic dissection.
What are increased comfort with morphine, reduction in SBP and HR with a beta blocker like esmolol and possibly nicardipine for SBP control, 2 large bore IVs, indwelling urinary catheter for strict I/Os?