NURSING 480-ADVANCED MED-SURG
What are Cardiac Cath /PCI pre and post procedure teachings?
Pre:
Maintain NPO/ Obtain VS/Consent signed/Asess allergies to shellfish/iodine
Assess renal function-before contrast
Admeinster premeds: steroids, benadryl
Takes metformin=hold. for 48 hours=can cause hypoglycemia /acidosis
Client education: Mild sedative given
Groin-common place
After procedure-pressure held on spot.
Extremity kept straight for a prescribed amount of time-
Post:
Assess VS q 15 minutes-X4
Every 30 minutes X2 q hour X4
Then every 4 hr/follow facility protocol
Assess affected extremity at same intervals for bleeding/hematoma/at insertion site
Maintain extremity straight for prescribed time.
Thrombosis- palpate it- circle it
Conduct continour cardaic monitor
Administer antiplatelet or antithrombotic-prevent clot formation.Aspirin, Clopidogrel.
heparin.Administer antianxiolytics.
Assist with sheath removal
Apply pressure to arterial/venous sites
prescribed amount of time.
Apply pressure dressing.withhold metformin 48 hr
CABG Pre and Post:
Pre-
Confirm recent chest x ray/ ecg/labs and consent
Baseline assessment of client's cognitive status-
ID any health issues
Adminster preop meds: Lozepam,prophylatic antibotics,anticholergenics,
scopolamine,reduce secretions.
Ensure client understands procedure
, Assess family/client for anxiety
Client education: Coughing/deep breath after procedure
Splint incision when cough/DB
Perform exercises as tolerated
Expect to be on a vent
Sternal/leg excisions
D/C meds before CABG: Diuretics/ASA/Anticoag./
Meds for CABG: K+,antidsy-AMiodorane.
Anti-HTN.metoprolol/ dilatzem-Ca+ ch blocker
Post:Patent airway, adequate ventilation.
Monitor RR/Effort/Sa O2
Auscultate Breath sound/report crackles
Document vent settings
Suction as needed
Dangle legs/Assist with ambulation
Monitor bp/call RT-
Monitor hemodynamic pressures
Monitor chest tube/ patency and drainage
Assess/Control pain.
pacemaker insertion-pt teaching? post and pre
Informed consent
Prepare skin
educate about type of pacemaker
Post:
temp pacemaker: controlled facility for tele
Permanent pacemaker:D/S teach:
Carry ID
Wear sling/ do not raise arm for 1-2 wks
Take pulse daily same time
Report dizziness,fainting,fatigue,weakness,cp
Weight gain
ICD device-shock-ppl next-feel it
LOC occur prior ICD shock
Resume sexual activity-avoid positions put stress on incision site
No items in magnetic field-garage door,strong magnets, gennies
NO MRI/CT
Inform airport security
What are Cardiac Cath /PCI pre and post procedure teachings?
Pre:
Maintain NPO/ Obtain VS/Consent signed/Asess allergies to shellfish/iodine
Assess renal function-before contrast
Admeinster premeds: steroids, benadryl
Takes metformin=hold. for 48 hours=can cause hypoglycemia /acidosis
Client education: Mild sedative given
Groin-common place
After procedure-pressure held on spot.
Extremity kept straight for a prescribed amount of time-
Post:
Assess VS q 15 minutes-X4
Every 30 minutes X2 q hour X4
Then every 4 hr/follow facility protocol
Assess affected extremity at same intervals for bleeding/hematoma/at insertion site
Maintain extremity straight for prescribed time.
Thrombosis- palpate it- circle it
Conduct continour cardaic monitor
Administer antiplatelet or antithrombotic-prevent clot formation.Aspirin, Clopidogrel.
heparin.Administer antianxiolytics.
Assist with sheath removal
Apply pressure to arterial/venous sites
prescribed amount of time.
Apply pressure dressing.withhold metformin 48 hr
CABG Pre and Post:
Pre-
Confirm recent chest x ray/ ecg/labs and consent
Baseline assessment of client's cognitive status-
ID any health issues
Adminster preop meds: Lozepam,prophylatic antibotics,anticholergenics,
scopolamine,reduce secretions.
Ensure client understands procedure
, Assess family/client for anxiety
Client education: Coughing/deep breath after procedure
Splint incision when cough/DB
Perform exercises as tolerated
Expect to be on a vent
Sternal/leg excisions
D/C meds before CABG: Diuretics/ASA/Anticoag./
Meds for CABG: K+,antidsy-AMiodorane.
Anti-HTN.metoprolol/ dilatzem-Ca+ ch blocker
Post:Patent airway, adequate ventilation.
Monitor RR/Effort/Sa O2
Auscultate Breath sound/report crackles
Document vent settings
Suction as needed
Dangle legs/Assist with ambulation
Monitor bp/call RT-
Monitor hemodynamic pressures
Monitor chest tube/ patency and drainage
Assess/Control pain.
pacemaker insertion-pt teaching? post and pre
Informed consent
Prepare skin
educate about type of pacemaker
Post:
temp pacemaker: controlled facility for tele
Permanent pacemaker:D/S teach:
Carry ID
Wear sling/ do not raise arm for 1-2 wks
Take pulse daily same time
Report dizziness,fainting,fatigue,weakness,cp
Weight gain
ICD device-shock-ppl next-feel it
LOC occur prior ICD shock
Resume sexual activity-avoid positions put stress on incision site
No items in magnetic field-garage door,strong magnets, gennies
NO MRI/CT
Inform airport security
