CASE STUDY week 8 with CABG

Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an apicalmyocardial infarction (MI). In addition, he has chronic anemia, hypertension, chronic renal insufficiency, and a recently diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to retire from his job as a railroad engineer about 6 months ago. This morning, he is being admitted to your telemetry unit for a same-day cardiac catheterization. As you take his health history, you note that his wife died a year ago (at about the same time he had his MI) and he does not have any children. He is a current cigarette smoker with a 50-pack-year smoking history. His vital signs are 158/94, 88, 20, and 97.2°F (36.2 ° C). As you talk with him, you realize he has only a minimal understanding of the catheterization procedure. 1. Before he leaves for the cath lab, you briefly teach him the important things he needs to know before having the procedure. List 5 priority topics you will address. Five priorities I will discuss with the patient are checking for sensitivity to contrast media, withhold food and fluids for 6-12 hrs before procedure, advise him there will be use of a local anesthesia at insertion site, a flushed feeling is felt at injection of dye, and possible flutter sensation of heart as the catheter is passed. He may be asked to cough or take deep breaths. This patient will need hydration therapy because of his chronic renal insufficiency, baseline serum creatinine levels will be obtained as well because the contrast can worsen renal dysfunction. Medical Surgical by Lewis p. 677, 717