Page 158 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 143

Give the patient oxygen at high liter flow to help recruit functional alveoli.
Elevate the head of the bed to allow the patient to breathe easier by drop-
ping the diaphragm using gravity.
Keep the patient on bedrest to decrease the chances that a clot can travel
farther and to prevent strain on the heart.
Monitor the heart rhythm for atrial fibrillation and flutter, which can cause PE.

Prepare the patient for a spiral CAT scan, which can indicate that a clot is
actually occurring.

Prepare to administer thrombolytics to dissolve the blood clot (see Table 3–9
for anticoagulants for nursing care).

Prepare the patient for a pulmonary angiogram if embolectomy is being
considered.

Prepare to administer anticoagulants like heparin or low molecular weight
heparin to help prevent the clot(s) from enlarging or others from occurring.

Prepare to insert a PA catheter if pressures of the heart and fluid status are
in question.

Observe for heparin-induced thrombocytopenia, which is a complication of Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
heparin therapy (a marked drop in platelets after giving heparin).

Teach the patient that he or she may need a vena caval umbrella, which can
help prevent clots from going to the right side of the heart by acting like a
sieve.
Teach the need for systemic anticoagulation on coumadin, usually for life, to
prevent further PE.
Teach the patient to keep mobile, hydrated, and be cognizant of signs/symp-
toms of deep venous thrombosis (DVT)/PE so he or she can seek early help
and treatment for PE.

Surgical CV Conditions Requiring Critical Care

Percutaneous Coronary Interventions (PCIs)

What Went Wrong?
6 PCIs in the form of coronary angioplasty or cardiac stenting are generally
done after a cardiac catheterization to compress the underlying plaque into the
arterial wall (angioplasty) and prop the artery open by lining it with a mesh-
pipe link device (stenting).