Page 159 - Critical Care Nursing Demystified

144 CRITICAL CARE NURSING DeMYSTIFIED

When the patient has angina and is given clot busters (thrombolytics), the clot
busters open the artery dissolving the clot, but the plaque still narrows the
coronary arteries. To restore unimpeded blood flow, the lumen of the artery
must be widened and plaque compressed. If that is not possible, coronary artery
bypass grafting (CABG) will be necessary.
Generally, the first procedure is coronary angioplasty, but this does not ensure
that the artery will remain open. Since the area where the angioplasty occurs is
inflamed, platelets and other sticky substances migrate to this area and can reclot
what the health care workers have tried hard to keep open. Therefore, many
times during an angioplasty the physician will insert a stent. The stent covers
these inflamed areas, decreasing the likelihood that the vessel will reocclude.
Sometimes additional drugs will be given after PCIs to help prevent reocclu-
sion. These drugs, II-III glycoprotein inhibitors like ReoPro and Integrilin, stop
clot activation. The platelet membrane contains glycoprotein receptors that
bind with fibrinogen, linking the platelets together. Glycoprotein inhibitors
block this platelet-linking process, leading to less reoclussion after PCIs. Drug-
emitting stents may also be placed. To prevent reocclusion after the PCIs,
patients are usually prescribed aspirin and clopidogrel (Plavix) for long-term
anticoagulation. 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.

Hallmark Signs and Symptoms
Refer to the sections on angina/MI for signs and symptoms of reoclussion of the
artery.

Prognosis
The prognosis is good after an angioplasty or stent, but the nurse must be obser-
vant for signs/symptoms of reocclusion of the vessel.

Interpreting Test Results

• See signs and symptoms for MI/angina.
• Baseline coagulation studies including H&H, PT, PTT, platelets.
• Baseline renal studies like BUN and creatinine can show the kidney’s ability
to excrete the dye injected.
• Baseline ECG and rhythm strip to monitor for postoperative complications.

Nursing Diagnoses for PCIs Expected Outcomes
Risk for decreased CO related to reocclu- The patient will have 0 pain on a
sion of the coronary artery scale of 1–10