Page 160 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 145

Interventions (Preprocedure)

Assess for consent form and time out to make sure that legally the patient
knows what will occur and to identify the correct patient/procedure.

Assess baseline VS to determine normal from abnormal after the proce-
dure.

Assess all baseline laboratories and diagnostic studies so that nurse knows
what is normal for the patient.

Assess baseline peripheral pulses as clots can embolize to any organ/extremity.
Prepare the patient for angioplasty and stenting telling the patient that he or
she will have to lay quiet and flat and that flushing may occur with dye inser-
tion so the patient will know what to expect.

Ensure a patent IV; so medications maybe administered during the
procedure.

Administer preprocedural sedation to decrease sympathetic stimulation and
relax the patient as much as possible.

Teach the patient to report any abnormal sensations like chest pain/pressure,
numbness, or tingling in extremities so the patient can self-monitor and let 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.
the nurse know what to report to him or her.
Teach the patient that he or she will be on aspirin and Plavix (clopidogrel)
after the procedure to prevent reblockage of the artery.

Interventions (Post Procedure)

Assess VS and rhythm according to protocols to note early signs of complica-
tions.

Assess all peripheral pulses to make sure no clot formation has occurred.
Assess the insertion site according to protocols to monitor for hematoma and
hemorrhage.
Monitor the IV and any medications that may have been added like II-III
glycoprotein inhibitors.
Administer fluids as per protocol to dilute the dye injected and prevent renal
failure (the dyes are nephrotoxic).
Teach the patient to lay flat and log roll if he or she needs to turn, to prevent
reopening or hemorrhage at the PCI site.
Teach the patient about the importance of taking medications like ASA and
Ticlid as prescribed to prevent reocclusion.