Page 658 - Cardiac Nursing

634 P AR T IV / Pathophysiology and Management of Heart Disease

Nursing Care Plan 26-1 (continued)

Nursing Diagnosis 2 ç Decreased cardiac output related to suboptimal IABP therapy, manifested by lowered mean arte-
rial blood pressure with requirement for high-dose inotropic support.
Nursing Goal 1 ç To prevent decreases in cardiac output as a result of suboptimal IABP therapy.

Outcome Criteria ç 1. Mean arterial blood pressure will be 60 to 70 mm Hg or higher.
2. IABP timing will be correct with:
Inflation occurring at the dicrotic notch
Optimal diastolic augmentation
Deflation at end-diastole wit a drop in pressure of at least 8 to 10 mm Hg below unassisted
end-diastole.
3. Balloon will be refilled before large gas losses secondary to diffusion.
4. Patient will have decreasing requirements for inotropic support over the course of IABP
assistance.

NURSING INTERVENTIONS RATIONALE

1. Verify correct timing of IABP hourly. Make correction as 1. Timing may be altered if the heart rate changes or sys-
needed. tolic function improves.
2. Document settings for inflation, deflation, and systolic, 2. Documentation will illustrate trends, improvement, and
end-diastolic, and mean arterial pressures with IABP assis- necessary interventions to achieve optimal assistance.
tance.
3. Document level of diastolic augmentation, evaluate for a 3–4. A decrease in diastolic augmentation may indicate a
decrease in augmentation. need to refill the balloon. A major loss of diastolic aug-
4. Maintain proper volume of balloon to ensure optimal dias- mentation in a short time may indicate a tear or leak in
tolic augmentation. the balloon (Check catheter for evidence of blood back-
ing up from aorta.)
5. Ensure that the balloon is refilling every 1 to 2 hours, 5. An optimally filled balloon is necessary for optimal dias-
depending on the type of machine. tolic augmentation.

Nursing Goal 2 ç To reduce or eliminate situations that will interfere with maintenance of proper IABP timing
assist ratio (i.e., assistance of every beat).
Outcome Criteria ç 1. Patient will have a regular heart rhythm.
2. There will be no interference of trigger signal to IABP console.
3. Timing will be corrected with changes in heart rate.
4. Balloon will be free of kinking.

NURSING INTERVENTIONS RATIONALE

1. Re-evaluate timing anytime there is greater than a 10- to 1. A 10- to 20-beat or greater change in heart rate alters
20-beat change in heart rate on onset of new arrhythmias. the systole-to-diastole ratio in each cardiac cycle. Previ-
Use the automatic timing feature on the IABP console if ous inflation and deflation settings may be inappropri-
available. ate for a change in this ratio (i.e., the time spent in dias-
tole is longer at slower heart rates and shorter at rapid
heart rates) unless the IABP console has an automatic
timing feature.
2. Maintain adequate electrocardiogram (ECG) trigger signals 2. Loss of trigger signals impairs IABP ability to assist the
to IABP console. Change any ECG electrodes that become heart with each cardiac cycle.
loose, placing new ones on clean, dry skin.
3. Notify physician of any dysrhythmias. Secure cardiac pac- 3. Irregular rhythms may impair IABP ability to assist each
ing parameters if dysrhythmia is irregular and is impairing cardiac cycle. Pacing can stabilize this situation so that
IABP tracking. Administer antiarrhythmic agents as systole-to diastole ratio is the same for each cardiac
ordered. cycle. The pacemaker spike may be used as the trigger
for IABP timing.
4. Maintain patient in proper body position (head of bed 4–5. Sitting the patient upright or elevating head of bed may
15 degrees and no hip flexion). Use leg brace and soft cause hip flexion and subsequent catheter kinking. Kinking
restraint as necessary. Log roll patient when turning. impairs the flow of gas in and out of balloon. An upright
5. Instruct x-ray technicians and other personnel not to sit position also may cause the catheter to advance up the
patient upright. aorta with potential migration into an aortic arch vessel.