Page 233 - ACCCN's Critical Care Nursing

210 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

Nursing Care of Patients Undergoing Cardiac urgent action. In the critical care environment two main
CT, MRI and Nuclear Medicine Studies forms of cardiac monitoring are commonly employed:
All the above methods have advantages and benefits in continuous cardiac monitoring, and the 12-lead ECG.
assessing patient cardiac condition. For the critical care Accurate assessment of the patient’s intracardiac status is
nurse, preparation of patients for these examinations is frequently employed and often considered essential to
important because the patients often need to be trans- guide management. The beneficial claims of invasive pul-
ported to the radiology or nuclear medicine departments. monary artery pressure monitoring have, however, been
Important considerations include: questioned in the literature. Consequently, as invasive
pulmonary artery monitoring is frequently utilised in
● Patient’s allergy profile in relation to imaging contrast practice, there is great need for continuing education
needs to be evaluated before the requests are made. about the use of this technology and a need to ensure
● These tests all require the patient to lie still for certain that patient safety is always considered. In day-to-day
periods of time, therefore sedation may be required management of critically ill patients, critical care nurses
during the procedure. must ensure they are skilled and educated in the tech-
● Appropriate equipment, such as non-metal equip- niques of non-invasive and invasive cardiovascular moni-
ment, needs to be organised beforehand if the patient toring techniques and technologies, and be able to
is having an MRI study. synthesise all data gathered and base their practice on the
best available evidence to date.
A strength of this study is the prospective observational
Practice tip design utilised allowing serial measurements to be
Hearing aids and partial dental plates with metal parts must be recorded. However, the findings need to be considered in
removed prior to MRI. Additionally, patients with implantable light of the small sample size and the potential for varia-
devices such as permanent pacemakers cannot have MRI. tion in vasoactive medications used that may have con-
founded results reported. While this study does not
definitively answer a well-debated issue regarding the
SUMMARY value of monitoring peripheral temperatures as a surro-
gate for invasive cardiac output and SVR the potential
The cardiovascular system is essentially a transport system value of simple noninvasive peripheral temperature and
for distributing metabolic requirements to, and collecting clinical assessment in monitoring trends in the intensive
byproducts from, cells throughout the body. A thorough care patient following cardiac surgery is highlighted.
understanding of anatomical structures and physiological
events are critical to inform a comprehensive assessment Of interest for the critical care nurse, subjective peripheral
of the critically ill patient. Findings from assessment assessment was recorded using a simple method that can
should define patient cardiovascular status as well as easily be applied in practice. Foot warmth was recorded
inform the implementation of a timely clinical manage- on a scale of 1–3, with a core of 1 equating to the whole
ment plan. A thorough cardiac assessment requires the foot being cool, a score of 2 equating warm feet but cool
critical care nurse to be competent in a wide range of toes and a score of 3 being equal to the whole foot being
interpersonal, observational and technical skills. warm, including the toes. Using this assessment method,
subjective skin assessment was significantly associated
Current minimum standards for critical care units in with both lactate levels and blood pressure while changes
Australia and New Zealand require that patient monitor- in peripheral skin assessment correlated to changes in
ing include circulation, respiration and oxygenation. For cardiac output and SVR. It has so often been said that
many critically ill patients, haemodynamic instability is there is no complete substitute for hands-on clinical
a potentially life-threatening condition that necessitates examination and this study reinforces this mantra.

Case study

Mr Ryan, a 47-year-old man, was admitted to the Intensive Care ● passing dark urine and pale stools frequently
Unit from the hospital medical ward. The following is a summary ● denied abdominal pain, jaundice, haematuria, prodromal or
of events prior to admission taken from the patient hospital presyncopal symptoms
records:
In the emergency department the patient observations were as
Relevant past medical history included: follows:
● hypercholesterolaemia ● BP 100/70 mmHg
● elevated blood sugar levels ● HR 126/min, Sinus tachycardia
● Body temp 37.9–38.1°C per axilla
Admitted to hospital 2 days ago following collapse: ● SaO 2 96% on room air
● with a 4-day history of fever, sweats and rigors ● jugular venous pressure noted as normal
● anorexic: only able to drink 5–6 glasses fluid per day ● tongue dry
● lethargic: able to carry out ADLs with effort
● heart sounds audable S1, S2 and considered normal