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ATI Nursing considerations for Cardiovascular Diagnostic and Therapeutic Procedu

What is the diet order prior to a stress test and -what foods are important to avoid? -NPO 2 to 4 hours before the procedure -Avoid tobacco, alcohol, and caffeine before the test
What are the nursing actions during a stress test? Apply a 12 lead EKG
True or False: Fluids can be infused via an arterial line. False. Arterial lines provide continuous information about changes in blood pressure and permit the withdrawal of samples of arterial blood. Intra-arterial pressures can differ from cuff pressures.
What assessments should be done for a patient with an arterial line? The integrity of the arterial waveform should be assessed to verify the accuracy of blood pressure readings. Monitor circulation in the limb with the arterial line (capillary refill, temperature, color).
Where are arterial lines placed? Arterial lines are placed in the radial (most common), brachial, or femoral artery
True or False: Fluids can be infused via Pulmonary Artery (PA) Catheters. True PA catheters have multiple lumens, ports, and components that allow for various hemodynamic measurements, blood sampling, and infusion of IV fluids.
Where is a PA located? The PA catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricle into a branch of the pulmonary artery.
The proximal lumen of a PA is used for? To measure right atrial pressure (CVP), infuse IV fluids, and obtain venous blood samples.
The distal lumen of a PA is used for? To measure pulmonary artery pressures (PA systolic, PA diastolic, mean PA pressure, and PA wedge pressure). This lumen is not used for IV fluid administration
Which lumen of the PA can be used to infuse IV fluids? Proximal
How and what is the balloon inflation port used for regarding a pulmonary artery catheter? It is intermittently used for PAWP measurements. When not in use, it should be left deflated and in the “locked” position.
What is the function of the thermistor for a PA? To determine cardiac output. By measuring the temperature differences between the right atrium and the pulmonary artery in order to determine cardiac output.
What happens to an older adults intravascular volume and how would this effect hemodynamic monitoring? It decreases. Therefore, the nurse should anticipate lower hemodynamic values, particularly if dehydration is a complication
What position should a patient be in for a line insertion? Supine or Trendelenburg position
Where should the transducer be leveled (anatomically)? Phlebostatic axis (4th intercostal space, midaxillary line) This corresponds with the right atrium
How should the hemodynamic pressure lines be calibrated? Zero system with atmospheric pressure
How is the indwelling central catheter placement verified? Chest X-ray
How often should catheter placement be documented? Each shift and as needed (like after transport)
What is the position of the head of the bed when documenting hemodynamic values? 15 to 30 degrees
What are EKG abnormalities that would indicate the need for a coronary angiography? T wave inversion, ST segment elevation, depression
What allergy should the nurse assess the patient for prior to a coronary angiography? iodine/shellfish
For a scheduled coronary angiography how long should the patient be NPO? 8 hours
What are complications associated with a coronary angiography? Cardiac Tamponade, Hematoma Formation, Restenosis of Treated Vessel, Retroperitoneal Bleeding
What are the signs and symptoms of a cardiac tamponade? Hypotension, JVD, muffled heart sounds, & paradoxical pulse (variance of 10 mm Hg or more in SBP between expiration and inspiration).Hemodynamic monitoring reveals intracardiac and pulmonary artery pressures are similar and elevated (plateau pressures).
How should a nurse collect a blood specimen from a central line? Withdraw 10 mL of blood and discard A second syringe to withdraw 10 mL of blood for sample Take a third syringe and flush with 10 mL of 0.9% sodium chloride.
What medication should the nurse anticipate administering if the central line becomes occluded? Urokinase (Abbokinase) -This is used to lyse obstructions.
True or False. Hand veins are an acceptable place to administer a vesicant medication. False
A nurse should anticipate what preventive measure for a line that is affected by motion of a joint? The nurse should anticipate applying an arm board to restrict movement of the joint. Prior to placing the restraint the nurse should wrap a washcloth folded in thirds around the arm to prevent the restraint from sliding and dislodging the catheter.
What is the nursing action for an air embolism related to vascular access? If the patient becomes SOB, place in Trendelenburg on left side, give O2, and notify the provider (to trap and aspirate air)
When changing a dressing for a vascular access device, what direction should the nurse remove the dressing to prevent dislodgement? The nurse should remove the dressing from distal to proximal.
What needle should be used to access a tunneled percutaneous central catheter? Noncoring (Huber) needle. This is to prevent damaging the mesh on port catheters.
Created by: rexp