ATI Nursing considerations for Cardiovascular Diagnostic and Therapeutic Procedu
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| 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
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| What are the nursing actions during a stress test? | Apply a 12 lead EKG
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| 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.
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| 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).
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| Where are arterial lines placed? | Arterial lines are placed in the radial (most common), brachial, or femoral artery
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| 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.
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| 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.
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| The proximal lumen of a PA is used for? | To measure right atrial pressure (CVP), infuse IV fluids, and
obtain venous blood samples.
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| 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
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| Which lumen of the PA can be used to infuse IV fluids? | Proximal
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| 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.
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| 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.
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| 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
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| What position should a patient be in for a line insertion? | Supine or Trendelenburg position
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| Where should the transducer be leveled (anatomically)? | Phlebostatic axis (4th intercostal space, midaxillary line)
This corresponds with the right atrium
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| How should the hemodynamic pressure lines be calibrated? | Zero system with atmospheric pressure
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| How is the indwelling central catheter placement verified? | Chest X-ray
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| How often should catheter placement be documented? | Each shift and as needed (like after transport)
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| What is the position of the head of the bed when documenting hemodynamic values? | 15 to 30 degrees
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| What are EKG abnormalities that would indicate the need for a coronary angiography? | T wave inversion, ST segment elevation, depression
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| What allergy should the nurse assess the patient for prior to a coronary angiography? | iodine/shellfish
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| For a scheduled coronary angiography how long should the patient be NPO? | 8 hours
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| What are complications associated with a coronary angiography? | Cardiac Tamponade,
Hematoma Formation,
Restenosis of Treated Vessel,
Retroperitoneal Bleeding
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| 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).
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| 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.
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| What medication should the nurse anticipate administering if the central line becomes occluded? | Urokinase (Abbokinase)
-This is used to lyse obstructions.
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| True or False. Hand veins are an acceptable place to administer a vesicant medication. | False
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| 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.
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| 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)
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| 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.
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| 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.
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