Question

The nurse is caring for a client who just had a cardiac catheterization 2 hours ego. Which of the following findings would require immediate follow up

Answer 1

CARDIAC CATHETERIZATION

Cardiac catheterization (also called cardiac cath or coronary angiogram) is an invasive imaging procedure that allows your doctor to look at your coronary arteries to diagnose coronary artery disease. It can also be used to measure pressures in your chambers, and evaluate the function of your heart.

NURSING INTERVENTIONS

Nursing responsibilities after cardiac catheterization may include the following:

1. Observe the catheter access site for bleeding or hematoma formation, and assess the peripheral pulses in the affected extremity (dorsalis pedis and posterior tibial pulses in the lower extremity, radial pulse in the upper extremity) every 15 minutes for 1 hour, and then every 1 to 2 hours until the pulses are stable.

2. Evaluate temperature and color of the affected extremity and any patient complaints of pain, numbness, or tingling sensations to determine signs of arterial insufficiency. Report changes promptly.

3. Monitor for dysrhythmias by observing the cardiac monitor or by assessing the apical and peripheral pulses for changes in rate and rhythm. A vasovagal reaction, consisting of bradycardia, hypotension, and nausea, can be precipitated by a distended bladder or by discomfort during removal of the arterial catheter, especially if a femoral site has been used. Prompt intervention is critical; this includes raising the feet and legs above the head, administering intravenous fluids, and administering intravenous atropine.

4. Inform the patient that if the procedure is performed percutaneously through the femoral artery , the patient will remain on bed rest for 2 to 6 hours with the affected leg straight and the head elevated to 30 degrees . For comfort, the patient may be turned from side to side with the affected extremity straight. If the cardiologist uses deployed devices, check local nursing care standards, but anticipate that the patient will have less restrictions on elevation of the head of the bed and will be allowed to ambulate in 2 hours or less . Analgesic medication is administered as prescribed for discomfort.

5. Instruct the patient to report chest pain and bleeding or sudden discomfort from the catheter insertion sites immediately.

6. Encourage fluids to increase urinary output and flush out the dye.

7. Ensure safety by instructing the patient to ask for help when getting out of bed the first time after the procedure, because orthostatic hypotension may occur and the patient may feel dizzy and lightheaded.

Patient education after catheterization

After discharge from the hospital for cardiac catheterization, guidelines for self-care include the following:

• For the next 24 hours, do not bend at the waist (to lift anything), strain, or lift heavy objects.
• Avoid tub baths, but shower as desired.
• Talk with your physician about when you may return to work, drive, or resume strenuous activities.
• Call your physician if any of the following occur: bleeding, swelling, new bruising or pain from your procedure puncture site, temperature of 101.5°F (38.6°C) or more.
• If test results show that you have coronary artery disease, talk with your physician about options for treatment, including cardiac rehabilitation programs in your community.
• Talk with your physician and nurse about lifestyle changes to reduce your risk for further or future heart problems, such as quitting smoking, lowering your cholesterol level, initiating dietary changes, beginning an exercise program, or losing weight.