44-year-old male ETOH Abuse Smokes 1ppd for 30 years PMH: COPD, DM, HTN, CHF, Cirrhosis, Ascites,...

44-year-old male

ETOH Abuse

Smokes 1ppd for 30 years

PMH: COPD, DM, HTN, CHF, Cirrhosis, Ascites, BPH

PSH: TURP, Repair of right inguinal hernia, Cholecystectomy

Allergies: PCN

The above patient came to the ED c/o, spitting up blood and altered mental status. VS 103.5 – 189/103 – 114 – 26 – 89% NRB. The patient was intubated and vented, and NGT was placed. When lungs were auscultated, there crackles heard halfway up. Line and labs were done, and IVF 0.45 NS started at 60ml/hr. BC x 2 drawn, and Vancomycin 1gm IV given. Also given was Tylenol 650mg PO, Labetalol 100mg IV, Lasix 40mg IV. FC placed to bedside drainage with hematuria returned. Labs returned. WBC 28.6, H/H 7.3/18.6, PT 28, PTT 66, PLT 126, Ammonia 58, BNP, 158, Bands 10.5, Glucose 621, K+ 6.8, HgbA1C 10.9, CK 7.4 and Trop 1.6. EKG shows a STEMI, and CXR shows RUL pneumonia and pleural effusion. The patient is intubated via rapid sequence intubation and placed on a vent. Sedation is done with fentanyl and propofol. The patient went to cardiac cath for a PCI. 2 stents placed successfully for 95% blockage. The patient is to be transferred to ICU.

EKG in ED.

question. upon transfer to the ICU, what would you the nurse expectant anticipate in the following scenario?

Expert Solution

Based on the scenario the ICU nurse should be prepared to take care of post PCI patient on ventilator support.

Keep post operative ICU bed ready to receive the patient
Keep Cardiac Monitor,Ventilator,Crash cart,12 lead ECG machine and Suction ready

After receiving the patient Monitor for:

Monitoring for bleeding ( including retro peritoneal bleeding) pseudoaneurysm formation,Infection,arrhythmias,contrast medium- induced renal failure,and ECG changes that might indicate cardiac ischemia or myocardial infarction.
The patient may be receiving anticoagulation or anti platelet therapy ( or both)If anticoagulants have been administered pre catheterization the patient is at higher risk of bleeding.All patients will have received heparin during the procedure
Observation for complications of PCIincluding:
Assessment of puncture site for Bleeding:- check pressure dressing for oozing or bleeding from puncture site and mark the size of bleed if possible
Haematoma- Assess site for swelling,redness and pain and mark the size of hematoma is possible.( It can indicate bleeding into the thigh,pelvis or retro peritoneal space.
Infection- Assess site for heat,pain and redness.Also Assess for other signs of infection including an increase in temperature,tachycardia,and rigors.
Ecchymosis- Assess skin around site for purple discoloration.
Coronary artery dissection: may require an immediate coronary artery bypass,symptoms include chest discomfort or pain,arrhythmias,ECG changes indicating ischemia or infarction,In- stent restenosis can occur within 48 hours or more gradually over 2-3 months.
Monitor patients 12 lead ECG for changes,and be alert for chest discomfort or pain,which may indicate in- stent restenosis,
Monitor for reperfusion injury( characterized by chest discomfort,pain,or arrhythmias such as premature ventricular contractions) and coronary artery spasm
Care of a patient on mechanical ventilation
FC care,NG tube care.

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