Professional Documents
Culture Documents
RESPONSES TO ALTERED
OXYGENATION, CARDIAC AND
TISSUE PERIPHERAL PERFUSION/
TRANSPORT
Learning outcomes
1. Discuss the different assessment parameters for cardiac functioning.
2. Describe nursing care of clients undergoing diagnostics tests to
assess cardiac functioning.
3. Describe treatment modalities for clients with cardiac disorders.
4. Explain the pathophysiology, clinical manifestations and
collaborative management of cardiac disorders.
5. Make a nursing care plan for clients with cardiac disorders.
6. Teach clients with cardiac disorders about prevention, management
and rehabilitation factors that optimize health.
Heart Wall
The three layers of the heart are as follows:
epicardium, outermost layer
myocardium, the cardiac muscle;
endocardium, the endothelium
The heart is enclosed by the pericardium
which consist of two layers:
visceral pericardium (inner layer)
parietal pericardium (outer layer)
There is is 5 to 20 mls. Of fluid in the
pericardial sac which prevents friction
between the two pericardial layers.
Coronary Arteries
The coronary arteries originate
from the aorta, behind the cusps of
the aortic valve, in an area known
as Vasalvas sinus.
The two main coronary arteries are
the left coronary artery (LCA) and
the right coronary artery (RCA).
The LCA divides into two branches
namely, the circumflex coronary
artery (CCA) and the left anterior
descending artery (LADA).
Coronary Arteries
The LADA supplies the anterior wall of the
left ventricle, the anterior interventricular
septum, the anterior papillary muscles
and apex of the heart.
The RCA supplies the right atrium, right
ventricle, a portion of the septum, SA
node, AV node, and inferior portion of the
left ventricle.
Coronary artery blood flow to the
myocardium occurs during diastole, when
coronary vascular resistance is reduced.
During diastole, blood enters the
coronary artery, which is called diastolic
filling.
Cardiac Cycle
The two phase of the cardiac cycle are
diastole and systole.
Systole, contraction of the myocardium,
results in ejection of blood from the
ventricles.
Relaxation of the myocardium, or diastole,
allows for filling of the ventricles.
Cardiac Output
Cardiac output (C.O) is the volume of blood ejected from
the left ventricle into the aorta per minute.
C.O = Stroke Volume x Heart Rate
(70 mls X 70 bpm = 4,900 mls or approximately 5 L)
The average cardiac output is approximately 5L/minute.
Stroke volume (SV) is the mount of blood rejected by the
left ventricle into the aorta per beat. The stroke volume
is determined by three factors, namely: preload,
contractility and afterload.
It is approximately 70 mls.
Baroreceptors
The baroreceptors in the carotid and
aortic bodies are pressure
sensitive structures.
Decreased BP causes a reflex SNS
response with increased pulse,
increased contractility and
vasoconstriction.
Increased BP causes reflex vagal
responces, which results in
decreased heart rate and passive
vasidilation in the systemic
arterioles. This phenomenon is
known as Marcys Law of the heart.
Chemoreceptors:
The major chemoreceptor
of the heart is the
medulla oblongata, and
special receptors are
found in the carotid and
aortic bodies.
A decreased pH or paO
level causes a reflex SNS
response that results in
tachycardia
NURSING ASSESSMENT
SUBJECTIVE DATA
1. Health History
Identifying the risk factors
HPI
Past medical history
Medications
Family History
Lifestyle
Risk Factors
HISTORY OF PRESENT
ILLNESS
MEDICATIONS
Current and past use of medications
Many cardiac drugs must be tapered off to
prevent a rebound effect.
Many drugs affect heart rate and may cause
orthostatic hypotension
Estrogen preparation may lead to
thromboembolism
FAMILY HISTORY
Ask for cardiovascular illnesses of
blood relatives
LIFESTYLE
2. Common Clinical
manifestations of
Cardiovascular Disorders
Angina Pectoris
Substernal or
5-15min
retrosternal pain
spreading across
chest; may radiate to
inside of arm, neck,
or jaw
Myocardial Infarction
MI
Occurs
spontaneousl
y but may be
sequela to
unstable
angina
Morphine
sulfate,
successful
reperfusion of
blocked
coronary
artery
Esophageal Pain
Substernal pain;
may be projected
around chest to shoulders.
560 min
anxiety
Pain over chest; may be 23 min
variable. Does not radiate.
Patient may complain of
numbness and tingling of
hands and mouth.
Stress, emotional
tachypnea
Removal of stimulus,
relaxation
2. Paroxysmal nocturnal
Sudden dyspnea at night; awakens patient with feeling of suffocation; sitting up relieves
breathlessness
severe shortness of breath usually occurs 2 to 5 hours after the onset of sleep. During
waking hours, the client usually assumes upright position most of the time. This causes
venous pooling. When the client lies recumbent during the night, the blood from the lower
extremities are distributed to the upper parts of the body and lung congestion may occur
and the client experiences difficulty of breathing.
SIGNIFICANCE:
It may be a sign of left ventricular failure or transient congestive heart
failure
SIGNIFICANCE:
Pounding, jumping sensations in chest usually due to tachydysrhythmia.
Skipped beats usually due to premature atrial or ventricular beats.
CHARACTERIZATION:
A. What activities can you perform without becoming tired?
B. What activities cause you to become tired?
C. Is the fatigue relieved by rest?
D. Is leg weakness accompanied by pain or swelling?
SIGNIFICANCE:
Fatigue is produced by low cardiac output. The heart is unable to provide sufficient
blood to meet the increased metabolic needs of cells.
As heart disease advances, fatigue is precipitated by less effort.
Weakness or tiring of the legs may be caused by peripheral arterial or venous disease.
SIGNIFICANCE:
Syncope is transient loss of consciousness due to a fall in cardiac output with resulting
cerebral ischemia. Near syncope refers to lightheadedness, dizziness, temporary confusion.
Dysrhythmias related to cardiac disease may cause syncope.
CLUBBING
CLUBBING
-Clubbing of the fingers is associated with
decreased oxygen.
In clubbing, the distal tips of the fingers
become bulbous, the nails are thickened
hard, and curved at the tip, and the nail bed
feels boggy when squeezed.
- Separation from the nail bed produces a
white, yellowish, or greenish color on the
non-adherent portion of the nail.
OBJECTIVE DATA:
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION
A. GENERAL APPEARANCE:
Dyspnea, tachypnea, use of accessory respiratory muscles,
discomfort from pain, diaphoresis, and cyanosis may all indicate
underlying cardiac disease.
PHYSICAL EXAMINATION
B. VITAL SIGNS
1. PULSE
Time for 1 full minute; note irregularity.
Compare apical and radial pulse (pulse deficit)
TYPES:
PHYSICAL EXAMINATION
B. VITAL SIGNS
2. BLOOD PRESSURE
Take pressure on both arms and note differences (5-10 mmhg
difference is normal). Difference > 10 may indicate subclavian steal
syndrome or dissecting aortic aneurysm.
Determine pulse pressure (systolic pressure minus diastolic pressure)
to evaluate cardiac output (30-40 mmHg is NORMAL; less than 30
mmHg indicates decreased cardiac output).
Note presence of pulsus alternans- loud sounds alternate with soft
sounds with each auscultatory beat (hallmark of left ventricular
failure)
Note presence of pulsus paradoxus- abnormal fall in blood pressure
during inspirations (cardiac sign of cardiac tamponade)
PHYSICAL EXAMINATION
B. VITAL SIGNS
3. ASSESS FOR POSTURAL OR ORTHOSTATIC
HYPOTENSION
Orthostatic hypotension prompt hypotension occurs with
assumption of the upright position
May be due to volume depletion, bed rest, drugs such as beta
or alpha adrenergic blockers or neurologic disease.
Note changes in heart rate and blood pressure in at least two
of three positions: lying, standing, sitting; allow at least 3
minutes between position changes before obtaining rate and
pressure.
Orthostatic changes evident if BP decreases by 15 mmHg
(systolic) or 5 mmHg diastolic and/or HR increases 15 beats
PHYSICAL EXAMINATION
C. SKIN AND EXTREMITIES
A. PALPATE FOR TEMPERATURE AND EVIDENCE OF
DIAPHORESIS
Warm/dry skin indicates adequate cardiac output.
Cool, clammy skin indicates compensatory
vasoconstriction due to low cardiac output.
B. OBSERVE FOR CYANOSIS, JAUNDICE AND FATTY SKIN
DEPOSITTS (XANTHOMAS)
1. Cyanosis
PHYSICAL EXAMINATION
C. SKIN AND EXTREMITIES
B. OBSERVE FOR CYANOSIS, JAUNDICE AND FATTY SKIN DEPOSITTS
(XANTHOMAS)
1. CYANOSIS bluish discoloration of the skin and mucous membranes
A. CENTRAL CYANOSIS
PHYSICAL EXAMINATION
C. SKIN AND EXTREMITIES
B. OBSERVE FOR CYANOSIS, JAUNDICE AND FATTY SKIN
DEPOSITTS (XANTHOMAS)
2. JAUNDICE yellow discoloration of the sclera of eyes
or skin
may be a sign of right sided heart failure or chronic
hemolysis from prosthetic heart valve
3. YELLOW PLAQUE (fatty deposits) on the skin
Associated with hyperlipidemia and coronary artery
disease
YELLOW PLAQUES
PHYSICAL EXAMINATION
C. SKIN AND EXTREMITIES
C. INSPECT THE NAIL BEDS FOR SPLINTER HEMORRHAGES
and CLUBBING
Splinter hemorrhages
Thin brown lines in nail beds associated with endocarditis
PHYSICAL EXAMINATION
C. SKIN AND EXTREMITIES
D. INSPECT AND PALPATE FOR EDEMA
Edema is an abnormal accumulation of serous fluid in soft tissues.
Location of edema is influenced by gravity fluid collects bilaterally in lower
parts of the body: sacral area (bedridden patients), ankles, and feet
(ambulatory pts) and pits with pressure (dependent-pitting edema)
Weight gain occurs before clinical evidence of edema. Edema is a late sign of
heart failure.
Describe the degree of edema in terms of depth of pitting that occurs with
slight pressure:
Mild 0 to inch, moderate- inch, severe- to 1 inch
PHYSICAL EXAMINATION
C. SKIN AND EXTREMITIES
E. PALPATE ARTERIAL PULSES
1. Examine the pulses bilaterally; peripheral pulses should be equal.
Note amplitude (fullness), which depends on pulse pressure ( difference
between systolic and diastolic pressures); this gives an estimate of stroke
volume
Small volume pulse may be from low stroke volume and peripheral
vasoconstriction (MI, shock, constrictive pericarditis, vasoconstrictive drugs)
Large volume pulse produced by large stroke volume (aortic regurgitation,
pregnancy, thyrotoxicosis, bradycardia, PDA)
Palpate carotid artery- reveals character of pulse in the proximal aorta and
provides indication of any abnormality causing disease of left ventricle.
JUGULAR VEIN
central
venous
pressure
can
be
INTERPRETATION:
Palpation
Palpating the Carotid
palpate
each
carotid
separately.
- Note rate, rhythm, amplitude,
contour, symmetry, elasticity, thrills.
Aortic Area
Pulmonic Area
Landmarks
ABNORMAL RESULTS:
Thrills are palpable vibrations created by
turbulent blood flow.
Bruit "vascular murmur is the abnormal
sound generated by turbulent flow of blood
in an artery due to either an area of partial
obstruction; or a localized high rate of blood
flow through an unobstructed artery.
Lifts or heaves are diffuse, lifting impulses.
A thrust is a rocking movement.
AUSCULTATION
HEART SOUNDS
S1 closure of mitral and tricuspid
valves
S2 closure of aortic and pulmonic
valves
Low pitched sounds S3, S4, mitral
Aortic Area
Pulmonic Area
Landmarks
ABNORMAL FINDINGS
S3 (also called a ventricular gallop) may be heard in the tricuspid and
mitral areas during the early to mid-diastole following the S2 sound.
S3 is heard well when the client is in the left lateral recumbent
position
S3 gallop (may indicate ventricular failure)
S4 (also called atrial diastolic gallop) may be heard in the tricuspid
and mitral areas during the late phase of diastole, before S1 of the
next cardiac cycle.
S4 is heard well when the client is in the supine position
S4 gallop ( present in left ventricular hypertrophy, pulmonary or aortic
stenosis and hypertension
Lungs
Abdomen
LABORATORY STUDIES
A. ENZYME and ISOENZYME TESTS
1. Creatinine Kinase (CK)
2. Lactic Dehydrogenase (LDH)
3. Aspartate Aminotransferase (AST, formerly known as
SGOT)
These enzymes are widely distributed in tissues and
elevated in condition NOT associated with MI such as
damage to the skeletal tissues, liver, brain, kidneys and
other organs.
CREATININE KINASE
Creatine kinase (CK) is an enzyme found in the
muscles
The level of the CK enzymes rises when the muscles
are damaged.
The three types of CK are called isoenzymes. They are:
CK-MM
which is found in the skeletal muscle
CK-MB
which is found in the heart and rises when heart muscle is
damaged
CK-BB
CARDIAC TROPONINS
Troponin, a complex of three contractile regulatory
proteins, troponin C, T and I, controls the calciummediated interactions between actin and myosin in
cardiac and skeletal muscles.
Troponin-I and T are specific to cardiac muscles,
unlike troponin-C which is associated with both
cardiac and skeletal muscles.
Hence, troponin-C is not used in the diagnosis of
myocardial damage.
MYOGBLOBINS
Is a protein in heart and skeletal muscles.
When muscle is damaged, myoglobin is
released into the bloodstream.
SERUM LIPIDS
ELECTROLYTES
NONINVASIVE
Electrocardiography
The most commonly used test for evaluating
cardiac status.
Graphically records the electrical current
(electrical potential) generated by the heart.
This current radiates from the heart in all
directions and, on reaching the skin, is
measured by electrodes connected to an
amplier and strip chart recorder.
The standard resting ECG uses five electrodes to
measure the electrical potential from 12
different leads; the standard limb leads (I,II,III),
the augmented limb leads (aVf, aVL, and aVr),
and the precordial, or chest, leads (V1 through
V6)
Electrocardiography
ECG tracings normally consist
of three identifiable
waveforms:
The P wave
The P wave depicts atrial
depolarization
The T wave
HOLTER MONITORING
Electrocardiography
(ECG) Procedure
Implementation
Place the patient in a supine or semi-Fowlers
position.
Expose the chest, ankles, and wrists.
Place electrodes on the inner aspect of the
wrists, on the medical aspect of the lower legs,
and on the chest.
After all electrodes are in place, connect the lead
wires.
Press the START button and input any required
information.
Make sure that all leads are represented in the
tracing. If not, determine which electrode has
come loose, reattach it, and restart the tracing.
All recording and other nearby electrical
Nursing Interventions
Disconnect the equipment, remove the
electrodes, and remove the gel with a moist
cloth towel.
If the patient is having recurrent chest pain
or if serial ECGs are ordered, leave the
electrode patches in place.
Abnormal Results
Myocardial infarction (MI), right or left
ventricular hypertrophy, arrhythmias,
right or left bundle-branch block,
ischemia, conduction defects or
pericarditis, and electrolyte abnormalities.
Abnormal wave forms during angina
episodes or during exercise.
ECHOCARDIOGRAM
Is a noninvasive
procedure based on
the principles of
ultrasound
It evaluates structural
and functional
changes in the heart
CHEST RADIOGRAPHY
Is done to determine
the size, silhouette,
and position of the
heart
Interventions: prepare
the client, explain the
procedure and remove
jewelry
Heart CT scan
A computed tomography (CT) scan of the heart is an imaging
method that uses x-rays to create detailed pictures of the heart and
its blood vessels.
A computer creates separate images of the body area, called slices.
These images can be stored, viewed on a monitor, or printed on
film.
3D or three-dimensional models of the heart can be created.
Contrast can be given through a vein (IV) in hand or forearm. If
contrast is used, pt is asked not to eat or drink anything for 4-6
hours before the test. And to inc fluid intake post procedure
MRI
Heart magnetic resonance
imaging (MRI) is an
imaging method that uses
powerful magnets and
radio waves to create
pictures of the heart.
It does not use radiation
(x-rays).
INVASIVE DIAGNOSTIC
PROCEDURE
CARDIAC CATHETERIZATION
RIGHT CARDIAC
CATHETERIZATION
LEFT CARDIAC
Preprocedure
PROCEDURE
Postprocedure
Postprocedure
Coronary angiography
Coronary angiography is a procedure that
uses a special dye (contrast material) and
x-rays to see how blood flows through the
arteries in the heart.
Coronary angiography is often done along
with cardiac catheterization.
Once the catheter is in place, dye (contrast
material) is injected into the catheter. X-ray
images are taken to see how the dye moves
through the artery. The dye helps highlight
any blockages in blood flow.
The procedure may last 30 to 60 minutes.
Nursing responsibilities
Nursing Interventions
While the marrow slides are being prepared,
apply pressure to the biopsy site until
bleeding stops.
Clean the biopsy site and apply a sterile
dressing.
Monitor the patients vital signs and the
biopsy site for signs and symptoms of
infection.
Complications
Precautions
Know that bone marrow biopsy is
contraindicated in the patient with a severe
bleeding disorder.
Send the tissue specimen or slide to the
laboratory immediately.
Hemodynamic monitoring
CVP Monitoring
When measuring CVP
it is very important
that the zero mark on
the manometer is
placed at a standard
reference point which
is called the
phlebostatic axis.
ABNORMAL RESULT:
Elevated measurement indicates an
increased in blood volume as a result of
sodium and water retention, excess IV
fluids or renal failure
ASSIGNMENT!!!
Describe the following diagnostic procedures and laboratory studies.
(Definition, procedure, normal value, significance of abnormal values, nursing
responsibilities pre,during and post procedure)
Intraarterial BP monitoring
C-Reactive Protein
Brain (B-type) Natriuretic Peptide
C-reactive Protein
Homocysteine
ESR, ASO-Titer
Torniquet Test
TREATMENT MODALITIES
Clinical Indication
1. Symptomatic bradycardia
2. Symptomatic heart block
.
3. Prophylaxis
171
Pacemaker Design
1. Pulse generator
2. leads
172
Pacemaker Design
Pulse generator
In permanent pacemaker is
encapsulated in a metal can ,to
protect the generator from
electromagnetic interference
173
Pacemaker Design
Pulse generator
Temporary pacing system generator is externally
contained in a small box
174
Pacemaker Design
Pulse generator
Transcutanus external pacing
system house the generator
in a piece of equipment
similar to portable ECG
monitor.
175
Pacemaker Design
Pacemaker lead
1. Single chamber (unipolar) pacemaker
.
177
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Pacemaker Design
2. Dual-chamber (bipolar) pacemaker
.
179
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Pacemaker function
1. Pacing function
2. Sensing function
3. Capture function
182
Pacing function
Atrial pacing:
stimulation of RT atrium produce spike
on ECG preceding P wave
183
Pacing function
Ventricle pacing :
stimulation of RT or LT ventricle produce a
spike on ECG preceding QRS complex.
184
Pacing function
AVpacing:
direct stimulation of RT atrium and either
ventricles mimic normal heart conduction
185
Sensing function
Sensing :
Ability of the cardiac pace maker
to see intrinsic cardiac activity
when it occurs.
186
Sensing function
Demand:
pacing stimulation delivered only if the heart
rate falls below the preset limit.
Fixed:
no ability to sense. constantly delivers the
preset stimulus at preset rate.
187
Capture function
Capture:
Ability of the pacemaker to
generate a response from the
heart (contraction) after
electrical stimulation.
188
Pacing types
Permanent
Temporary
biventricular
189
Types of pacing
1. Permanent pacemaker
.
190
Permanent pacemaker
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Types of pacing
2. Temporary pacemaker
.
192
Types of pacing
3. Biventricular pacemaker
.
Nursing intervention
1. Maintain adequate cardiac output
.
Nursing intervention
2. Avoid injury
.
position
Nursing intervention
3. Monitor for evidence of lead migration and
perforation of heart
.
196
Nursing intervention
4. Provide electrically safe environment
.
197
Nursing intervention
198
Nursing intervention
6. Prevent accidental pacemaker malfunctions
.
199
Nursing intervention
Place a sign over pt's bed alerting
personnel to the presence of
pacemaker.
200
Nursing intervention
7. Preventing infection
.
201
Patient education
1. Anatomy and physiology of the heart
2. Pacemaker function
3. Activity
Specific instruction include
.
202
Patient education
4. Pacemaker failure
.
203
Patient education
5. Electromagnetic interference
.
204
Patient education
Most pacemaker equipped with internal
filters to prevent interaction with cell
phone.
Tell pt that antitheft devices and airport
security alarms may affect pacemaker and
trigger security alarm.
Household and kitchen appliance will not
affect pacemaker.
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Patient education
6. Care of pacemaker site.
.
Wear loose-fitting
clothes around pacemaker
DEFIBRILLATIO
N AND
CARDIOVERSIO
N
DEFINITION
The therapeutic use of controlled
electric current over a brief period of
time.
DEFINITION
Defibrillation is the nonsynchronized delivery of energy during
any phase of the cardiac cycle.
Cardioversion is the delivery of
energy that is synchronized to the
large R waves or QRS complex.
To disrupt the
abnormal
electrical
circuits in the
heart.
CARDIOVERSION
INDICATIONS
Supra
ventricul
ar
tachycar
dia
Atrial
fibrillati
on
Atrial
flutter
Ventricul
ar
tachycar
dia
CONTRAINDICATIONS
Dysrhythmias due to enhanced automaticity
(digitalis toxicity and catecholamine-induced
arrhythmia)
Multifocal atrial tachycardia
DEFIBRILLATION
INDICATIONS
Pulseless ventricular
tachycardia (VT)
Ventricular fibrillation(VF)
CONTRAINDICATIONS
Awake, responsive patients
TYPES OF DEFIBRILLATOR
ELECTRODES
Spoon shaped
Paddle type
Pad type
SIZE OF PADDLES
Adult size (10-13cm diameter)
Pediatric size ( 4.5 cm diameter) for
patient weight < 10 kg.
Children > 10 kg 8 cm.
Contd
SIZE OF PADDLES
Small paddles concentrate current, burns
heart.
Large paddles reduces current density.
In pediatric patient ensure 3 cm distance
between pads.
PADDLE PLACEMENT
ANTEROLATERAL
ANTEROPOSTERIOR
PROCEDU
RE
EQUIPMENTS
Defibrillators with paddle or adhesive
patch
Conductive gel
Crash Cart with emergency drugs
Sedatives
Intubation set
PROCEDURE
COMPLICATIONS
Arrhythmias (premature beats)
Ventricular Fibrillation
Thromboembolization
Myocardial necrosis
Pulmonary edema
Skin burns
DESCRIPTION
One or more arteries are dilated with a
balloon catheter to open the vessel
lumen and improve arterial blood flow
The client can experience reocclusion
after the procedure, thus the procedure
may need to be repeated
PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY (PTCA)
DESCRIPTION
Complications can include arterial
dissection or rupture, immobilization of
plaque fragments, spasm, and acute
myocardial infarction (MI)
Firm commitment is needed on the clients
part to stop smoking, lose weight, alter
exercise pattern, and stop any behaviors
that lead to progression of artery occlusion
From Mosbys Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
PREPROCEDURE
Maintain NPO status after midnight
Prepare the groin area with antiseptic
soap and shave per institutional
procedure and as prescribed
Assess baseline VS and peripheral
pulses
PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY (PTCA)
POSTPROCEDURE
Monitor VS closely
Assess distal pulses in both extremities
Maintain bed rest as prescribed, keeping
the limb straight for 6 to 8 hours
Administer anticoagulants and
antiplatelets as prescribed to prevent
thrombus formation
POSTPROCEDURE
Monitor IV nitroglycerin that may be prescribed
to prevent coronary artery spasm
Instruct the client in the administration of
nitrates, calcium channel blockers, antiplatelet
agents, and anticoagulants as prescribed
Instruct the client to take daily aspirin
permanently if prescribed
Assist the client with planning lifestyle
modifications
ATHERECTOMY
DESCRIPTION
Removes plaque from an artery by the use of a cutting
chamber on the inserted catheter or a rotating blade that
pulverizes the plaque
Used to improve blood flow to ischemic limbs in individuals
with peripheral arterial disease
POSTPROCEDURE
Monitor for complications of perforation, embolus, and
reocclusion
ATHERECTOMY
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3, St. Louis: Mosby.
DESCRIPTION
The occluded coronary arteries are bypassed with the
clients own venous or arterial blood vessels
The saphenous vein, radial artery, or internal mammary
artery is used to bypass lesions in the coronary arteries
Performed when the client does not respond to medical
management of coronary artery disease (CAD) or when
disease progression is evident
END