|
 |




  
 
m
|  
  
|


m 

m| 
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
m
|  
  
|


m 

m| 
DESCRIPTION
± Complications can include arterial
dissection or rupture, immobilization of
plaque fragments, spasm, and acute
myocardial infarction (MI)
± Firm commitment is needed on the
client¶s part to stop smoking, lose
weight, alter exercise pattern, and stop
any behaviors that lead to progression
of artery occlusion






|


From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for

clinical practice, ed 2, Philadelphia: W.B. Saunders
m
|  
  
|


m 

m| 

From Mosby¶s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
m
|  
  
|


m 

m| 
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
m
|  
  
|


m 

m| 
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
 m
|  
  
|


m 

m| 
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
  


 
m 

DESCRIPTION
± A laser probe is advanced through a
cannula similar to that used for PTCA
± Also used in clients with small
occlusions in the distal superficial
femoral, proximal popliteal, and
common iliac arteries
± Heat from the laser vaporizes the
plaque to open the occluded artery
  


 
m 

PREPROCEDURE AND
POSTPROCEDURE CARE
± Similar to the PTCA
± Monitor for complications of coronary
dissection, acute occlusion, perforation,
embolism, and MI
 |







DESCRIPTION
± Used instead of PTCA to eliminate the
risk of acute coronary vessel closure
and to improve long-
long-term patency of
the vessel
± A balloon catheter bearing the stent is
inserted into the coronary artery and
positioned at the site of occlusion
± When placed in the coronary artery, the
stent reopens the blocked artery
|








From Monahan FD, Neighbers M: u


 

 
  , ed. 2, Philadelphia, 1998, W.B. Saunders.
 |







POSTPROCEDURE
± Acute thrombosis is a major concern
following the procedure, and the client
is placed on antiplatelet and
anticoagulation therapy for several
months following the procedure
± Monitor for complications of the
procedure, such as stent migration or
occlusion, coronary artery dissection,
and bleeding due to anticoagulation
 
|

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
 
|

From Beare PG, Myers JL (1998): Y
  

, ed. 3, St. Louis: Mosby.
 

|
 

 |
 
Used for clients with widespread
atherosclerosis involving vessels that
are too small and numerous for
replacement or balloon
catheterization
Uses a high-
high-powered laser that
creates 15 to 30 holes (channels) in
the heart; blood enters these small
channels providing the affected
region of the heart with oxygenated
blood
Performed through a small chest


 

 |
 
DESCRIPTION
± Performed to increase arterial blood flow
to the affected limb
± Inflow procedures involve bypassing the
arterial occlusion above the superficial
femoral arteries
± Outflow procedures involve bypassing
the arterial occlusions at or below the
superficial femoral arteries
± Graft material is sutured above and
below the occlusion to facilitate blood
flow around the occlusion


 

 |
 
PREOPERATIVE
± Assess baseline VS and peripheral
pulses
± Insert an IV and urinary catheter as
prescribed
± Maintain central venous catheter and or
arterial line if inserted


 

 |
 
POSTOPERATIVE
± Assess VS
± Monitor the blood pressure and notify
the physician if changes occur
± Monitor for hypotension, which may
indicate hypovolemia
± Monitor for hypertension, which may
place stress on the graft and facilitate
clot formation
± Maintain bed rest for 24 hours as
prescribed


 

 |
 
POSTOPERATIVE
± Instruct the client to keep affected
extremity straight, limit movement, and
avoid bending the knee and hip
± Monitor for warmth, redness, and
edema, which are often expected
outcomes due to increased blood flow
± Monitor for graft occlusion, which often
occurs within the first 24 hours
± Assess peripheral pulses and for
adverse changes in color and
temperature of the extremity


 

 |
 
POSTOPERATIVE
± Monitor for a sharp increase in pain,
since pain is frequently the first
indicator of postoperative graft
occlusion
± If signs of graft occlusion occur, notify
the physician immediately
± Encourage coughing and deep breathing
and the use of incentive spirometry
± Maintain NPO status with progression to
clear liquids as prescribed
± Use strict aseptic technique when in
contact with the incision


 

 |
 
POSTOPERATIVE
± Assess the incision for drainage,
warmth, or swelling
± Monitor for excessive bleeding (a small
amount of bloody drainage is expected)
± Monitor the area over the graft for
hardness, tenderness, and warmth,
which may indicate infection; if this
occurs, notify the physician immediately


 

 |
 
POSTOPERATIVE
± Instruct the client about proper foot
care and measures to prevent ulcer
formation
± Instruct the client to take medications
as prescribed
± Instruct the client how to care for the
incision
± Assist the client in modifying lifestyle to
prevent further plaque formation
 |







m  
 | 
DESCRIPTION
± The occluded coronary arteries are
bypassed with the client¶s 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
 |







m  
 | 

From Lewis SM, Heitkemper M, Dirksen S: u


 
Y  

u
    (5th ed), St. Louis, 2000, Mosby.
|






m 

 | 
PREOPERATIVE
± Familiarize the client and family with the
cardiac surgical critical care unit
± Instruct the client how to splint the
chest incision, cough and deep breathe,
and perform arm and leg exercises
± Instruct the client to inform the nurse of
any postoperative pain, as pain
medication will be available
|






m 

 | 
PREOPERATIVE
± Inform the client to expect a sternal
incision, possible arm or leg incision(s),
one or two chest tubes, a Foley
catheter, and several IV fluid catheters
± Inform the client that an endotracheal
(ET) tube will be in place and connected
to a ventilator for 6 to 24 hours
± Advise the client to breathe with the
ventilator and not fight it
|






m 

 | 
PREOPERATIVE
± Inform the family that the client will not
be able to talk while the ET tube is in
place
± Note that prescribed medications are to
be discontinued preoperatively
(diuretics 2 to 3 days prior to surgery,
digitalis 12 hours prior to surgery, and
aspirin and anticoagulants 1 week prior
to surgery)
|






m 

 | 
PREOPERATIVE
± Administer medications as prescribed,
which may include potassium chloride,
antihypertensives, antidysrhythmics,
and antibiotics
± Encourage the client and family to
discuss anxieties and fears related to
surgery
|






m 

 | 
CARDIAC SURGICAL UNIT
± Maintain mechanical ventilation for 6 to
24 hours as prescribed
± Monitor heart rate and rhythm,
pulmonary artery and arterial pressures,
and neurological status
± Monitor mediastinal and pericardial
tubes and water seal drainage system,
and report drainage exceeding 100 to
150 ml per hour
|






m 

 | 
CARDIAC SURGICAL UNIT
± Ground epicardial pacer wires
± Assess fluid and electrolyte balance
± Restrict fluids as prescribed to 1500 to
2000 ml because the client usually has
edema
± Monitor for hypotension, which can
cause collapse of a vein graft
|






m 

 | 
CARDIAC SURGICAL UNIT
± Monitor for hypertension because
increased pressure promotes leakage
from the suture line and may cause
bleeding
± Monitor the temperature and initiate
rewarming procedures using warm or
thermal blankets if the temperature
drops below 96.8
96.8 F; rewarm the client
no faster than 1.8
1.8 F per hour to
prevent shivering, and discontinue when
the temperature approaches 98.6
98.6 F
|






m 

 | 
CARDIAC SURGICAL UNIT
± Administer potassium IV as prescribed
to maintain the potassium level between
4 and 5 mEq/L to prevent dysrhythmias
± Monitor for signs of cardiac tamponade,
which will include sudden cessation of
previously heavy mediastinal drainage,
jugular vein distention with clear lung
sounds, and pulsus paradoxus
± Monitor pain, differentiating sternotomy
pain from anginal pain, which would
indicate graft failure
|






m 

 | 

TRANSFER FROM THE CARDIAC

SURGICAL UNIT
± Monitor VS, level of consciousness
(LOC), and peripheral perfusion
± Monitor for dysrhythmias
± Auscultate lungs and assess
respiratory status
± Encourage the client to splint the
incision, cough and deep breathe, and
use an incentive spirometer to raise
secretions and prevent atelectasis
|






m 

 | 

TRANSFER FROM THE CARDIAC

SURGICAL UNIT
± Monitor temperature and WBC count,
which if elevated after 3 to 4 days,
indicates infection
± Provide adequate fluids and hydration
as prescribed to liquefy secretions
± Assess suture line and chest tube
insertion sites for redness, purulent
discharge, and signs of infection
|






m 

 | 

TRANSFER FROM THE CARDIAC

SURGICAL UNIT
± Assess sternal suture line for
instability, which may indicate an
infection
± Guide the client to gradually resume
activity
± Assess the client for tachycardia;
orthostatic hypotension; and fatigue
before, during, and after activity
± Discontinue activities if the BP drops
more that 10 to 20 mmHg or if the
HOME CARE INSTRUCTIONS FOLLOWING
CARDIAC SURGERY
Progression with activities at home
Limit pushing or pulling activities for
6 weeks following discharge
Incisional care and to record signs of
redness, swelling, or drainage
Sternotomy incision heals in about 6
to 8 weeks
Avoid crossing legs, wear elastic
hose as prescribed until edema
subsides, and elevate surgical limb
when sitting in a chair
  |
 
|
 |
 |



Use of prescribed medications

Dietary measures including the avoidance
of saturated fats and cholesterol and the
use of salt
Sexual intercourse can be resumed on the
advice of the physician after exercise
tolerance is assessed; if the client can
walk one block or climb two flights of
stairs without symptoms, they can safely
resume sexual activity