Nursing role in cardiac catheterization (2nd part ) بالانجليزية
The nurse plays a vital role before, during, and after cardiac catheterization procedure. Pre catheterization interventions involve completing assessments, obtaining informed consent, documentation, and adjusting care plans based on patient changes. To provide the best possible outcomes, discharge planning and patient education should be included in the care plan. Addressing the patient's physical, psychological, and social needs are also important. It is critical that the nurse informs the patient and their family about the procedure, risks and benefits, and alleviating anxiety for both the patient and their family. Additionally, reassure the patient that the entire process, which includes preparation before the catheterization and after-care, may take up to 4 hours.
Pre-procedure fasting, and either withholding or decreasing the dosages of scheduled medications (including insulin, antihypertensive drugs, and diuretics) may be necessary. Patients should be given oral antiplatelet drugs to reduce thrombotic issues before, during, and after surgery. Preparing the insertion site, following strict aseptic technique and proper wound care to prevent infections are vital. Two peripheral venous access sites should be established, IV fluids administered as necessary, and various lab tests, X-rays, and an ECG should be obtained. Also, pulse assessment and urine voiding before the procedure are recommended, and analgesics and sedatives should be given as directed by the physician.
The nurse's role during the procedure is to inform the patient of what to expect, including receiving intravenous medication for anxiety and pain, being in a cool, dimly lit room, being connected to monitoring equipment for continuous heart, blood pressure, and pulse oximeter monitoring, remaining conscious throughout the procedure, and being asked to cough or take deep breaths at times. Patients are advised to report any abnormal symptoms promptly, such as chest pain or difficulty breathing. After the contrast media is injected into the left ventricle, the patient may feel warm or flushed for up to a minute.
Another nurse role is to promote the patient's comfort and safety while collaborating with the cardiologist for a successful treatment. The ECG, arterial pressure, signs and symptoms of contrast sensitivity, symptoms of ischemia or chest discomfort, and any significant changes that may take place during medication administration are all noted by nurses. They are prepared for any situation and alert the doctor to any changes in the patient's health.
After catheterization, the catheter is removed and any bleeding is controlled either by applying direct pressure or by using a vascular closure device. The patient will then be regularly checked and supervised in a designated recovery area for postcardiac catheterization. This involves monitoring the patient's vital signs, observing the catheter site for complications, and managing chest pain. Ensuring the patient rested with the affected limb immobilized to prevent any significant bleeding and allow the artery to heal. As well, checking the circulation of the affected limb regularly (by examining the capillary refill, peripheral skin temperature, colour, and the existence of peripheral pulses every 15 minutes for the first 4 times, every 30 minutes for the next 2 times, and then every hour for 2 times, before going back to a routine schedule). If there is any change in the patient's neurovascular status, the physician should be informed immediately. Nurses also administer medications as needed, and monitor fluid intake and output, monitor the patient for nausea or pain (such as back pain from being still). Once the patient is fully awake, encourage the patient to drink at least two litres of fluid during the first 12 hours post cardiac Cath unless contraindicated.
It is important to go over the discharge instructions with the patient and their family, explaining how to care for the catheter insertion site, take medication, eat properly, and follow activity guidelines during their recovery period. This helps in improving the quality of life and may reduce mortality. They should also be given advice on potential complications such as heart attack, stroke, or infection at the insertion site. If necessary, let the patient know that they may need to have their blood urea nitrogen and creatinine levels monitored after being discharged. Lastly, instruct the patient to have a follow-up appointment with their healthcare provider.
References
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