Ateneo de Zamboanga University

College of Nursing
NURSING SKILLS OUTPUT (NSO)
Report No. 7
Angiography
DSCRIPTION!
Using X-ray or Ultrasound images to guide the procedure, the Vascular
Angiography!"#nterventional Radiologist inserts thin tubes catheters! and other tiny
instruments through the blood vessels and other path$ays o% the body to diagnose and treat
a $ide variety o% conditions that previously re&uired surgery. 'any o% the procedures can
be done on an outpatient basis through day medicine or day surgery. (he procedures listed
in this section o% our $eb site can be done on an outpatient basis $ithout any signi%icant
complications.
"ATRIALS#$UIP"NTS NDD!
PROCDUR!
).! *+plain the procedure to the client.
,.! -ou $ill be given a mild sedative to help you rela+.
..! -ou $ill be ta/en into the 01ath 2ab3 on a trolley, and then moved onto the Xray
table.
4.! -ou $ill have electrodes placed on your chest. -our groin $ill be s$abbed $ith
antiseptic and then your body covered $ith drapes.
5.! -our cardiologist $ill in6ect your groin $ith Xylocaine. (his $ill numb the area.
-our cardiologist $ill then insert a small catheter into your blood vessels.
7.! -our cardiologist $ill guide the catheter, via the blood vessels, to the heart.
(here $ill be several in6ections o% the dye via the catheter. (he catheter may be
moved around during the procedure in order to get di%%erent vie$s o% your heart
local anaesthetic,
thin tube
dye
(issue
X-ray %ilm
catheter
and coronary arteries. #t is normal to %eel %lushed all over the body $hen dye is
in6ected.
7.! 8uring the catheterisation procedure you may be as/ed to breathe deeply and
cough. -ou $ill be able to communicate $ith -our cardiologist through the
procedure, ho$ever, due to the nature o% the sedative, you may not recall much
o% $hat has occurred. -ou can e+pect this procedure to last up to an hour.
Diagra%# Illus&ra&ion


NURSING RSPONSI'ILITIS
()) '*OR PROCDUR
8rin/ only clear %luids a%ter a normal supper the evening be%ore your procedure. (his
may include co%%ee, tea, 6uice, 9ell-:, clear soups. No dairy products please.
(a/e all your regular medications $ith $ater as ordered by your doctor.
;ring all your medications, and respective dosages o% these medications, $ith you on
the morning o% your procedure. #% you are on medications %or diabetes as/ your %amily
doctor about the need to stop these medications.
-ou must not be ta/ing any anticoagulants <blood thinners<! be%ore your angiogram. #%
you ta/e these medications they must be stopped $ell be%ore your procedure, please
consult $ith your doctor about these medications.
Report to the Admitting 8epartment o% =as/atoon 1ity >ospital and =t. ?aul@s >ospital
.A minutes prior to your scheduled appointment to register. At Royal University >ospital,
please report 7A minutes be%ore your scheduled appointment. A%ter registration please
report to the Reception des/ o% the 'edical #maging 8epartment $ith your admission
papers.
-ou must be accompanied by an adult $ho $ill transport you to and %rom the hospital
-ou must arrange to spend the night a%ter your angiogram or biopsy in the company o%
an adult $ho can transport you to the >ospital $ithin )5 minutes i% a delayed
complication o% the procedure occurs. ?atients $ho have a venous access procedure
may return home.
?atients should e+pect a t$o to si+ hour supervised recovery period a%ter their procedure
is completed. (his is standard practice and is in the interest o% patient sa%ety and
com%ort.
+)) DURING T, PROCDUR
8uring the catheterisation procedure you may be as/ed to breathe deeply and cough.
-ou $ill be able to communicate $ith -our cardiologist through the procedure, ho$ever,
due to the nature o% the sedative, you may not recall much o% $hat has occurred. -ou
can e+pect this procedure to last up to an hour.
-)) A*TR T, PROCDUR
-ou must stay in the company o% a responsible adult $ithin )5 minutes o% the
hospital on the night %ollo$ing your angiogram. ?lease /eep in mind that 1ity
>ospital *mergency 8epartment closes at BC.A p.m.
A responsible adult must drive you %rom the hospital to your accommodations.
?lan to spend the night %ollo$ing your e+am resting &uietly. Any type o% physical
activity is discouraged. Return to normal activity the day a%ter the angiogram.
Avoid heavy li%ting or strenuous labour %or t$o to three days a%ter your test.
*at and drin/ normally. #ncreased %luid inta/e is recommended.
(a/e all your normal medications as ordered by your doctor. -ou may ta/e (ylenol
or Aspirin %or any pain or discom%ort you may e+perience.
#% bleeding occurs $here the catheter $as inserted, apply direct pressure to the
bleeding. Return immediately to the *mergency 8epartment o% Royal University
>ospital or 1ity >ospital i% you have di%%iculty in stopping the bleeding. ;ring this
instruction sheet $ith you.
#% your %oot becomes cold, numb, or pain%ul a%ter discharge, return to the *mergency
8epartment immediately. ;ring this instruction sheet $ith you.
#% a complication arises and you do not /no$ $hat to do, report to the *mergency
8epartment $ith this instruction sheet.
?atients should e+pect a t$o to si+ hour supervised recovery period a%ter their
procedure is completed. (his is standard practice and is in the interest o% patient
sa%ety and com%ort.
Referen.es!
httpC""$$$.nhs.u/"1onditions"Angiography"?ages">o$-is-it-per%ormed.asp+
httpC""$$$.christopher%lood.com.au"procedurese+plained"coronaryDangiograms.html
httpC""$$$.sas/atoonhealthregion.ca"yourDhealth"tpDangioDpostDangio.htm
Ateneo de Zamboanga University
College of Nursing
NURSING SKILLS OUTPUT (NSO)
Report No. B
'ariu% S/allo/
DSCRIPTION!
A barium s$allo$ is a radiographic X-ray! e+amination o% the upper gastrointestinal
E#! tract, speci%ically the pharyn+ bac/ o% mouth and throat! and the esophagus a hollo$
tube o% muscle e+tending %rom belo$ the tongue to the stomach!. (he pharyn+ and
esophagus are made visible on X-ray %ilm by a li&uid suspension called barium sul%ate
barium!. ;arium highlights certain areas in the body to create a clearer picture. A barium
s$allo$ may be per%ormed separately or as part o% an upper gastrointestinal UE#! series,
$hich evaluates the esophagus, stomach, and duodenum %irst part o% the small intestine!.
"ATRIALS#$UIP"NTS NDD!
=mall video screen
;arium
X ray %ilm
(V monitor
PROCDUR!
).! *+plain the procedure to the patient
,.! -ou may be as/ed to sign a consent %orm that gives your permission to do
the procedure. Read the %orm care%ully and as/ &uestions i% something is not
clear.
..! -ou3ll be as/ed to remove any clothing, 6e$elry, or other ob6ects that may
inter%ere $ith the procedure.
4.! #% you3re as/ed to remove clothing, you3ll be given a go$n to $ear.
5.! -ou3ll be positioned on an X-ray table that can tilt you %rom a horiFontal to an
upright position. -ou may also be as/ed to change positions %or e+ample,
lying on your side, bac/, or stomach! at intervals during the procedure.
7.! =tandard X-rays o% the heart, lung, and abdomen may be per%ormed %irst.
7.! (he radiologist $ill as/ you to ta/e a s$allo$ o% a thic/ened barium drin/.
(he barium is usually %lavored, although it may not be very pleasant tasting.
B.! As you s$allo$ the barium, the radiologist $ill ta/e single pictures, a series o%
X-rays, or a video %luoroscopy! to observe the barium moving through the
pharyn+.
G.! -ou may be as/ed to hold your breath at certain times during the procedure.
)A.! -ou $ill be given a thinner barium drin/ to s$allo$. X-rays and"or
%luoroscopy $ill be used to observe the barium3s passage do$n the
esophagus. -ou may also be as/ed to s$allo$ a barium tabletHa small,
solid pill, $hich can help to visualiFe certain structural problems o% the
esophagus.
)).! #% an additional procedure called a small bo$el %ollo$-through has been
re&uested, it $ill be per%ormed a%ter t :nce all re&uired X-rays have been
ta/en, you3ll be assisted %rom the table.
),.! >e barium s$allo$ has been completed.
Diagra%# Illus&ra&ion



NURSING RSPONSI'ILITIS
()) '*OR PROCDUR
-our physician $ill e+plain the procedure to you and o%%er you the opportunity to
as/ any &uestions that you might have about the procedure.
-ou may be as/ed to sign a consent %orm that gives your permission to do the
procedure. Read the %orm care%ully and as/ &uestions i% something is not clear.
-ou3ll be as/ed to not eat or drin/ li&uids %or eight hours be%ore the procedure,
generally a%ter midnight.
#% you3re pregnant or suspect that you may be pregnant, you should noti%y your
physician.
Noti%y your physician i% you3re sensitive to or are allergic to any medications, late+,
tape, and anesthetic agents local and general!.
Noti%y your physician o% all medications prescribed and over the counter! and
herbal supplements that you3re ta/ing. -our physician may advise you to $ithhold
certain medications prior to the procedure.
Noti%y the radiologist i% you3ve had a recent barium X-ray or cholangiography
procedure, as this may inter%ere $ith obtaining an optimal X-ray e+posure o% the
upper E# area.
;ased upon your medical condition, your physician may re&uest other speci%ic
preparation.
+)) DURING T, PROCDUR
-ou may be as/ed to hold your breath at certain times during the procedure.
-ou $ill be given a thinner barium drin/ to s$allo$. X-rays and"or %luoroscopy $ill
be used to observe the barium3s passage do$n the esophagus. -ou may also be
as/ed to s$allo$ a barium tabletHa small, solid pill, $hich can help to visualiFe
certain structural problems o% the esophagus.
#% an additional procedure called a small bo$el %ollo$-through has been re&uested,
it $ill be per%ormed a%ter the barium s$allo$ has been completed.
:nce all re&uired X-rays have been ta/en, you3ll be assisted %rom the table.
-)) A*TR T, PROCDUR
-ou may resume your normal diet and activities a%ter a barium s$allo$, unless your
physician advises you di%%erently.
;arium may cause constipation or possible impaction a%ter the procedure i% it isn3t
completely eliminated %rom your body. -ou may be advised to drin/ plenty o% %luids and
eat %oods high in %iber to e+pel the barium %rom the body. -ou may also be given a
cathartic or la+ative to help e+pel the barium.
=ince barium isn3t absorbed into the body but passes through the entire intestinal tract,
your bo$el movements may be lighter in color until all o% the barium has been e+creted.
Noti%y your physician to report any o% the %ollo$ingC
8i%%iculty $ith bo$el movements or inability to have a bo$el movement
?ain and"or distention o% the abdomen
=tools that are smaller in diameter than normal
-our physician may give you additional or alternate instructions a%ter the procedure,
depending on your particular situation.
Referen.es!
httpC""$$$.drugs.com"cg"barium-s$allo$-precare.html
httpC""$$$.hop/insmedicine.org"healthlibrary"testDprocedures"gastroenterology"bariumDs$allo$
DG,,?A77BB"
httpC""$$$.medicalhealthtests.com"barium-s$allo$.html
Ateneo de Zamboanga University
College of Nursing
NURSING SKILLS OUTPUT (NSO)
Report No. G
Defi0rilla&ion
DSCRIPTION!
8e%ibrillation is achieved by delivering a strong electric current though electrodes
placed on the sur%ace o% a patient@s chest $all. ?roper electrode placement ensures that
the a+is o% the heart is directly situated bet$een the sources o% current de%ibrillator
paddles!. =ince dysrhythmias are chaotic $ith no coordinated ventricular response, the
electric current is delivered randomly. #t is through implementation o% emergent
de%ibrillation that ventricular %ibrillation and pulseless ventricular tachycardia can be
terminated and cardiac output restored.
"ATRIALS#$UIP"NTS NDD!
8e%ibrillator
1onductive medium- de%ibrillator pads
1ardiac monitor $ith recorder
*mergency cart and medications
*mergency pacing e&uipment
PROCDUR!
). Veri%y V-%ib or V-tach by *1E and correlate $ith clinical state. Assess to
determine absence o% pulse. 1all %or help and per%orm 1?R until de%ibrillator and
crash cart arrives.
,. ?repare %or de%ibrillation
a. (urn po$er <:N<. 8e%aults to ,AA 6oules.
b. =elect correct paddles- adult, pediatric or internal.
c. ?repare patient and"or paddles $ith proper conductive agent.
d. 1hec/s that de%ibrillator is in asynchronous mode.
111 #% other than ,AA 6oules desired, press <*N*RE- =*2*1(< and select
desired amount
.. (urn on *1E recorder %or continuous printout.
4. ?laces one paddle at the heart@s Ape+ 6ust le%t o% the nipple in mida+illary line.
?lace the other paddle 6ust belo$ the right clavicle to the right o% the sternum,
applying ,5 lbs. " s&uare inch pressure to paddles.
5. 111?ress <1>ARE*< on de%ibrillator %ront panel or on the Ape+ paddle. Iait until
indicator stops %lashing to indicate %ully charged.
7. 111=tate <A22 12*AR< and visually chec/ that all personnel are clear o% contact
$ith bed, patient and e&uipment.
7. 1111hec/s rhythm immediately be%ore discharge.
B. B. 8epress both buttons simultaneously and maintain pressure until electrical
current delivered. 'aintain ,5 lbs"in,!
G. 111Assess conversion o% dysrhythmia.
)A. )A. #% %irst de%ibrillation unsuccess%ul, immediately charge paddles to .AA 6oules
and repeat steps , through G.
)). #% second de%ibrillation unsuccess%ul, immediately charge paddles to .7A 6oules
and repeat steps , through G.
),. #% third attempt is unsuccess%ul, continue 1?R, initiate A12= protocols, intubate
and obtain #V access. Assess patient status and precipitating %actors to prevent
%urther decompensation o% patient.
).. 1lean de%ibrillator and paddles, discard supplies, and $ash hands.
)4. 8ocuments procedure in patient record or cardiac arrest %lo$sheet.
Diagra%# Illus&ra&ion





NURSING RSPONSI'ILITIS
()) '*OR PROCDUR
;e%ore starting the de%ibrillation, patient@s pulse and electrocardiogram should be
monitored. (o treat the possible cause o% abnormal heart rhythm medications can be
administered. 8e%ibrillation continues until the patient@s condition stabilises or the
procedure is ordered to be discontinued.
*arlier, large-siFed de%ibrillators $ere used in ambulances and hospitals. ;ut these days
smaller, lighter, less e+pensive and easy-to-use de%ibrillators are available. (hey are
computerised and provide verbal instructions to the operator and deliver shoc/ to patient
$hose heart is not %ibrillating.
+)) DURING T, PROCDUR
'ay be mista/en %or arti%act or leads may be o%%.
Asses situation. #% a second person is getting the de%ibrillator, establish an
air$ay and begin 1?R.
a. 1onvert to pediatric siFe %or children or internal i% the patient is has an
open chest.
b. *nhances electrical conduction through subcutaneous tissue and assists
in minimiFing burns.
c. 2imit to paddle area.Use , 6oules"/g %or children.
d. Iill not %ire i% it is in synchronous mode due to absence o% R $ave
*stablishes a visual recording and a permanent record o% current *1E status
and response to intervention.
8e%ibrillation s achieved by passing an electric current through cardiac
muscle mass to restore a single source o% impulse generation. 8ecreases
transthoracic resistance and improves %lo$ o% current across a+is o% heart.
(his $ill charge unit $ith current.
'aintains sa%ety to caregivers, since electric current can be conducted %rom
the patient to another individual i% contact occurs.
*1E rhythm may change, ensure it is a rhythm that re&uires de%ibrillation.
?remature release may result in %ailure to discharge energy. 'ay also be
delivered by depressing discharge button on the de%ibrillator.
#% rhythm has converted, must reassess.
#mmediate action increases chance %or success%ul depolariFation o% cardiac
muscle. (ransthoracic resistance decreases by appro+imately B J $ith the
second shoc/.
#mmediate action increase chance o% success%ul depolariFation o% cardiac
muscle. <=tac/ed shoc/s< se&uence is more important than ad6unctive drug
therapy and delays bet$een shoc/s to deliver medications are detrimental.
Necessary to maintain the delivery o% o+ygenated blood to vital organs.
1onductive gel accumulated on de%ib paddles impedes sur%ace contact and
increases transthoracic resistance.
?rovides %or completion o% medical" nursing records.
-)) A*TR T, PROCDUR
Neurologic status. Reorient to person, place, and time.
Respiratory status. Auscultate lung sounds, 'onitor rate, depth, K &uality o%
breathing. :+ygen as ordered.
1ardiovascular status. Eet ),-lead *1E and continue to monitor rhythm and
blood pressure, pulse and respirations %re&uently until stable.
#nitiate #V antidysrhythmic therapy.
'onitor %or burns. (reat i% indicated.
8ocumentation. #nclude neurologic, respiratory and cardiovascular
assessment be%ore and a%ter de%ibrillation. All code related in%ormation should
be completed on the code summary %lo$sheet.
?atient"%amily education. Assess understanding o% past, current and %uture
needs.
Referen.e! httpC""$$$.mdhil.com"an-introduction-to-de%ibrillation-procedure-a%tercare-ris/s"
httpC""micunursing.com"de%ib.htm
Ateneo de Zamboanga University
College of Nursing
NURSING SKILLS OUTPUT (NSO)
Report No. ))
Pa.e%a2er I%plan&
DSCRIPTION!
A pacema/er is a device that sends small electrical impulses to the heart muscle
to maintain a suitable heart rate or to stimulate the lo$er chambers o% the heart
ventricles!. A pacema/er may also be used to treat %ainting spells syncope!, congestive
heart %ailure and hypertrophic cardiomyopathy.
"ATRIALS#$UIP"NTS NDD!
PROCDUR!
).! A small incision, appro+imately , inches long $ill be made in the upper chest
,.! :ne or t$o leads thin insulated $ires! $ill be guided through a vein into the
heart
..! (he doctor $ill then connect the leads! to your pacema/er and program the
device %or your medical needs
4.! (hen the pacema/er $ill be inserted beneath your s/in, and the incision in your
chest $ill be closed
5.! -our doctor $ill test the pacema/er to ensure it is $or/ing properly to meet
your medical needs
:ne or t$o leads thin insulated $ires! 2ocal Anaesthetic
pacema/er
=pecial soap
=terile drapes
=o%t strap
*lectrocardiogram or *LE
8e%ibrillator"pacema/er"cardioverter
O3i%e&er %oni&or
Diagra%# Illus&ra&ion





NURSING RSPONSI'ILITIS
()) '*OR PROCDUR
-our doctor may also as/ you to stop ta/ing other medications, such as those that
control your heart rate.
As/ your doctor $hich medications you should stop ta/ing and $hen to stop ta/ing them.
*at a normal meal the evening be%ore your procedure.
Remove all ma/eup and nail polish.
Iear com%ortable clothes $hen you come to the hospital. -ou $ill change into a hospital
go$n %or the procedure.
?lease leave all 6e$elry including $edding rings!, $atches and valuables at home. (he
clothing you are $earing that morning $ill be returned to the person $ho accompanies
you.
+)) DURING T, PROCDUR
An antibiotic $ill be given through the #V at the beginning o% the procedure.
(he le%t or right side o% your chest $ill be shaved
A special soap $ill be used to cleanse the area
=terile drapes are used to cover you %rom your nec/ to your %eet
A so%t strap $ill be placed across your $aist and arms to prevent your hands %rom
coming in contact $ith the sterile area
A medication $ill be given through your #V to rela+ you and ma/e you %eel dro$sy, but
you $ill not be asleep during the procedure.
(he nurse $ill connect you to several monitors that allo$ the health care team to chec/
your heart rhythm and blood pressure during the procedure. (he nurse continually
monitors you during the procedure.
-)) A*TR T, PROCDUR
-ou $ill be admitted to the hospital and stay overnight a%ter the procedure. Usually you
$ill be able to go home the day a%ter your pacema/er $as implanted.
#n your hospital room, a special monitor, called a telemetry monitor, $ill continually
monitor your heart rhythm. (he telemetry monitor consists o% a small bo+ connected by
$ires to your chest $ith stic/y electrode patches. (he bo+ displays your heart rhythm on
several monitors in the nursing unit. (he nurses $ill be able to observe your heart rate
and rhythm.
-ou $ill also have a holter monitor, a small recorder attached to your chest $ith stic/y
electrode patches. (he holter monitor records your heart rhythm %or ), hours to ensure
that the pacema/er is %unctioning properly.
A chest X-ray $ill be done a%ter the pacema/er implant to chec/ your lungs as $ell as
the position o% the pacema/er and leads!. ;e%ore you are discharged, the holter monitor
$ill be removed, and the results $ill be given to your doctor. -ou $ill then go to the
8evice 1linic.
-ou may %eel discom%ort at the pacema/er implant site during the %irst 4B hours a%ter the
procedure. (he doctor $ill tell you $hat medications you can ta/e %or pain relie%. ?lease
tell your doctor or nurse i% your symptoms are prolonged or severe.
-our doctor $ill discuss the results o% the procedure and ans$er any &uestions you
have.
-ou $ill receive speci%ic instructions about ho$ to care %or yoursel% a%ter the procedure
including medication guidelines, $ound care, activity guidelines, pacema/er care and
maintenance, and a %ollo$-up schedule. Also re%er to M8ischarge #nstructions a%ter a
?acema/er #mplant.N
Referen.e!
httpC""my.clevelandclinic.org"heart"services"tests"procedures"pacema/er.asp+
httpC""$$$.medtronic.com"patients"bradycardia"getting-a-
device"surgery"inde+.htm
httpC""$$$.nhs.u/"conditions"pacema/erimplantation"pages"introduction.asp+