ANGIOPLASTY

PURPOSE:

A surgical treatment used to widen blocked or narrowed coronary arteries to restore blood flows.

NURSING CONSIDERATIONS
PRIOR:
 Secure written informed consent. Make sure that the patient signed the consent before proceeding to the
procedure.
 Routine vital signs must be obtained before the procedure.
 Assess patients allergies, especially seafood, iodine, dyes, or any drug allergy. Coronary angioplasty are
procedures that use contrast media like a dye. Make sure to inform the physician if the patient has allergies. The
client is usually pre-medicated with antihistamines and corticosteroids to avoid allergic reactions.
 NPO post-midnight or hours prior to the procedure, usually 6-8 hours (depends upon the physician’s order or the
protocol of the catheterization laboratory)
 Make sure that ordered diagnostic and laboratory tests were taken before the procedure like creatinine, CBC with
platelet, activated partial thromboplastin time (aPTT), Prothrombin Time, Potassium.
 Shave and prepare both groins with an antiseptic solution, if the site for insertion will be the femoral vein.
 Pre-medicate the patient before wheeling into the cardiac catheterization laboratory as ordered.
 Usually, anti-anxiety is given before the procedure.
 Aspirin or Clopidogrel is also given as ordered to avoid clotting during the procedure.

POST:
 Assess vital signs every hour
 Assess peripheral pulses and check for signs of ischemia like change in color (pallor - cyanosis), change in
sensation and change in temperature. Assessing pulses after cardiac catheterization to identify clotting
complications. If pulses are absent, this can indicate that there is an arterial occlusion.
 Encourage bed rest
 Increase Oral Fluid Intake
 Position patient in supine position with feet not flexing.
 Hematoma, bruising, and tenderness on the site is normal. These symptoms should decreases in size within a two
weeks period.
 Inspect the site daily. Consult the attending physician immediately if you experience
 Assess for signs and symptoms of infection: fever, chills, redness, and warmth on the site
 Assess the punctured site for BLEEDING

CABBAGE - CORONARY ARTERIAL BY PASS GRAFT

PURPOSE: COMPLICATIONS
 Restore blood flow to the heart  Pneumonia
 Relieves chest pain and ischemia  Shock
 Improves the patient’s quality of life  Trombophlebitis
 Lower the risk of heart attack

NURSING CONSIDERATIONS
PRIOR:
 Secure written informed consent.
 Assess patients allergies, especially seafood, iodine, dyes, or any drug allergy.
 Ask the patient if she has a history of bleeding disorders or if she is taking any blood-thinning medicines such as
aspirin, or other medicines that affect blood clotting. Tell patient that she may stop some of these before the
procedure.
 NPO post-midnight or hours prior to the procedure, usually 6-8 hours
 Make sure that ordered diagnostic and laboratory tests were taken before the procedure like creatinine, CBC with
platelet, activated partial thromboplastin time (aPTT), Prothrombin Time, Potassium.

POST:
 Maintain airway patency
 Monitor the patients pulmonary status closely and report any changes such as pulmonary congestion, dyspnea, or
SPO2 below 92%.
 Monitor Vital Signs and record I&O hourly.
 Note the urine’s color and clarity. Notify the surgeon of any signs of decreased renal perfusion.

ENDARTERECTOMY
A carotid endarterectomy is surgical removal of the inner layer of an artery when thickened and
atheromatous or occluded (as by intimal plaques) may be needed if one or both of your carotid arteries become
narrowed because of a build-up of fatty deposits (plaque). This is known as carotid artery disease.and it significantly
increases your risk of having a stroke or transient ischaemic attack (TIA).

NURSING CONSIDERATIONS
PRIOR
 Secure written informed consent. Make sure that the patient signed the consent before proceeding to the
procedure.
 Routine vital signs must be obtained before the procedure.

 Tell the patient to take some of your usual medications (such as your blood pressure pills or heart pills) on the
morning of surgery,take them with a sip of water
 encourage in your personal care items such as a toothbrush, comb, and shampoo.
 Bring telephone numbers of your spouse/relative who will be helping you, so they can be contacted if needed.
Include both the home, cell and work numbers.
POST OP
 Assess that airway is intact. Assess neck for edema and hematomas. Take note of any tracheal deviation,
respiratory distress (stridor), drooling, and problems swallowing. Assess breath sounds. Call surgeon
immediately for any airway issues.
 Assess incision for approximation of edges and any bleeding, drainage or redness. Assess for hematoma at
neck- Call if increase edema or grapefruit size hematoma.
 Assess Vital Signs as ordered. Due to manipulation of baroreceptors close to the carotid artery, Blood Press
control is very important and must be within normal parameters. Call if SBP > 180 or DBP < 100.
 Evaluate heart rhythm for any arrhythmias.
 Patients with local nerve block anesthesia may have numbness after surgery extending into the neck/throat
area, shoulder and down to the nipple line on side of surgery. This should wear off in 6-8 hours after surgery.
 If the patient has a head ache after surgery due to reperfusion, give Tylenol. If not relief of headache within 1-
2 hours of Tylenol, call surgeon- this may be a sign of an intracranial bleed and will need an US of the neck
and a CT of the head to r/o bleed.
 Surgeons do not want these patients to receive Lovenox until cleared by them. Administration of Lovenox is
associated with high risk of bleeding which could cause respiratory compromise if hematoma develops at
incisional site.
 Prior to discharge, have patient look into the mirror to see how much swelling is present in the neck area. Tell
the patient to notify the surgeon immediately if the swelling enlarges.

LIPID PROFILE

A lipid profile screening is used to identify lipid levels to identify lipids levels including total cholesterol, HDL
cholesterol (good), LDL cholesterol (bad) and triglyceride levels.

NURSING CONSIDERATIONS

PRIOR

 Requires Fasting
 Fasting samples needs to be collected after a minimum 12-14 hour overnight fasting status.
 Clear fluids like water can be consumed during this period. Do not consume beverages like tea, coffee and
milk in the morning until specimen collection is completed.
 In case of diabetics on oral or injectable hypoglycemic agents, please consult your physician about continuing
with these medications prior to specimen collection."
 Not eat high-fat foods the night before 
 Not drink alcohol, and Not exercise strenuously before your test
 You are usually allowed to take your medicines in the morning of the test, with water. While fasting is not
always necessary, it might be recommended. Your doctor can inform you about any additional precautions
that you need to take before the test. Make sure you inform them about
BLOOD TRANSFUSSION
PRIOR
 Verify doctor’s order. Inform the client and explain the purpose of the procedure.
 Check for cross matching and typing. To ensure compatibility
 Obtain and record baseline vital signs
 Practice strict asepsis
 At least 2 licensed nurse check the label of the blood transfusion. Check the following:
 Serial number
 Blood component
 Blood type
 Rh factor
 Expiration date
 Screening test (VDRL, HBsAg, malarial smear) – this is to ensure that the blood is free from blood-
carried diseases and therefore, safe from transfusion.
 Warm blood at room temperature before transfusion to prevent chills.
 Identify client properly. Two Nurses check the client’s identification.
 Use needle gauge 18 to 19 to allow easy flow of blood.
 Use BT set with special micron mesh filter to prevent administration of blood clots and particles.
 Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30 minutes. Adverse reaction usually occurs
during the first 15 to 20 minutes.

DURING
 Monitor vital signs. Altered vital signs indicate adverse reaction (increase in temp, increase in respiratory rate)
 Do not mix medications with blood transfusion to prevent adverse effects. Do not incorporate medication into the
blood transfusion. Do not use blood transfusion lines for IV push of medication.
 Administer BT for 4 hours (whole blood, packed RBC). For plasma, platelets, transfuse quickly (20 minutes)
clotting factor can easily be destroyed.
 Observe for potential complications. Notify physician.

AFTER
 Once transfusion is done, the line should be flushed with normal saline solution. If there are no more succeeding
transfusions, the line is discontinued, and the BT set is disposed of properly.
 document the reaction of the patient to blood transfusion.
 Monitor vital signs 1 hour after the transfusion is over
PHARMACOLOGICAL MANAGEMENT

GENERIC NAME: isosorbide nitrates, isosorbide dinitrate, isosorbide mononitrate

BRAND NAME: Isordil
Classification: Antianginal, Nitrate, Vasodilator
DOSAGE AND ROUTE: 20 mg PO bid given 7 hr apart; ER tablets—30–60 mg/day PO may be increased to 120
mg/day if needed.
Contraindications
 Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic
cardiomyopathy, narrow-angle glaucoma, postdural hypotension
 Use cautiously with pregnancy, lactation, acute MI, CHF.
Nursing considerations
CLINICAL ALERT! Name confusion has occurred between Isordil (isosorbide) and Plendil (felodipine); use caution.
 Give sublingual preparations under the tongue or in the buccal pouch; discourage the patient from
swallowing.
 Create a nitrate-free period to minimize tolerance.
 WARNING: Give chewable tablets slowly, only 5 mg initially, because severe hypotension can occur;
ensure that patient does not chew or crush sustained-release preparations.
 Give oral preparations on an empty stomach, 1 hr before or 2 hr after meals; take with meals if severe,
uncontrolled headache occurs.
 WARNING: Keep life support equipment readily available if overdose occurs or cardiac condition
worsens.
 WARNING: Gradually reduce dose if anginal treatment is being terminated; rapid discontinuation can
lead to problems of withdrawal.
Teaching points
 Place sublingual tablets under your tongue or in your cheek; do not chew or swallow the tablet. Take the
isosorbide before chest pain begins, when activities or situation may precipitate an attack. Take oral
isosorbide dinitrate on an empty stomach, 1 hour before or 2 hours after meals; do not chew or crush
sustained-release preparations; do not take isosorbide mononitrate to relieve acute anginal episodes.
 You may experience these side effects: Dizziness, lightheadedness (may be transient; use care to change
positions slowly); headache (lie down in a cool environment, rest; over-the-counter preparations may not
help; take drug with meals); flushing of the neck or face (reversible).
 Report blurred vision, persistent or severe headache, rash, more frequent or more severe angina attacks,
fainting.

GENERIC NAME: ranitidine hydrochloride

BRAND NAME: Zantac
CLASSIFICATION: Histamine2 (H2) antagonist
DOSAGE AND ROUTE: 75 mg PO as needed.
Contraindications
 Porphyria.
Interventions
 Administer oral drug with meals and at bedtime.
 Decrease doses in renal and liver failure.
 Provide concurrent antacid therapy to relieve pain.
 Administer IM dose undiluted, deep into large muscle group.
 Arrange for regular follow-up, including blood tests, to evaluate effects.
Teaching points
 Take drug with meals and at bedtime. Therapy may continue for 4–6 weeks or longer.
 If you also are using an antacid, take it exactly as prescribed, being careful of the times of administration.
 Have regular medical follow-up care to evaluate your response.
 You may experience these side effects: Constipation or diarrhea (request aid from your health care
provider); nausea, vomiting (take drug with meals); enlargement of breasts, impotence or decreased
libido (reversible); headache (adjust lights and temperature and avoid noise).
  Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations, dizziness,
severe headache, muscle or joint pain.

Generic Name: atorvastatin calcium

Brand Name: Lipitor
Classification: Antihyperlipidemic, HMG-CoA reductase inhibitor
Dosage & Route
ADULTS
 Initially, 10 mg PO once daily without regard to meals; for maintenance, 10–80 mg PO daily. May be
combined with bile acid–binding resin.
Contraindications

 Contraindicated with allergy to atorvastatin, fungal byproducts, active liver disease or unexplained and
persistent elevations of transaminase levels, pregnancy, lactation.
 Use cautiously with impaired endocrine function.
Interventions
 Obtain LFTs as a baseline and periodically during therapy; discontinue drug if AST or ALT levels
increase to 3 times normal levels.
 WARNING: Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major
surgery, trauma, severe metabolic or endocrine disorder, seizures) that may suggest myopathy or serve as
risk factor for development of renal failure.
 Ensure that patient has tried cholesterol-lowering diet regimen for 3–6 mo before beginning therapy.
 Administer drug without regard to food, but at same time each day.
 Atorvastatin may be combined with a bile acid–binding agent. Do not combine with other HMG-CoA
reductase inhibitors or fibrates.
 Consult dietitian about low-cholesterol diets.
 WARNING: Ensure that patient is not pregnant and has appropriate contraceptives available during
therapy; serious fetal damage has been associated with this drug.
Teaching points
 Take this drug once a day, at about the same time each day, preferably in the evening; may be taken with
food. Do not drink grapefruit juice while taking this drug.
 Institute appropriate dietary changes.
 Arrange to have periodic blood tests while you are taking this drug.
 Alert any health care provider that you are on this drug; it will need to be discontinued if acute injury or
illness occurs.
 Do not become pregnant while you are on this drug; use barrier contraceptives. If you wish to become
pregnant or think you are pregnant, consult your health care provider.
 You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint
aches and pains (may lessen over time).
 Report muscle pain, weakness, tenderness; malaise; fever; changes in color of urine or stool; swelling.
GENERIC NAME: Fondaparinux sodium
BRAND NAME: arixta
Classification: anticoagulant, antithrombin
Uses: is indicated for the treatment of acute pulmonary embolism when administered in conjunction with warfarin
sodium when initial therapy is administered in the hospital.
Contraindication:
 Hypersensitivity.
 Active clinically significant bleeding, acute bacterial endocarditis
Nursing responsibilities:
 Severe renal impairment (CrCl <30mL/min). Active major bleeding. Bacterial endocarditis.
 Thrombocytopenia associated with (+) in vitro test for antiplatelet antibody in presence of fondaparinux. Also
for prophylaxis: body weight <50kg.
 Do not administer IM.
 Do not give24 hr prior to CABG surgery & maybe restarted 48 hr post-op. STEMI patients undergoing
primary PCI for reperfusion. Monotherapy inUA/NSTEMI & STEMI patients undergoing non-primary PCI.
Increased risk of hemorrhage congenital or acquired bleeding disorders, active ulcerative GI disease, recent
intracranial hemorrhage, shortly after brain, spinal or ophth surgery. Low body wt <50 kg; spinal/epidural
anesthesia or spinal puncture. History of heparin-induced thrombocytopenia & latexallergy.
  Renal (CrCl <20 or 30mL/min) or severe hepatic impairment. Close monitoring is recommended in patients
concomitantly taking products enhancing the risk of hemorrhage. Pregnancy & lactation. Children <17 yr.
Elderly ≥75 yr

Generic Name : tramadol hydrochloride

Brand Name: Ultram
Dosage & Route: ???
Contraindications:
Suicidal patients, acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment;

Nursing considerations:
Assessment
 History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids, psychotropic drugs
or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal
or hepatic impairment; past or present history of opioid addiction
 Physical: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP;
bowel sounds, normal output; LFTs, renal function tests.
Interventions
 Control environment (temperature, lighting) if sweating or CNS effects occur.
 WARNING: Limit use in patients with past or present history of addiction to or dependence on opioids.
Teaching points
 You may experience these side effects:
 Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require
alertness);
 nausea, loss of appetite (lie quietly, eat frequent small meals).
 Report severe nausea, dizziness, severe constipation.