Nursing 211

N211: Health Differences Across the Lifespan I

Cardiac catheterization: detects arterial blockage. Nursing Diagnosis • Acute pain related to myocardial ischemia •

Altered tissue perfusion, cardiac, related to occlusion of coronary arteries Nursing Interventions: monitor medications and instruct in proper administration of medications. Determine factors precipitating pain and assist client and family in adjusting lifestyle to decrease these factors. Teach risk factors and identify clients own risk factors. During an angina attack: provide immediate rest, take vital signs, record an EKG, administer no more than three nitroglycerine tablets, 5 minutes apart. Seek emergency treatment is no relief has occurred after taking nitroglycerine. Teach avoidance of isometric activity; implement an exercise program. Sexual activity can be resumed after exercise is tolerated, usually when able to climb two flights of stairs without exertion. Nitroglycerin can be taken prophylactically before intercourse. Diet modification of fat (saturated) and sodium. Antilipemic medications may be ordered to lower cholesterol levels. Medical Interventions Percutaneous transluminal coronary angioplasty (PTCA) is when a balloon catheter is repeatedly inflated to split or fracture plaque, and the arterial wall is stretched, enlarging the diameter of the vessel. A rotoblade is used then to pulverize plaque. Arthrectomy is when a catheter with a collect chamber is used to remove plaque that is trapped in the chamber. Other interventions include Coronary artery bypass graft (CABG), coronary artery laser therapy and coronary artery stents. Medications include Nitroglycerine, Isosorbide dinitrate, and Propranolol to cause vasodilation. These medications increase the available oxygen supply by increasing blood flow. Beta-adrenergic blockers, such as Propranolol and Lopressor, and calcium channel blockers Verapamil, Cardizem, Procardia may also be used. The aim is to decrease oxygen demand or increase myocardial oxygen supply. Nitroglycerine must be stored in a dark, glass, securely capped vial, and kept fresh enough that it tingles when you place it under your tongue. When using paste do not rub it in and always rotate sites. Proper patient teaching would always include keeping nitroglycerine available, use at the first sign of pain and stop and rest until pain subsides. Seek medical attention if pain lasts more than 20


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