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This document covers a wide range of topics related to cardiac catheterization lab nursing, including pre-operative patient preparation, monitoring and managing patients during procedures, and post-operative care. It provides detailed information on various interventions and assessments performed by nurses to ensure the safety and well-being of patients. The nurse's role in managing contrast-induced nephropathy, arterial line setup, coronary artery occlusion, radiation safety protocols, post-pci complications, and the interpretation of various hemodynamic and laboratory findings is also covered. Additionally, the document highlights the importance of patient education, discharge planning, and effective communication throughout the care continuum. This comprehensive resource would be valuable for nursing students, new graduate nurses, and experienced cardiac catheterization lab nurses.
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What orders do you expect from the physician to decrease the risk of contrast induced nephropathy in a patient who has been identified as at risk? Pre-operative hydration with intravenous normal saline When setting up a pressure monitoring system for an arterial line, what kind of tubing is used to transmit pressure waves from the patient to the transducer? Non-compliant An occlusion of which coronary artery will decrease blood supply to the SA node? Right coronary artery What radiology practice decreases x-ray exposure to staff? Observation of ALARA protocol Post PCI, your patient complains of increasing chest pain, nausea, vomiting and hypotension. What would be your FIRST intervention? Obtain STAT 12 lead EKG A right heart catheterization is on the schedule. What type of condition might this procedure be used to identify?
Covered stent, pericardiocentesis tray, ECHO A cardiologist has performed a radial approach to access the coronary arteries. What dod you expect to see on the radiographic image screen as the catheter approaches the coronary arteries? Catheter traveling through the brachiocephalic artery to the aorta The physician selectively engages the conus branch of the RCA. What change inn the waveform would you anticipate? A dampened arterial waveform What vessel supplies oxygenated blood to the right atrium? Pulmonary veins In what order would you apply sterile surgical attire? Apply sterile gown, insert hands inn gloves, hand tie to staff member Why is cardiac index better than cardiac output for the assessment of cardiac function when considering variation between individuals? Cardiac index takes into account the patient’s body surface area Which lab finding is MOST suggestive of increased risk of contrast induced nephropathy? 40 ml/min estimated GFR
After successful revascularization of a totally occluded RCA, which of the following complications should the circulating nurse prepare for? Arrythmias Your STEMI patient tells you they drive to the hospital after experiencing acute onset chest pain. What coaching would you give this patient if this occurs in the future? call 911 You have been tasked with administering moderate sedation to a patient in the cardiac catheterization lab. What tasks are your priority? Counting respirations, readying suction, observing chest rise and fall Which statement made by the patient after a cardiac stent placement indicates patient education was effective? I will take Brilinta twice a day with food While performing a PCI, you notice contrast staining the pericardium. The patient experiences chest pain, acute hypotension, and tachycardia. What emergent intervention should you prepare? Pericardidocentesis During transfer of care post-procedure, what should you do with the receiving nurse to decrease the chance of missing a hematoma or bleeding? View the sheath insertion site
What finding would be MOST concerning post sheath removal? Hematoma at insertion site In order to calculate Fick cardiac output which of the following saturations do you need? AO and PA What is the FIRST action you should take if a patient who is receiving moderate sedation has the following vital signs: HR 82, SpO2 93%, RR 18, elevated end tidal CO2 and begins snoring? Open airway with head tilt/chin lift What intervention do you expect would be ordered for a patient with a blood pressure of 128/83, elevated right atrial, left ventricular, and pulmonary artery pressures, along with SOB, adventitious lung sounds, and SpO2 87%? Lasix What size wires are usually utilized in coronary balloon angioplasty? 0.014 x 180 Which cardiac pressure findings are consistent with aortic stenosis? LV pressure is greater than the AO pressure
A patient has just had a cardiovascular procedure and arrives in the recovery area with a sheath in place in the right groin. Their ACT in the lab was 357. What important patient education should be given prior to sheath removal? The patient’s head must remain on the pillow and the right leg must remain straight What type and amount of IV fluids should a patient receive before cardiac catheterization to reduce the risk of contrast induced nephropathy? 500ml of 0.9 NS You are assessing a patient with left-sided heart failure. What is an early finding for this patient? Shortness of breath In addition to ST elevation, which new ECG finding is suggestive of acute MI? LBBB Normal QRS length? 0.08 – 0. What post-procedure findings should be IMMEDIATELY communicated to the cardiologist? Absent pedal pulses with blueish toes After a procedure during which heparin was administered, what finding is suggestive of HIT? Decrease in platelets by 50%
Guiding catheters have wire braiding Prior to draping the patient for a cardiovascular procedure, how should the skin be prepared for the insertion of a catheter? Cleansed with chlorhexadine prep When putting on a sterile gown, how should you initially grasp it? Grasp the inside of the neckline and lift it away from the wrapper Which statement made by a patient post coronary stent placement indicates successful understanding of patient education? I made an appointment for cardiovascular rehab Post PCI your patient is started on Brilinta. What important side effect should you make them aware of? Shortness of Breath SOB What is the mechanism of action of Aspirin? Antiplatelet agent When considering cardiac output, what is stroke volume? The amount of blood ejected into the aorta from the left ventricle during systole
As the circulating nurse, what should you wear to protect yourself from radiation? WRONG Lead thyroid collar, cap, eye protection, and humoral shield - Lead thyroid collar, apron, and eye protection – Non-leaded apron, humoral shield, and surgical mask – Non-leaded collar, apron, humoral shield, badge, and mask Why is scatter radiation a safety concern? WRONG It causes leakage radiation from the radiation source or equipment – It is the main source of radiation exposure for patients and staff – It is the primary beam of radiation from the collider to the patient – It causes leakage from the radiation source or equipment What is the normal range for cardiac output? WRONG 5 - 9 liters/min – 4 – 8 L/min - 6 – 10 L/min - 8 – 12 L/min In patients with a right to left shunt, in which chamber would you expect to record the lower oxygen saturation? WRONG Right Atrium – Pulmonary Artery – Left Ventricle – Left Atrium What procedure helps the interventional cardiologist make accurate measurements of a coronary artery? WRONG Standard angiography – Intravascular ultrasound – Transesophageal echo – Intracardiac echocardiography Where is the LIMA take-off located?