Nursing Management After PCI

The nurse working in the catheterization laboratory recovery section or stationed either within a telemetry unit or coronary care unit plays a critical role in monitoring and evaluating a patient’s recovery. Post-PCI care is meant for the caregivers to closely observe the sick person for any indications and signs of myocardial ischemia. One of the most apparent symptoms of probable complication is angina pectoris may reoccur and often needs quick nursing action. Immediately after receiving a patient from the lab, the responsible nurse is required to attach an ECG monitor. The device helps to do a short preliminary assessment and forms a baseline should the patient’s situation change abruptly. Further, the nurse is expected to check the condition of the sick person from head to toe, taking note of the consciousness, temperature, and tone. Once the patient is laid in bed and attached to a monitor, the professional is checking heart and breath sounds.

If the Judkins technique is applied, then the sick person will have an entry hole on the groin, which is used to put sheaths in the blood vessels. Alternatively, if the Sones method is used, then an arterial catheter exists within the brachial area. After the sheath has been withdrawn, a number of mechanical instruments and clamps may be employed to help in hemostasis. The effect can also be achieved by routinely putting collagen plugs or applying a surgical junction near the opening of the blood vessel (Morton & Fontaine, 2018). The nurse plays a critical role in monitoring the regions around the puncture spot, examining pulses, and regularly reporting any signs of bleeding to the physician. Blood loss at the sheath site can lead to a major hematoma that can necessitate a surgical evacuation or hinder blood flow to the further extremity.

The nurse is required to instruct the sick individual on the significance of maintaining the involved leg straight and ahead at not more than 45 degrees. Clotting in the lumens of the introducing sheaths is avoided through an IV infusion that is held to the venous sheath (Morton & Fontaine, 2018). The method guarantees patency if there is a need to swiftly move back to the catheterization laboratory due to a complication. Caregivers attending to post-PCI patients must be alert for loss of radial pulse. In case the patient’s cardiac enzyme laboratory value is abnormal, the nurse is required to alert the physician instantly since the individual’s postoperative care regime may need to be adjusted to avoid more injury.

The nurse also plays a critical role in monitoring and checking for angina that recurs just after a PCI. Any aches around the chest need prompt and watchful attention since it may signal the beginning of either vasospasm or imminent subacute thrombosis. The caregiver needs to alert the physician of any changes in the patient’s state because observation alone is not enough to confirm whether it points to a temporary vasospastic episode. When the first sign of vasospasm occurs, the nurse needs to provide oxygen through either a nasal canal or a mask (Morton & Fontaine, 2018). For the fast temporary or permanent relief, nifedipine, nitroglycerin, or isosorbide is given sublingually. Further, IV drip nitroglycerin can be titrated to sustain blood pressure guarantee coronary artery perfusion, and reduce any chest aches.

If there are no complications in the post-PCI stage, then the sheaths are withdrawn after two to four hours and pressure dressing put on the spot. The nurse needs to ensure that the sick person completes a bed rest of between four and six hours after the sheaths have been detached. During the recovery phase, the nurse needs to familiarize the patient with the rehabilitation process and stress lifestyle changes to mitigate the advance of CAD (Morton & Fontaine, 2018). The caregiver needs to emphasize the need for aerobic training with consistent moderate exercise. Other aspects that may be vital to be discussed include weight loss, stress reduction, and quitting smoking. The implications may differ for various age groups; for instance, older patients may need more specialized care.

After PCI, the nurse asks the patient to take the prescribed medications to avert thrombus formation as well as uphold a maximal dilation at the lesion spot. Recommendations for prevention of stent thrombosis post-PCI are that at least the patient should be treated with clopidogrel and aspirin for four weeks following bare-stent implantation, or three months for clopidogrel, and one year for bleeding (Morton & Fontaine, 2018). Currently, DESs are being applied in high-risk lesions and may be linked to either delayed or absent endothelialization, as well as late stent thrombosis. For sick persons on clopidogrel whose elective CABG is prearranged, the medication should be withheld for between five and seven days. Most of the time, the nurse needs to recommend that long-acting nitrates, calcium channel brokers, as well as ACE inhibitors, and lipid-lowering additives are introduced to the medical regime.

Further, the nurse may be tasked with explaining to the sick person the indications for specific medications prescribed by the physician. The professional may also have to clarify to the patent the potential side effects and any signs of a drug overdose. While explaining these, the caregiver should respond to any questions the patient may have concerning the follow-up care. Four to six weeks after discharge from a medical facility, a test using a treadmill and thallium imaging may be executed to check the PCI’s effectiveness. The treadmill stress tests ideally should be performed every year after the procedure.

Reference

Morton, P. G., & Fontaine, D. K. (2018). Critical care nursing: A holistic approach (11th ed.). Wolters Kluwer.