Identify indications for, complications of, and nursing management of patients undergoing coronary angiography and percutaneous coronary interventions.
Describe the etiology, pathophysiology, clinical presentation, patient needs, and principles of management of patients with ischemic heart disease.
Discuss the etiology, pathophysiology, clinical presentation, patient needs, and principles of management of patients in shock, heart failure, and hypertensive crisis.
SPECIAL ASSESSMENT TECHNIQUES, DIAGNOSTIC TESTS, AND MONITORING SYSTEMS
Assessment of Chest Pain
Obtaining an accurate assessment of chest pain is an important aspect of differentiating cardiac chest pain from other sources of pain (eg, musculoskeletal, respiratory, anxiety). Ischemic chest pain, caused by lack of oxygen to the myocardium, must be quickly identified for therapeutic interventions to be effective. The most important descriptors of ischemic pain include precursors of pain onset, quality of the pain, pain radiation, severity of the pain, what relieves the pain, and timing of onset of the current episode of pain that brought the patient to the hospital. Each of these descriptors can be assessed using the “PQRST” nomogram (Table 9-1). This nomogram prompts the clinician to ask a series of questions to help identify the characteristics of the chest pain.
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TABLE 9-1 CHEST PAIN ASSESSMENT
| ||Ask the Question ||Examples |
|P (Provoke) ||What provokes the pain or what precipitates the pain? ||Climbing the stairs, walking; or may be unpredictable—comes on at rest |
|Q (Quality) ||What is the quality of the pain? ||Pressure, tightness; may have associated symptoms such as nausea, vomiting, diaphoresis |
|R (Radiation) ||Does the pain radiate to locations other than the chest? ||Jaw, neck, scapular area, or left or right arm |
|S (Severity) ||What is the severity of the pain (on a scale of 1-10)? ||On a scale of 1-10, with 10 being the worst, how bad is your pain? |
|T (Timing) ||What is the time of onset of this episode of pain that caused you to come to the hospital? || |
When did this episode of pain that brought you to the hospital start?
Did this episode wax and wane or was it constant?
For how many days, months, or years have you had similar pain?
Coronary angiography is a common and effective method for visualizing the anatomy and patency of the coronary arteries. This procedure, also known as cardiac catheterization, is used to diagnose atherosclerotic lesions or thrombus in the coronary vessels. Cardiac catheterization is also used for evaluation of valvular heart disease (including stenosis or insufficiency), atrial or ventricular septal defects, congenital anomalies, and myocardial wall motion abnormalities (Table 9-2).
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TABLE 9-2 INDICATIONS FOR CARDIAC CATHETERIZATION
Measurement of right-sided heart pressures:
Evaluation of valvular disease (tricuspid or pulmonic)
Evaluation of atrial or ...