Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

INTRODUCTION

KNOWLEDGE COMPETENCIES

  1. Identify indications for, complications of, and nursing management of patients undergoing coronary angiography and percutaneous coronary interventions.

  2. Describe the etiology, pathophysiology, clinical presentation, patient needs, and principles of management of patients with ischemic heart disease.

  3. Discuss the indications for, complications of, and management of patients undergoing electrophysiology studies.

  4. 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.

TABLE 9-1.CHEST PAIN ASSESSMENT

Coronary Angiography

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 cardiac wall motion abnormalities (Table 9-2).

TABLE 9-2.INDICATIONS FOR CARDIAC CATHETERIZATION

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.