Cardiac/Vascular Nurse Exam Secrets Study Guide (25 page)

During the procedure, patients should only receive medications via an intravenous route, except for aspirin, which is given orally prior to the procedure. Pharmacologic agents used during the procedure include heparin, nitroglycerin, and/or glycoprotein IIb/IIIa receptor inhibitor such as abciximab.

Post coronary atherectomy procedure, practicing clinicians should perform an electrocardiogram, echocardiogram, perform a physical assessment, monitor peripheral blood flow and look for swelling and evaluate cardiac pain. Hospital protocols for aftercare should be followed. Prior to patient release, practicing clinicians should perform additional physical assessments and laboratory tests such as hematocrit, potassium levels, creatinine levels, and cardiac enzymes. Cardiac stress testing should be completed 2 to 6 months postprocedure.

Percutaneous transluminal angioplasty

The lower extremity
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The types of percutaneous transluminal angioplasty of the lower extremity include iliac percutaneous transluminal angioplasty and stenting, femoropopliteal percutaneous transluminal angioplasty, and tibioperoneal percutaneous transluminal angioplasty.

Iliac percutaneous transluminal angioplasty is a procedure that involves access through a retrograde approach or an iliac crossover approach. Access can also be gained from the axillary or brachial arteries. The catheter has a balloon at the end of the device to be used to reduce plaque buildup in the diseased vessel. Once the catheter is inserted, balloon pressure is applied to the area of plaque formation to cause plaque rupture, endothelial disruption, and/or stretching of the vessel wall.

Femoropopliteal percutaneous transluminal angioplasty is a procedure that involves access through an antegrade femoral approach or femoral crossover approach. The role of stents in this approach is currently being investigated.

Percutaneous transluminal angioplasty of the lower extremity is a procedure used for the treatment of peripheral arterial disease. The procedure involves balloon angioplasty of the diseased peripheral vessel to improve blood flow to extremities. The procedure is similar to percutaneous transluminal coronary angioplasty. The catheter has a balloon at the end of the device to be used to reduce the plaque in the diseased vessel. Once the catheter is inserted, balloon pressure is applied to the area of plaque formation to decrease plaque size and/or stretch the vessel wall. The procedure can be done with stents, thrombolytic agents and with arthrectomy approaches.

Percutaneous transluminal angioplasty of the lower extremity is indicated for symptoms of severe claudication and critical limb ischemia. Percutaneous transluminal angioplasty of the lower extremity can be done in combination with surgical bypass surgery.

Percutaneous transluminal angioplasty of the lower extremity is contraindicated in patients who are medically unstable, have long arterial occlusions, have poor distal runoff, or who have diabetes.

Complications associated with percutaneous transluminal angioplasty of the lower extremity include vasospasm, thrombus formation, arterial dissection, vessel perforation, compartment syndrome, arterial dissection, restenosis, and sudden death. Other complications may occur due to the patient’s overall health, allergies, and other comorbid conditions. Therefore, practicing clinicians need to take careful medical history and perform physical examination prior to the procedure.

Prior to a percutaneous transluminal angioplasty of lower extremity, practicing clinicians should take the patient’s medical history, perform a physical examination, and evaluate the patient’s overall health. Patients should be screened for drug-drug interactions, allergies, vital signs such as heart rate and blood pressure and cardiovascular blood indicators such as potassium levels, prothrombin time, and hematocrit and creatinine levels. Patients should also undergo an electrocardiogram and echocardiogram prior to the procedure.

During the procedure, patients should only receive medications via an intravenous route, except for aspirin, which is given orally prior to the procedure. Pharmacologic agents used during the procedure include heparin, nitroglycerin, and/or glycoprotein IIb/IIIa receptor inhibitor such as abciximab. Post percutaneous transluminal angioplasty of the lower extremity, practicing clinicians should perform an electrocardiogram, echocardiogram, perform physical assessments, monitor peripheral blood flow and look for swelling and evaluate ischemic pain. Hospital protocols for aftercare should be followed. Prior to patient release, practicing clinicians should perform additional physical assessments and laboratory tests such as hematocrit, potassium levels, creatinine levels, and cardiac enzymes.

The carotid artery
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Percutaneous transluminal angioplasty of the carotid artery is indicated for stenosis of the internal carotid artery, stenosis associated with transient ischemic attacks, bilateral stenosis, contralateral carotid artery occlusion, previous neck irradiation, radial neck dissection, increased operative risk such as severe coronary artery disease, and systemic restenosis.

Percutaneous transluminal angioplasty of the carotid artery is contraindicated in patients with major thrombus formation and thick circular or semicircular stenosis. Complications associated with percutaneous transluminal angioplasty of the carotid artery include transient ischemic attacks, stroke, cerebral hemorrhage, amaurosis fugax, stent restenosis, cranial nerve injury, and sudden death.

Percutaneous transluminal angioplasty of the carotid artery is a procedure that involves increasing blood flow by reducing plaque buildup within the brain. The procedure can be done alone or in combination with stenting. Vascular approaches include the femoral artery to access the internal carotid artery, but access through the axillary and brachial arteries can be done. During the procedure, a wire is guided from the vascular access to the site within the carotid artery and a stent is put into place. Balloon angioplasty may be done prior to wire access to dilate the blood vessel and reduce plaque buildup.

Prior to percutaneous transluminal angioplasty of the carotid artery, practicing clinicians should take the patient’s medical history, perform a physical examination, and evaluate the patient’s overall health. Patients should be screened for drug-drug interactions, neurological status, allergies, vital signs such as heart rate and blood pressure and cardiovascular blood indicators such as potassium levels, prothrombin time, hematocrit, and creatinine levels. Patients should also undergo an electrocardiogram and echocardiogram prior to the procedure. Also, patients are premedicated with heparin, atropine, and nifedipine.

During the procedure, patients should only receive medications via an intravenous route, except for aspirin, which is given orally prior to procedure. Pharmacologic agents used during the procedure include heparin, nitroglycerin, and/or glycoprotein IIb/IIIa receptor inhibitor such as abciximab.

Post percutaneous transluminal angioplasty of the carotid artery, practicing clinicians should perform an electrocardiogram, echocardiogram, perform physical assessments, monitor peripheral blood flow and look for swelling and evaluate cardiac pain. Hospital protocols for aftercare should be followed. Prior to patient release, practicing clinicians should perform additional physical assessments and laboratory tests such as hematocrit, potassium levels, creatinine levels, and cardiac enzymes. Follow-up examination 1-week post procedure is completed to check neurological status. Additionally, Doppler ultrasound is performed every 3 to 6 months and then every year. Magnetic resonance imaging will be performed 3-months postprocedure as well.

The renal artery
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Percutaneous transluminal angioplasty of the renal artery is indicated for renovascular hypertension caused atherosclerotic disease, renal transplant artery stenosis, renal artery or vein bypass graft stenosis and renal insufficiency with more than 50% renal artery stenosis.

Percutaneous transluminal angioplasty of the renal artery is contraindicated for borderline lesions, long section of occlusion, aortic plaque extending to renal artery and other unstable comorbid medical conditions.

Complications of percutaneous transluminal angioplasty include vascular access complications, worsening of renal failure, thrombus, nonocclusive dissection, embolism to peripheral artery, rupture of artery, and sudden death.

Percutaneous transluminal angioplasty of the renal artery is a procedure that involves increasing blood flow to the kidney, decreasing associated secondary hypertension, and improving renal function. Percutaneous transluminal angioplasty of the renal artery is typically done for fibromuscular dysplasia, but stenting can be used as an adjunctive approach for atherosclerotic plaque formation.

The procedure involves the use of a catheter introduced through the femoral or brachial arteries into the renal artery. The catheter has a balloon at the end of the device to be used to reduce plaque buildup in the diseased vessel. Once the catheter is inserted, balloon pressure is applied to the area of plaque to decrease size and/or stretch the vessel wall.

Prior to percutaneous transluminal angioplasty of the renal artery, practicing clinicians should take the patient’s medical history, perform a physical examination, and evaluate the patient’s overall health. Patients should be screened for drug-drug interactions, urine output, allergies, vital signs such as heart rate and blood pressure and cardiovascular blood indicators such as potassium levels, prothrombin time, hematocrit, and creatinine levels. Patients should also undergo electrocardiogram and echocardiogram prior to procedure.

During the procedure, patients should only receive medications via an intravenous route, except for aspirin, which is given orally prior to the procedure. Patients undergoing the procedure with stent placement may receive clopidogrel post procedure.

Postpercutaneous transluminal angioplasty of the renal artery, practicing clinicians should perform an electrocardiogram, echocardiogram, physical assessment, monitor peripheral blood flow and look for swelling and evaluate cardiac pain. Hospital protocols for aftercare should be followed. Prior to patient release, practicing clinicians should perform additional physical assessment and laboratory tests such as hematocrit, potassium levels, creatinine levels, and cardiac enzymes. Cardiac stress testing should be completed 2 to 6 months postprocedure.

Percutaneous balloon valvuloplasty

Percutaneous balloon valvuloplasty is a procedure that involves restoring blood flow and cardiac function by opening a constricted heart valve. Two types of percutaneous balloon valvuloplasty include percutaneous balloon mitral valvuloplasty and percutaneous balloon aortic valvuloplasty.

The percutaneous balloon mitral valvuloplasty procedure involves the use of a catheter introduced through the femoral, brachial, or radial artery into the diseased valve. Transeptal catheterization is performed and a large balloon catheter is placed over the mitral valve. Once the catheter is inserted, balloon pressure is applied to the area of the mitral valve. Please note that 2 balloon catheters can be used for this procedure as well.

The percutaneous balloon aortic valvuloplasty involves the use of a catheter introduced through the femoral, brachial, or radial artery into the diseased valve. Transeptal catheterization is performed and a large balloon catheter is placed over the aortic valve. Once the catheter is inserted, balloon pressure is applied to the area of aortic valve.

Percutaneous balloon mitral valvuloplasty is indicated for symptomatic mitral valve stenosis with or without valvular disease with a small degree of mitral valve regurgitation and nonsurgical candidates with severely calcified or fused mitral valves.

Percutaneous balloon aortic valvuloplasty is indicated for short-term relief of valve surgery candidates, left ventricular dysfunction, and symptomatic patients subject to undergo noncardiac surgery.

Contraindications associated with percutaneous balloon valvuloplasty include atrial thrombus, severely fused or calcified leaflets, severe coronary artery disease, and severe aortic regurgitation.

Complications associated with percutaneous balloon valvuloplasty include periprocedural myocardial infarction, emergency coronary artery bypass surgery, coronary restenosis, bleeding, or hematoma at catheter introduction site, arterial embolism, pseudoaneurysm, retroperitoneal bleeding, hemopericardium or tamponade, mitral regurgitation, atrial septal defects and sudden death.

Prior to percutaneous balloon valvuloplasty, practicing clinicians should take the patient’s medical history, perform a physical examination, and evaluate the patient’s overall health. Patients should be screened for drug-drug interactions, allergy, vital signs such as heart rate and blood pressure and cardiovascular blood indicators such as potassium levels, prothrombin time, hematocrit, and creatinine levels. Patients should also undergo electrocardiogram and echocardiogram prior to procedure.

During the procedure, patients should only receive medications via an intravenous route, except for aspirin, which is given orally prior to the procedure. Pharmacologic agents used during the procedure include heparin, nitroglycerin, and/or glycoprotein IIb/IIIa receptor inhibitor such as abciximab. After percutaneous balloon valvuloplasty, practicing clinicians should perform an electrocardiogram, echocardiogram, physical assessment, monitor peripheral blood flow and look for swelling and evaluate cardiac pain. Hospital protocols for aftercare should be followed. Prior to patient release, practicing clinicians should perform additional physical assessments such as the patient’s heart sounds and laboratory tests such as hematocrit, potassium levels, creatinine levels and cardiac enzymes. Patients should follow-up with their practicing clinician 1 week post procedure and should undergo an echocardiogram 3 to 6 months postprocedure.