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Chapter 30 Coordinating Care for Patients With Cardiac Disorders
z Administer morphine or other opioid as ordered if nitroglycerin does not relieve pain. Minimizes pain and decreases the workload on the heart. Monitor for adverse effects of hypotension, nausea, vomiting, and respiratory depression. z Administer beta blockers/calcium channel blockers as ordered. Beta blockers inhibit cardiac response to physical activity and decrease oxygen consumption; may consider holding before exercise test. z Administer statin medications as ordered. Reduce cholesterol level and decrease the risk of increased plaque formation ■ Actions After PCI z Perform cardiac catheterization care as described in Chapter 28. z Report and treat chest pain immediately. Reocclusion, vasospasm, or stenosis can result in ischemia and requires prompt intervention. z Administer additional anticoagulants and antiplatelet medications. Prevents vessel occlusion by thrombus z Maintain fluids through catheterization sheaths if left in place. Allows for immediate coronary access if return to catheteri- zation lab is needed z Maintaining bedrest and compression devices at the catheter insertion site Promotes hemostasis and prevents bleeding ■ Teaching z Medication regimen Medication adherence lowers mortality and risk of hospitali- zation and MI. z Angina management If angina occurs during activity, stop activity and rest. Take dose of nitroglycerin. Tabs can cause tingling or taste bitter when placed under the tongue. Not to exceed three doses 5 minutes apart. Caution patient about the use of the medi- cation in the setting of light-headedness or dizziness because this can be indicative of hypotension. See Medication Safety Alert for more information. z Bleeding precautions if on anticoagulants or antiplate- let medications Avoiding activities that have high injury or fall risk, using a soft toothbrush and electric razor, and using caution with sharp objects reduces bleeding risk. z Risk factor reduction strategies: physical activity, blood pressure management, healthy diet/weight loss, smoking cessation, decreased alcohol consump- tion, control of glucose Risk factor reduction can prevent primary disease and limits the progression of CAD. z When to call providers or emergency services Unrelieved chest pain—chest pain at rest requires early intervention.
For PCI patients: uncontrolled bleeding, swelling, redness, purulent discharge, and pain at insertion site or fever need prompt treatment. z Encourage participation in cardiac rehabilitation for ACS patients after PCI or CABG.
Reduces morbidity and mortality Evaluating Care Outcomes
Patients with CAD can achieve optimal functional status by complying with prescribed medical therapy, maintain- ing a healthy diet, limiting alcohol, and engaging in regular exercise. Achieving desired activity levels and meeting self- care needs with minimal or no pain indicate achievement of care goals in this patient population. It is important that the patient understands the disease process, the medica- tions used to treat it, and when to call 911.
INFECTIVE ENDOCARDITIS Epidemiology
The exact prevalence of infective endocarditis (IE) is unknown; however, an estimated 15 cases per 100,000 patients occur annually in the United States, the highest in the world, and the number of cases has steadily risen since 2000. This increase is attributed to increased IV sub- stance use and an aging population. The risk of developing IE increases 100-fold with IV substance abuse. Infective endocarditis can be classified as native or prosthetic or as right or left sided. It most frequently affects the native mitral or aortic valves. The pulmonic valve is the least fre- quently affected. Individuals who abuse IV drugs tend to have right-sided or tricuspid valve infections. Risk factors for IE include age (greater than 60), immu- nodeficiency, IV drug use, diabetes mellitus, the presence of prosthetic heart valves, prior history of endocarditis, congen- ital or structural heart disease, and the presence of an intra- vascular access or an implanted cardiac device. Recent studies have indicated others at risk of developing IE are persons with poor oral hygiene or periodontal disease, patients on hemodi- alysis, and patients with frequent exposures to the healthcare system or invasive procedures. Rheumatic heart disease is also considered a risk factor, but a sharp decline in the incidence in developed countries has lessened its impact. Mortality from IE is high, ranging from 20% to 40% of cases. Connection Check 30.2 The nurse determines which patient is at greatest risk for developing IE? A. A 22-year-old patient undergoing a dental cleaning B. A 35-year-old patient with a past medical history of IV substance use C. A 65-year-old heart transplant patient on immunosup- pressive therapy undergoing a colonoscopy D. A 70-year-old patient with heart failure with an intra- vascular access device for home infusion
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