Ateneo de Zamboanga University College of Nursing

NURSING SKILLS OUTPUT (NSO) Report No. 7 Angiography

D SCRIPTION!

Using X-ray or Ultrasound images to guide the procedure, the Vascular Angiography!"#nterventional Radiologist inserts thin tubes catheters! and other tiny instruments through the blood vessels and other path$ays o% the body to diagnose and treat a $ide variety o% conditions that previously re&uired surgery. 'any o% the procedures can be done on an outpatient basis through day medicine or day surgery. (he procedures listed in this section o% our $eb site can be done on an outpatient basis $ithout any signi%icant complications. "AT RIALS# $UIP" NTS N D D!

local anaesthetic, thin tube dye (issue X-ray %ilm catheter

PROC DUR ! ).! *+plain the procedure to the client. ,.! -ou $ill be given a mild sedative to help you rela+. ..! -ou $ill be ta/en into the 01ath 2ab3 on a trolley, and then moved onto the Xray table. 4.! -ou $ill have electrodes placed on your chest. -our groin $ill be s$abbed $ith antiseptic and then your body covered $ith drapes. 5.! -our cardiologist $ill in6ect your groin $ith Xylocaine. (his $ill numb the area. -our cardiologist $ill then insert a small catheter into your blood vessels. 7.! -our cardiologist $ill guide the catheter, via the blood vessels, to the heart. (here $ill be several in6ections o% the dye via the catheter. (he

catheter may be moved around during the procedure in order to get di%%erent vie$s o% your heart and coronary arteries. #t is normal to %eel %lushed all over the body $hen dye is in6ected. 7.! 8uring the catheterisation procedure you may be as/ed to breathe deeply and cough. -ou $ill be able to communicate $ith -our cardiologist through the procedure, ho$ever, due to the nature o% the sedative, you may not recall much o% $hat has occurred. -ou can e+pect this procedure to last up to an hour.

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8rin/ only clear %luids a%ter a normal supper the evening be%ore your procedure. (his may include co%%ee, tea, 6uice, 9ell-:, clear soups. No dairy products please. (a/e all your regular medications $ith $ater as ordered by your doctor. ;ring all your medications, and respective dosages o% these medications, $ith you on the morning o% your procedure. #% you are on medications %or diabetes as/ your %amily doctor about the need to stop these medications.

-ou must not be ta/ing any anticoagulants <blood thinners<! be%ore your angiogram. #% you ta/e these medications they must be stopped $ell be%ore your procedure, please consult $ith your doctor about these medications. Report to the Admitting 8epartment o% =as/atoon 1ity >ospital and =t. ?aul@s >ospital .A minutes prior to your scheduled appointment to register. At Royal University >ospital, please report 7A minutes be%ore your scheduled appointment. A%ter registration please report to the Reception des/ o% the 'edical #maging 8epartment $ith your admission papers. -ou must be accompanied by an adult $ho $ill transport you to and %rom the hospital -ou must arrange to spend the night a%ter your angiogram or biopsy in the company o% an adult $ho can transport you to the >ospital $ithin )5 minutes i% a delayed complication o% the procedure occurs. ?atients $ho have a venous access procedure may return home. ?atients should e+pect a t$o to si+ hour supervised recovery period a%ter their procedure is completed. (his is standard practice and is in the interest o% patient sa%ety and com%ort.

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8uring the catheterisation procedure you may be as/ed to breathe deeply and cough. -ou $ill be able to communicate $ith -our cardiologist through the procedure, ho$ever, due to the nature o% the sedative, you may not recall much o% $hat has occurred. -ou can e+pect this procedure to last up to an hour.

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-ou must stay in the company o% a responsible adult $ithin )5 minutes o% the hospital on the night %ollo$ing your angiogram. ?lease /eep in mind that 1ity >ospital *mergency 8epartment closes at BC.A p.m. A responsible adult must drive you %rom the hospital to your accommodations. ?lan to spend the night %ollo$ing your e+am resting &uietly. Any type o% physical activity is discouraged. Return to normal activity the day a%ter the angiogram. Avoid heavy li%ting or strenuous labour %or t$o to three days a%ter your test. *at and drin/ normally. #ncreased %luid inta/e is recommended. (a/e all your normal medications as ordered by your doctor. -ou may ta/e (ylenol or Aspirin %or any pain or discom%ort you may e+perience. #% bleeding occurs $here the catheter $as inserted, apply direct pressure to the bleeding. Return immediately to the *mergency 8epartment o% Royal University >ospital or 1ity >ospital i% you have di%%iculty in stopping the bleeding. ;ring this instruction sheet $ith you.

#% your %oot becomes cold, numb, or pain%ul a%ter discharge, return to the *mergency 8epartment immediately. ;ring this instruction sheet $ith you. #% a complication arises and you do not /no$ $hat to do, report to the *mergency 8epartment $ith this instruction sheet. ?atients should e+pect a t$o to si+ hour supervised recovery period a%ter their procedure is completed. (his is standard practice and is in the interest o% patient sa%ety and com%ort.

Referen.es! httpC""$$$.nhs.u/"1onditions"Angiography"?ages">o$-is-it-per%ormed.asp+ httpC""$$$.christopher%lood.com.au"procedurese+plained"coronaryDangiograms.htm l httpC""$$$.sas/atoonhealthregion.ca"yourDhealth"tpDangioDpostDangio.htm

Ateneo de Zamboanga University College of Nursing

NURSING SKILLS OUTPUT (NSO) Report No. B 'ariu% S/allo/

D SCRIPTION!

A barium s$allo$ is a radiographic X-ray! e+amination o% the upper gastrointestinal E#! tract, speci%ically the pharyn+ bac/ o% mouth and throat! and the esophagus a hollo$ tube o% muscle e+tending %rom belo$ the tongue to the stomach!. (he pharyn+ and esophagus are made visible on X-ray %ilm by a li&uid suspension called barium sul%ate barium!. ;arium highlights certain areas in the body to create a clearer picture. A barium s$allo$ may be per%ormed separately or as part o% an upper gastrointestinal UE#! series, $hich evaluates the esophagus, stomach, and duodenum %irst part o% the small intestine!.

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=mall video screen ;arium X ray %ilm (V monitor

PROC DUR !

).! *+plain the procedure to the patient ,.! -ou may be as/ed to sign a consent %orm that gives your permission to do the procedure. Read the %orm care%ully and as/ &uestions i% something is not clear. ..! -ou3ll be as/ed to remove any clothing, 6e$elry, or other ob6ects that may inter%ere $ith the procedure. 4.! #% you3re as/ed to remove clothing, you3ll be given a go$n to $ear. 5.! -ou3ll be positioned on an X-ray table that can tilt you %rom a horiFontal to an upright position. -ou may also be as/ed to change positions %or e+ample, lying on your side, bac/, or stomach! at intervals during the procedure. 7.! =tandard X-rays o% the heart, lung, and abdomen may be per%ormed %irst. 7.! (he radiologist $ill as/ you to ta/e a s$allo$ o% a thic/ened barium drin/. (he barium is usually %lavored, although it may not be very pleasant tasting. B.! As you s$allo$ the barium, the radiologist $ill ta/e single pictures, a series o% X-rays, or a video %luoroscopy! to observe the barium moving through the pharyn+. G.! -ou may be as/ed to hold your breath at certain times during the procedure. )A.! -ou $ill be given a thinner barium drin/ to s$allo$. X-rays and"or %luoroscopy $ill be used to observe the barium3s passage do$n the esophagus. -ou may also be as/ed to s$allo$ a barium tabletHa small, solid pill, $hich can help to visualiFe certain structural problems o% the esophagus. )).! #% an additional procedure called a small bo$el %ollo$-through has been re&uested, it $ill be per%ormed a%ter t :nce all re&uired Xrays have been ta/en, you3ll be assisted %rom the table.

),.!

>e barium s$allo$ has been completed.

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-our physician $ill e+plain the procedure to you and o%%er you the opportunity to as/ any &uestions that you might have about the procedure.

-ou may be as/ed to sign a consent %orm that gives your permission to do the procedure. Read the %orm care%ully and as/ &uestions i% something is not clear.

-ou3ll be as/ed to not eat or drin/ li&uids %or eight hours be%ore the procedure, generally a%ter midnight.

#% you3re pregnant or suspect that you may be pregnant, you should noti%y your physician.

Noti%y your physician i% you3re sensitive to or are allergic to any medications, late+, tape, and anesthetic agents local and general!. Noti%y your physician o% all medications prescribed and over the counter! and herbal supplements that you3re ta/ing. -our physician may advise you to $ithhold certain medications prior to the procedure.

Noti%y the radiologist i% you3ve had a recent barium X-ray or cholangiography procedure, as this may inter%ere $ith obtaining an optimal X-ray e+posure o% the upper E# area.

;ased upon your medical condition, your physician may re&uest other speci%ic preparation.

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-ou may be as/ed to hold your breath at certain times during the procedure.

-ou $ill be given a thinner barium drin/ to s$allo$. X-rays and"or %luoroscopy $ill be used to observe the barium3s passage do$n the esophagus. -ou may also be as/ed to s$allo$ a barium tabletHa small, solid pill, $hich can help to visualiFe certain structural problems o% the esophagus. #% an additional procedure called a small bo$el %ollo$-through has been re&uested, it $ill be per%ormed a%ter the barium s$allo$ has been completed. :nce all re&uired X-rays have been ta/en, you3ll be assisted %rom the

table.

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-ou may resume your normal diet and activities a%ter a barium s$allo$, unless your physician advises you di%%erently. ;arium may cause constipation or possible impaction a%ter the procedure i% it isn3t completely eliminated %rom your body. -ou may be advised to drin/ plenty o% %luids and eat %oods high in %iber to e+pel the barium %rom the body. -ou may also be given a cathartic or la+ative to help e+pel the barium. =ince barium isn3t absorbed into the body but passes through the entire intestinal tract, your bo$el movements may be lighter in color until all o% the barium has been e+creted. Noti%y your physician to report any o% the %ollo$ingC
8i%%iculty $ith bo$el movements or inability to have a bo$el movement

?ain and"or distention o% the abdomen =tools that are smaller in diameter than normal

-our physician may give you additional or alternate instructions a%ter the procedure, depending on your particular situation.

Referen.es!

httpC""$$$.drugs.com"cg"barium-s$allo$-precare.html httpC""$$$.hop/insmedicine.org"healthlibrary"testDprocedures"gastroenterology"bar iumDs$allo$DG,,?A77BB" httpC""$$$.medicalhealthtests.com"barium-s$allo$.html

Ateneo de Zamboanga University College of Nursing

NURSING SKILLS OUTPUT (NSO)

Report No. G Defi0rilla&ion

D SCRIPTION! 8e%ibrillation is achieved by delivering a strong electric current though electrodes placed on the sur%ace o% a patient@s chest $all. ?roper electrode placement ensures that the a+is o% the heart is directly situated bet$een the sources o% current de%ibrillator paddles!. =ince dysrhythmias are chaotic $ith no coordinated ventricular response, the electric current is delivered randomly. #t is through implementation o% emergent de%ibrillation that ventricular %ibrillation and pulseless ventricular tachycardia can be terminated and cardiac output restored.

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8e%ibrillator 1onductive medium- de%ibrillator pads 1ardiac monitor $ith recorder *mergency cart and medications *mergency pacing e&uipment

PROC DUR ! ). Veri%y V-%ib or V-tach by *1E and correlate $ith clinical state. Assess to determine absence o% pulse. 1all %or help and per%orm 1?R until de%ibrillator and crash cart arrives. ,. ?repare %or de%ibrillation a. (urn po$er <:N<. 8e%aults to ,AA 6oules. b. =elect correct paddles- adult, pediatric or internal. c. ?repare patient and"or paddles $ith proper conductive agent. d. 1hec/s that de%ibrillator is in asynchronous mode. 111 #% other than ,AA 6oules desired, press <*N*RE- =*2*1(< and select desired amount .. (urn on *1E recorder %or continuous printout. 4. ?laces one paddle at the heart@s Ape+ 6ust le%t o% the nipple in mida+illary line. ?lace the other paddle 6ust belo$ the right clavicle to the right o% the sternum, applying ,5 lbs. " s&uare inch pressure to paddles. 5. 111?ress <1>ARE*< on de%ibrillator %ront panel or on the Ape+ paddle. Iait until indicator stops %lashing to indicate %ully charged.

7. 111=tate <A22 12*AR< and visually chec/ that all personnel are clear o% contact $ith bed, patient and e&uipment. 7. 1111hec/s rhythm immediately be%ore discharge. B. B. 8epress both buttons simultaneously and maintain pressure until electrical current delivered. 'aintain ,5 lbs"in,! G. 111Assess conversion o% dysrhythmia. )A.)A. #% %irst de%ibrillation unsuccess%ul, immediately charge paddles to .AA 6oules and repeat steps , through G. )).#% second de%ibrillation unsuccess%ul, immediately charge paddles to .7A 6oules and repeat steps , through G. ),.#% third attempt is unsuccess%ul, continue 1?R, initiate A12= protocols, intubate and obtain #V access. Assess patient status and precipitating %actors to prevent %urther decompensation o% patient. )..1lean de%ibrillator and paddles, discard supplies, and $ash hands. )4.8ocuments procedure in patient record or cardiac arrest %lo$sheet.

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;e%ore starting the de%ibrillation, patient@s pulse and electrocardiogram should be monitored. (o treat the possible cause o% abnormal heart rhythm medications can be administered. 8e%ibrillation continues until the patient@s condition stabilises or the procedure is ordered to be discontinued. *arlier, large-siFed de%ibrillators $ere used in ambulances and hospitals. ;ut these days smaller, lighter, less e+pensive and easy-to-use de%ibrillators are available. (hey are computerised and provide verbal instructions to the operator and deliver shoc/ to patient $hose heart is not %ibrillating.

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'ay be mista/en %or arti%act or leads may be o%%. Asses situation. #% a second person is getting the de%ibrillator, establish an air$ay and begin 1?R. a. 1onvert to pediatric siFe %or children or internal i% the patient is has an open chest. b. *nhances electrical conduction through subcutaneous tissue and assists in minimiFing burns. c. 2imit to paddle area.Use , 6oules"/g %or children. d. Iill not %ire i% it is in synchronous mode due to absence o% R $ave

*stablishes a visual recording and a permanent record o% current *1E status and response to intervention. 8e%ibrillation s achieved by passing an electric current through cardiac muscle mass to restore a single source o% impulse generation. 8ecreases transthoracic resistance and improves %lo$ o% current across a+is o% heart. (his $ill charge unit $ith current. 'aintains sa%ety to caregivers, since electric current can be conducted %rom the patient to another individual i% contact occurs. *1E rhythm may change, ensure it is a rhythm that re&uires de%ibrillation. ?remature release may result in %ailure to discharge energy. 'ay also be delivered by depressing discharge button on the de%ibrillator. #% rhythm has converted, must reassess. #mmediate action increases chance %or success%ul depolariFation o% cardiac muscle. (ransthoracic resistance decreases by appro+imately B J $ith the second shoc/. #mmediate action increase chance o% success%ul depolariFation o% cardiac muscle. <=tac/ed shoc/s< se&uence is more important than

ad6unctive drug therapy and delays bet$een shoc/s to deliver medications are detrimental. Necessary to maintain the delivery o% o+ygenated blood to vital organs. 1onductive gel accumulated on de%ib paddles impedes sur%ace contact and increases transthoracic resistance. ?rovides %or completion o% medical" nursing records.

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Neurologic status. Reorient to person, place, and time. Respiratory status. Auscultate lung sounds, 'onitor rate, depth, K &uality o% breathing. :+ygen as ordered. 1ardiovascular status. Eet ),-lead *1E and continue to monitor rhythm and blood pressure, pulse and respirations %re&uently until stable. #nitiate #V antidysrhythmic therapy. 'onitor %or burns. (reat i% indicated. 8ocumentation. #nclude neurologic, respiratory and cardiovascular assessment be%ore and a%ter de%ibrillation. All code related in%ormation should be completed on the code summary %lo$sheet. ?atient"%amily education. Assess understanding o% past, current and %uture needs.

Referen.e! httpC""$$$.mdhil.com"an-introduction-to-de%ibrillation-procedurea%tercare-ris/s" httpC""micunursing.com"de%ib.htm Ateneo de Zamboanga University College of Nursing

NURSING SKILLS OUTPUT (NSO) Report No. )) Pa.e%a2er I%plan&

D SCRIPTION! A pacema/er is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lo$er chambers o% the heart ventricles!. A pacema/er may also be used to treat %ainting spells syncope!, congestive heart %ailure and hypertrophic cardiomyopathy.

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D D! 2ocal Anaesthetic

:ne or t$o leads thin insulated $ires! pacema/er =pecial soap =terile drapes =o%t strap *lectrocardiogram or *LE 8e%ibrillator"pacema/er"cardioverter O3i%e&er %oni&or PROC DUR ! ).! ,.! ..! 4.! 5.!

A small incision, appro+imately , inches long $ill be made in the upper chest :ne or t$o leads thin insulated $ires! $ill be guided through a vein into the heart (he doctor $ill then connect the lead s! to your pacema/er and program the device %or your medical needs (hen the pacema/er $ill be inserted beneath your s/in, and the incision in your chest $ill be closed -our doctor $ill test the pacema/er to ensure it is $or/ing properly to meet your medical needs

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-our doctor may also as/ you to stop ta/ing other medications, such as those that control your heart rate. As/ your doctor $hich medications you should stop ta/ing and $hen to stop ta/ing them. *at a normal meal the evening be%ore your procedure. Remove all ma/eup and nail polish. Iear com%ortable clothes $hen you come to the hospital. -ou $ill change into a hospital go$n %or the procedure. ?lease leave all 6e$elry including $edding rings!, $atches and valuables at home. (he clothing you are $earing that morning $ill be returned to the person $ho accompanies you.

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An antibiotic $ill be given through the #V at the beginning o% the procedure. (he le%t or right side o% your chest $ill be shaved A special soap $ill be used to cleanse the area =terile drapes are used to cover you %rom your nec/ to your %eet A so%t strap $ill be placed across your $aist and arms to prevent your hands %rom coming in contact $ith the sterile area A medication $ill be given through your #V to rela+ you and ma/e you %eel dro$sy, but you $ill not be asleep during the procedure.

(he nurse $ill connect you to several monitors that allo$ the health care team to chec/ your heart rhythm and blood pressure during the procedure. (he nurse continually monitors you during the procedure.

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-ou $ill be admitted to the hospital and stay overnight a%ter the procedure. Usually you $ill be able to go home the day a%ter your pacema/er $as implanted.

#n your hospital room, a special monitor, called a telemetry monitor, $ill continually monitor your heart rhythm. (he telemetry monitor consists o% a small bo+ connected by $ires to your chest $ith stic/y electrode patches. (he bo+ displays your heart rhythm on several monitors in the nursing unit. (he nurses $ill be able to observe your heart rate and rhythm. -ou $ill also have a holter monitor, a small recorder attached to your chest $ith stic/y electrode patches. (he holter monitor records your heart rhythm %or ), hours to ensure that the pacema/er is %unctioning properly. A chest X-ray $ill be done a%ter the pacema/er implant to chec/ your lungs as $ell as the position o% the pacema/er and lead s!. ;e%ore you are discharged, the holter monitor $ill be removed, and the results $ill be given to your doctor. -ou $ill then go to the 8evice 1linic. -ou may %eel discom%ort at the pacema/er implant site during the %irst 4B hours a%ter the procedure. (he doctor $ill tell you $hat medications you can ta/e %or pain relie%. ?lease tell your doctor or nurse i% your symptoms are prolonged or severe. -our doctor $ill discuss the results o% the procedure and ans$er any &uestions you have. -ou $ill receive speci%ic instructions about ho$ to care %or yoursel% a%ter the procedure including medication guidelines, $ound care, activity guidelines, pacema/er care and maintenance, and a %ollo$-up schedule. Also re%er to M8ischarge #nstructions a%ter a ?acema/er #mplant.N

Referen.e! httpC""my.clevelandclinic.org"heart"services"tests"procedures"pacema/er.asp+ httpC""$$$.medtronic.com"patients"bradycardia"getting-adevice"surgery"inde+.htm httpC""$$$.nhs.u/"conditions"pacema/erimplantation"pages"introducti on.asp+