Med-Surg - Cardiovascular System, part 7: Diagnostic Procedures, Coronary Angiogram

I am Cathy with Level Up RN. In this video, I'm going to wrap up our coverage of diagnostic tests associated with the cardiovascular system. And at the end of the video, I'm going to provide you guys with a little quiz to test your knowledge of some of the information I'll be covering in this video. If you have our medical-surgical nursing, second edition flashcards, definitely pull those out so you can follow along.

Specifically, in this video, we will be talking about procedures that we can use to diagnose disorders of the cardiovascular system.

An EKG or electrocardiogram provides a graphic representation of the heart's electrical activity. And if you are needing help with EKG interpretation, we have a great flashcard deck and a complete video playlist to help you with that. So definitely check that out if needed.

An echocardiogram uses ultrasound waves to help visualize cardiac structures, especially the heart valves. It also measures ejection fraction, so normal left ventricular ejection fraction is between 55 and 70 percent. So if your patient has a reduced ejection fraction, then that would be indicative of heart failure.

We also have a transesophageal echocardiogram, so a TEE. This is where a transducer is placed down the esophagus to provide a more detailed view of those cardiac structures. And this procedure is done under conscious sedation.

Hemodynamic monitoring provides direct measurement of pressures in the heart and the great vessels through an arterial line.

So some of the pressures that we can obtain through hemodynamic monitoring include central venous pressure, which should be between 2 and 6 mmHg.

We can get the pulmonary artery wedge pressure, which should be between 4 and 12 mmHg, and we can also measure cardiac output through hemodynamic monitoring.

Next, let's talk about a coronary angiogram or what is referred to as a cardiac cath.

This is an invasive procedure that is used to determine if your patient has a blockage or narrowing of a coronary artery. And during this procedure, a catheter is inserted at the femoral artery and then threaded up to the heart. So in terms of nursing care, we have pre-procedure and post-procedure, nursing care.

Pre-procedure, we're going to want to make sure our patient is NPO for eight hours or more. We're going to want to assess for allergies to iodine and shellfish. Although I have to be honest with you, there's a lot of data and research to indicate that an allergy to iodine or shellfish does not increase an individual's risk for having a reaction to the contrast dye associated with a cardiac cath. However, most providers still assess the patient for these allergies, and as a nurse and a nursing student, this is definitely important to know as well. So you're going to assess for those allergies to iodine and shellfish. You're also going to assess your patient's kidney function. So you're going to check their creatinine and BUN levels because if the patient has impaired kidney function, then they may not be able to excrete the contrast dye easily, and that can be toxic to the kidneys. In addition, we want to assess and mark their distal pulses so that we can easily find those after the procedure and check their pulses. So you're going to mark that dorsal pitas pulse and that posterior tibial pulse as well.

After the procedure, we're going to want to check the insertion site at the femoral artery for bleeding, and we're going to want to check the extremity distal to that insertion site for pulse, capillary refill, color, and temperature. So we want to make sure we're getting good blood flow down to that extremity. And then we're going to closely monitor the patient's vital signs per facility policy. So this often includes taking vital signs every 15 minutes, four times. So that first hour, you're going to take it every 15 minutes and then after that, you're going to take it every hour for four hours. Again, your facility policy may vary, but we will definitely be closely monitoring their vital signs. And then we also want to encourage our patient to increase their intake of fluids to try to flush out that contrast dye. And we're going to have our patient lay flat for four to six hours after the procedure.

Okay, time for a quiz. I have three questions for you. First question, what procedure uses ultrasound waves to visualize cardiac structures and measure ejection fraction? If you said an echocardiogram, you're correct. Question number two, what lab values are used to assess a patient's kidney function prior to a cardiac cath? The answer is creatinine, as well as BUN. Creatinine being the more important of those two. Question number three, how should a patient be positioned after a cardiac cath? The answer is they need to lay flat, and they need to lay flat for four to six hours after the procedure.

Okay, that's it for this video. I hope it's been helpful. If so, be sure to like this video. Leave me a comment if there are other topics or suggestions you have for me. I definitely want to hear those. In my next video, we will start talking about dysrhythmias, so definitely check that out.