Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an anterior wall myocardial infarction (MI)
In addition, he has chronic anemia, hypertension, chronic renal insufficiency, and a
recently diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to
retire from his job as a railroad engineer about 6 months ago. This morning, he is being admitted to your
telemetry unit for a same-day cardiac catheterization. As you take his health history, you note that his
wife died a year ago (at about the same time that he had his MI) and he does not have any children. He
is a current cigarette smoker with a 50–pack-year smoking history. His vital signs (VS) are 158/94, 88, 20,
and 97.2 ° F (36.2 ° C). As you talk with him, you realize that he has only a minimal understanding of the
catheterization procedure.
Before he leaves for the catheterization laboratory, you briefly teach him the important things
he needs to know before having the procedure. List five priority topics you will address.
Look at his past history. What other factors are present that could contribute to his risk for
cardiac ischemia?
• The purpose of the procedure
• How he will be prepared for the procedure
• What to expect during the catheterization itself (what the cathlab will look like; sensations he may
feel during the procedure, such as a feeling of heat or a hot flash, or palpitations; that someone will
be applying pressure to the groin to prevent bleeding after the procedure)
• What routine monitoring to expect after the procedure, and that he will have to stay in bed for 4 to
6 hours after the procedure, with the procedure leg flat and possible pressure with a sandbag over
the insertion site
• Which staff members will be present to support him
• Possible complications, and how they will be prevented or managed
Factors that may contribute to a higher risk for cardiac ischemia are K.Z.'s chronic anemia and his
smoking, which causes vasoconstriction and maintains a higher level of circulating carbon monoxide
in his red blood cells (RBCs).
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