Several hours later, K.Z. returns from his catheterization
The catheterization report shows 90% occlusion
of the proximal left anterior descending (LAD) coronary artery, 90% occlusion of the distal LAD, 70% to
80% occlusion of the distal right coronary artery (RCA), an old apical infarct, and an ejection fraction (EF)
of 37%. About an hour after the procedure is finished, you perform a brief physical assessment and note
a grade III/VI systolic ejection murmur at the cardiac apex, crackles bilaterally in the lung bases, and trace pitting edema of his feet and ankles. Except for the soft systolic murmur, these findings were not present before the catheterization.
What is your evaluation of the catheterization results?
Explain the significance of having an EF of 37%.
What problem do the changes in assessment findings suggest to you? What led you to your conclusion?
List five actions you should take as a result of your evaluation of the assessment, and state
your rationales.
He has severe occlusion of two major coronary arteries (RCA, LAD), meaning that much of
his ventricular muscle is without adequate blood supply. The old apical infarct is now tough,
noncontractile scar tissue. The coronary occlusions and scar tissue contribute to the low EF. An EF of 37% indicates that his left ventricle has lost almost half of its ability to pump blood.
The ejection fraction is the percentage of blood that is ejected from the heart during systole. EF in a normal heart is 50% to 70%. When it drops to below 40%, it indicates left ventricular HF and a serious drop in cardiac output (CO) from the left ventricle having lost much of its pumping ability. This is especially important because this is the "working ventricle" that pumps blood throughout the body.
K.Z. is developing HF with valve involvement. He has crackles in bilateral bases, pitting edema in his lower extremities, and a systolic ejection murmur (indicating valve involvement).
• Take K.Z.'s VS and continue taking them every 15 minutes. K.Z. is experiencing some sudden
changes in his cardiovascular status that require close monitoring.
• Ask him about symptoms relevant to HF such as shortness of breath and anxiety. Subjective
reports of how the patient feels (symptoms) supplement the objective data (signs) obtained by
your assessment.
• Note K.Z.'s mental status. Is he restless, confused, or lethargic? Mental status is a good indicator of
cerebral perfusion and hypoxemia. Watch carefully for changes.
• Determine his need for supplemental oxygen. Initiate oxygen therapy if needed. The crackles
indicate the development of pulmonary edema and potential need for oxygen.
• Call the physician immediately, and report the previous findings.
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