post pci 환자간호 - summitmd.comsummitmd.com/pdf/pdf/1_kyoung-soon yang.pdf · 2013. 5. 14. ·...

Post PCI 환자간호

Asan Medical Center

CCU 양경순

Stable angina

Atherosclerosis

UA

NSTEMI

STEMI

Thrombosis

Decreased O2 Supply

- Flow- limiting stenosis

- Anemia

- Plaque rupture/clot

Increased O2 Demand

O2 supply/demand mismatch→Ischemia

Myocardial ischemia→necrosis

Pathophysiology ACS

Asy

mpto

mat

ic

Ang

ina

Myoca

rdia

l In

farc

tion

Stable Angina and ACS

▣ Decreased

myocardial O2

consumption- Nitrates

- Vasodilator

- Beta blocking agents

- Sedatives

- Ca++ channel blocking

agents

- Exercise program

- Risk factor modification

Rest

Selected

diet(small,

frequent)

Stool

softner

Stress

management

Medication

Cardiac

rehabilitation

ACS Management

ACS Management

▣ Increase

coronary

blood supply

Oxygen

Revascularization

Medication

Cardiac

rehabilitation

- Thrombolysis

- PCI

- CABG

- Nitrates

- Anticoagulants

- Antiplatelet agents

- Lipid lowering agents

- Ca++ channel blocking agent

- Exercise program

- Risk factor modification

Acute complication

Cardiac tamponade

Abrupt closure

Renal failure

Atheroembolism, CNS problem

Hypersensitivity reaction

Fetal arrhythmia

Bleeding

Cardiogenic shock

Close Observation!!!!

Chest pain

Hemodynamic monitoring

Neurologic examination

Sheath site management

Renal perfusion

Cardiogenic shock

Patients education

Hemodynamic monitoring

Chest pain

EKG monitoring

12 lead EKG

Heart sounds

Cardiac enzyme

Cardiovascular system

Hemodynamic monitoring

Cardiac tamponade

Benign stent sensation

Acute thrombosis

Abrupt vessel closure

Transient coronary spasms

Side branch occlusion

Distal embolization of debris

Chest pain

EKG

Arrhythmia

PVC

VT/VF

Accelerated idioventricular rhythm

SVT

Sinus bradycardia

Block

Anatomic Groups

RV infarction Reverse ECG

Case

Post PCI

Respiratory system

Respiration

: dyspnea, orthopnea, tachypnea

SpO2

Lung sounds

Dye reaction

nausea, vomiting

urticaria, itching sense, facial flushing

anaphylaxis

– dyspnea, inspiration stridor, wheezing,

– bronchospasm, laryngeal edema,

– hypotension, pulmonary edema

Neurologic examination

Level of consciousness

P/S, L/R

GCS/Muscle strength

Nausea/vomiting, headache

Seizure

Speech disturbance

Intracraneal bleeding

Sheath management

Arterial sheath 관리

- bleeding, hematoma

- peripheral circulation assess

: peripheral pulse, pain, paresthesia, bruits

- bleeding tendency : CBC, coagulation study

Sheath management

Sheath removal & compression

- vasovagal shock

: bradicardia, hypotension, dizziness, nausea

vomiting, sweating, pallor

- local anesthesia, atropine, fluid 투여

Vascular related complication

Hematomas

Retroperitoneal bleeding

Pseudoaneurysms

A-V fistulas

Nerve compression

Artheroembolism

Renal perfusion

Urine output

Hemodynamic parameter

Hydration

BUN/Cr

CRRT/HD

Cardiogenic shock

Cardiogenic shock

Cardiogenic shock

ECMO (ExtraCoporial Membrane Oxygenation)

IABP (Intra-Aortic Balloon Pump)

Patient education !!!!