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