Pre and post Angiography and

angioplasty care

Group members,
Muhammad iqbal
Azra inayat
 Objectives..
• At the of this presentation the students will
be able to know,
A. Describe angiography and angioplasty.
B. Identify indication and contraindication of
angioplasty.
C. Discuss Pre and post nursing care of angiography
and angioplasty.
D. Discuss patient history related to angiography.
 Heart gross Anatomy
• The heart is a conical shaped, muscular organ
which lie in the midiastinam.
• It is divided into four chambers ,
• right and left Atrium.
• Right and left ventricle.
• The heart contains four valves
• The tricuspid, bicuspid , pulmonary , and
aortic valve.
 Coronary arteries supply..
• The heart is a pumping organ which pump
blood around the body.
• Like other organs, the heart itself need
oxygen, and nutrients to work which is supply
by the coronary arteries .
• An atherosclerosis is the narrowing of the
coronary arteries which impaired blood supply
to the heart (ischaemia )
 IHD
• Ischaemia case angina
, chest tightness , pain
in the left shoulder
and neck.
• Angina and shortness
of breath is mostly
associated with
exertion also called
(heart attack )
 Patient demographic data..
• Name, Muhammad Shair Sha
• PR no, 19-09-107706
• Age, 67 years
• Gender, male
• Word , A
• Diagnose CAD ,
 History of CAD patient ..
• Muhammad shair sha is a 67 year old male
patient admitted in word (A) under the care of
doctor Aftab altaf. According to the patient ..

• Presenting complains
• ( chest pain last 3 days
• , SOB since 1 month,
• ascites ,
• productive cough )
 Labs investigation
Diagnose ..
• ECG ---- shows inferior wall MI

• RFTs---- urea , 34
• creatinine 0.9
• GFR , 90

• CBC-- WBC – 12,000

• Hb -- 13.7

• Electolytes
• Na … 141 k, 3.7 Cl, 102
 Continued …
• VIROLOGY,
• HCV Non reactive 0.06 ( < 1.0 )
• HIV Non reactive 0.31 ( < 1.0)

• ECHO
• Ejection fraction EF.. 56 %

• Cardiac markers..
• High sensitive troponion I …4468
 Assessment
• Cardio-vascular system,
s1,s2 + O
chest pain, dyspnoea
• Respiratory system
B/L wheezing ,

• Abdominal system
soft non tenderness, bowel sound present

• General impression
GCS (15 / 15 )
 Continued,
• past medical history..
• DM, CCF ,
• Physical examination shows Anemia.
• Systemic examination shows bilateral chest
crackles.

• Past surgical history ..

• angioplasty done.
• Single vessel angioplasty .
 Current diagnose ..

 ischemic heart disease (IHD)

 Inferior wall myocardial infraction . (IWMI)
 Acute LVF, CCF , CAD

Doctor suggest..
 angioplasty for LCx 95 % occluded.
 Vitals sign ..
• BP.. ( 140/90)
• Pulse ( 80 )
• Temperature ( 99 F )
• RR (17 )
 Medication ..
• Clexane 60 mg BD (anticogulant)
• Loprin 150 mg OD (NSAID)
• Plavax 75 mg OD (antiplatelet)
• Concor 2.5 mg OD ( betabloker )
• Ramipace 2.5 mg HS ( antihypertensive )
• Rovista 40 mg HS ( antilipidemic )
• Angisid 0.5 mg SOS ( glyceral trinitrate )
• Lasix 20 mg BD ( antidiuretic )
• Dobotrex 1500 mg ( positive ionotropic )
 Nursing diagnosis
• Anxiety related to medical procedure as evidence
by restlessness.

• Goals ..
• Patient will be able to state their anxiety level,
• By discussing feeling of dread, anxiety, and so
forth.
• By reducing anxiety level through relaxation
technique .
 Nursing intervention
• Establish and maintained trust worthy
relationship by listening to the client.
• Maintain a calm, non threatening manner
while working with the client.
• Remain with the client at all time when level
of anxiety is high.
• Move the client to a quiet area with minimal
stimuli.
 Nursing diagnose,
• Deficient knowledge related to treatment, as
evidence by verbalizing inaccurate
information.

• Goals & outcomes

• Patient explain disease state.
• Recognize need for medication.
• Understand treatment.
 Nursing intervention
• Educate the patient about procedure and
treatment.
• Include the patient in creating the teaching
plan.
• Consider what is important to the patient.
• Provide thorough, and understandable
explanation and demonstration.
• Encourage questions.
 What is angiography ..
• Coronary angiography also
called (cardiac
catheterization ) is a
diagnostic procedure that
identifies whether you have
narrow or blocked coronary
arteries. If You are at risk of
unstable angina, atypical
chest pain, aortic stenosis,
heart failure .
•
 Continued ..
• During this procedure a contrast dye is
injected into your arteries though a catheter
to watch your heart through monitor.
 Indication of Angiography …
• Evaluation of IHD
• Valve heart disease
• Cardiomyopathies
• unstable Angina
• Variant angina
• ACS
• Congestive heart failure
• Acute myocardial infraction
• Large VSD
• Mitral insufficiency
• Large aneurysm
• Sudden death syndrome
 Contra Indication of angiography
• Severe uncontrolled hypertension
• Ventricular arrhythmias
• Acute stroke
• Severe Anemia
• Acute gastrointestinal bleeding
• Allergy to radiographic contrast
• Acute renal failure
 Pre care of angiography pt..
Nursing care ..
• Monitor patient weight in kg.
• Maintain IV line .
• Assess patient knowledge of the procedure.
• Explain procedure to the client, that the procedure will
be performed under the local anesthesia.
• Assess vitals signs , peripheral pulse ,heart and lungs
sounds .
• Sign inform consent before procedure.
• Keep patient NPO 6-8 hours before procedure .
• Assess patient if the patient is allergic to iodine dye.
ii
 Continued,
• Assess CBC , platelets , prothrombine , electrolytes ,
creatinine level before procedure.
• Instruct patient to empty his bladder before
procedure .

• Explain to the patient that he will experience a

feeling of heat, flushing of face ,desire to cough
during dye injection .
 Angioplasty ..
• Angioplasty also
called percutaneous
coronary
intervention (PCI) is
a treatment used to
improve blood flow
to heart muscle by
opening a narrowed
or blocked coronary
artery.
 Procedure ..
• Angioplasty is a treatment where a metal
mesh tube stunt is used to open a narrow or
blocked artery.
• Which increase blood flow to the heart
muscles .
• Which itself decrease Angina symptoms and
better quality of life.
 After procedure
• Assess vital sign ,
• Catheter site for bleeding , hematoma,
neurovascular status , 15 minutes for 1st H, 30
minutes for the next H, then hourly .
• Maintain bed rest , for radial angiography for 3H,
while for femoral 6 H rest is advice to prevent
bleeding .
• The head of the bed may be raised up to 30
degree.
• Keep a pressure dressing , sandbag , or ice pack
in place over the arterial access site.
 Continued..
• Instruct to avoid flexing or hyperflexing the
effected extremity for 12-24 h. to reduce chances
of bleeding, hematoma or thrombus formation.
• Maintained iv fluid to remove contrast dye from
patient body to avoid adverse reaction.
• Report diminished periphral pulse , formation of
new hematoma, severe pain at the insertion site
chest pain , dyspnia, MI, or other complication
my occur.
• Provide instruction about dressing changes ,
follow up ,potential complication .
 Future plain
• Doctor his visited the patient and advised to
discharge the patient .
• Strictly fallow medication regime.
• if not treated , suggest CABG next follow up .
ANY QUESTION
?