If you’re administering a thrombolytic drug, monitor your patient’s heart rhythm for reperfusion arrhythmias. Also, monitor him for reocclusion of the coronary artery. Report any chest pain or ischemic changes on the ECG to the physician. To reduce the risk of reocclusion, begin heparin therapy after thrombolytic therapy, as prescribed, and monitor your patient’s partial thromboplastin time (PTT). Titrate the heparin to maintain the PTT at twice the control time.Assess the puncture site for bleeding and hematoma formation. Also, avoid performing venipunctures or a phlebotomy after injecting the thrombolytic drug. Assess the patient’s pedal pulses distal to the puncture and immediately report any loss of pulse. Monitor his vital signs for signs of hemorrhage, such as hypotension and tachycardia. If you’re administering streptokinase, observe the patient for an allergic reaction.
Some More Facts
Help your patient identify his personal risk factors for CAD and develop a realistic risk-reduction plan. Encourage him to enroll in a cardiac rehabilitation program for exercise training to improve his cardiovascular endurance.
Depending on the severity of the patient’s disease, tell him that he may need to exercise while attached to an ECG monitor to increase his confidence and allow detection of ischemia and arrhythmias. Tell him that as he progresses, he’ll be instructed about home activities that he can perform safely. And explain that cardiac rehabilitation professionals will help determine when he can return to work and resume recreational activities.
A cardiac rehabilitation program also may have classes in which he can learn about the anatomy and physiology of the heart and the pathophysiology of CAD. The program may help him by offering psychosocial support as he makes lifestyle changes to manage his disease.
If your patient is scheduled for an invasive procedure, explain the procedure, the expected outcome, and the care he’ll receive afterward. If a surgical procedure will involve a saphenous vein graft, make sure he understands that the physician will make an incision in his leg.
Before he’s discharged, instruct your patient and his family about prescription drugs he must take at home. Make sure they know the proper administration route, whether oral, trans dermal, or sublingual. In particular, ensure that the patient knows how to use sublingual nitroglycerin for angina. Discuss the therapeutic and adverse effects of each drug. Also, teach him the symptoms that warrant an immediate call to his physician.
Risk Factors
To slow the progression of CAD, a patient needs to change his lifestyle. Be sure you teach your patient the importance of taking the following measures:
- quitting smoking
- controlling his weight
- controlling his lipid levels
- reducing stress
- lowering his elevated blood pressure
- exercising.