Cardiac Catheterization Care Plan Assistance Needed

[la_chica_suerte85, BSN, RN]

Hi everyone,

I had the opportunity to be in a cath lab and, unfortunately, it was full of outpatient (great for the cath lab, bad for the hapless student who had a care plan due) diagnostic procedures. I chose my patient (the health history is amazing and if pt was there for anything r/t that I would be set) but there is very limited priority information for me to go on.

The pt was minimally symptomatic (cc of chest pain and with hx of autoimmune disease the procedure was being done to determine any CAD along with the extent of stenosis of the aortic valve). The pt was a compliance star -- great support system at home and was demonstrating the beneficial effects of eating right and exercising (perhaps a little bit late for the aortic valve but the autoimmune issue wasn't exactly helping the situation).

I have 2 problems. First, I have to come up with 2 physiological Dxs and 1 psychosocial Dx. Of course I must prioritize my physiological but my best stab at it, according to what was assessed, was Decreased Cardiac Output r/t cardiac dysfunction (truly only based on the chief complaint of angina and the current Dx of aortic valve stenosis) and Readiness for enhanced comfort r/t tissue trauma and muscle spasm (procedure-related and the pt was having some discomfort in an upper extremity).

My second problem is trying to write this care plan without including details from the actual procedure. So, do I do pre-procedure or post-procedure? The practice care plan was judged by my instructor as being difficult to follow. Of course it is! If I choose pre-procedure, the major issue was anxiety (and I can't put a psychosocial Dx first). The pt was flagged for CHF fluid restrictions and the IV fluids were reduced but the pt's output was fantastic and there were no symptoms of CHF. If I choose post-procedure, the pt had no pain except the upper extremity and from having to lie flat (the Versed/Fentanyl took good care of the anxiety) — the pt took it all like a champ. I also can't prioritize a risk for bleeding. Everything was perfect, save for a little blip with the post-procedure BP being a little high and some meds were given (to protect the insertion site and to protect the left ventricle which already had enough to deal with). The majority of the REALISTIC care plan would be giving the BP meds (i.e. risk for injury r/t hematoma risk factor: hypertension and invasive procedure), ensuring comfort and education to reinforce what the pt was already doing right, what could be done better, and to prevent bleeding complications from the insertion site after discharge.

I'm stuck and my hands are tied because of the format we must adhere to in order to get all the points as laid out in the rubric. I guess I could take my chances with a care plan during the procedure but that just seems way too far out there at this point. So now I'm stuck with this whacky pre- and post-procedure Frankenstein of a care plan that, in hindsight, truly looks ridiculous and overly complicated from the instructor's standpoint.

Any ideas, anyone? Any assistance would be appreciated.

[Tex.]

Good stuff! So, the patient WAS symptomatic, so he bought a trip to the catch lab. Your priority problem could be the Dx that landed him in the catch lab (decreased perfusion, cardiac output, etc.). Second problem could be r/t post procedure issues: risk for bleeding r/t invasive procedure, or the HTN you mentioned. Or you could go with the risk for fluid overload r/t CHF (or whatever was going on with him that made them out him on CHF protocol)

Psychosocial....I would not use the r/t to muscle spasm part. Quick google search gives you the care plan with that exact Nursing Dx mentioned. I would not use it solely for that reason.

[la_chica_suerte85, BSN, RN]

^^ Thanks for the input! It helps me clarify it a little bit better to think about that he was symptomatic even though there was very little for me to do at that moment intervention-wise. I will simplify it and hopefully it works out. Thanks again for responding. I know I'm long-winded.

[PyridiumP]

Risk for bleeding is not a low-priority diagnosis post cath bec people do bleed from their artery after the stick and it can be big. The other is risk for loss of blood flow to the arm or leg where the artery was punctured. Big bleeding or clotting off an arm or leg is serious so the nurse should be on top of monitoring for those. Safety always comes first, thats why theres a big section on it in nursing diagnosis books and its a priority in NCLEX.

[la_chica_suerte85, BSN, RN]

Risk for bleeding is not a low-priority diagnosis post cath bec people do bleed from their artery after the stick and it can be big. The other is risk for loss of blood flow to the arm or leg where the artery was punctured. Big bleeding or clotting off an arm or leg is serious so the nurse should be on top of monitoring for those. Safety always comes first, thats why theres a big section on it in nursing diagnosis books and its a priority in NCLEX.

Yes, I agree, but wouldn't ya know, instructors don't like "risk for" as priorities no matter how rational and serious something like what you mentioned is. It's so frustrating.

[PyridiumP]

Defend your choice by using Nanda. I used the original in school, from 2012, there's a newer one now. My faculty liked it that I did.