Keep abreast of diagnostic tests

Reassure the client that electrical shock

wont occur.
Apply the electrodes to clean, dry skin.
Interpret the electrocardiogram (ECG) for
changes, such as life-threatening arrhythmias
or ischemia.

24-hour record of the heart

Ambulatory ECG, also known as Holter
monitoring, is a noninvasive test that records
the hearts electrical activity and cardiac
events over a 24-hour period.

Maintain a pressure dressing and bed rest

as ordered after the procedure.
Encourage fluids unless contraindicated.
Monitor for complaints of chest pain, and
report any complaints immediately.
If bleeding occurs at the site, apply manual
pressure until the bleeding stops.

33

Cardiac
catheterization
is an invasive
procedure. Be aware
of the complications
that may occur.

Echoing heart structures

Echocardiography is a noninvasive examination of the heart that uses echoes from sound
waves to visualize intracardiac structures and
monitor the direction of blood flow.

Nursing actions
Explain the purpose of Holter monitoring.
Instruct the client to keep an activity diary.
Advise the client not to bathe or shower,
operate machinery, or use a microwave
oven or an electric shaver while wearing the
monitor.

View through a catheter

Cardiac catheterization and arteriography
(also called angiography) involve an injection
of radiopaque dye through a catheter, after
which a fluoroscope is used to examine the
coronary arteries and intracardiac structures.
The procedure is also used to monitor major
intracardiac pressures, oxygenation, and
cardiac output.

Nursing actions
Before the procedure
Withhold the clients food and fluids after
midnight.
Administer daily medications as ordered
by the physician.
Discuss any anxiety the client may have
about the procedure.
Assess and record baseline vital signs and
peripheral pulses.
Make sure that written, informed consent
has been obtained.
Inform the client about possible nausea,
chest pain, flushing of the face, or a sudden
urge to urinate from the injection of radiopaque dye.
Note the clients allergies to seafood,
iodine, or radiopaque dyes.
After the procedure
Monitor vital signs, peripheral pulses, and
the injection site for bleeding.

313419NCLEX-RN_Chap03.indd 33

Nursing actions
Determine the clients ability to lie still for
30 to 60 minutes.
Explain the procedure to the client.

Jog and monitor

An exercise ECG, also known as a stress test,
is a noninvasive test that studies the hearts
electrical activity and monitors for ischemic
events during levels of increasing exercise.

Nursing actions
Explain the procedure to the client.
Withhold food and fluids for 2 to 4 hours
before the test.
Instruct the client to wear loose-fitting
clothing and supportive shoes.
Perform a cardiopulmonary assessment.
Tell the client to report chest discomfort,
shortness of breath, fatigue, leg cramps, or
dizziness immediately if it occurs during the
test.

No fallout here
Nuclear cardiology examines the heart
using radioisotopes. After I.V. injection of the
isotopes, a monitor is used to read images of
myocardial perfusion and contractility.

Nursing actions
Before the procedure
Explain the procedure.
Make sure that written, informed consent
has been obtained.
Determine the clients ability to lie still
during the procedure.
After the procedure
Examine the injection site for bleeding.

4/8/2010 7:01:37 PM