NLE Cardiovascular Nursing — Cardiovascular Assessment and DiagnosticsRevision Notes

Formulas

Exam Tips

• NLE frequently asks about CO = HR × SV. Know how each component affects CO and which nursing interventions address each.
• When a question mentions increased SVR or hypertension impairing cardiac function, think AFTERLOAD problem.
• When a question mentions JVD, pitting edema, and dyspnea, think increased PRELOAD (volume overload/heart failure).
• Memorize the conduction pathway in order — SA Node → AV Node → Bundle of His → Bundle Branches → Purkinje Fibers. This is tested in dysrhythmia recognition.
• MAP ≥ 65 mmHg = adequate organ perfusion. This is critical in ICU/critical care scenarios on the NLE.

Key Points

• The heart is a four-chambered pump: right side handles deoxygenated blood (pulmonary circulation); left side handles oxygenated blood (systemic circulation).
• Blood flow sequence (RIGHT SIDE): Vena cava → Right Atrium → Tricuspid Valve → Right Ventricle → Pulmonic Valve → Pulmonary Artery → Lungs.
• Blood flow sequence (LEFT SIDE): Pulmonary Veins → Left Atrium → Mitral (Bicuspid) Valve → Left Ventricle → Aortic Valve → Aorta → Systemic Circulation.
• Cardiac Output (CO) = Heart Rate (HR) × Stroke Volume (SV); normal CO is 4–8 L/min.
• Stroke Volume is determined by THREE factors: Preload, Afterload, and Contractility — remember PACe.
• Preload = volume of blood in the ventricle at end of diastole (venous return); governed by the Frank-Starling Law: the more the ventricle is stretched, the stronger the contraction — up to a point.
• Afterload = the resistance the ventricle must overcome to eject blood (systemic vascular resistance); hypertension INCREASES afterload.
• Contractility = the intrinsic force of myocardial contraction; positive inotropes (digoxin, dobutamine) increase contractility.
• Electrical conduction pathway: SA Node → AV Node → Bundle of His → Right and Left Bundle Branches → Purkinje Fibers.
• SA Node is the natural pacemaker: inherent rate 60–100 bpm. AV Node backup rate: 40–60 bpm. Ventricular rate: 20–40 bpm.
• The cardiac cycle consists of SYSTOLE (contraction, ejection) and DIASTOLE (relaxation, filling).
• Ejection Fraction (EF) is the percentage of blood ejected per beat; normal EF is 55–70%. EF below 40% indicates heart failure with reduced EF (HFrEF).

Definitions

Section Title

Cardiac Physiology Review: The Foundation of Assessment

Common Mistakes

• Confusing preload and afterload: Remember PRELOAD = FILLING (venous return before contraction); AFTERLOAD = RESISTANCE (what the heart pumps against during contraction).
• Forgetting that the SA node is the PRIMARY pacemaker — not the AV node. The AV node is a BACKUP pacemaker.
• Mixing up valve positions: Tricuspid is on the RIGHT (between RA and RV); Mitral is on the LEFT (between LA and LV). Mnemonic: 'Right side has the Tricuspid; Left side has the Mitral — like Left and Mitral both have M-shape sounds.'
• Confusing systole and diastole: SYSTOLE = contraction (blood OUT); DIASTOLE = relaxation (blood IN/filling).
• Forgetting that an EF below 40% indicates significant systolic dysfunction (HFrEF), not a normal finding.

Exam Tips

• NLE scenario tip: If a patient complains of waking up at night unable to breathe → think PND → left-sided heart failure → High-Fowler's position, O2, and notify physician.
• Pulse amplitude grading is commonly tested: A 1+ pulse in the dorsalis pedis after cardiac catheterization is a WARNING SIGN of arterial compromise — report immediately.
• JVD + hypotension + muffled heart sounds = BECK'S TRIAD = Cardiac Tamponade — this is a medical emergency. Know this combination.
• The DOH's PhilPEN (Philippine Package of Essential NCD Interventions) emphasizes BP control, smoking cessation, healthy diet, and physical activity — align patient teaching with these national guidelines.
• When prioritizing nursing diagnoses using Maslow's hierarchy, physiological needs (airway, breathing, circulation) always take priority. Cardiovascular compromise (Decreased Cardiac Output, Ineffective Tissue Perfusion) ranks highest.

Key Points

• Use the PQRST mnemonic to assess chest pain: Provocation/Palliation, Quality, Region/Radiation, Severity (0–10 scale), Timing.
• Classic MI chest pain: crushing, substernal, radiates to left arm or jaw, not relieved by rest or nitroglycerin alone — a MEDICAL EMERGENCY.
• Assess for cardinal cardiovascular symptoms: chest pain, dyspnea (at rest or on exertion), orthopnea (SOB when lying flat), paroxysmal nocturnal dyspnea (PND — waking up at night unable to breathe), palpitations, fatigue, edema, and syncope.
• Orthopnea is measured in 'pillows' — how many pillows a patient needs to sleep comfortably (2-pillow orthopnea, 3-pillow orthopnea).
• PND is a hallmark sign of left-sided heart failure — fluid redistributes from dependent areas when lying down, increasing pulmonary venous pressure.
• Cardiovascular risk factors to assess: hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, sedentary lifestyle, family history of CAD, age (men >45 yrs; women >55 yrs), and stress.
• INSPECTION findings: cyanosis (central = heart/lung issue; peripheral = poor circulation), clubbing of fingers (chronic hypoxia), JVD (right heart failure/fluid overload), and peripheral edema (pitting vs. non-pitting).
• PALPATION: Check all peripheral pulses — radial, brachial, femoral, popliteal, posterior tibial, dorsalis pedis. Grade pulses 0–4+: 0=absent, 1+=weak/thready, 2+=normal, 3+=full/bounding, 4+=bounding/forceful.
• Point of Maximal Impulse (PMI): Normally palpated at the 5th intercostal space (ICS), midclavicular line. Displacement suggests cardiomegaly.
• Capillary Refill Time (CRT): Normal is LESS THAN 3 seconds. Greater than 3 seconds suggests decreased peripheral perfusion.
• Jugular Venous Distension (JVD): Assessed with patient at 30–45 degrees. Visible JVD above the clavicle suggests elevated CVP and right heart failure.
• AUSCULTATION of heart sounds must be done systematically using the APE To Man sequence across all valvular areas.

Definitions

Section Title

Cardiovascular Health History and Physical Assessment

Common Mistakes

• Forgetting to assess for PND and orthopnea — these are classic NLE-tested symptoms of left heart failure that are often missed in history-taking questions.
• Confusing cyanosis types: CENTRAL cyanosis (bluish lips/tongue) = systemic hypoxemia (cardiac or respiratory); PERIPHERAL cyanosis (bluish fingers/toes) = poor local perfusion (vasoconstriction, cold).
• Not grading pulses using the 0–4+ scale. The NLE expects nurses to use this standardized scale for documentation.
• Placing PMI in the wrong location: it is 5th ICS, MIDCLAVICULAR LINE — not midsternal. A displaced PMI (lateral to midclavicular line) suggests cardiomegaly.
• Forgetting that JVD assessment requires positioning at 30–45 degrees — not supine and not fully upright.

Exam Tips

• NLE frequently presents a clinical scenario with an adult patient who has an S3. The correct interpretation is ALWAYS heart failure/volume overload — not a normal finding.
• When asked what to use for low-pitched sounds (S3, S4) → BELL of stethoscope. High-pitched sounds (S1, S2, most murmurs) → DIAPHRAGM.
• Pericardial friction rub + chest pain + fever → pericarditis. The nurse's priority is positioning (lean forward to reduce pain) and monitoring for complications like cardiac tamponade.
• For valvular murmur questions: SYSTOLIC murmurs occur between S1 and S2; DIASTOLIC murmurs occur between S2 and the next S1.
• Remember: Tricuspid is on the RIGHT side of the heart; Pulmonic is on the RIGHT side too. Mitral and Aortic are on the LEFT. This helps when correlating murmur location with valve pathology.

Key Points

• Auscultation sequence mnemonic — APE To Man: Aortic (2nd RIGHT ICS), Pulmonic (2nd LEFT ICS), Erb's Point (3rd LEFT ICS), Tricuspid (4th LEFT ICS), Mitral/Apex (5th LEFT ICS, midclavicular line).
• Use the DIAPHRAGM of the stethoscope for HIGH-pitched sounds (S1, S2, murmurs); use the BELL for LOW-pitched sounds (S3, S4).
• S1 ('lub') = closure of MITRAL and TRICUSPID valves (AV valves) = marks the START of SYSTOLE. LOUDEST at the APEX (mitral area).
• S2 ('dub') = closure of AORTIC and PULMONIC valves (semilunar valves) = marks the START of DIASTOLE. LOUDEST at the BASE (aortic area).
• The sequence of a normal cardiac cycle sound: S1 (lub) → systole → S2 (dub) → diastole → S1 again.
• S3 (VENTRICULAR GALLOP): Low-pitched, early diastolic sound heard AFTER S2. Sounds like 'lub-dub-dee' or 'Ken-tuc-KY'. NORMAL in children and young adults. In ADULTS OVER 30, S3 suggests HEART FAILURE and VOLUME OVERLOAD.
• S4 (ATRIAL GALLOP): Low-pitched, late diastolic sound heard BEFORE S1. Sounds like 'dee-lub-dub' or 'TEN-nes-SEE'. Indicates a STIFF, NONCOMPLIANT VENTRICLE — seen in hypertension, ventricular hypertrophy, and CAD.
• MURMURS: Turbulent blood flow through cardiac valves. Graded I–VI: Grade I (barely audible) to Grade VI (audible without stethoscope). SYSTOLIC murmurs may be innocent (benign) or pathologic; DIASTOLIC murmurs are ALWAYS pathologic.
• Pericardial Friction Rub: Harsh, scratchy, grating sound heard in PERICARDITIS. Best heard with patient leaning forward. Heard throughout the cardiac cycle.
• Common valvular murmurs: Aortic Stenosis = systolic ejection murmur at 2nd right ICS radiating to neck; Mitral Regurgitation = holosystolic murmur at apex; Mitral Stenosis = diastolic rumble at apex; Aortic Regurgitation = diastolic decrescendo murmur.

Definitions

Section Title

Heart Sounds: Auscultation and Clinical Significance

Common Mistakes

• Confusing S3 and S4 timing: S3 comes AFTER S2 (early diastole — post-filling); S4 comes BEFORE S1 (late diastole — atrial kick). Use the Tennessee/Kentucky mnemonics to remember the sound patterns.
• Using the diaphragm to listen for S3 and S4 — these are LOW-pitched sounds and MUST be auscultated with the BELL of the stethoscope at the apex.
• Saying S1 is loudest at the 'base' — S1 is loudest at the APEX; S2 is loudest at the BASE. This is a common NLE distractor.
• Forgetting that ALL diastolic murmurs are pathologic — NLE options may include 'innocent murmur' for a diastolic murmur, which is WRONG.
• Mixing up the APE To Man auscultation sequence — practice placing each area correctly on a diagram. Aortic = 2nd RIGHT; all others = LEFT ICS.

Formulas

Exam Tips

• NLE will show ECG strips and ask you to identify the rhythm or the priority intervention. MASTER these: NSR (60–100, regular, P before every QRS), V-Fib (chaotic, no recognizable waveform = defibrillate), V-Tach (wide regular QRS, no P waves = check pulse first).
• ST elevation on ECG → STEMI → PRIORITY = Call physician STAT, prepare for cardiac catheterization, administer aspirin and antiplatelet as ordered, obtain IV access.
• Hyperkalemia ECG clue: TALL PEAKED T waves, then widening QRS, then sine wave pattern — a progression toward cardiac arrest. Monitor K+ levels in patients on ACE inhibitors, ARBs, K-sparing diuretics.
• Prolonged QT + hypokalemia or hypomagnesemia = risk for Torsades de Pointes. Electrolyte replacement is the nursing intervention.
• When counting rate: 1 large box between R waves = 300 bpm (very fast); 5 large boxes = 60 bpm (lower normal). Use the sequence 300-150-100-75-60-50 as a quick reference.

Key Points

• The ECG records the ELECTRICAL ACTIVITY of the heart. It does NOT directly measure mechanical pump function.
• Standard ECG paper: Each SMALL box = 0.04 second (horizontal) and 1 mm (vertical). Each LARGE box (5 small boxes) = 0.20 second.
• P WAVE = ATRIAL DEPOLARIZATION. Represents the electrical impulse spreading through the atria. Normal: upright in lead II; duration < 0.12 sec.
• PR INTERVAL = conduction from the atria through the AV node to the ventricles. Normal: 0.12–0.20 second (3–5 small boxes). PROLONGED PR > 0.20 sec = 1st degree AV block.
• QRS COMPLEX = VENTRICULAR DEPOLARIZATION. Normal duration: 0.06–0.10 second (up to 0.12 sec = 3 small boxes). WIDE QRS (>0.12 sec) suggests bundle branch block or ventricular origin (PVC, V-tach).
• T WAVE = VENTRICULAR REPOLARIZATION. Normally upright. TALL PEAKED T waves = HYPERKALEMIA. INVERTED T waves = ischemia or ventricular strain.
• ST SEGMENT = isoelectric period after QRS. ELEVATION above baseline = MYOCARDIAL INJURY (STEMI — acute MI). DEPRESSION below baseline = MYOCARDIAL ISCHEMIA.
• QT INTERVAL = total ventricular depolarization AND repolarization. PROLONGED QT predisposes to TORSADES DE POINTES (a life-threatening ventricular dysrhythmia). Prolonged by medications (amiodarone, quinidine, haloperidol) and hypokalemia/hypomagnesemia.
• Normal Sinus Rhythm (NSR) criteria: Rate 60–100 bpm; Regular rhythm; One P wave before EVERY QRS; Normal PR interval (0.12–0.20 sec); Normal QRS (< 0.12 sec).
• Quick RATE calculation method: Count large boxes between two R waves, divide into 300. Memorize: 300-150-100-75-60-50 (for 1, 2, 3, 4, 5, 6 large boxes between R waves).
• Systematic ECG interpretation: (1) Rhythm regular? (2) What is the rate? (3) Is there a P wave before EVERY QRS? (4) Is the PR interval normal? (5) Is the QRS normal width? (6) What is the ST segment doing?
• ST elevation in two or more contiguous leads = STEMI. The nurse's PRIORITY is activating the cardiac catheterization lab (door-to-balloon time < 90 minutes) and administering ordered antiplatelet therapy.

Definitions

Section Title

Electrocardiogram (ECG) Interpretation

Common Mistakes

• Confusing ST elevation (INJURY/STEMI) with ST depression (ISCHEMIA). Remember: ELEVATION = cells are injured and dying; DEPRESSION = cells are ischemic (still alive but stressed).
• Forgetting the normal PR interval range: 0.12–0.20 seconds. A PR > 0.20 sec = 1st-degree AV block (delayed conduction). A common NLE distractor uses values like PR = 0.24 sec.
• Using the rate calculation method (300 ÷ large boxes) for IRREGULAR rhythms like atrial fibrillation — this only works for REGULAR rhythms. For irregular rhythms, count the number of QRS complexes in a 6-second strip and multiply by 10.
• Misidentifying T wave changes: TALL PEAKED T waves = HYPERKALEMIA (not tachycardia); INVERTED T waves = ISCHEMIA (not repolarization).
• Forgetting that a WIDE QRS can indicate a ventricular origin rhythm (PVC, V-tach), bundle branch block, OR severe hyperkalemia — all serious findings.

Exam Tips

• NLE question pattern: 'Which cardiac enzyme is the MOST specific for MI?' Answer: TROPONIN (specifically Troponin I).
• NLE question pattern: 'A patient had an MI 5 days ago. Which marker will still be elevated?' Answer: TROPONIN (elevated up to 10–14 days). CK-MB would already be normal (clears in 2–3 days).
• NLE question pattern: 'Which biomarker diagnoses heart failure?' Answer: BNP. BNP < 100 pg/mL = heart failure unlikely; BNP > 400 pg/mL = heart failure likely.
• Remember lipid target: LDL 'L' for 'Low is better' — target < 100 mg/dL for high-risk patients (post-MI, diabetic with CAD). HDL 'H' for 'Higher is better' — > 60 mg/dL is protective.
• Electrolyte imbalance + dysrhythmia question: Peaked T waves + wide QRS = HYPERKALEMIA. Low flat T waves + U waves = HYPOKALEMIA. Both require immediate intervention.

Key Points

• Cardiac biomarkers are proteins RELEASED INTO THE BLOODSTREAM when myocardial cells are damaged or necrosed.
• TROPONIN (Troponin I and Troponin T) is the GOLD STANDARD — the MOST SPECIFIC AND SENSITIVE marker for myocardial injury.
• Troponin I: Normal is approximately BELOW 0.04 ng/mL (lab reference ranges vary). Rises: 3–6 hours post-MI. Peak: 12–24 hours. Returns to normal: 10–14 DAYS.
• The prolonged elevation of troponin (up to 14 days) makes it useful for diagnosing MI even when a patient presents LATE (days after onset).
• SERIAL TROPONIN MEASUREMENTS are the standard: drawn on admission and repeated at 3–6 hours and again as needed. A RISING TROPONIN confirms evolving MI.
• CK-MB (Creatine Kinase-MB): Cardiac-specific isoenzyme. Rises: 3–6 hours. Peak: 12–24 hours. Returns to normal: 2–3 DAYS. Useful for detecting REINFARCTION because it clears faster than troponin.
• MYOGLOBIN: Rises EARLIEST (1–3 hours) after MI. BUT it is NOT cardiac-specific (also released from skeletal muscle after exercise or trauma). A NEGATIVE myoglobin RULES OUT MI; a POSITIVE result needs confirmation with troponin.
• BNP (B-type Natriuretic Peptide): Released by ventricular walls in response to STRETCH and VOLUME OVERLOAD. Used to DIAGNOSE HEART FAILURE. BNP < 100 pg/mL makes heart failure UNLIKELY. BNP > 400 pg/mL strongly suggests heart failure.
• LIPID PROFILE components for cardiovascular risk assessment: Total cholesterol (desirable < 200 mg/dL), LDL (bad cholesterol — lower is better; goal < 100 mg/dL in high-risk patients), HDL (good cholesterol — higher is better; > 60 mg/dL is protective), Triglycerides (normal < 150 mg/dL).
• ELECTROLYTES affecting cardiac function: Potassium (K+) — hypokalemia causes dysrhythmias (PVCs, V-tach, digitalis toxicity); hyperkalemia causes peaked T waves, bradycardia, heart block. Magnesium (Mg2+) — hypomagnesemia causes torsades de pointes. Calcium (Ca2+) — hypocalcemia prolongs QT; hypercalcemia shortens QT.
• When drawing serial cardiac enzymes, label tubes with TIME of draw and document accordingly — timing is essential for interpreting the significance of biomarker levels.

Definitions

Section Title

Cardiac Biomarkers: Laboratory Diagnosis of MI

Common Mistakes

• Saying myoglobin is the BEST marker for MI — it is the EARLIEST marker but NOT the most specific. Troponin is BOTH the most sensitive AND the most specific.
• Forgetting that CK-MB returns to normal in 2–3 days (faster than troponin). This makes it the preferred marker to detect REINFARCTION.
• Confusing BNP with a cardiac injury marker — BNP diagnoses HEART FAILURE (volume overload), not MI. A patient can have both elevated troponin (MI) and elevated BNP (resulting heart failure).
• Not knowing that SERIAL troponin measurements are standard — a single troponin drawn immediately on arrival may be falsely negative if the patient just had onset of symptoms. Repeat at 3–6 hours.
• Forgetting electrolyte effects on the heart: Low K+ = dysrhythmias (especially with digoxin); Low Mg2+ = Torsades de Pointes. These are high-frequency NLE questions.

Formulas

Exam Tips

• NLE critical care scenario: CVP is 1 mmHg → hypovolemia → priority nursing action = administer IV fluid replacement as ordered and monitor response.
• NLE critical care scenario: PAWP is 22 mmHg → left ventricular failure/pulmonary edema → priority = elevate HOB, administer O2, diuretics as ordered (furosemide), notify physician.
• MAP < 65 mmHg in ICU = hemodynamic instability → vasopressors (dopamine, norepinephrine) may be required. Nurses titrate vasopressors to maintain MAP ≥ 65 mmHg per protocol.
• Phlebostatic axis location: 4th ICS + midaxillary line. This is a FIXED anatomical landmark — memorize it. It is tested in NLE questions about invasive monitoring.
• In the Philippine healthcare context, hemodynamic monitoring is performed in hospital ICUs. As a staff nurse in ICU, RA 9173 mandates competence in monitoring and interpreting hemodynamic data as part of safe, evidence-based care.

Key Points

• Hemodynamic monitoring uses INVASIVE catheters to directly measure cardiac pressures and output — performed in CRITICAL CARE/ICU settings.
• CVP (Central Venous Pressure): Measured via a central line in the right atrium or superior vena cava. Reflects RIGHT VENTRICULAR PRELOAD and overall fluid volume status. Normal CVP: 2–8 mmHg.
• LOW CVP (< 2 mmHg) = HYPOVOLEMIA (dehydration, hemorrhage, excessive diuresis). Nursing intervention: IV fluid resuscitation as ordered.
• HIGH CVP (> 8–10 mmHg) = FLUID OVERLOAD or RIGHT HEART FAILURE. Nursing intervention: fluid restriction, diuretics as ordered, assess for JVD and peripheral edema.
• PULMONARY ARTERY (Swan-Ganz) CATHETER: Floated through the right heart into the pulmonary artery. Measures pulmonary artery pressure and PAWP (Pulmonary Artery Wedge Pressure), which reflects LEFT VENTRICULAR PRELOAD.
• Normal PAWP: 8–12 mmHg. Elevated PAWP (> 18 mmHg) = left ventricular failure/pulmonary edema. Decreased PAWP = hypovolemia.
• ARTERIAL LINE (A-line): Provides CONTINUOUS BEAT-TO-BEAT blood pressure monitoring and allows easy access for FREQUENT ABG sampling. Inserted in radial artery (most common), femoral, or brachial artery.
• MAP (Mean Arterial Pressure): The AVERAGE perfusion pressure throughout the cardiac cycle. A MAP ≥ 65 mmHg is required for adequate perfusion of vital organs (brain, kidneys, heart).
• PHLEBOSTATIC AXIS: The reference point for zeroing hemodynamic transducers. Located at the 4th intercostal space, midaxillary line — approximates the level of the RIGHT ATRIUM.
• LEVELING AND ZEROING the transducer at the phlebostatic axis is ESSENTIAL for accurate readings. If the transducer is BELOW the axis, readings will be falsely HIGH; if ABOVE, readings will be falsely LOW.
• Nursing responsibilities for hemodynamic monitoring: Level and zero transducer at phlebostatic axis; maintain aseptic technique at insertion site; monitor waveform quality; assess for complications (infection, bleeding, air embolism, thrombosis); perform Allen's test before radial artery line insertion.

Definitions

Section Title

Hemodynamic Monitoring

Common Mistakes

• Placing the transducer BELOW the phlebostatic axis and getting a falsely HIGH CVP reading — always re-level when the patient changes position.
• Confusing CVP and PAWP: CVP reflects RIGHT VENTRICULAR preload; PAWP reflects LEFT VENTRICULAR preload. Both assess preload but on different sides of the heart.
• Saying MAP < 65 mmHg is 'acceptable' — it is NOT. MAP < 65 mmHg indicates inadequate organ perfusion, risk for acute kidney injury, and organ failure. This is a critical value requiring immediate intervention.
• Forgetting to perform Allen's test before radial arterial line insertion — this is a safety standard in nursing practice.
• Confusing CVP and PAWP normal ranges: CVP = 2–8 mmHg; PAWP = 8–12 mmHg. These values are frequently tested as answer choices on the NLE.

Exam Tips

• NLE PRIORITY QUESTION post-cardiac catheterization: The PRIORITY nursing assessment is MONITORING THE INSERTION SITE FOR BLEEDING AND CHECKING DISTAL PULSES. This comes before everything else.
• Pre-cath allergy question: 'What is the MOST important allergy to assess before cardiac catheterization?' = Iodine/shellfish/contrast dye allergy (due to contrast use). Also remember: assess RENAL FUNCTION.
• Patient teaching before discharge: Drink plenty of water, keep the site clean and dry, avoid heavy lifting or strenuous activity for 24–48 hours, report any bleeding/swelling/numbness/coldness of the arm or leg.
• Post-catheterization nursing diagnosis: Risk for Bleeding (priority), Impaired Skin Integrity, Risk for Impaired Renal Function (contrast nephropathy), Acute Pain.
• Reinforce cardiovascular risk factor modification aligned with DOH PhilPEN guidelines: Blood pressure control, smoking cessation, heart-healthy diet (low sodium, low fat), regular physical activity — these are testable patient teaching points.

Key Points

• CARDIAC CATHETERIZATION is an INVASIVE procedure where a catheter is threaded through a peripheral artery (femoral or radial approach) to the heart.
• CORONARY ANGIOGRAPHY uses contrast dye to VISUALIZE coronary arteries — it is the GOLD STANDARD for diagnosing coronary artery disease (CAD) and determining the degree of stenosis.
• Cardiac catheterization can be combined with THERAPEUTIC INTERVENTION: Percutaneous Coronary Intervention (PCI) = balloon angioplasty + stent placement to restore blood flow in stenosed coronary arteries.
• PRE-PROCEDURE: Verify INFORMED CONSENT (nurse's legal responsibility under RA 9173 — physician obtains consent; nurse witnesses and ensures patient understanding).
• ALLERGY ASSESSMENT before catheterization: IODINE, SHELLFISH, and CONTRAST DYE allergy — contrast media can trigger ANAPHYLAXIS. Also assess renal function (creatinine) — contrast is NEPHROTOXIC.
• Pre-procedure: Patient is NPO for 6–8 hours as ordered to prevent aspiration during sedation.
• BASELINE DOCUMENTATION: Record vital signs, document and MARK PERIPHERAL PULSES distal to the insertion site (usually dorsalis pedis and posterior tibial for femoral approach; radial for wrist approach). This is critical for POST-PROCEDURE comparison.
• Inform patient about expected sensations: WARM FLUSHING SENSATION when contrast dye is injected; possible FLUTTERING SENSATION as catheter passes through the heart.
• POST-PROCEDURE PRIORITY #1: MONITOR INSERTION SITE FOR BLEEDING AND HEMATOMA. Check distal pulses, color, temperature, capillary refill, and sensation of the affected extremity FREQUENTLY.
• POST-PROCEDURE: Maintain BED REST with AFFECTED LEG STRAIGHT (femoral approach) for the prescribed period (usually 2–6 hours depending on closure method). Keep HOB LOW (< 30 degrees for femoral approach).
• Apply PRESSURE or compression device (FemoStop, manual pressure) to the insertion site as ordered. For radial approach: radial artery compression band is applied.
• PUSH FLUIDS post-procedure: Encourage oral hydration (or IV fluids if NPO) to FLUSH OUT CONTRAST DYE through the kidneys and PREVENT CONTRAST-INDUCED NEPHROPATHY (CIN). Monitor URINE OUTPUT closely.
• Monitor for COMPLICATIONS post-catheterization: Bleeding, hematoma, RETROPERITONEAL BLEEDING (back/flank pain + hypotension), contrast-induced nephropathy (rising creatinine, decreased urine output), dysrhythmias, and chest pain (coronary artery spasm or re-occlusion).

Definitions

Section Title

Cardiac Catheterization: Pre- and Post-Procedure Nursing Care

Common Mistakes

• Forgetting to ask about SHELLFISH allergy — shellfish contains iodine, and cross-reactivity with iodinated contrast dye is possible. This is a standard pre-procedure assessment question.
• Not marking peripheral pulses BEFORE the procedure — without a baseline, post-procedure changes in pulse quality cannot be accurately assessed.
• Allowing the patient to bend the affected leg after femoral catheterization — the leg must remain STRAIGHT to prevent arterial disruption and hematoma formation. Bending = potential for serious bleeding.
• Restricting fluids post-catheterization out of concern for fluid overload — the priority in most patients post-cath is PUSHING FLUIDS to protect the kidneys from contrast dye. Clarify the physician's fluid orders.
• Missing the signs of retroperitoneal bleeding: back pain + hypotension after femoral catheterization — not checking the site for external bleeding does NOT rule out internal retroperitoneal hemorrhage.