Cardiac-Vascular Nursing Exam Prep II

Answer- B - The first treatment the nurse should start is immediate heparinization with 5000 IU bolus and continuous infusion to maintain PTT > 60. The symptoms of this patient are highly suggestive of acute arterial occlusion.
Management of acute arterial occlusion:
•Immediate heparinization at 5000 IU bolus and continuous infusion to maintain PTT > 60
•In the absence of power and sensation - need emergent re-vascularization: for embolus - embolectomy; (ii) for thrombus - bypass
•In the presence of power and sensation - need work-up - including angiogram: for embolus - embolectomy; (ii) for thrombus - bypass
•Embolectomy: Fogarty catheter tied to fish embolus out of artery
•Bypass: bypass occlusion allowing blood flow to resume to distal site
•Identify and treat underlying cause
•Continue heparin post-op, start warfarin post-op day 1 for 3 months
•Re-perfusion phenomenon
•Toxic metabolites from ischemic muscle --> renal failure and multi-organ system failure