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Assessment Framework for Recognizing Clinical Deterioration in Patients With ACS Undergoing PCI
journal contributionposted on 2021-01-01, 00:00 authored by Kevin White, Judy CurreyJudy Currey, Julie ConsidineJulie Considine
Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment.
Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration.
Purpose of Paper
To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome.
Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention.
JournalCritical Care Nurse
Pagination18 - 28
PublisherAmerican Association of Critical Care Nurses
Publication classificationC1 Refereed article in a scholarly journal
Read the peer-reviewed publication
Science & TechnologyLife Sciences & BiomedicineCritical Care MedicineNursingGeneral & Internal MedicinePERCUTANEOUS CORONARY INTERVENTIONACUTE MYOCARDIAL-INFARCTIONVENTRICULAR SEPTAL RUPTURECARDIOGENIC-SHOCKSTENT THROMBOSISDISTAL EMBOLIZATIONCONTRAST-MEDIAPRIMARY ANGIOPLASTYNATIONAL HEARTCARDIAC DEATH