Cardio Diagnostic

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Author:
servinggod247
ID:
289399
Filename:
Cardio Diagnostic
Updated:
2014-11-16 19:35:30
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med surge
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med/surge
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  1. indications for cardiac enzymes and lipid profile
    • agina
    • MI
    • heart disease
    • hyperlipidemia
  2. Creatinine kinase MB isoenzyme (CK-MB) is more sensitive to
    myocardium
  3. expected range of CK-MB
    first detectable when after myocardial injury?
    duration of elevated levels
    • 0% of total CK (30-170 units/L)
    • 4-6 hr
    • 3 days
  4. expected range of troponin T
    first detectable when after myocardial injury?duration of elevated levels
    • Less than 0.2 ng/L
    • 3-5 hr
    • 14-21 days
  5. expected range of troponin I
    first detectable when after myocardial injury?duration of elevated levels
    • less than 0.03 ng/L
    • 3 hr
    • 7-10 days
  6. expected range of myoglobin
    first detectable when after myocardial injury?duration of elevated levels
    • less than 90 mcg/L
    • 2 hr
    • 24 hr
  7. cholesterol referange range
    <200 mg/DL
  8. HDL reference range
    • Females 35-80 mg/DL
    • Males 35-65 mg/dL
  9. LDL reference range
    less than 130 mg/dL
  10. triglycercides reference range
    • females 35-135
    • males 40-160
    • older adults 55-220
  11. Indications for echo
    • cardiomyopathy
    • heart failure
    • angina
    • MI
  12. position for echo
    left side. Remain still
  13. Indications for stress test
    • angina
    • heart failure
    • MI
    • dysrhythmia
  14. medications that can be used for pharmocological stress test
    andenosine (Adenocard)

    dobutamine (DObutrex
  15. how should client prepare for stress test
    • fast 2-4 hr before
    • avoid caffeine, tobacco, and alcohol
  16. ECG is wha type of lead
    • 12 lead
    • Holter monitor
    • Telemetry
  17. Arterial lines can be placed where?
    • radial(most common), brachial, femoral artery
    • Provide continuous info about changes in bp 
    • Can draw arterial blood
  18. are intra-arterial pressure and cuff pressure the same?
    can differ
  19. Arterial lines are or are not used for IV fluid admin?
    Are NOT
  20. Pulmonary arter cathethers are placed where
    into a large vein (internal jugular, femoral, subclavian, brachial) and threaded thorugh the right atria and ventricle into a branch of the pumonary artery
  21. PA catheters allow for
    • hemodynamic measurements 
    • blood sampling
    • IV fluids
  22. Proximal lumen of PA used for
    • right atrial pressure (CVP)
    • IV fluids
    • venous blood samples
  23. Distal lumen of PA used for
    • pulmonary arter pressure
    • NO iv fluids
  24. Balloon inflation port of PA used for
    • PAWP mesaurement
    • Left deflated when not in use and in LOCKED position
  25. Thermistor of PA mseaures
    temp difference between the right atrium and the pulmonary artery in order to determine output
  26. Indications hemodynamic monitoring
    • Serious or critical illness
    • HF
    • post CABG
    • ARDS
    • acute kidney injury 
    • burn injury 
    • trauma injury
  27. CVP range
    1-8 mm Hg
  28. pulmonary artery systolic range
    15-26
  29. pulmonary artery diastolic range
    5-15
  30. PAWP range
    4-12
  31. Cardiac output range
    4-7
  32. SvO2 range
    60-80%
  33. Hemodynamic monitoring position
    supine or trendelenburg
  34. Nursing actions for hemodynamic monitoring
    • Purge air from system
    • maintain sterile connections
    • supine or trendelenburg
    • sedation
    • align transducer with 4th intercostal space, midaxillary line, to coorespond with right atrium
    • zero system with atmospheric pressure
  35. Altered PRELOAD hemodynamics
    • elevated:
    • crackles in lungs
    • jugular vein distention
    • hepatomegaly
    • peripheral edema
    • taut skin turgor

    • Decreased:
    • poor skin turgor 
    • dry mucous membranes
  36. Altered AFTERLOAD hemodynamic
    • elevated:
    • cool extremeties
    • weak peripheral pulses

    • Decreased:
    • warm extremeties
    • bounding peripheral pulses
  37. Indications of angiography
    unstable angina and ECG changes (T wave inversion, ST segment elevation, depression)

    Confirm and determine location and extent of heart disease
  38. Preprocedure Angiography
    • NPO 8 hr
    • Iodine allergy
    • renal function
  39. Postprocedure for Angiography
    assess vitals 15 minx 4, 30 min x2, every hour x4, and then every 4 hr

    bedrest
  40. client education for Angiography
    • avoid strenuous exercise
    • report bleeding, chest pain, shortness of breath, change in color of exterminity
    • dont lift more than 10 lbs

    • If stent:
    • anti coagulation therapy 6-8 weeks
  41. Cardiac tamponade
    fluid accumulation in the pericardial sac

    • hypotension
    • jugular venous distention
    • muffled heart sounds
    • paradoxical pulses
    • hemodynamic monitoring reveals intracardiac and pumonary artery pressure are similar and elevated (plateau pressures)
  42. changes in heart rhythm during pericardiocentesis indicate
    improper placement of the needle
  43. causes of dysrhythmias
    • MI
    • cardiomyopathy
    • electrolyte and acid imbalance
    • hypoxemia
    • drugs
  44. Types of dysrhythmias
    • bradycardia
    • tachycardia
    • fibrillation
    • block
    • premature
  45. clinical manifestation of dysrhtymias
    • decreased cardiac output
    • ineffective perfussion
  46. interventions for dysrhthmias
    • drug therapy
    • vagal maneuvers-carotid massage
    • radiofrequency catheter ablation
    • implantable cardioverter-defibrillator
    • pacemaker
    • synchronized cardioversion
    • defibrillation
  47. pacemaker
    • stimulation to initiate or override impulse 
    • temporary (transcutaneous and transvenous)
    • permanent (single, dual, biventricular)
    • synchronous or asynchronous 
    • Dysrhythmias:bradycahrdia (symptomatic), asystole, blocks
  48. Nursing actions for pacemaker
    • pre-procdure- Explain that it may hurt, concent, o2, monitor, document, emergency equipment available, sedation
    • Intra procdure- monitor rhythm and status, meds
    • Post- monitor, CXR, immobilize shoulder movement, document post rhythm, settings, VS, educate well

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