cardiovascular disorders: diagnostics procedures Flashcards
1
Q
Diagnostic and Therapeutic Procedures
A
- Evaluate the functioning of the heart by monitoring for enzymes in the blood
- Using ultrasound to visualize the heart
- Using catheters to determine blood volume, perfusion, fluid status, how the heart is pumping, and degree of artery blockage.
2
Q
familiar tests
A
- Cardiac enzymes and lipid profile
- Echocardiogram
- Stress testing: no smoke, caffeine ,cardiac meds expect antihypertensive prior
- Hemodynamic monitoring
- Angiography
- Vascular access
3
Q
what is a cardiac enzyme
A
- Cardiac enzymes are released into the bloodstream when the heart muscle suffers ischemia.
- Cardiac enzymes are specific markers in diagnosing a myocardial infarction (MI).
4
Q
lipid profile provides
A
provides information regarding cholesterol levels and is used for early detection of heart disease.
5
Q
serium cardiac markers
A
- are proteins released into the blood from necrotic heart muscle after an MI.
- These markers are important in the diagnosis of MI. The onset, peak, and duration of levels of these markers are shown in this graph.
6
Q
myoglobin
A
Earliest marker of injury to cardiac or skeletal muscle. Levels no longer evident after 24 hr.
7
Q
creatine kinase-mb
A
Peaks around 24 hr after onset of chest pain. Levels no longer evident after 3 days.
8
Q
troponin I/T
A
Any positive value indicates damage to cardiac tissue and should be reported.
9
Q
what can a enzyme and lipid profile diagnosis
A
Angina
MI
Heart disease
Hyperlipidemia
10
Q
echocardiogram and what it diagnoses
A
An echocardiogram is an ultrasound of the heart.
Cardiomyopathy: enlarged
Heart failure
Angina: chest pain
MI
Used to diagnose valve disorders and cardiomyopathy
11
Q
stress test: what is it, what it provide, discontinued?
A
- The client exercises the heart by walking/running on a treadmill.
- This provides information regarding the workload of the heart.
- The test is discontinued once the heart rate reaches a certain rate.
- Clients can become too tired, or be disabled or physically challenged, and be unable to finish the test.
- test supply and demand of o2
12
Q
hemodynamic monitoring
A
Involves indwelling catheters, which provide information about blood volume and perfusion, fluid status, and how well the heart is pumping.
13
Q
arterial lines: where they placed, what it provide, monitor what?, what not used for
A
- Placed in the radial (most common), brachial, or femoral artery.
- Provide continuous information about changes in blood pressure and permit the withdrawal of samples of arterial blood.
- Monitor circulation in the limb with the arterial line (capillary refill, temperature, color).
- Arterial lines are not used for IV fluid or medication administration. (only heparinizedsaline can go in)
14
Q
angiography
A
- A coronary angiogram, also called a cardiac catheterization, is an invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage.
- usually in groin
- Angiography is also done on the lower extremities to determine blood flow and areas of blockage.
- assess all pulses distal to cath
15
Q
what does an angiography involve and what it find
A
- Involves the insertion of a catheter into a femoral (sometimes a brachial) vessel and threading it into the right or left side of the heart.
- Coronary artery narrowings and/or occlusions are identified by the injection of contrast media under fluoroscopy.
16
Q
preprocedure angiography
A
- Maintain NPO status for 8 hr due to the risk for aspiration.
- Obtain vital signs, auscultate heart and lung sounds, and assess peripheral pulses.
- Ensure that the consent form is signed.
- Assess for iodine/shellfish allergy
- Assess renal function prior to introduction of contrast dye.
- Administer pre-medications as prescribed (methylprednisolone, diphenhydramine).
17
Q
Angiography: Post-procedure nursing actions
A
- Assess vital signs every 15 min × 4, every 30 min × 2, every hour × 4, and then every 4 hr.
- Assess the groin site at the same intervals for:
Bleeding and hematoma formation.
Thrombosis. (Document pedal pulse, color, temperature.) - Maintain bed rest in supine position with extremity straight for 4 to 6 hr after the procedure. (min of 2hr and needs a pressure dressing)
- Conduct continuous cardiac monitoring for dysrhythmias.
+ Reperfusion following angioplasty can cause dysrhythmias.
18
Q
Angiography: Post-procedure nursing actions meds and monitoring
A
- Administer antiplatelet or thrombolytic agents as prescribed
+Aspirin
+Clopidogrel, ticlopidine
+Heparin
+Low molecular weight heparin (enoxaparin ) - Administer analgesics as needed.
- Monitor urine output and administer IV fluids for hydration.
- Apply pressure to arterial/venous sites for the prescribed period of time
- Observe for vagal response (hypotension, bradycardia) from compression of nerves.
- Apply pressure dressing.
19
Q
angiography complications
A
cardiac taponade
hematoma
20
Q
what does cardiac tamponade result from
A
can result from fluid accumulation in the pericardial sac.
21
Q
manifestations for cardiac tamponade
A
- Hypotension
- Jugular venous distention
- Muffled heart sounds
- Paradoxical pulse
+ variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration.
22
Q
nursing actions for cardiac tamponade
A
- Notify the provider immediately.
- Administer IV fluids to combat hypotension.
- Obtain a chest x-ray or echocardiogram
- Prepare the client for pericardiocentesis.
- Monitor hemodynamic pressures.
- Monitor heart rhythm.
- Monitor for reoccurrence of manifestations after the procedure
23
Q
hematoma formation
A
Blood clots can form near the insertion site
- don’t remove clot
24
Q
nursing actions for hematoma
A
- Assess the groin at prescribed intervals and as needed.
- Hold pressure for uncontrolled oozing/bleeding.
- Monitor peripheral circulation.
- Notify the provider.
25
what are invasive procedures used for
- Invasive methods used to improve blood flow for occluded arteries and veins.
- Indicated after noninvasive interventions have been tried, such as diet, exercise, and medications.
26
invasive cardio procedures
Coronary intervention (PCI)
Coronary artery bypass grafts (CABG)
Peripheral bypass grafts
27
what is Percutaneous coronary intervention
A nonsurgical procedure performed to open coronary arteries
28
atherectomy
Used to break up and remove plaques within cardiac vessels
29
stent
Placement of a mesh-wire device to hold an artery open and prevent restenosis
30
Percutaneous transluminal coronary angioplasty
- Also referred to simply as angioplasty
- Inflating a balloon to dilate the arterial lumen and the adhering plaque
- Widening the arterial lumen.
+ This can include stent placement.
31
what does pci treat
- Can treat coronary artery disease when there is occlusion of one to two coronary arteries.
- Might reduce ischemia during the occurrence of an acute myocardial infarction (MI) by opening coronary arteries and restoring perfusion.
- Might be used as an alternative to coronary artery bypass graft.
- Might be used with stent placement to prevent artery re-occlusion and to dilate the coronary artery.
32
what is Coronary artery bypass grafts
- An invasive surgical procedure that aims to restore vascularization of the myocardium.
- Performed to bypass an obstruction in one or more of the coronary arteries
- Does not alter the atherosclerotic process but improves the quality of life for clients restricted by painful coronary artery disease.
33
nursing considerations for CABG
- The majority of pain stems from the harvest site for the vein.
- Endotracheal tube and mechanical ventilator following surgery
- Sternal incision and possible leg incision
- Early ambulation to prevent complications
- Administration of analgesics for pain control
One to two mediastinal chest tubes
- Indwelling urinary catheter
- Pacemaker wires
- Hemodynamic monitoring devices (pulmonary artery catheter, arterial line)
34
med regimen prior to cabg
- Instruct the client to alter or discontinue regular medications as prescribed by the provider.
- Diuretics 2 to 3 days before surgery
- Aspirin and other anticoagulants 1 week before surgery
35
med continued for cabg
- Potassium supplements
- Scheduled antidysrhythmics, such as amiodarone
- Scheduled antihypertensives, such as metoprolol, a beta-blocker, and diltiazem, a calcium-channel blocker
- Insulin
