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Med Surg 2 > cardiovascular disorders: diagnostics procedures > Flashcards

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.
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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
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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).
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4
Q

lipid profile provides

A

provides information regarding cholesterol levels and is used for early detection of heart disease.

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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.
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6
Q

myoglobin

A

Earliest marker of injury to cardiac or skeletal muscle. Levels no longer evident after 24 hr.

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7
Q

creatine kinase-mb

A

Peaks around 24 hr after onset of chest pain. Levels no longer evident after 3 days.

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8
Q

troponin I/T

A

Any positive value indicates damage to cardiac tissue and should be reported.

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9
Q

what can a enzyme and lipid profile diagnosis

A

Angina
MI
Heart disease
Hyperlipidemia

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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

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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
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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.

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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)
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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
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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.
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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
Q

what are invasive procedures used for

A
  • 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
Q

invasive cardio procedures

A

Coronary intervention (PCI)
Coronary artery bypass grafts (CABG)
Peripheral bypass grafts

27
Q

what is Percutaneous coronary intervention

A

A nonsurgical procedure performed to open coronary arteries

28
Q

atherectomy

A

Used to break up and remove plaques within cardiac vessels

29
Q

stent

A

Placement of a mesh-wire device to hold an artery open and prevent restenosis

30
Q

Percutaneous transluminal coronary angioplasty

A
  • 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
Q

what does pci treat

A
  • 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
Q

what is Coronary artery bypass grafts

A
  • 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
Q

nursing considerations for CABG

A
  • 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
Q

med regimen prior to cabg

A
  • 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
Q

med continued for cabg

A
  • Potassium supplements
  • Scheduled antidysrhythmics, such as amiodarone
  • Scheduled antihypertensives, such as metoprolol, a beta-blocker, and diltiazem, a calcium-channel blocker
  • Insulin

Med Surg 2 (35 decks)

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