ch 31 cardiovascular assessment Flashcards
classes of meds that can have potential cardiovascular adverse effects (7)
- anticancer meds
- antipsychotics
- corticosteroids
- hormone therapy/oral contraceptives
- NSAIDs
- psychostimulants
- tricyclic antidepressants
major cardiovascular risk factors (6)
- abnormal serum lipids
- HTN
- sedentary lifestyle
- diabetes
- obesity
- smoking
cardiovascular abnormalities found upon inspection (5)
- cyanosis
- nail clubbing
- JVD
- ulcers
- varicose veins
cardiovascular abnormalities found upon palpation (6)
- HR >100 bpm or <60 bpm
- absent pulse
- bounding pulse
- irregular pulse
- thready pulse
- thrill
cardiovascular abnormalities found in extremities (4)
- abnormal cap refill (>2 secs)
- asymmetry in limb circumference
- cold extremities or unusually warm extremities
- pitting edema
cardiovascular abnormalities found upon ausculatation
- S3
- S4
- bruit
- murmur
- pericardial friction rub (high pitched scratchy sound)
- pulse deficit
whats the normal range for BNP
<100
who might have increased bnp
with HF or after heart surgery
normal range for CK-MB
<4-6%
who might have increased CK-MB
pt who has recently had MI
normal range for copeptin
<10
who might have increased copeptin
pt with MI
influenced by fasting and water load
normal ranges for C reactive protein (low-high risk)
lowest risk: <1
moderate risk: 1-3
high risk: >3
who might have increased c reactive proteins
higher risk for cardiac disease and MI
normal range for homocysteine
4-14
who might have increased homocysteine
risk factor for cardiovascular disease
normal ranges for NT-Pro-BNP (<74 yo, >75 yo)
<74 yo = 124
>75 yo = 449
who might have increased NT-Pro-BNP
helps assess severity of HF
levels higher in women and pts with renal insufficiency
normal range for troponin (T and I)
T: <0.1
I: <0.03
who might have increased troponin
cardiac injury/ischemia
normal range for cholesterol
<200
who might have increased cholesterol
associated with atherosclerosis
risk factor cardiovascular heart disease
normal range for lipoprotein a
<30
who might have increased lipoprotein a
increased risk for atherosclerosis, MI, stroke
normal range for high density lipoprotein (low and high risk)
low risk: >60
high risk: <40
normal range for low density lipoprotein (normal and high risk)
normal: <130
high risk: >160
normal range for triglycerides (men and women)
men: 40-160
women: 35-135
who might have increased triglycerides
cardiovascular disease and diabetes
what should pts getting triglycerides tested avoid for 24 hr before
alcohol
nursing considerations with ECG testing
-tell pt to lay down and lay still
what should you tell pt before exercise treadmill test (3)
- hold b blocker for 24 hr before
- no caffeine 24 hr before
- no smoking or strenuous activity 3 hrs before
how should you position pts for echocardiogram
left side
substitute for exercise test for pts unable to exercise
-IV meds are given during ECG to detect wall motion abnormalities
pharm echocardiogram
what is the purpose of cardiovascular MRI
provides information about heart tissues, EF, aneurysms, cardiac output, and patency of proximal coronary arteries
nursing considerations before MRI
- assess for pregnancy, allergies, and renal function before
- ask about any implants
what is the purpose of transesophageal echocardiogram (TEE)
pt swallows probe and gets pics of heart size, wall motion, valve abnormalities, endocarditis vegetation, possible source of thrombi
nursing considerations before TEE
before: fast for 6+ hrs
during: bite block in mouth, monitor SpO2 and bp
after: NPO until gag reflex returns, temporary sore throat
what is the purpose of cardiac catheterization
evaluates chest pain and obtains info about about aorta, inferior vena cava, pulmonary artery and veins
nursing considerations cardiac catheterization
preop:
- assess for allergies to contrast
- NPO 6-12 hrs before
postop:
- observe insertion site for hematoma q15 mins for first hour
what pts would TEE testing be contraindicated in (3)
- esophogeal disorder
- dysphagia
- radiation therapy to chest wall
