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Labs & Diagnostic Collab > CV Labs & Diagnostics > Flashcards

CV Labs & Diagnostics Flashcards

1
Q

what is Troponin an indicator of?

A

most sensitive indicator of myocardial damage

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2
Q

what does troponin differentiate between?

A

cardiac vs non cardiac chest pain

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3
Q

how long after an MI does a troponin elevate?

A

2-3 hours

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4
Q

when does a troponin level return to baseline?

A

10-14 days

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5
Q

what is the lab draw schedule for troponin?

A

initial occurrence, 12 hours, then daily for 3-5 days

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6
Q

What is a CK-MB?

A

an enzyme found primarily in the heart muscle, helps to diagnose an acute MI

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7
Q

how long is a CK-MD elevated after an MI?

A

3 hours

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8
Q

when does a CK-MD peak?

A

24 hours after MI

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9
Q

between a troponin and a CK-MB which is more specific to cardiac damage?

A

troponin

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10
Q

What does CRP indicate?

A

inflammatory illness

NONSPECIFIC

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11
Q

when does a CRP peak?

A

18-72 hours

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12
Q

if a CRP fails to normalize what may it indicate?

A

ongoing damage to heart muscle

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13
Q

how is a CRP useful?

A

monitors acute inflammation

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14
Q

when is a CRP not elevated?

A

with angina

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15
Q

What is a ESR used for?

A

nonspecific indicator of acute OR chronic infection, inflammation, or tissue infarction

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16
Q

how is an ESR useful?

A

monitors for chronic inflammation

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17
Q

What is a BNP the main source in?

A

cardiac ventricle

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18
Q

what does BNP aid in?

A

distinguishing between cardiac vs. respiratory causes of dyspnea

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19
Q

when are concentrations higher in a Pro-BNP?

A

Left ventricular dysfunction

levels are approximately fourfold higher than BNP concentrations

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20
Q

what is the main lipid associated with CV disease?

A

cholesterol

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21
Q

what are the two sources of cholesterol?

A

endogenous and exogenous

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22
Q

what affects cholesterol?

A

malnutrition

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23
Q

what are two types of lipoprotiens?

A

HDL,LDL

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24
Q

are lipoproteins an accurate predictor of heart disease?

A

yes

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25
Q

what is HDL’s job?

A

to remove cholesterol

HDL is good cholesterol

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26
Q

What is LDL’s job?

A

to deposit cholesterol in peripheral tissues

LDL “low down dirty” bad cholesterol

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27
Q

what is a normal cholesterol range?

A

150-200
<200 low risk of CAD
200-400 mod risk of CAD
>240 high risk of CAD

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28
Q

what is a normal range of triglycerides?

A

40-160

>190 high risk of CAD

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29
Q

What is a normal range of LDL?

A

<100
130-159 mod risk for CAD
>160 high risk of CAD

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30
Q

What is a normal range of HDL?

A

> 40-50
60 low risk of CAD
<40 high risk of CAD

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31
Q

types of non-invasive procedures for CV disease

A

EGK/ECG
Holter monitor
Exercise stress test
Echocardiogram

32
Q

what is the difference between a 12 lead EKG and telemetry?

A

EKG provides a more accurate picture of electroconductivity of the heart

33
Q

What is a holter monitor

A

ambulatory EKG/ECG monitoring

34
Q

what do you teach a patient prior to a holter monitor

A

test is painless
requires no prep
electrodes must stay firm against chest.
continue with usual activities

35
Q

how long do patients wear a holter monitor?

A

24 hours

36
Q

what is a holter monitor used for?

A

to dx atrial fib

37
Q

what are some reasons a patient may wear a holter monitor?

A

syncope or tachycardia

38
Q

what is an exercise stress/treadmill test used for?

A

to evaluate the hearts response to exercise
can use a treadmill or exercise bike

exercise may unmask symptoms of CAD or dysrhythmias in patients with minimal symptoms with normal activity

39
Q

what must be continuously monitored during a exercise stress test?

A

heart monitoring and vital signs

40
Q

is there special prep for an exercise stress test?

A

no, wear comfortable shoes and clothes

41
Q

what are echocardiograms used for?

A

uses sound waves to create moving pictures of the heart to evaluate valves and chambers of the heart.

42
Q

what does an echocardiogram measure?

A

ejection fraction

43
Q

what do you teach a patient about an echocardiogram?

A

no prep
no radiation is used
painless
can be done at bedside

44
Q

what is ejection fraction?

A

Percentage of blood pumped out of the left ventricle with each contraction.

45
Q

what is a ejection fraction an indicator of?

A

effectiveness of the heart to pump

46
Q

what is a normal ejection fraction?

A

55-70%

values less than 40% are seen with HF

47
Q

types of invasive procedures of CV disease

A

trans-esophageal echocardiogram (TEE)
cardiac catheterization
Electrophysiology study (EPS)

48
Q

What department is a TEE done in?

A

vascular lab

49
Q

how is a TEE done?

A

a probe with an ultrasound inducer is placed down the throat with the end near the heart. Provides improved images, compared to an echo

contrast dye may be used

50
Q

what type of sedation is used with a TEE?

A

requires IV access

can be local or conscious sedation

51
Q

how long must a patient be NPO for a TEE?

A

6 hours

52
Q

what must be removed from the patient prior to a TEE?

A

dentures

53
Q

What must return before a patient can take anything by mouth after a TEE?

A

gag reflex

54
Q

what symptom can be expected after a TEE?

A

sore throat

55
Q

What does an EPS do?

A

evaluates the electrical health of the heart
induces dysrhythmia’s
confirms the root of the suspected electrical problem of the heart

56
Q

what must be stopped several days before an EPS?

A

anti-dysrhythmics

57
Q

how long must a patient be NPO before a EPS?

A

8 hours

58
Q

What type of sedation is used for an EPS?

A

IV sedation

59
Q

where are the catheters placed during a EPS?

A

near SA, AV nodes, and right ventricle

60
Q

what must be checked frequently after a EPS?

A

VS

61
Q

what is diagnostic use of cardiac catheterization with angiography “heart cath” used for?

A

to confirm location and extent of CAD

62
Q

what is the therapeutic use of a heart cath?

A

to perform an intervention such as angioplasty/stent placement

63
Q

what type of information does a heart cath provide?

A

about heart muscles, blood vessels and valves.

64
Q

what path does a LT heart cath follow?

A 
aorta
RT coronary artery
LT anterior descending coronary artery
Circumflex coronary artery
LT main coronary artery
65
Q

what are the insertion sites of a heart cath?

A

neck or groin ( RT or LT femoral, radial, brachial artery)

66
Q

angiogram

A

done during a heart cath
contrast dye injected through catheter and xray images are taken.
pt may feel a warm flush

67
Q

nursing pre-procedure responsibilities of a heart cath

A 
NPO (some may be allowed morning meds with small sip of water)
consent signed
pt/family teaching
little pain
will experience hot flash when dye injected
check labs BUN/Cr
empty bladder
local anesthesia and IV sedation likely
68
Q

nursing post-procedure responsibilities of a heart cath

A

will occur in cath lab or observation area
heparin drip will be d/c and clotting time monitored before sheath is pulled
when sheath removed apply pressure
bed rest
frequent circulation checks of extremities
check for pulses, color and sensation

69
Q

what must be checked before the sheath can be removed following a heart cath?

A

clotting times

70
Q

how long must you apply pressure after removing the sheath from a heart cath?

A

20 min

71
Q

how long must a patient remain in bed after a heart cath and what position?

A

at least 6 hours with affected leg straight and HOB BELOW 30 degrees

72
Q

potential complications of a heart cath?

A

bleeding (heparin drip used during procedure, monitor puncture site closely for hematoma)
emboli ( monitor for s/s of stroke)
infection
dysrhythmias
damage to heart (cardiac tamponade)
allergic reaction to dye
renal failure (r/t contrast dye “nephrotoxic”)

73
Q

what is contrast nephrotoxicity?

A

AKI occurring within 3 days of contrast dye injection

major cause of AKI in hospitalized patients

74
Q

what patient populations are at higher risk of contrast nephrotoxicity?

A

pre-existing renal impairment, diabetic, FVD patients

75
Q

how do you prevent contrast nephrotoxicity?

A

sodium bicarb IV and acetylcysteine PO before and after procedure
force fluids

Labs & Diagnostic Collab (18 decks)

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