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Sav NUR 405 exam 1 content > 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? ___ - ____ hours

when does a troponin level return to baseline? ___ - ____ days

A

2-3 hours

10-14 days

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4
Q

what is the lab draw schedule for troponin? (3)

A

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

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5
Q

What is a CK-MB? ______ found primarily in the ________ _______

What does it help diagnose?

A

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

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6
Q

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

when does a CK-MD peak? ___ hours

when does it return to baseline?

A

3 hours

24 hours
2 days/18-72 hours

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7
Q

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

A

troponin

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8
Q

What does CRP indicate?

acute or chronic?

specific to heart?

is ESR or CRP more sensitive and quicker?

A

inflammatory illness

acute

(not specific to heart, could be anywhere in the body)

More sensitive and quicker compared to ESR

NONSPECIFIC

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9
Q

when does a CRP peak?

if a CRP fails to normalize what may it indicate?

A

18-72 hours

ongoing damage to heart muscle

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10
Q

what CHD issue is CRP not elevated with?

A

with angina

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11
Q

What is a ESR used for?

acute or chronic?

specific to heart?

is ESR or CRP more sensitive and quicker?

A

infection, inflammation, or tissue infarction

acute OR chronic infection, chronic inflammation

nonspecific

CRP

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12
Q

how is an ESR useful?

A

only one that monitors for chronic inflammation

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13
Q

What is a BNP the main source in?

BNP is a _______ released by the __________ in the _______

A

BNP is a hormone released by the cardiac ventricles in the heart

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14
Q

what does BNP aid in discovering for example with dyspnea?

Elevated BNP = ______ issue (specifically which part?)

Not elevated BNP = ______ issue

A

distinguishing between cardiac vs. respiratory causes of dyspnea

Elevated BNP = left ventricle dysfunction (cardiac issue)

Not elevated BNP = respiratory issue

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15
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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16
Q

what is the main lipid associated with CV disease?

(higher the ________ = the higher the risk of CAD)

A

cholesterol

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17
Q

what are the two sources of cholesterol?

A

endogenous and exogenous

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18
Q

what affects cholesterol?

A

malnutrition and diurnal variations

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19
Q

what are two types of lipoprotiens?

A

HDL,LDL

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20
Q

are lipoproteins an accurate predictor of heart disease?

is Cholesterol an accurate predictor of heart disease?

A

yes

no - Cholesterol is part of a lipid profiling test (not totally accurate predictor of heart disease itself)

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21
Q

what is HDL’s job?

A

to remove cholesterol

HDL is good cholesterol

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22
Q

What is LDL’s job?

A

to deposit cholesterol in peripheral tissues

LDL “low down dirty” bad cholesterol

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23
Q

what is a normal cholesterol range?
low risk =
normal =
mod risk =
high risk =

A

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

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24
Q

types of non-invasive procedures for CV disease (4)

A

EGK/ECG
Holter monitor
Exercise stress test
Echocardiogram
- also consider tele

25
Q

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

which one provides a more accurate picture of electroconductivity of the heart?

which one records the electrical activity of the heart for a short period, 2-3 minute time frame?

which one can diagnose MI?

which one can look for abnormal rhythms?

which one Monitors cardiac rhythm on an ongoing/continuous basis?

A

EKG provides a more accurate picture of electroconductivity of the heart

EKG

EKG only

tele

tele

26
Q

What is a holter monitor

A

ambulatory EKG/ECG monitoring

27
Q

what do you teach a patient prior to a holter monitor
pain?
prep?
electrodes?
activity?

A

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

28
Q

how long do patients wear a holter monitor?

A

24 hours

29
Q

what is a holter monitor used for?
dx - (1)
find out - (2)

A

to dx atrial fib

to find out why someone is syncope or tachycardia

30
Q

what is an exercise stress/treadmill test used for?

when is it indicated?

what is used to induce exercise?

what are the test results?
exercise may unmask symptoms of ______ or ______ in patients with minimal symptoms with normal activity

A

to evaluate the hearts response to exercise

Test is indicated when person has angina w/ exercise and no angina w/ rest
So we want to see the heart’s response to exercise

can use a treadmill or exercise bike
If the person can’t do treadmill/bike they can induce heart stress with meds

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

31
Q

what must be continuously monitored during a exercise stress test? (2)

is there special prep for an exercise stress test?

A

heart monitoring and vital signs

no, wear comfortable shoes and clothes

32
Q

what are echocardiograms used for?

uses _______ to create ________ of the heart

evaluates ________ and ______ of the heart

shows anterior or posterior of heart?

A

uses sound waves to create moving pictures of the heart

to evaluate valves and chambers of the heart.

Shows anterior of heart

33
Q

what does an echocardiogram measure?

A

ejection fraction

34
Q

what do you teach a patient about an echocardiogram?
prep
radiation
pain
where

A

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

35
Q

what is ejection fraction?

indiactes?

normal EF

low EF < ____% = HF
might need a

A

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

effectiveness of the heart to pump

55-70%

<40%
heart transplant

36
Q

types of invasive procedures of CV disease (3)

A

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

37
Q

What department is a TEE done in?

A

vascular lab

38
Q

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

A

how is a TEE done?

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

39
Q

what type of sedation is used with a TEE?

how long must a patient be NPO before a TEE?

A

requires IV access
local anesthetic or conscious sedation

6 hours

40
Q

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

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

what symptom can be expected after a TEE?

A

dentures

gag reflex

sore throat

41
Q

evaluates the electrical health of the heart

induces dysrhythmia’s

confirms the root of the suspected electrical problem of the heart

A

EPS
Electrophysiology study

42
Q

what must be stopped several days before an EPS?

how long must a patient be NPO before a EPS?

What type of sedation is used for an EPS?

where are the catheters placed during a EPS? (3)

what must be checked frequently after a EPS?

A

anti-dysrhythmics

8 hours

IV sedation

near SA, AV nodes, and right ventricle

VS

43
Q

what is diagnostic use of cardiac catheterization with angiography “heart cath” used for? (2)

A

to confirm location and extent of CAD

44
Q

what is the therapeutic use of a heart cath? (1)

A

to perform an intervention such as angioplasty/stent placement

45
Q

what type of information does a heart cath provide? (3)

A

about heart muscles, blood vessels and valves.

46
Q

what path does a ____ heart cath follow?
1. aorta
2. RT coronary artery
3. LT anterior descending coronary artery
4. Circumflex coronary artery
5. LT main coronary artery

A

left

47
Q

what are the insertion sites of a heart cath? (4)

A

neck = artery or vein

groin = femoral (artery)

radial and brachial = artery

48
Q

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

A

angiogram

49
Q

nursing pre-procedure responsibilities of a heart cath
NPO
consent
pain
dye
bladder
sedation

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 (conscious sedation) likely
50
Q

nursing post-procedure responsibilities of a heart cath
where
what is d/c
monitor ____ before sheath is pulled

when sheath removed apply pressure for _____ mins
-bed rest for at least ___ hors with affected extremity _____ and HOB below ___ degrees
-Frequently assess ________ of the extremity used for artery/vein entrance
-check for _____, _____, and ______ (especially of area distal/below entrance site) and compare to unaffected extremity

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 for 20 mins
bed rest

-bed rest for at least 6 hors with affected extremity straight and HOB below 30 degrees
-Frequently assess circulation of the extremity used for artery/vein entrance
-check for pulses, color, and sensation (especially of area distal/below entrance site) and compare to unaffected extremity

51
Q

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

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

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

A

clotting times

20 min

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

52
Q

potential complications of a heart cath?

_______ (heparin drip used during procedure, monitor puncture site closely for hematoma)

________ ( monitor for s/s of stroke)

infection

dysrhythmias

damage to heart (cardiac tamponade)

allergic reaction to _____

_______ failure (r/t contrast dye “nephrotoxic”)

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”)

53
Q

AKI occurring within 3 days of contrast dye injection

A

contrast nephrotoxicity

major cause of AKI in hospitalized patients

54
Q

what patient populations are at higher risk of contrast nephrotoxicity? (3)

A

pre-existing renal impairment, diabetic, FVD patients

55
Q

how do you prevent contrast nephrotoxicity?

(2) meds before and after procedure

after procedure =

A

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

56
Q

think triponin = think ________

think BNP = think _______

A

MI

heart failure

57
Q

If _______ is elevated = muscle damage has occurred (anywhere in the body, not specific to heart)

So it could be elevated if the patient has had a lot of IM injections or they were in a MVA

A

CK-MB

58
Q

in addition to triponin and CK-MB

Another lesser used serum lab for monitoring myocardial damage (not specific to heart)

A

Myoglobin

Sav NUR 405 exam 1 content (7 decks)

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