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ABSN > CV labs & Dx - medsurg2 > Flashcards

CV labs & Dx - medsurg2 Flashcards

1
Q

if troponin is elevated, think

A

MI

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2
Q

if BNP is elevated, think

A

heart failure

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3
Q

troponin

A

most sensitive indicator of MI & helps differentiates between cardiac & non cardiac pain
-will be elevated 2-3 hrs after MI and will return to baseline in 10 to 14 days

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4
Q

how to draw serial troponin levels

A

initially -> 12 hrs -> daily for 3-5 days

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5
Q

does angina elevate troponin

A

no

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6
Q

CK-MB

A

a less specific indicator of myocardial damage -> could be elevated d/t multiple IM injections or if a person was involved in a trauma b/c it shows muscle damage

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7
Q

C-Reactive Protein (CRP)

A

non specific indicator of acute inflammation
-more sensitive than ESR
-failure to normalize after 72 hrs may indicate damage to heart muscle

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8
Q

is CRP elevated with angina

A

no

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9
Q

erythrocyte sedimentation rate (ESR or sed rate)

A

nonspecific indicator of acute/chronic infection, chronic inflammation & tissue infarction
-best used to monitor chronic inflammation
-less sensitive than CRP

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10
Q

brain natriuretic peptides (BNP)

A

aids in distinguishing cardiac vs respiratory cause of dyspnea
-main source is found in the cardiac ventricles so if elevated, indicates heart failure/left ventricular dysfunction

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11
Q

Pro-BNP

A

in healthy patient, usually similar levels compared to BNP but if left ventricular dysfunction, pro will be elevated 4x higher than BNP

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12
Q

what is the main lipid associated with CV disease

A

cholesterol

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13
Q

is cholesterol an accurate predictor of heart disease

A

not by itself, take in part of a lipid profile test

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14
Q

what affects cholesterol levels

A

-diurnal variations (time of day)
-malnutrition (so check albumin levels)

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15
Q

what are the lipoproteins

A

HDL & LDL

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16
Q

are lipoproteins an accurate predictor of heart disease

A

yes

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17
Q

HDL

A

want high
-“good cholesterol”
-removes cholesterol

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18
Q

LDL

A

want low
-“bad cholesterol”
-deposits cholesterol in peripheral tissues

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19
Q

what noninvasive test can dx an MI

A

12 lead ekg

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20
Q

EKGs provide info on what

A

a snap shot of the electrical conduction of the heart w/ a multidirectional view

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21
Q

tele

A

-monitors cardiac rhythm on a continuous basis
-cannot dx
-unidirectional

22
Q

if a patient is complaining of chest pain, what is the next best nursing action

A

get an EKG

23
Q

holter monitor

A

a painless, no prep test that attaches electrodes to a person for 24 hours and that person then continues normal activity w/ monitor
ambulatory EKG monitoring

23
Q

what can a holter monitor dx

A

afib
reason for syncope
tachycardia

24
Q

if a person is having weird episodes of syncope at home, what should be ordered

A

a holter monitor

25
Q

exercise stress test

A

evaluates the heart’s response to exercise to unmask sx of CAD or dysrhythmias that may not occur w/ normal activity
requires continuous heart monitoring & VS

26
Q

if a patient complains of chest pain only w/ exercise, what test should be ordered

A

stress test

27
Q

prep for stress test

A

-VS & EKG step up
-tell pt to wear comfy clothes and good shoes

28
Q

what is done if a person is unable to perform a stress test d/t mobility limitations

A

medications can be used to induce similar effects of exercise induced stress on the heart

29
Q

echocardiogram

A

uses sound waves to create a moving picture of heart -> evaluates valves & chambers of the heart + measures EF

30
Q

nursing considerations of an echo

A

-no radiation
-no prep
-painless
-done at bedside

31
Q

ejection fraction

A

amount of blood pumped out of the left ventricle w/ each contraction -> normal is 55-70%
indicator of how effective the heart is pumping

32
Q

what is considered a low EF and what is it associated w/

A

<40%, seen w/ heart failure
very low values might indicate need for transplant

33
Q

transesophageal echocardiogram (TEE)

A

a probe w/ an ultrasound transducer is placed down the throat w/ the end near the heart -> provides improved pictures to be taken compared to echo

34
Q

echo shows what side of the heart and TEE shows what

A

anterior ; posterior

35
Q

TEE nursing considerations

A

-contrast may be used
-done in vascular lab
-IV access for local or conscious sedation
-NPO 6hrs before test
-remove dentures
-NPO until gag reflex returns
-educate on sore throat after

36
Q

electrophysiology study (EPS)

A

evaluates the electrical health of the heart by inducing dysrhythmias to confirm the root of suspected electrical problems within the heart

37
Q

where are the the probes in the EPS placed

A

near the SA node, AV node and right ventricle

38
Q

EPS nursing considerations

A

-anti dysrhythmics dc’d several days before procedures
-NPO 8hr before test
-IV sedation
-frequent VS after procedure

39
Q

cardiac cath + angiography

A

uses contrast dye and takes pictures of the heart to provide information about the heart muscles, blood vessels & valves

40
Q

heart cath: diagnostic

A

confirm location and extent of CAD

41
Q

heart cath: therapeutic

A

can preform interventions like angioplasty / stent placement

42
Q

left sided heart cath

A

enter an artery (usually femoral) -> works retrograde up to the ascending aorta -> enters coronary arteries

43
Q

what structures can a left sided heart enter

A

-aorta
-right coronary artery
-left anterior descending coronary artery
-circumflex coronary artery
-left main artery

44
Q

right sided heart cath

A

cannot look at arteries
-can measure EF and look at pressures
-enters through the venous system

45
Q

left sided heart cath nursing considerations

A

-contrast used w/ x ray imaging
-pt conscious w/ local aneesthesia so educate on warm flush

46
Q

heart cath pre procedure nursing responsibilities

A

-NPO (meds may be allowed)
-consent
-pt/fam teaching
-only a little pain is to be expected
-hot flash w/ dye
-check bun/Cr
-empty bladder

47
Q

heart cath post procedure nursing responsibilities

A

-d/c heparin drip & monitor clotting times closely before sheath is pulled
-after removing sheath, hold pressure for 20 mins
-bed rest for at least 6hrs w/ affected leg straight & HOB <30 degrees
-assess circulation of extremity used
-check pulses, colors & sensation

48
Q

potential complications of heart cath

A

-bleeding & hematoma at puncture site
-emboli: monitor for stroke
-infection
-dysrhythmias
-damage to heart (tamponade if pericardium is poked)
-allergic rx
-renal failure secondary to dye

49
Q

what is contrast nephrotoxicity

A

AKI occurring w/n 3 days of contrast dye injection

50
Q

who is at risk for contrast nephrotoxicity

A

preexisting renal impairment
diabetic pts
pts who are volume depleted

51
Q

how to prevent contrast nephrotoxicity

A

-sodium bicard IV & acetylcysteine po before & after procedure
-force fluids after

ABSN (145 decks)

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