CV labs & Dx - medsurg2

Question 1

if troponin is elevated, think

Answer 1

MI

Question 2

if BNP is elevated, think

Answer 2

heart failure

Question 3

troponin

Answer 3

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

Question 4

how to draw serial troponin levels

Answer 4

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

Question 5

does angina elevate troponin

Answer 5

no

Question 6

CK-MB

Answer 6

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

Question 7

C-Reactive Protein (CRP)

Answer 7

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

Question 8

is CRP elevated with angina

Answer 8

no

Question 9

erythrocyte sedimentation rate (ESR or sed rate)

Answer 9

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

Question 10

brain natriuretic peptides (BNP)

Answer 10

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

Question 11

Pro-BNP

Answer 11

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

Question 12

what is the main lipid associated with CV disease

Answer 12

cholesterol

Question 13

is cholesterol an accurate predictor of heart disease

Answer 13

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

Question 14

what affects cholesterol levels

Answer 14

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

Question 15

what are the lipoproteins

Answer 15

HDL & LDL

Question 16

are lipoproteins an accurate predictor of heart disease

Answer 16

yes

Question 17

HDL

Answer 17

want high
-“good cholesterol”
-removes cholesterol

Question 18

LDL

Answer 18

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

Question 19

what noninvasive test can dx an MI

Answer 19

12 lead ekg

Question 20

EKGs provide info on what

Answer 20

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

Question 21

tele

Answer 21

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

Question 22

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

Answer 22

get an EKG

Question 23

holter monitor

Answer 23

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

Question 23

what can a holter monitor dx

Answer 23

afib
reason for syncope
tachycardia

Question 24

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

Answer 24

a holter monitor

Question 25

exercise stress test

Answer 25

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**

Question 26

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

Answer 26

stress test

Question 27

prep for stress test

Answer 27

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

Question 28

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

Answer 28

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

Question 29

echocardiogram

Answer 29

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

Question 30

nursing considerations of an echo

Answer 30

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

Question 31

ejection fraction

Answer 31

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

Question 32

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

Answer 32

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

Question 33

transesophageal echocardiogram (TEE)

Answer 33

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**

Question 34

echo shows what side of the heart and TEE shows what

Answer 34

anterior ; posterior

Question 35

TEE nursing considerations

Answer 35

-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

Question 36

electrophysiology study (EPS)

Answer 36

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

Question 37

where are the the probes in the EPS placed

Answer 37

near the SA node, AV node and right ventricle

Question 38

EPS nursing considerations

Answer 38

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

Question 39

cardiac cath + angiography

Answer 39

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

Question 40

heart cath: diagnostic

Answer 40

confirm location and extent of CAD

Question 41

heart cath: therapeutic

Answer 41

can preform interventions like angioplasty / stent placement

Question 42

left sided heart cath

Answer 42

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

Question 43

what structures can a left sided heart enter

Answer 43

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

Question 44

right sided heart cath

Answer 44

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

Question 45

left sided heart cath nursing considerations

Answer 45

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

Question 46

heart cath pre procedure nursing responsibilities

Answer 46

-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

Question 47

heart cath post procedure nursing responsibilities

Answer 47

-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

Question 48

potential complications of heart cath

Answer 48

-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

Question 49

what is contrast nephrotoxicity

Answer 49

AKI occurring w/n 3 days of contrast dye injection

Question 50

who is at risk for contrast nephrotoxicity

Answer 50

preexisting renal impairment diabetic pts pts who are volume depleted

Question 51

how to prevent contrast nephrotoxicity

Answer 51

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