DIAGNOSTIC TEST THERAPEUTICS SURGICAL, MEDICAL & NURSING MANAGEMENT Flashcards
Highly sensitive
Early detection of MI within 2 hours
It assessed reperfusion
Most useful in ruling MI
DISADVANTAGE- rapid return to normal
MYOGLOBIN
(CK MM)-raises fast (2 hours) after MI; peaks at 6-8 hrs. returns to normal in 20- 36 hours.
MYOGLOBIN
Elevates 4-6hrs from the onset of infarction; peaks 24-36 hrs. returns to normal 4-7 days.
CK-MB (Creatinine Kinase Myoglobin)
normally undetectable or very low in the blood.
Chest pain and increased CK levels plus elevated CK-MB indicate that it is likely that a person has recently had a
heart attack.
Powerful tool for risk stratification ( remember the
KILLIP’s
Greater specificity and sensitivity to CK-MB
It detects confirm MI up to 2 weeks
Helpful to determine therapy
TROPONIN
(nanograms) male
normal myoglobin
10-95 ng
( nanograms) female
10-65 ng
Most specific lab test to confirm MyocardiaI
Infarction. And is elevated after the 1st 6 hours of attack
Troponin
0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs,
persist for: 4-7 days)
Troponin I
Troponin T
0.2 ng/ml (onset: 3-4 hrs, peak: 10-24
hrs, return to normal: 10-14 days)
To determine if the etiology of MI is due to
increased
cholesterol (Dyslipidemia).
They are the most common type of fat .
● They come from foods, especially butter, oils, and
other fats
Serum Triglycerides: 140-200 mg/dl
suggests tissue
oxygenation.
- Elevated WBC may indicate infectious heart
disease and MI.
Complete Blood Count
- It is
elevated in infectious heart disorder or MI. - Normal range: Males: 15-20 mm/hr
- Females: 20-30 mm/hr
Erythrocyte Sedimentation Rate (ESR)
Elevated level
indicates tissue necrosis. Also known as (SGOT
Aspartate Aminotransferase (AST)-
Serum Glutamic Oxaloacetic Transaminase
- Normal Range:
7-40 mu/ml
- A high level of SGOT released into the
blood may be a sign of liver or heart damage
valuable in diagnostic of silent MI because it is
elevated for a long period of time.
Hydroxybuterate Dehydroxynase (HBD)
Indicator of renal
function
-
Blood Urea Nitrogen (BUN)
- It measures time
required for clotting to occur.
Prothrombin Time (PT, Pro Time)- I
Used to evaluate
effectiveness of COUMADIN
Prothrombin Time (PT, Pro Time)- I
- Best screening
test for disorders of coagulation.
Partial Thromboplastin Time (PTT)
Used to determine
the effectiveness of HEPARIN. Normal Range: 60-70
secs.
Partial Thromboplastin Time (PTT)
SERUM ELECTROLYTES
Sodium- 135-145 mmol/ L
- Potassium - 3.5- 5.0 mmol/L
- Calcium- 8.5- 10.5 mg/dl
- Magnesium - 1.3- 2.1 mg/dl
Hemodynamic Monitoring- S
Swan Ganz Catheter
Exercise Test
Treadmill Stress test
- Dobutamine/Adenosine
● Stress Test
- Myocardial Perfusion
● Scan Holter Monitor
Echocardiography identifies thickened ventricular walls, septal
thickening, and chamber dilation or restriction.
2D ECHO
KINDS OF 2D-ECHO
TRANSTHORACIC ECHOCARDIOGRAM
TRANSESOPHAGEAL ECHOCARDIOGRAM
two- dimensional 2-D Echo
- capable of displaying a cross-sectional
“slice” of the beating heart, including the
chambers, valves and the major blood
vessels that exit from the left and right
ventricle
TRANSTHORACIC ECHOCARDIOGRAM
If it’s difficult to get a clear picture of your heart with a
standard echocardiogram, your doctor may
recommend a transesophageal echocardiogram.
- Also known as TEE
TRANSESOPHAGEAL ECHOCARDIOGRAM
The catheter is introduced through large veins- internal jugular
or subclavian and femoral veins
HEMODYNAMIC MONITORING
- Swan-Ganz Catheterization
It is used to diagnosed heart failure or sepsis
● Monitor Therapy
● To evaluate the effectiveness of a certain drug
Swan-Ganz Catheterization
POSt OP CARE
for Swan-Ganz Catheterization
Apply pressure to the incision site for about thirty
minutes manually or with a mechanical compression
device
● Take your patients vital signs every 15 minutes for two
hours after the procedure, th
Evaluate or confirm the presence of heart disease
(such as coronary artery disease, heart valve disease,
or disease of the aorta)
● Evaluate heart muscle function
SWAN GANZ CATHETERIZATION
is a special X-ray test.
● A procedure to find out if the coronary arteries are
blocked or narrowed, location and extent of
injury/damage diagnosed
A coronary angiogram i
is essential if the patient needs
treatment such as
- Angioplasty or stent
- Coronary artery bypass surgery (CABG)
- Medical therapy
An angiogram
Determine the amount of stress that the heart can
manage.
● Diagnose Coronary Artery Disease and heart related
cause of syndrome
EXERCISE STRESS TEST
TREADMILL TEST
Nursing Considerations
Inform the patient to have an adequate rest at night.
● Avoid stimulants such as tea, coffee or chocolate on
the day of the test.
An Adenosine Stress Test uses the drug ______________ to stress
the heart
Adenosine
NURSING RESPONSIBILITY
DOBUTAMINE/ADENOSINE STRESS TEST
NO caffeine for 24 hours prior to the test, this includes
coffee, tea, and caffeinated pop
● Medications containing Theophylline, Aminophylline,
Viagra
An imaging drug Thallium is injected thru IV
● Accurately visualize the motion of the heart walls
when the heart is stressed while patient is in bed
DOBUTAMINE/ADENOSINE STRESS TEST
A battery-operated portable device that measures
and records heart’s activity (ECG) continuously for 24
to 48 hours or longer depending on the type of
monitoring used.
HOLTER MONITOR
NURSING RESPONSIBILITY
● Once the Holter Monitor is attached
nurses must
document in the Patient’s Progress Notes the time of
attachment, and the prescribed time to be left ON.
The first goal for healthcare professionals in
management of acute myocardial infarction (MI) is to
diagnose the condition in a very rapid manner.
Act by augmenting perfusion at the border of the
ischemic zone.
- Generalized vasodilation
- Reducing myocardial O2 demand
Nitrates
THERAPEUTIC: MEDICATION
Nitrates
Only a maximum of 3 doses at 5 min. interval.
● Offer sips of water before giving it sublingually.
does have antipyretic, antiplatelet and
analgesic actions, but the primary reason aspirin is
administered to the client experiencing an MI is its
antithrombotic action.
ASPIRIN - antiplatelet therapy
Thrombolytic Therapy that reduces the
risk of blood clot
HEPARIN -
Nx Cons for Coumadin
Assess for bleeding
- Keep Vitamin K available.
- Monitor for Prothrombin Time
- is a class of medications that are particularly
used to manage cardiac arrhythmias, and to protect the heart
from a second heart attack after a first heart attack
Beta Blockers
have the greatest benefit in patients
with ventricular dysfunction
ACE inhibitors
To prevent straining during defecation
Laxative
The occurrence of constipation relates to the
position
and range of myocardial infarction
Long-term bed rest weakens
gastrointestinal
peristalsis
are a class of drugs often prescribed by doctors to help
lower cholesterol levels in the blood. By lowering the levels,
they help prevent heart attacks and stroke
Statins
What are statin side effects?
Myalgia and muscle pain
● Liver damage
● Increased blood sugar or type 2 diabetes
is considered the drug of choice for the treatment
of malignant ventricular arrhythmias
Lidocaine
Malignant ventricular arrhythmias are of 3 forms:
- out-of hospital ventricular fibrillation (VF),
- recurrent sustained ventricular tachycardia and
- torsades de pointes
PTCA
Percutaneous Transluminal Coronary
Angioplasty
CABG
Coronary Artery Graft Bypass Surgery
Treatment of choice
● Performed to OPEN BLOCKED coronary arteries
caused by Coronary Artery Disease
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
It restores ARTERIAL BLOOD FLOW TO THE
HEART without OPEN-HEART surgery
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
is a
procedure to place a stent in an artery of the heart
that has plaque buildup.
Coronary intravascular stent placement
mixture of fat and cholesterol.
Plaque
Post management; stent replacement
Patients will take more than one antiplatelet drug such
as Aspirin, Clopidogrel, Ticlopine, Warfarin.
● Aspirin is used indefinitely and the other drugs are for
4 to 6 weeks
Angioplasty fails
● Severe narrowing of 1 or more coronary artery
Commonly used: Saphenous vein and internal mammary
artery.
EMERGENT / URGENT CORONARY ARTERY GRAFT
BYPASS SURGERY (CABG)
is the longest vein in
the body, begins on the medial side of the foot.
e great saphenous vein used for CABG
a surgeon will make an incision down the center of
the sternum (breastbone), to get direct access to the
heart.
Traditional Coronary Artery BypassGraft (CABG) Surgery
Connection to the heart-lung bypass machine
- The heart is stopped and the surgeon then performs
the bypass procedure
Coronary Artery Bypass Graft
Minimally invasive bypass surgery can be performed
through a small thoracotomy (chest wall) incision for
patients that require a LIMA (left internal mammary)
graft
Minimally Invasive Coronary Artery Bypass (MIDCAB)
Surgery
Who are good candidates for this procedure? CABG
if the blockages are present only on the vessels on
the left side of the heart, then most likely the patient is
a candidate.
An electronic device that delivers direct stimulation to the heart
causing electrical depolarization and cardiac contractions.
CARDIAC PACEMAKER
A process in which a person restored to health and maintains
optimal physiologic, psychosocial and recreational functions
CARDIAC REHABILITATION
