DIAGNOSTIC TEST THERAPEUTICS SURGICAL, MEDICAL & NURSING MANAGEMENT

Question 1

Highly sensitive
Early detection of MI within 2 hours
It assessed reperfusion
Most useful in ruling MI
DISADVANTAGE- rapid return to normal

Answer 1

MYOGLOBIN

Question 2

(CK MM)-raises fast (2 hours) after MI; peaks at 6-8 hrs. returns to normal in 20- 36 hours.

Answer 2

MYOGLOBIN

Question 3

Elevates 4-6hrs from the onset of infarction; peaks 24-36 hrs. returns to normal 4-7 days.

Answer 3

CK-MB (Creatinine Kinase Myoglobin)

Question 4

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

Answer 4

heart attack.

Question 5

Powerful tool for risk stratification ( remember the

Answer 5

KILLIP’s

Question 6

Greater specificity and sensitivity to CK-MB
It detects confirm MI up to 2 weeks
Helpful to determine therapy

Answer 6

TROPONIN

Question 7

(nanograms) male
normal myoglobin

Answer 7

10-95 ng

Question 8

( nanograms) female

Answer 8

10-65 ng

Question 9

Most specific lab test to confirm MyocardiaI
Infarction. And is elevated after the 1st 6 hours of attack

Answer 9

Troponin

Question 10

0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs,
persist for: 4-7 days)

Answer 10

Troponin I

Question 11

Troponin T

Answer 11

0.2 ng/ml (onset: 3-4 hrs, peak: 10-24
hrs, return to normal: 10-14 days)

Question 12

To determine if the etiology of MI is due to

Answer 12

increased
cholesterol (Dyslipidemia).

Question 13

They are the most common type of fat .
● They come from foods, especially butter, oils, and
other fats

Answer 13

Serum Triglycerides: 140-200 mg/dl

Question 14

suggests tissue
oxygenation.
- Elevated WBC may indicate infectious heart
disease and MI.

Answer 14

Complete Blood Count

Question 15

• It is
  elevated in infectious heart disorder or MI.
• Normal range: Males: 15-20 mm/hr
• Females: 20-30 mm/hr

Answer 15

Erythrocyte Sedimentation Rate (ESR)

Question 16

Elevated level
indicates tissue necrosis. Also known as (SGOT

Answer 16

Aspartate Aminotransferase (AST)-

Question 17

Serum Glutamic Oxaloacetic Transaminase
- Normal Range:

Answer 17

7-40 mu/ml
- A high level of SGOT released into the
blood may be a sign of liver or heart damage

Question 18

valuable in diagnostic of silent MI because it is
elevated for a long period of time.

Answer 18

Hydroxybuterate Dehydroxynase (HBD)

Question 19

Indicator of renal
function
-

Answer 19

Blood Urea Nitrogen (BUN)

Question 20

• It measures time
  required for clotting to occur.

Answer 20

Prothrombin Time (PT, Pro Time)- I

Question 21

Used to evaluate
effectiveness of COUMADIN

Answer 21

Prothrombin Time (PT, Pro Time)- I

Question 22

• Best screening
  test for disorders of coagulation.

Answer 22

Partial Thromboplastin Time (PTT)

Question 23

Used to determine
the effectiveness of HEPARIN. Normal Range: 60-70
secs.

Answer 23

Partial Thromboplastin Time (PTT)

Question 24

SERUM ELECTROLYTES

Answer 24

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

Question 25

Hemodynamic Monitoring- S

Answer 25

Swan Ganz Catheter

Question 26

Exercise Test

Answer 26

Treadmill Stress test - Dobutamine/Adenosine ● Stress Test - Myocardial Perfusion ● Scan Holter Monitor

Question 27

Echocardiography identifies thickened ventricular walls, septal thickening, and chamber dilation or restriction.

Answer 27

2D ECHO

Question 28

KINDS OF 2D-ECHO

Answer 28

TRANSTHORACIC ECHOCARDIOGRAM TRANSESOPHAGEAL ECHOCARDIOGRAM

Question 29

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

Answer 29

TRANSTHORACIC ECHOCARDIOGRAM

Question 30

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

Answer 30

TRANSESOPHAGEAL ECHOCARDIOGRAM

Question 31

The catheter is introduced through large veins- internal jugular or subclavian and femoral veins

Answer 31

HEMODYNAMIC MONITORING - Swan-Ganz Catheterization

Question 32

It is used to diagnosed heart failure or sepsis ● Monitor Therapy ● To evaluate the effectiveness of a certain drug

Answer 32

Swan-Ganz Catheterization

Question 33

POSt OP CARE for Swan-Ganz Catheterization

Answer 33

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

Question 34

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

Answer 34

SWAN GANZ CATHETERIZATION

Question 35

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

Answer 35

A coronary angiogram i

Question 36

is essential if the patient needs treatment such as - Angioplasty or stent - Coronary artery bypass surgery (CABG) - Medical therapy

Answer 36

An angiogram

Question 37

Determine the amount of stress that the heart can manage. ● Diagnose Coronary Artery Disease and heart related cause of syndrome

Answer 37

EXERCISE STRESS TEST

Question 38

TREADMILL TEST Nursing Considerations

Answer 38

Inform the patient to have an adequate rest at night. ● Avoid stimulants such as tea, coffee or chocolate on the day of the test.

Question 39

An Adenosine Stress Test uses the drug ______________ to stress the heart

Answer 39

Adenosine

Question 40

NURSING RESPONSIBILITY DOBUTAMINE/ADENOSINE STRESS TEST

Answer 40

NO caffeine for 24 hours prior to the test, this includes coffee, tea, and caffeinated pop ● Medications containing Theophylline, Aminophylline, Viagra

Question 41

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

Answer 41

DOBUTAMINE/ADENOSINE STRESS TEST

Question 42

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.

Answer 42

HOLTER MONITOR

Question 43

NURSING RESPONSIBILITY ● Once the Holter Monitor is attached

Answer 43

nurses must document in the Patient’s Progress Notes the time of attachment, and the prescribed time to be left ON.

Question 44

The first goal for healthcare professionals in management of acute myocardial infarction (MI) is to

Answer 44

diagnose the condition in a very rapid manner.

Question 45

Act by augmenting perfusion at the border of the ischemic zone. - Generalized vasodilation - Reducing myocardial O2 demand

Answer 45

Nitrates

Question 46

THERAPEUTIC: MEDICATION Nitrates

Answer 46

Only a maximum of 3 doses at 5 min. interval. ● Offer sips of water before giving it sublingually.

Question 47

does have antipyretic, antiplatelet and analgesic actions, but the primary reason aspirin is administered to the client experiencing an MI is its antithrombotic action.

Answer 47

ASPIRIN - antiplatelet therapy

Question 48

Thrombolytic Therapy that reduces the risk of blood clot

Answer 48

HEPARIN -

Question 49

Nx Cons for Coumadin

Answer 49

Assess for bleeding - Keep Vitamin K available. - Monitor for Prothrombin Time

Question 50

- 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

Answer 50

Beta Blockers

Question 51

have the greatest benefit in patients with ventricular dysfunction

Answer 51

ACE inhibitors

Question 52

To prevent straining during defecation

Answer 52

Laxative

Question 53

The occurrence of constipation relates to the

Answer 53

position and range of myocardial infarction

Question 54

Long-term bed rest weakens

Answer 54

gastrointestinal peristalsis

Question 55

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

Answer 55

Statins

Question 56

What are statin side effects?

Answer 56

Myalgia and muscle pain ● Liver damage ● Increased blood sugar or type 2 diabetes

Question 57

is considered the drug of choice for the treatment of malignant ventricular arrhythmias

Answer 57

Lidocaine

Question 58

Malignant ventricular arrhythmias are of 3 forms:

Answer 58

1. out-of hospital ventricular fibrillation (VF), 2. recurrent sustained ventricular tachycardia and 3. torsades de pointes

Question 59

PTCA

Answer 59

Percutaneous Transluminal Coronary Angioplasty

Question 60

CABG

Answer 60

Coronary Artery Graft Bypass Surgery

Question 61

Treatment of choice ● Performed to OPEN BLOCKED coronary arteries caused by Coronary Artery Disease

Answer 61

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Question 62

It restores ARTERIAL BLOOD FLOW TO THE HEART without OPEN-HEART surgery

Answer 62

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Question 63

is a procedure to place a stent in an artery of the heart that has plaque buildup.

Answer 63

Coronary intravascular stent placement

Question 64

mixture of fat and cholesterol.

Answer 64

Plaque

Question 65

Post management; stent replacement

Answer 65

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

Question 66

Angioplasty fails ● Severe narrowing of 1 or more coronary artery Commonly used: Saphenous vein and internal mammary artery.

Answer 66

EMERGENT / URGENT CORONARY ARTERY GRAFT BYPASS SURGERY (CABG)

Question 67

is the longest vein in the body, begins on the medial side of the foot.

Answer 67

e great saphenous vein used for CABG

Question 68

a surgeon will make an incision down the center of the sternum (breastbone), to get direct access to the heart.

Answer 68

Traditional Coronary Artery BypassGraft (CABG) Surgery

Question 69

Connection to the heart-lung bypass machine - The heart is stopped and the surgeon then performs the bypass procedure

Answer 69

Coronary Artery Bypass Graft

Question 70

Minimally invasive bypass surgery can be performed through a small thoracotomy (chest wall) incision for patients that require a LIMA (left internal mammary) graft

Answer 70

Minimally Invasive Coronary Artery Bypass (MIDCAB) Surgery

Question 71

Who are good candidates for this procedure? CABG

Answer 71

if the blockages are present only on the vessels on the left side of the heart, then most likely the patient is a candidate.

Question 72

An electronic device that delivers direct stimulation to the heart causing electrical depolarization and cardiac contractions.

Answer 72

CARDIAC PACEMAKER

Question 73

A process in which a person restored to health and maintains optimal physiologic, psychosocial and recreational functions

Answer 73

CARDIAC REHABILITATION