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NUR 254-Test 1 > Perfusion DIAGNOSTICS > Flashcards

Perfusion DIAGNOSTICS Flashcards

1
Q

Cholesterol Goals (after overnight fast):

TOTAL SERUM cholesterol

A

Desirable = < 200 mg/dL

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2
Q

Cholesterol Goals (after overnight fast):

LDL cholesterol (“lousy”/bad lipids)

A

Optimal if < 100 mg/dL

@ risk if only < 70 mg/dL (???)

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3
Q

Cholesterol Goals (after overnight fast):

HDL cholesterol (good lipids)

A

Desirable = > 40 mg/dL

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4
Q

Cholesterol Goals (after overnight fast):

Triglycerides

A

Desirable = < 150 mg/dL

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5
Q

Lab Values:

CAD

A

–homocystine
(amino acid that INCREASES w/ HD)

–C-reactive protein
(responds to inflamm.; ELEVATED in CAD)

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6
Q

Lab Values:

CHF

A

–BNP
INCREASES w/ CHF ( pump failure )
** NORMAL = < 100 **
CLIN. SIGNIF. = > 500

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7
Q

Lab Values:

MI

A

CK is an enzyme found in brain, skeletal, & cardiac muscles. Levels INCREASE w/ DAMAGE TO TISSUES.

    • CK-MB is SPECIFIC TO CARDIAC MUSCLE; it is the most sensitive indicator of MI
  • —NORMAL = 0 - 3 %
  • ——** positive indicator of MI = > 5 % **
  • -detected in 4 - 8h // peak @ 18 -24h // lasts 72h

Troponins are proteins that are released during MI that are sensitive to myocardial damage

  • -released w. NECROSIS of heart muscle
  • -can detect MI very early (better than CK)
  • -can time when person had heart attack
  • -*CHF makes heart stretch (damages a few muscles) so it may bump the troponin level

type T: detect 2-4h // peak 24-36h // lasts 10-14 days

type I: detect 2-4h // peak 24-36h // lasts 7-10 days

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8
Q

COAGULATION studies:

PTT (partial thromboplastin time)

A

aPTT monitors the effectiveness of HEPARIN therapy
and detects coagulation d/o

Baseline: 20 - 39 seconds

THERAPEUTIC: 2 - 3x the base line (60-70 seconds)

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9
Q

COAGULATION studies:

PT (prothrombin time)

A

PT monitors the effectiveness of COUMADIN therapy and detects coagulation d/o

Baseline: 9.5 - 12 seconds

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10
Q

COAGULATION studies:

INR

A

** most important of PT/INR **
reported WITH PT eliminate variation of PT results

Baseline: < 1 second

THERAPEUTIC: 2 - 3 seconds (want 2-3x the normal)

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11
Q

Serum Electrolytes (4)

A

regulate electrical impulses
(affect ability of myocardium to contract)

1) Na: 135 - 145
2) K: 3.5 - 5.5
3) Mg: 1.5 - 2.5 ( 2-3 )
4) Ca: 8.5 - 10.5 ( 9-11 )

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12
Q

Arterial Blood Gases

A

** perform the Allen test PRIOR TO ABGs to check for collateral circulation **

Post-ABG:
–apply pressure for 5 MINS to prevent hematoma
(for 15 mins if pt is on anticoagulants)
–check arm for swelling, discoloration, pain, numbness, or tingling

VALUES:
pH: 7.35 - 7.45
CO2: 45 - 35
HCO3: 22 - 26

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13
Q

Ultrasound Echocardiogram

A

non-invasive sounds waves used to determine cardiac structures (pictures and pumping action of <3)

**pt is positioned slightly on LEFT-SIDE (by rad. tech.)

teaching:
- -chest will be exposed
- -gel applied to chest will be cold

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14
Q

Exercise Stress Test

A

Used to assess cardiac response to increased workload

PREPARATION:

  • -monitor EKG & VS throughout
  • -fast for at least 4h prior (NPO)
  • -no stimulants (coffee/tobacco)
  • -need patent IV access
  • -MEDS TO HOLD:
    • -Nitrates,
    • -Beta-Blockers,
    • -Caffeine containing meds,
    • -Theophylline

teaching:
- -pt will be walking on treadmill, bike, or stairs
- -IF UNABLE TO TOLERATE EXERCISE:
- -the following drugs may be used to STRESS the <3
- -dipyridamole (Persantine)
- -adenosine
- -dobutamine

POST-PROCEDURE:

  • -monitor EKG & VS for 15 mins
  • -if NEG = pt d/c home
  • -if POS&raquo_space; chest pain, EKG changes = pt sched. for CARDIAC CATH. for a definitive diagnosis
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15
Q

Ankle Brachial Index (ABI)

A

indicates ATHEROSCLEROSIS of extremeties

  • -compare SPB in brachil, PT, & DP
  • —divide SBP of ankle BY SPB of arm
  • ** ABI that is < 0.9 in either leg = PVD & CAD ***
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16
Q

Central Venous Pressure (CVP) monitoring

A

–measurement of effective blood volume &
efficiency of cardiac pumping
–indicates ability of R-side of heart to manage fluid load
–CVP is also a guide to fluid replacement
–the catheter is threaded into the RA; placement confirmed w/ X-ray
–transducer should be leveled with access point;
–HOB 0-45
–monitor for hematoma
–ACCESS POINTS: Jugular, Subclavian, or Antecubital

NORMAL = 3 - 12cm water
HYPERvolemia / poor cardiac ctx = > 12
HYPOvolemia = < 3

Post-procedure:

  • -dry, sterile, air occlusive dressing; change daily
  • -inspect daily for s/s of infx
  • -have pt HOLD BREATH when withdrawn (or inserted or when tubing is changed) TO PREVENT AIR EMBOLISM

Complications: Air embolism, pneumothorax, infection at insertion site

17
Q

Cardiac Catheterization

A

Cath in chamber to evaluate ventricular function and obtain chamber pressure

PREP:

  • -NPO 8-12h
  • -consent
  • -EMPTY BLADDER
  • -check pulses
  • -ensure IV access
  • -*teaching: sensations&raquo_space; flushing w/ contrast, pressure w/ balloon
  • -EKG baseline
  • -Labs: BUN, creat., PT/INR, aPTT, H&H, platelet, elect.
  • **pts are HEPARINIZED during procedure&raquo_space; chk PTT
18
Q

Angiography

A

used to evaluate specific areas of arterial system for NARROWING or OBSTRUCTION; usually used w/ cardiac Cath. (uses dye to look at perfusion)

PREP:

  • -Allergies?&raquo_space;shellfish, iodine (use antihistamines if so)
  • -remove all jewelry
19
Q

Cardiac Cath & Angiography:

Teaching and assessment

A
  • -catheter inserted in femoral artery and guided to <3
  • -contrast dye injected into arteries while x-rays taken (feel heat, flush, desire to cough, or salty taste)
  • -will lie of hard table for < 2h
  • -sedation & pain meds: Versed & Fentanyl

AFTER PROCEDURE:
–SHEATH REMOVAL:
—-remove sheath LAST; hold PRESSURE @ SITE for 20m
—-keep atropine at bedside (for Brady)
—-HAVE TO LAY FLAT 6 - 8H AFTER
—-DO NOT BEND at waist or STRAIN for 24H
(may dislodge clot and could bleed to death)
—-avoid tub baths until site healed
—-CALL MD FOR: bleeding, swelling, new bruising, pain at procedure site, or temp >/= 101.5

20
Q

Cardiac Cath & Angiography:

Post-procedure Assessment

A
  • *q 15 min x 8, …then q 30 min x 2, …THEN q 1 hour x 3
  • -check VS
  • *q 30 min x 6, …then q 1 hour x 3
  • -check distal pulses for perfusion
  • -check sensation,
  • -check bleeding at insertion site

**compare skin temp, color, and sensation in extremities

continuous EKG

bed rest (6-8hours) w/ insertion site VERY STRAIGHT

HOB < 30

pt helped w/ 1st out of bed experience

21
Q

Cardiac Cath & Angiography:

complications

A
  • -rxn to dye
  • -thrombosis
  • -infection
  • -hematoma
  • -contrast agent-induced nephropathy
    • -usually reversible
    • -risk: DM, HF, renal disease, hypotension, dehydration elderly
    • -prevention: HYDRATION (pre & post); Acetylcystine (mucomyst)&raquo_space; acidifies urine and makes it more protective of kidneys

NUR 254-Test 1 (6 decks)

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