Download Diagnostics - SimpleNursing

Cardiac - 1 video (8 minutes) = 1 chapter
Anatomy, Blood Flow, cardiac Output, Preload afterload, MI, CAD, CABG, Hemodynamics,
Pharmacology - Ace, ARBs, Diuretics, Beta Blocker,
CHF drugs, MI drugs.
http://www.youtube.com/playlist?list=PL8zFPglvM-dwcEsJYX-ZJFkhvX8ymhgJV
4 step study system
1. Gather notes from power point/ instructor
2. Watch playlist and take more notes
3. Go over your note 10-14x ( cardiac) 5-7 everything else
4. Practice NCLEX questions! 60/60minutes
Diagnostics
- CK-MB: cardiac specific ISO enzyme, an elevation in value indicates myocardial damage, an
elevation occurs within hours and peaks at 18hr. Returns to normal within 3-4 days w/o
treatment normal range 0%-5% of total CK, total CK 26-174 unit/l
-CPK: non cardiac specific creatine, phosphokianse, damage to skeletal muscle will increase
these numbers, goes back to normal within 3-4 days without treatment. Heart , skeletal muscle
and brain
-Troponin: tropoinin is a protein in the muscle that regulates contraction of my myocardium.
Rises within 3 hours and stays high for7-10 days post myocardial injury. 0.01ng/ml is normal
anything higher will indicate myocardial injury ( myo cell damage)
- myoglobin: oxygen binding protein in the cardiac and skeletal muscle, level rises within 2
hours ( early indicator) post cell death ( can also be increased with rhabdomyloisis) a
negative result yeids non cardiac relation.
-serum lipids: measures HDL/LDL triglyceride and lipoproteins. Used to assess the risk of
coronary artery disease. The desireable range for cholesterol is < 200 mg/dl LDL <130 HDL<3070. High LDL will increase the risk of atherosclerosis. Risk factors: gender ( male) , age,
genetics, intake of animal fat, menopause, tobacco, stress.
- Homocystine: elevated levels may increase the risk of cardiovascular disease. <14mmol/dl.
Highly sensitive C-reactive protein (liver/ atherosclerosis) detects an inflammatory response
that can trigger thrombus formation.
-BNP: brain naturetic peptide, enzyme that responds to the ventricles when fluid overload is
present.acts as a diuretic( HF) value of 100-300 indicates HF is present.
-ANP: atrial naturetic peptide, released from the atria in response to atrial stretch . ^ will be seen
in any event that causes atrial stretch or vascular increase in volume. ( pregnancy/ HF)
Overview of the cardiovascular system/ vocabulary to know
Automaticity: Ability to initiate electrical response
Excitability: ability to respond to electrical response
Chronotrope: heart rate
Dromotrope: AV conduction
Inotrope: force of myocardial contraction
Cardiac output: amount of blood leaving the ventricles/ min normally AV node doing the work
4-6l/ min
Stroke volume : amount of blood ejected per HB SVXHR=C/O
MAP: Av pressure in the arteries per cycle. Indicates perfusion normally 70-110mmg. Must
maintain > 60 to maintain perfusion true preload requires invasive monitor. S+ 2 D/3=MAP
afterload: the amount of resistance to ejection of blood from the ventricle
preload: degree of stretch of the cardiac muscle fibers at the end of diastole
contractility: ability of the cardiac muscle to shorten in response to an electrical impulse.
Increased by catcecholemines , medication, SNS. Decreased by : hypoxemia, acidosis, some
medications.
Ejection fraction: % of end diastolic vol ejected with each HB from the left ventricle. Normal 5565% < 40% = left ventricle dysfunction ( needs further treatment
Cardiac conduction system
SA NODE: Pacemaker of the heart 60-100 BP
AV NODE: Takes over when pacemaker is broken 40-60 BP
BUNDLE BRANCH/PERKINJE : last resort , takes over when everyone else fails ( the Donald
trump of the conduction system) 30-40 BP
Keep in mind a very healthy / athletic client may have a normal resting rate of 40 BPM do not
get excited! Just ask more HX.
Cardiac action potential
Depolarization: electrical activation of action potential caused by an influx of sodium going into
the cell and K coming out of the cell
Repolarization: return of cell to rest in state caused by reentry of k while sodium exits .
Refractory periods: phase in which cells are in capable of repolarizing ( effective)
Phase in whic cells require a stronger than normal action potential to depolarize ( relative)
Manifestations
Chest pain
Dyspnea
Peripheral edema
Fatigue
Dizziness syncope, loc changes
Assessment
Physical exam
Palate, auscultation,
Medications: ACE/ARB/DIURETIC/BETA BLOCKER.
Nutrition/elimination
Activity/exercise/rest
Health promotion
What type of health issues do you have? Do you have any family HX? What are your risk
factors for heart disease? Do you smoke? How do you stay healthy? How is your health, any
changes?
Do you have a cardiologist? How often do you go for check ups ? What medications do you
take?
Testing
ECG
12 lead non invasive diagnostic test records electrical activity of the heart. 3D look at the heart
on paper. Each lead looks at each section of the heart. Important that the electrodes are in the
right spot
Intervention: have the client lie still, breathe normally, refrain from talking.
Continuous monitor
Telemetry , hard wired
Halter monitor
Continuous ambulatory monitoring, electrocardiopgraphic image is recorded while the client
wears the evict 24/7. Identifies dysrrythmias and evaluates effects of antidysrrythmics or
pacemaker therapy.
Intervention : instruct the client to resume normal daily living, maintain a diary documenting
activities and symptoms. Client should avoid bath tubs and showers , they will interfere with
monitoring .
Trans telephonic monitoring
Sends a signal via telephone
Pharmacological stress test out patient
Adenosine/ dipyridmol
Interventions: avoid caffeine, tobacco and other stimulants
Exercise stress test out patient
Measures cardiac workload via excercise
Echocardiography
Transthorasic ( non invasive) ultrasound determines ejection fraction takes 45-1 hour
Transesophageal ( invasive)
A small transducer gets threaded down the throat. Better image. Pt will be sedated.
Interventions: NPO for 6 hrs before procedure, may give throat anesthetic, will need an IV
access. Remove dentures before procedure, ^ HOB for several hours post procedure @ 45*
angle. NPO until gag reflex returns may have a sore throat. If they get SOB report to the HCP
immediately.
Cardiac cathetrization
Invasive procedure that measures Patency of coronary arteries. Requires hemodynamics
monitoring, ECG, and emergancy equipment ready. Gold standard to DX coronary artery
disease. Feed catheter through femoral artery.
Assess allergies and blood work prior to test.
Homecare: do not let them bend at the waist, do not lift heavy objects, no bath tub educate on
s/sx of infection. , notify HCP I'd bleeding or bruising or ^ temp.
Interventions: assess site for bleeding or hematoma, dysrythmia, pulse deficit.
Raise head of bed 30* . Give plenty of H20, PT may have reflex bradycardia and hypotension.
Elevate feet. 2-6 bed rest, watch coagulation status. Leg that the cath was performed on should
remain straight.
Radionuclide testing
Myocardial perfusion test: thallium, takes several hours
PET: contrast/ IVP dye injected
MRA: use of magnetic field for the heart vessels, contraindicated in patients with metal plates,
pacemakers, jelwery , metal prosthesis , some transdermal patches ( nicoderm)
Hemodynamic monitoring
Done in the ICU
Nurse should specialize and it takes special training to do these tests.
CVP
PULMONARY ARTERY PRESSURE
INTRA-ARTERIAL BP MONITORING
Very important to maintain aseptic technique