Download Nursing Consideration

CARDIOVASCULAR
SYSTEM
Diagnostic and Laboratory
Studies
Prepared By
Ms. Jennifer Castillon,RN.MAN.
Electrolytes
Coagulation Studies
Erythrocyte Studies
White Blood Cell Count
Serum Enzymes and Cardiac Markers
Serum Lipids
ECG
CVP
Pericardiocentesis
ELECTROLYTES
POTASSIUM (3.5 – 4.5mEq/L)
Nursing Consideration:
A-ccurate note if the patient is
receiving K supplement
B-lood should not be drawn
from site where an IV
infusion exists
C-lenching and unclenching of
hand can increase the level
ELECTROLYTES
HYPERKALEMIA – elevated
potassium level
Results to ECG changes like:
Tall, peaked T wave
Prolonged PR interval
Loss of P wave
Widening of QRS complex
which lead to ventricular
fibrillation or cardiac arrest.
ELECTROLYTES
HYPOKALEMIA – decreased
potassium level
Results to ECG changes like:
Presence of U wave
premature ventricular
contractions (PVC’S) which
can deteriorate into VT or
VF.
ELECTROLYTES
MAGNESIUM (1.5 -2 mEq/L)
Nursing Consideration:
P-rolong use of magnesium products
will cause increased serum levels
-arenteral nutrition therapy or
P excessive loss of body fluids may
decrease serum levels
Hypomagnesemia
Hypermagnesemia
ELECTROLYTES
CALCIUM (4.8- 8.5 mg/dl)
Nursing Consideration:
Instruct the client to eat a diet
with a normal calcium level
(800 mg/day) for 3 days
before the test.
Instruct the client that fasting
may be required for 8 hours
before the test
ELECTROLYTES
HYPERCALCEMIAincreased level of
calcium.
Rhythm disturbances may
include:
Bradycardia; first, second
and third degree heart
block and RBBB
ELECTROLYTES
HYPOCALCEMIA- decreased
level of calcium.
 myocardial contractility,
cardiac output and
hypotension.
ECG prolonged QTc interval
leads to life-threatening
ventricular dysrthymia.
COAGULATION STUDIES
ACTIVATED PARTIAL
THROMBOPLASTIN TIME (APTT)- to
measure the effectiveness of IV or
subcutaneous heparin administration.
A-mount of time it takes in seconds for
recalcified plasma to clot after partial
thromboplastin is added
P-erformed for patient receiving heparin
T-est for deficiencies and inhibitors of
clotting factors
T-ime: 20 to 36 seconds
COAGULATION STUDIES
PROTHROMBIN TIME (PT) and
INTERNATIONAL NORMALIZED
RATIO (INR)- to determine
therapeutic dosage of warfarin
necessary to achieve anticoagulation.
P-rothrombin is a vitamin K
dependent glycoprotein
produced by the liver for fibrin
clot formation
T-o monitor response to warfarin
sodium (Coumadin)
COAGULATION STUDIES
PROTHROMBIN TIME (PT) and
INTERNATIONAL NORMALIZED
RATIO (INR)
Normal Values:
PT:
– 9.6 to 11.8 secs (male)
– 9.5 to 11.3 secs (female)
INR:
– 2.0 to 3.0 (standard warfarin tx)
– 3.0 to 4.5 (high dose warfarin tx)
COAGULATION STUDIES
PROTHROMBIN TIME (PT) and INTERNATIONAL
NORMALIZED RATIO (INR)
Nursing Considerations:
A - baseline PT should be drawn before anticoagulation
therapy
B -e sure to apply direct pressure to the venipuncture
site
C -oncurrent warfarin therapy with heparin therapy can
lengthen the PT
D -iets high in green leafy vegetables can shorten PT
E -xpect 1.5 to 2 times longer PT if on anticoagulation
therapy
F -or PT greater than 30 secs, initiate bleeding
precautions
COAGULATION STUDIES
PLATELET COUNT
Plug formation
Clot retraction
Coagulation factor
activation
COAGULATION STUDIES
PLATELET COUNT
Nursing Considerations:
B-leeding precautions should
be instituted in clients with
low platelet
M-onitor venipuncture site
C-hronic cold weather, high
altitudes, and exercise
increase platelet count
ERYTHROCYTE STUDIES
RED BLOOD CELLS
4.5-6 million/mm3 in males
4-5.5 million/mm3 in
females
• <RBC – Anemia (Fatigue,
SOB)
• >RBC – Polycythemia
(erythrocytosis) –
ERYTHROCYTE STUDIES
HEMOGLOBIN
Hemoglobin is the main
component of erythrocytes and
serves as the vehicle for
transporting O2 and CO2
Normal Values:
– 14 to 18g/dl (male)
– 12 to 16 g/dl (female)
ERYTHROCYTE STUDIES
HEMATOCRIT
Hematocrit represents the volume
percentage of RBC’s in whole
blood and is an important
measurement in the
identification of anemia or
polycythemia
Normal Values:
– 40% to 54% (male)
– 38% to 48% (female)
WHITE BLOOD CELL COUNT
WHITE BLOOD CELL or
leukocytes
Immune defense system of the
body
WBC 5,000-10,000 cells/mm3
– <WBC – leukopenia (risk for
infection)
– >WBC – leukocytosis
(infection/inflammation)
– >100,000 – incapable of
phagocytosis (leukemia)
CARDIAC BIOMARKERS OR
CARDIAC ENZYMES
CREATINE KINASE (CK)
Found in:
CK-MB (Cardiac)--- 0% to 5%
CK-BB (Brain)--- 0%
CK-MM (Muscles)--- 95% to 100%
Rise- 4-8hours after MI
Peak – 15 -24 hours
Remain elevated – 2-3days
CARDIAC MARKERS
CREATINE KINASE (CK)
Nursing Considerations:
CK-MM: Avoid strenuous physical
activity for 24 hours before the test
Avoid ingestion of alcohol for 24
hours before the test
Invasive procedures and
intramuscular injections may
falsely elevate CK levels
CARDIAC MARKERS
Troponin T and Troponin I
Elevation occurs after 3 –
6hours after the acute
myocardial damage has
occurred.
CARDIAC MARKERS
LACTASE DEHYDROGENASE
(LDH)
Nursing Considerations:
LDH isoenzyme levels should
be interpreted in view of
the clinical findings
Testing should be repeated
on 3 consecutive days
CARDIAC MARKERS
MYOGLOBIN – nonspecific
indicator of myocardial cell
damage both cardiac and
skeletal muscle.
Injury to skeletal muscle will
cause a release of myoglobin
into the blood.
Rise about 1 – 4hours after
myocardial injury
SERUM LIPIDS
Total Cholesterol--140 to 199 mg/dl
Low Density Lipoprotein
(LDL)--- <130 mg/dl
High Density Lipoprotein
(HDL)--- 30 to 70 mg/dl
Triglycerides--< 200 mg/dl
SERUM LIPIDS
Nursing Considerations:
No oral contraceptives
NPO except water for 12 to 14
hours
No alcohol for 24 hours
No high cholesterol foods the
evening meal before the
test
ECG
E -valuates heart rate and
the regularity of
heartbeats.
C-ardiac dysrhythmias, MI,
and cardiac hypertrophy
- raph of the electrical
G impulses moving through
the heart.
ECG
Nursing Consideration:
E -lectrical shock will not occur
C-ardiac medications of the
patient should be
documented
G-ive instructions to lie still,
breathe normally, and
refrain from talking during
the test
Central Venous Pressure (CVP)
C-atheter is attached to an IV
infusion and H2O
manometer by a three
way stopcock
V -eins external jugular,
antecubital, or femoral
P - ressure within the superior
vena cava
CVP
Normal Value: 3 to 8 mmHg
Position:
Cardiac Disease: Semi Fowler’s
Dressing or Tubing Change: Flat
or Trendelenburg
CVP Reading and Monitoring:
Flat, Supine, or Dorsal
Recumbent
Air Embolism: Left Side Lying
CVP
1. Maintain zero point of manometer always at
level of right atrium (intersection between
midaxillary line and 4th ICS, also referred to
as the phlebostatic axis)
2. Determine patency of catheter by opening IV
infusion line
3. Turn stopcock to allow IV solution to run into
manometer to a level of 10-20cm above
expected pressure reading
4. Turn stopcock to allow IV solution to flow from
manometer into catheter; fluid level in
manometer fluctuates with respiration
5. Stop ventilatory assistance during measurement of
CVP
6. After CVP reading, return stopcock to IV infusion
position
7. Record CVP reading and position of client (angle of
recline)
PERICARDIOCENTESIS
Pericardial effusion
Puncture
Pericardial sac
Pericardial fluid
PERICARDIOCENTESIS
PRE-PROCEDURE
P erform blood analysis
E CG
R estriction of food and water
is recommended for six
hours before the test.
I V line for sedation
PERICARDIOCENTESIS
A
B
C
D
INTRA-PROCEDURE
vail emergency resuscitative
equipment at bedside
ed is elevated to 45 to 60
degrees
ardiac activity monitoring
one in emergency room,
ICU, or at the bedside
PERICARDIOCENTESIS
POST-PROCEDURE
A pical pulse monitoring
B lood pressure
C VP
D etect complications:
Ventricular or coronary artery
puncture, dysrhythmias,
pleural laceration, gastric
puncture, myocardial trauma
•
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YOU