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indications for cardiac enzymes and lipid profile
- agina
- MI
- heart disease
- hyperlipidemia
-
Creatinine kinase MB isoenzyme (CK-MB) is more sensitive to
myocardium
-
expected range of CK-MB
first detectable when after myocardial injury?
duration of elevated levels
- 0% of total CK (30-170 units/L)
- 4-6 hr
- 3 days
-
expected range of troponin T
first detectable when after myocardial injury?duration of elevated levels
- Less than 0.2 ng/L
- 3-5 hr
- 14-21 days
-
expected range of troponin I
first detectable when after myocardial injury?duration of elevated levels
- less than 0.03 ng/L
- 3 hr
- 7-10 days
-
expected range of myoglobin
first detectable when after myocardial injury?duration of elevated levels
- less than 90 mcg/L
- 2 hr
- 24 hr
-
cholesterol referange range
<200 mg/DL
-
HDL reference range
- Females 35-80 mg/DL
- Males 35-65 mg/dL
-
LDL reference range
less than 130 mg/dL
-
triglycercides reference range
- females 35-135
- males 40-160
- older adults 55-220
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Indications for echo
- cardiomyopathy
- heart failure
- angina
- MI
-
position for echo
left side. Remain still
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Indications for stress test
- angina
- heart failure
- MI
- dysrhythmia
-
medications that can be used for pharmocological stress test
andenosine (Adenocard)
dobutamine (DObutrex
-
how should client prepare for stress test
- fast 2-4 hr before
- avoid caffeine, tobacco, and alcohol
-
ECG is wha type of lead
- 12 lead
- Holter monitor
- Telemetry
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Arterial lines can be placed where?
- radial(most common), brachial, femoral artery
- Provide continuous info about changes in bp
- Can draw arterial blood
-
are intra-arterial pressure and cuff pressure the same?
can differ
-
Arterial lines are or are not used for IV fluid admin?
Are NOT
-
Pulmonary arter cathethers are placed where
into a large vein (internal jugular, femoral, subclavian, brachial) and threaded thorugh the right atria and ventricle into a branch of the pumonary artery
-
PA catheters allow for
- hemodynamic measurements
- blood sampling
- IV fluids
-
Proximal lumen of PA used for
- right atrial pressure (CVP)
- IV fluids
- venous blood samples
-
Distal lumen of PA used for
- pulmonary arter pressure
- NO iv fluids
-
Balloon inflation port of PA used for
- PAWP mesaurement
- Left deflated when not in use and in LOCKED position
-
Thermistor of PA mseaures
temp difference between the right atrium and the pulmonary artery in order to determine output
-
Indications hemodynamic monitoring
- Serious or critical illness
- HF
- post CABG
- ARDS
- acute kidney injury
- burn injury
- trauma injury
-
-
pulmonary artery systolic range
15-26
-
pulmonary artery diastolic range
5-15
-
-
-
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Hemodynamic monitoring position
supine or trendelenburg
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Nursing actions for hemodynamic monitoring
- Purge air from system
- maintain sterile connections
- supine or trendelenburg
- sedation
- align transducer with 4th intercostal space, midaxillary line, to coorespond with right atrium
- zero system with atmospheric pressure
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Altered PRELOAD hemodynamics
- elevated:
- crackles in lungs
- jugular vein distention
- hepatomegaly
- peripheral edema
- taut skin turgor
- Decreased:
- poor skin turgor
- dry mucous membranes
-
Altered AFTERLOAD hemodynamic
- elevated:
- cool extremeties
- weak peripheral pulses
- Decreased:
- warm extremeties
- bounding peripheral pulses
-
Indications of angiography
unstable angina and ECG changes (T wave inversion, ST segment elevation, depression)
Confirm and determine location and extent of heart disease
-
Preprocedure Angiography
- NPO 8 hr
- Iodine allergy
- renal function
-
Postprocedure for Angiography
assess vitals 15 minx 4, 30 min x2, every hour x4, and then every 4 hr
bedrest
-
client education for Angiography
- avoid strenuous exercise
- report bleeding, chest pain, shortness of breath, change in color of exterminity
- dont lift more than 10 lbs
- If stent:
- anti coagulation therapy 6-8 weeks
-
Cardiac tamponade
fluid accumulation in the pericardial sac
- hypotension
- jugular venous distention
- muffled heart sounds
- paradoxical pulses
- hemodynamic monitoring reveals intracardiac and pumonary artery pressure are similar and elevated (plateau pressures)
-
changes in heart rhythm during pericardiocentesis indicate
improper placement of the needle
-
causes of dysrhythmias
- MI
- cardiomyopathy
- electrolyte and acid imbalance
- hypoxemia
- drugs
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Types of dysrhythmias
- bradycardia
- tachycardia
- fibrillation
- block
- premature
-
clinical manifestation of dysrhtymias
- decreased cardiac output
- ineffective perfussion
-
interventions for dysrhthmias
- drug therapy
- vagal maneuvers-carotid massage
- radiofrequency catheter ablation
- implantable cardioverter-defibrillator
- pacemaker
- synchronized cardioversion
- defibrillation
-
pacemaker
- stimulation to initiate or override impulse
- temporary (transcutaneous and transvenous)
- permanent (single, dual, biventricular)
- synchronous or asynchronous
- Dysrhythmias:bradycahrdia (symptomatic), asystole, blocks
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Nursing actions for pacemaker
- pre-procdure- Explain that it may hurt, concent, o2, monitor, document, emergency equipment available, sedation
- Intra procdure- monitor rhythm and status, meds
- Post- monitor, CXR, immobilize shoulder movement, document post rhythm, settings, VS, educate well
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