-
-
-
TCK:CK-MB
relative index:
<2.5-3
-
-
-
This blood test is considered the most accurate to see if a heart attack has occurred and how much damage it did to the heart.
Troponin
-
Can be detected a w/in a few hours ( approx 6 hrs) of
myocardial injury. Peaks between 1st & 2nd day
after injury & can remain elevated for as long as 3 weeks
Troponin
-
What does the TCK – CK-MB relative index result mean?
If the value of CK-MB is elevated and the ratio of CK–MB to total CK (relative index) is more than 2.5–3, it is likely that the heart was damaged. A high CK with a relative index below this value suggests that skeletal muscles were damaged.
-
a heme protein that helps to transport O2. Found in cardiac & skeletal muscle. Starts to increase w/in 1-3 hrs of injury & peaks w.in 12 hrs after onset of S&S. Not specific to an acute cardiac event. Negative results assist in R/O AMI
Myoglobin
-
This test is usually performed along with cardiac catheterization. A dye that can be seen by using x ray is injected through the catheter into the coronary
arteries. Your doctor can see the flow of blood through the heart and see where there are blockages.
Coronary angiography
-
Elevation of ST segment in more than 2 contiguous leads
is key to diagnosing STEMI
-
EKG chgs of ischemia (ST depression) & injury (ST elevation) may also be evident as MI size & depth increases until stopped
-
Antidote: Amicar ( aminocarproic acid)
For T-PA – Toxicity & OD
-
Goals for MI include:
- –The immediate and appropriate treatment & relief of chest
- pain
–Absence of respiratory distress
–Attain/maintain adequate tissue perfusion
–Reduce anxiety
–Awareness of the disease process
–Understanding of prescribed care
–Adherence to the self-care program – see Chart 28-11, p. 777
–Absence of complications
-
–Inability of the heart to pump sufficient oxygenated
blood to meet body tissue’s demand
CHF
-
Normal ejection fraction
55-65%
-
•Systolic failure – most common
–Weakened heart muscle due to infarction
–Unable to pump needed volume
–LV dilates
-
•Diastolic failure – less common
–Stiff, noncompliant ventricle–Reduces filling & volume pumped out
-
Stages of CHF
- • I - no effect on
- adl; good prognosis
- •II – slight limit on adls, S&S with increased physical activity, basilar rales & S3 possible;
- good prognosis
•III – Marked limits on adls, comfortable at rest but ordinary activity causes s&s; fair prognosis
- •IV – S&S of cardiac insufficiency at rest; poor
- prognosis
-
RVF:
- congestion in peripheral tissues & visceria predominates; JVD & HJR;
- perpherial edema (dependent);
- ascities;
- anorexia, N&V;
- weakness;
- weight gain;
- RUQ discomfort & hepatomegaly;
- respiratory distress;
-
LVF:
S&S areprogressive: dyspnea, dry, hacking cough [may become productive as congestionincreases; frothy pink sputum = pulmonary edema], bibasilarpulmonary crackles (early) – do not clear with coughing ,low O2 sat, S3,orthopnea or Paroysmal nocturnal dyspnea (PND), difficulty sleeping, nocturia,tachycardia/paplitations, cold & clammy skin, weak & thready pulse,fatigue
-
•DYSPNEA
•DRY COUGH
•CRACKLES
•WHEEZES
•ORTHOPNEA
•HEMOPTYSIS
•“Paroxysmal” NOCTURNAL DYSPNEA
•CHEYNE-STOKES RESPIRTIONS
•FATIQUE
•WEAKNESS
•CYANOSIS
•NOCTURIA
•TACHYCARDIA
•Serious:
life threatening
•Pulmonary
Edema
Left sided HF
-
•JUGULAR
VEIN DISTENSION
•DEPENDENT
PERIPHERAL EDEMA
•ASCITES
•WEIGHT
GAIN
•FATIGUE
•WEAKNESS
•SPLENOMEGALY
•HEPATOMEGALY
•GI
DISCOMFORT
•NOCTURIA
•TACHYCARDIA
Right sided HF
-
ACUTE HF
•RAPID RESPIRATIONS
•SEVERE DYSPNEA
•CRACKLES/WHEEZE
•COUGHING
•FROTHY SPUTUM
•ANXIOUS/RESTLESS
•CLAMMY SKIN/COOL
-
CHRONIC CHF
S/S INFLUENCED BY PATIENTS
•AGE
•UNDERLYING CAUSE
•VENTRICLE THAT IS FAILING
-
dig toxicity
- grn-yellow halos around
- objects/lights, n/v/anorexia
-
carvedilol or Coreg is often the beta
blocker of choice for CHF
-
Patient Teaching for CHF
OXYGEN main )2 sat 92% or>& raise HOB
- REST AND ACTIVITY:space activities out
- throughout the day. Don’t
- lift more than 10lbs.
POSITIONING q 2 hrs
FLUID RETENTION?
- MEDICATIONS: may be
- on other meds, Ca channel blockers, or
- Coumadin prvnt clots
- LOW SODIUM DIET:
- 2gm./day sodium AND WEIGHT REDUCTION
Diet: eat small frequent meals (6 meals/day)
COPING ?
- I & O: avoid
- fluid intake above 1.5-2L/day
- Weight: best
- measurement of fluid status or loss !(esp
11 / 28
-
CHF interventions
•Digoxin – improves efficiency slows HR & improves contraction
- • Diuretics – elimininate fluid excess to
- reduce workload on herat
•Oxygen – improves oxygen available
- •Sit up/legs dangle – allows for lung expansion and pooling of blood in legs
- decreasing venous return & reducing workload of heart
• Get ABGs – assess oxygenation
• Aminophylline/Bronchodilators opens airways to improve gas exchange
- •Morphine Sulfate IV - dilates veins and decreases blood returning to the heart
- and lungs."
•
Rotating Tourniquets
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