Cardiovascular assessment and diagnostics Part 2

46問 • 1年前

問題一覧

What role does the renal system play in regulating BP?

Retian sodium and water when renal blood flow or pressure decreases, Activate the renin-angiotensin-aldosterone mechanism (ACEs and ARBs work here)

We have to take a little dive into kidney function for this next part so I apologize but there’s a great nurse Sarah video breaking all of this down

OK great! Thanks! I LOVE NURSING SCHOOL😭

The Renin Angiotensin Aldosterone System “RAAS”. I know the picture doesn’t have aldostrone idk why he left that out but im making these questions based off info in a nurse Sarah video that seemed to break it down well. So how does the RAAS work? SELECT IN ORDER!

There is decrease in BP which stimulate the Sympathetic NS (S think faSt?), The sympathetic NS stimulates the kidneys, Once the kidneys are stimulated they release renin, Renin activates angiotensinogen, The angiotensinogen creates angiotensin 1, The angiotensin 1 is converted to angiotensin 2 via ACE (Angiotensin-Converting-Enzyme), The angiotensin 2 then causes vessels to constrict and increase blood volume increasing BP, Angiotensin 2 increases blood volume by Aldosterone which is found in adrenal cortex stimulating the kidneys to keep sodium and water in, ACE inhibitors work by blocking the conversion of angiotensin 1 to angiotensin 2

What are other influencing factors that influence the kidneys that effects BP?

Antidiuretic hormone- Causes kidneys to reabsorb water (or hold on to it) which=^volume=^pressure, Natriuretuc Peptides- Cause diuretics and renal vasodilation, Bradykinin and histamin- Cause vasodilation and ^ capillary permeability, Emotions stimulate sympathetic NS- which can increase BP and pulse rate

The valve between the left atrium and left ventricle is?

Mitral (bicuspid) valve

Which of the following statements about coronary arteries is correct?

The three main arteries are the LAD, RCA and circumflex

Cardiac output is the amount of blood…

Pumped from the ventricle in one minute

What are some age related changes that occur in the cardio vascular system.

Aortic and mitral valves can calcify, SA node overtime can become fibrotic resulting in dysrythmias, Left ventricular hypertrophy decreases filling time which decreases ability to respond to high O2demand, Large arteries can stiffen leading to increased systemic ventricular resistance (SVR), Baroreceptors are less sensitive which leads to positional hypotension

True or false? A murmur is a sound heard between a heart beat caused by blood flowing through a restriction.

True

What are some lab tests done?

Enzymes: CK, CKMB, LDH (CK-CKMB? used to be used for MI but is not very specific and is not used as definitive indicator anymore., Troponins- very specific to cardiac muscle damage!, Natriuretic peptide (BNP) Specific for heart failure!!, Homocysteine, C reactive protien, Serum lipids, Electrolytes

Electrolyte review:

Na- 135-145, K+ 3.5-5, Ca 8-10, Mg 1.8-2.4

Cardiac enzymes:

troponin- cTnT; cTnl, CKMB, LDH, Myoglobin

What is the Normal rnage for troponin?

0-0.2

Select onset peak and duration for the cardiac enzyme lab. Troponin(cTnT; cTnl):

Onset 4-6 hours, Peak 18-24 hours, Duratioin up to 10 days

Select onset peak and duration for the cardiac enzyme lab. CKMB

Onset 4-12 hrs, Peak 18-24 hrs, Duration 36-48

Select onset peak and duration for the cardiac enzyme lab. LDH

Onset 6-12 hrs, Peak 24-48 hrs, Duration 6-8 days

Select onset peak and duration for the cardiac enzyme lab. Myoblobin

Onset 1-2 hrs, Peak 8-10 hrs, Duration 24 hrs

What is B-type natriuretic peptide (BNP)

Elevations are associated with heart failure, Secreted from the heart when stretched, 100 or below is normal

Electrocardiographic Testing ECG/EKG

Resting- 12 lead 18 lead, Ambulatory, Stress- exercise or pharmacological, Electrophysiologic study, Can look at the different parts and the electricity

Resting ECG:

How is the heart doing without any load

Exercise stress ECG/EKG

Prep- no smoking, alcohol, or caffeine before, light meal, comfortable clothing, no adensoine or theophylline, Grade: 0-28%. in increments, Speed 1.7-7.5mph

Chemical or pharmacological stress:

Used if pt is contraindicated i.e., bad hip or knee, Get pictures needed reversal agent is given, Headache usually follows after the reversal agent

Ambulatory ECG aka Holter monitor:

Worn for 24-48 hrs, Can be worn or 1day- 2wks to gather more information, for example if someone is having issues at night, They NEED to do their normal activities not just rest around. The whole point is to see how th heart is doing at rest AND under stress.

Electrophysiologic Study (EPS)

Purpose- Look at electrical activity in heart and understand where extra impulses are coming form takes 1-1 1/2hrs, Prep- NPO @0000, hold beta blockers, Suporrtive care after assess site

Radiologic tests that can be done:

Chest x-ray- Enlarged heart, aortic node, pacemaker, HF, Echocardiogram - simple gel is applied prob is used to capture pictures, color to tell if valves are closing, regurgitation or stenosis, Ultrasound, Arteriogram, Coronary Arteriogram aka Cardiac catheterization

Echocardiogram:

Purpose- less invasive, painless, no prep, can measure valves, Common types: -2-D echo -Trans esophageal echocardiography (TEE)

Doppler Ultrasound:

Looking for blood flow, venous return, No prep no real danger

Angiography:

Contrast (Iodine) is injected into patient and X-rays are taken to visualizes areteris an veins, and see and possible blockages etc., Discontinue metformin for minimum 48 hrs, Make sure pt is hydrated, push fast not slow!

Angiogram catheter entry sites

Femoral, Brachial, Coronary angioplasties came first century through brachial artery and inflate balloon to compress. Stents came after!

Cardiac Catheterization:

Is the most invasive: dye injected in arteries to see blockage site a catheter is fed through and the blockage can be stunted sometimes, 2 types right side and left sife, Right side looks at what’s going on with lungs, measures pressures on right side high pressure = lung problem, Left side: done chest pain elephant on chest issues get blood into the system

Indication for Cardiac catheterization:

Great vessel disease, Coronary artery occlusion, Valvular disease (stenosis, insufficiency, regurgitation), Atrial or ventricular septal defects, Measurement of cardiac & Pulomnaru issues

Relative Contraindication (relative bc depends on situation)

Renal insufficiency - start IV at high rate, Coagulopathy, Fever or systemic infection, Ventricular irritability, Uncompensated heart failure, Contrast dye allergies

Nursing considerations/ Patient teaching pre-procedure for cardiac cath:

Consent required, NPO 4-6 hrs before, some Drs will allow light breakfast, Hold nephrotoxic meds 48 hrs to 2 wks before, neomycin etc, Antigoags held: Coumadin stop 6-7 days before elequis and zeralto 24 hours before, IV access required, Entry site cleansed and shaved as needed, Cardiac monitor, frequent VS and pulse on done, May last 1-3 hrs, A twighlight type sedation not asleep, need to be awake to see how patien is toleration ok

Select the order of a left sided heart cath (in order)

Femoral, radial, or brachial artery ➡️, Aorta ➡️Across aortic valve ➡️LV, Coronary angiography ➡️ RCA & LCA Cornaries fill during diastole so looked at last, Asess: Left sided pressures, mitral/aortic valves, coronary artery circulation

Select the order of the right sided heart cath (in order);

Femoral or basilic vein to the, Inferior and superior vena cava, To the right atrium ➡️ RV and pulmonary artery, Assess: valves, inracardiac pressures

Nursing consideration & patient teaching: Post procedure for cardiac cath

Ventricular arrhythmias may occur, resuscitation equipment must be available, Monitor VS q 15 for 1 hours and q30mins for the next hour, Evalute preipharial pulses, PEDAL pulses, skin color temp and sensation, Assess entry site for bleeding, hematoma, pseudo aneurysm; apply constant pressure if needed, May need to remain flat for 1-hrs

Cardiac Catheterization complications

Right: Embolus, vagal, response, atrial dysrythmias, Left: MI, CVA, ventricular dysrythmias, arterial bleeding, Both: tamponade, hypovolemia, hematoma, pseudo aneurysms, contrast dye reaction, infection, death

Contrast Induced Nephropathy;

Best prevention strategies: identify patient at risk hydration limit contrast exposure withhold nephrotxoic meds, Not helpful strategies, makes zero difference: sodium bicarb, ascrobic acid, acetylcystine, statins plus fluids, aminophyline, harmful strategies, furosemide, hemodialysis

A client in the ED complains of chest pain that began approximately one hour ago. Which lab test could indicted the evidence of cardiac damage at this time?

Troponin

Which of the following ordered meds can be given to a client scheduled for a cardiac cath in one hour?

Insulin 70/30 to units Subq

The client has had a cardiac cath using the left femoral artery. Two hours post op the RN is unable to palpate the left pedal pulse. What is the nurse’s best action?

Immediatley notify the physician

To identify disease of the mitral valve, left atrium or aortic arch, the client would be scheduled for which of the following?

Trans esophageal electrocardiogram (TEE) - i wrote on exam next to this!

A client has recently been admitted with a diagnosis of coronary artery disease (CAD). What lab assessment finding requires nursing interventions. (Select all that apply):

Triglycerides 168 mg/dL, HDLs 40 mg/dL

What teaching will the nurse provide to a client who says, “Smoking doesn’t hurt my heart?”

“Smoking increases risks for heart disease.”

Whic action with the nurse take when having difficulty ascultating the first heart sound, S1?

Direct the client to lay on his or her left side

Some labs to know:

Triglycerides 150 or higher is a problem, HDLs At least 60 or highgher is normal

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ユーザ名非公開 · 15問 · 2年前

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