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NR 324 EXAM 2 RUNNING REVIEW - Week 3.
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1NR 324 EXAM 2 RUNNING REVIEW - Week 3
Ch. 31: Assessment of Cardiovascular System
•
Labs
o Creatine kinase MB (CK-MB): 2-6 ng/mL
Release 4-6 hrs after MI
Myocardial muscle
So myocardial muscle death it will release CK-MB,
elevated means cell death so a cardiac problem o Troponin: < 0.3
ng/mL
If pt has chest pain, first thing is do ECG and check
troponin
Found in cardiac muscle
Enters blood stream before creatine kinase
Go to gold standard for cardiac cell death, rises 3
hours after injury, MI
Elevated levels point to cell death
Chest pain- 1st thing-EKG
Congestive heart failure and heart surgeries-
walked around with a 1 o WBC: 5-10 x 10^9/L
Infection (sepsis) can be cause of elevation
Inflammatory response to when cells die in heart o
C-reactive protein (CRP): < 1 mg/L
Inflammatory marker
If we think there is an inflammatory process
CRP elevation with inflamm process
Rheumatoid arthritis is a life long elevation
o K: 3.5-5 mEq/L
Kayexalate decreases K
Low K & Mg can stop a patients heart
Low Mg associated with malnutrition, alcoholism &
the two together
• Mg- 1.5-2.5 mEq/L
o BNP - elevation could be heart failure: <100 pg/mL
\NR324\NR324 Running Review – Week 3 10/13/2018
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Cardiac stretch receptor
First indication of HF
Patient has difficulty breathing, is it pneumonia or heart failure?
NCLEXpull BNP
Over 100, do EF test (ejection fraction) 50-70% is
Heart failure- less than 45% EF
o Ca: 9-10.5 mg/dL
o Mg+ 1.5-2.5
Low electrolytes can cause dysrhythmias o aPTT: 25-35 secs
Measurement of how fast blood clots
Lab value associated with IV heparin
If pt has IV heparin look at the aPTT
If higher-bleeding a lot (not clotting) o Prothrombin time (PT): 11-14
secs is WNL
o International normalized ratio (INR): 2-3 is therapeutic for warfarin
PT INR for warfarin or Coumadin
On warfarin if AFib (risk for clot), need to make sure blood is not clotting,
so thinner
Warfarin patient PT 24 good, if they have an INR of 1 it’s a normal
clotting time, you want to increase warfarin
Warfarin antidote-vitamin K
Calculated by taking patients PT and dividing by labs normal PT
If pt INR is 1 – increase dose, if pt INR is 4 – decrease dose
Ch. 31: Assessment of Cardiovascular System
• Terms & Concepts o CHEST PAIN IS NEVER NORMAL
o action potential, p. 659 - conduction system consists of specialized tissue
responsible for creating and transporting the electrical impulse
o afterload, p. 661 - peripheral resistance against which the left ventricle must
pump o arterial blood pressure, p. 662 - measure of the pressure exerted by
blood against the walls of the arterial system
o cardiac index (CI), p. 660 - CO divided by the body surface area
o cardiac output (CO), p. 660 - the amount of blood pumped by each ventricle in 1
minute, is calculated by multiplying the amount of blood ejected from the
ventricle with each heartbeat o perfusion
o cardiac reserve, p. 661 - ability to respond to these demands by altering CO o
coronary angiography, p. 678 - during cardiac catheterization, contrast medium
is injected directly into coronary arteries; used to elevate patency of coronary
arteries and collateral circulation
\NR324\NR324 Running Review – Week 3 10/13/2018
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angio-blood vessel
mapping or study of the coronary blood vessels
ask if allergic to shellfish o diastole, p. 659 - relaxation of
myocardium
o diastolic blood pressure (DBP), p. 662 - residual pressure in the
arterial system during ventricular relaxation
o ejection fraction (EF), p. 671 - percentage of end-diastolic blood
volume that is ejected during systole
o heaves, p. 667 - sustained lifts of the chest wall in the precordial area
that can be seen or palpated
o Korotkoff sounds, p. 662 - sounds of turbulent blood flow through
compressed artery
o mean arterial pressure (MAP), p. 662 - average pressure within the
arterial system that is felt by organs in the body
o murmur, p. 662 - turbulent blood flow across the affected valve o
point of maximal impulse (PMI), p. 667 - apical pulse
o preload, p. 660 - volume of blood in the ventricles at the end of
diastole, before the next contraction
o pulse pressure, p. 662 - difference between SBP and DBP, normally
about 1/3 of the SBP
o systole, p. 660 - contraction of heart muscle, results ejection of blood
from ventricles
o systolic blood pressure (SBP), p. 662 - peak pressure exerted against
the arteries when the heart contracts
o Pericardial sac o Cardiophysiology
Deoxygenated blood in inferior and superior vena cava → right atrium →
tricuspid valve → right ventricle → pulmonic valve → pulmonary artery
→ lungs for gas exchange → oxygenated blood in pulmonary veins → left
atrium → mitral valve → left ventricle → aortic valve → aorta → systemic
circulation o Cardioelectrophysiology
Sinoatrial (SA) node → atrioventricular (AV) node → bundle of His →
bundle branches → Purkinje fibers SA node – 60 - 100 bpm
AV node: intrinsically 40 - 60 bpm
• HR 45 - coming from AV node
o Coronary arteries
Supply blood and O2 to heart o
Electrocardiography (ECG) and EKG is the same thing
Shows where the electricity is going
Sinus – SA node o HR X SV = CO
\NR324\NR324 Running Review – Week 3 10/13/2018
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