Exam (elaborations)
MEDICAL-SURGICAL CMS - CARDIOVASCULAR SYSTEM
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MEDICAL-SURGICAL CMS - CARDIOVASCULAR SYSTEM
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MEDICAL-SURGICAL CMS - CARDIOVASCULARSYSTEM
CORONARY ANGIOGRAM (CARDIAC CATH) - POST PROCEDURE
check insertion site for bleeding
check extremity distal to puncture site
- pulses
- cap refill
- temperature
- color
take vital signs
- q15 min x 4 (first hour)
- q30 min x 2 (second hour)
- q60 min x 4 (hourly for 4 hours after)
patient lies flat in bed with legs straight for 4-6 hours after procedure
CILOSTAZOL (PLETAL)
anti-platelet medication
inhibits aggregation of platelets
CILOSTAZOL (PLETAL) - INDICATIONS
Rx for the treatment of intermittent claudication in clients with peripheral arterial
disease (PAD)
symptoms usually improve within 2-4 weeks of therapy
SICKLE CELL ANEMIA - COMPLICATION TO MONITOR FOR
iron toxicity
clients with SCD have increased risk of developing hemosiderosis that occurs
secondary to repeat blood transfusions
CARDIAC ENZYMES
released in the bloodstream in response to ischemia in heart muscle
troponin I is most specific
CREATINE KINASE MB ISOENZYME (CK-MB)
,more sensitive to myocardium
should be 0% of total CK
- range: 30 - 170 units/L
detectable 3-6 hours following MI
elevated for 2-3 days
TROPONIN-T
should be less than 0.1 ng/L
detectable 2-3 hours following MI
elevated for 10-14 days
TROPONIN-I
should be less than 0.03 ng/L
detectable 2-3 hours following MI
elevated for 7-10 days
MYOGLOBIN
can be elevated due to heart damage or skeletal muscle damage
should be less than 90 mcg/L
elevated for 24 hours
CHOLESTEROL LEVELS - TOTAL CHOLESTEROL
less than 200 mg/dL
CHOLESTEROL LEVELS - HIGH DENSITY LIPOPROTEIN (HDL)
women
greater than 55 mg/dL
men
greater than 45 mg/dL
CHOLESTEROL LEVELS - LOW DENSITY LIPOPROTEIN (LDL)
less than 130 mg/dL
,CHOLESTEROL LEVELS - TRIGLYCERIDES
women
35 - 135 mg/dL
men
40 - 160 mg/dL
HEMODYNAMIC MONITORING
involves special indwelling catheters
provides information about...
- blood volume/perfusion
- fluid status
- how well the heart is pumping
HEART RATE
number of beats per minute
CARDIAC OUTPUT
amount of blood pumped by the left ventricle each minute
CARDIAC INDEX
cardiac output normalized for body surface area
STROKE VOLUME
amount of blood pumped by the left ventricle in each contraction
HEMODYNAMIC MONITORING - CENTRAL VENOUS PRESSURE (CVP)
range: 2 to 6 mmHg
(7-12 cm H₂O)
HEMODYNAMIC MONITORING - PULMONARY ARTERY SYSTOLIC (PAS)
range: 15 to 28 mmHg
HEMODYNAMIC MONITORING - PULMONARY ARTERY DIASTOLIC (PAD)
range: 5 to 16 mmHg
HEMODYNAMIC MONITORING - CARDIAC OUTPUT (CO)
range: 3 to 6 L/min
, HEMODYNAMIC MONITORING - PULMONARY ARTERY WEDGE PRESSURE
(PAWP)
range: 6 to 15 mmHg
PULMONARY WEDGE PRESSURE (PWP)
measurement of LEFT atrial pressure
catheter with a balloon is placed in a patient's pulmonary artery branch
measurements helps diagnose left ventricular failure
gold standard for Dx of acute pulmonary edema
HEMODYNAMIC MONITORING - MIXED VENOUS OXYGEN SATURATION (SVO₂)
range: 60% to 80%
ARTERIAL LINES
can be placed in the radial, brachial, or femoral artery
provides continuous information about changes in blood pressure
allows withdrawal of arterial blood samples
arterial lines are NOT USED FOR IV FLUID INFUSION
ARTERIAL LINE INSERTION - NURSING CARE
level transducer with phlebostatic axis at the 4th intercostal space, midaxillary line
zero system
confirm placement with x-ray
CORONARY ANGIOGRAM/CARDIAC CATHETERIZATION
invasive procedure used to determine if patient has coronary artery blockages or
narrowing
catheter is inserted into the femoral artery and threaded up to the heart
CORONARY ANGIOGRAM (CARDIAC CATH) - PRE PROCEDURE
NPO 8 hours prior to procedure
assess for allergy to iodine/shellfish
assess kidney function
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