NR324 Exam 2 Running Review

NR324 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  Cardiac stretch receptor  First indication of HF  Patient has difficulty breathing, is it pneumonia or heart failure? NCLEX-pull 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