DIAGNOSTICS (Cardio) 2.pdf

nursingcaremngt112: oxygenation&perfusion mpesinable lecturer nursingcaremngt112: respiratorysystem 2: Diagnostics DIAGNOSTIC TESTS Purpose: 1. Assist in identifying the causes of cardiac- related signs and symptoms 2. Identify...

nursingcaremngt112: oxygenation&perfusion mpesinable lecturer nursingcaremngt112: respiratorysystem 2: Diagnostics DIAGNOSTIC TESTS Purpose: 1. Assist in identifying the causes of cardiac- related signs and symptoms 2. Identify abnormalities that affect the prognosis of the patient 3. Screen for risk factors associated with CAD 4. To determine baseline values before initiating interventions. Cardiac biomarkers 1.CK-MB - Creatine- Kinase Myocardial Bound ( most specific) 2. LDH - Lactic Dehydrogenase 3. Myoglobin - released from myocardium within 2 hours of coronary occlusion 4. Trop I or Trop T - proteins involved in muscle contraction  Blood chemistry 1. Lipid profile - Cholesterol, triglycerides & lipoproteins 2. Na - helps send electrical signals between cells and controlling the amount of fluid in the body 3. Potassium - Has major role in cardiac electrophysiology function Blood chemistry 4. Calcium - necessary for blood coagulability, neuromuscular activity and automaticity of the nodal cells (sinus and atrioventricular node) 5. Magnesium - plays a major role in muscular contraction Blood chemistry (B-type) natriuretic peptide (BNP) = a neurohormone that helps regulate BP and Fluid volume = secreted from the ventricles in response to increased preload with resulting elevated ventricular pressure = useful for prompt diagnosis of HF Blood chemistry C-reactive protein (CRP) = a protein produced by the liver in response to systemic inflammation. = Inflammation is thought to play a role in the development and progression of atherosclerosis Blood chemistry Homocysteine = an amino acid, is linked to the development of atherosclerosis because it can damage the endothelial lining of arteries and promote thrombus formation. Hematologic studies 1. CBC 2. WBC 3. Hemoglobin and hematocrit 4. Platelets Blood chemistry 6. BUN, Creatinine 7. Glucose 8. Glycosylated hemoglobin (HbA1C) - hemoglobin which is bound to glucose 9. Coagulation studies Coagulation studies 1. PTT - partial thromboplastin time 2. PT - protime 3. INR - international normalized ratio Other exams 1. ECG - Most important initial diagnostic procedure 2. Chest x- ray 3. Continous cardiac monitoring 4. Cardiac stress testing 5. Echocardiography 6. Cardiac catheterization  Other exams Hemodynamic Monitoring = Critically ill patients require continuous assessment of their cardiovascular system to diagnose and manage their complex medical conditions Other exams Central Venous Pressure Monitoring = is a measurement of the pressure in the vena cava or right atrium = 2 to 6 mm Hg or 5-10cmH2O Other exams Pulmonary Artery Pressure Monitoring = used in critical care for assessing left ventricular function, diagnosing the etiology of shock, and evaluating the patient’s response to medical interventions (e.g., fluid administration, vasoactive medications Pharmacological therapy Medications Major Indications Nitrates Short and long term reduction of myocardial Ex. Nitroglycerine (Transderm patch) oxygen consumption through selective Isosorbide dinitrate (Isoket, Isordil) vasodilation; A potent vasodilator Beta- Adrenergic blocking agents (beta- Reduction of myocardial oxygen blockers) consumption by blocking beta-adrenergic Ex. Metoprolol (Neobloc, Lopressor), stimulation of the heart atenolol (Tenormin) Calcium Ion Antagonists (calcium channel Reduce coronary vasospasm; blockers) Pharmacological therapy Medications Major Indications Ex. Amlodipine (Norvasc) Indicated in patients not responsive Diltiazem (Dilzem, Cardizem) to beta-blockers Antiplatelet Prevention of platelet aggregation or Ex. Aspirin, clopidogrel (Plavix) adherence of platelet on coronary artery Anticoagulants Ex. Heparin (unfractionated) Prevention of thrombus formation; Low molecular -weight heparins: Ex. Enoxaparin (Clexane)  Oxygen administration - Oxygen therapy is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and to decrease pain.