M1P3Q PDF - Cardiovascular Procedures

1. Why should pharmacologic stress tests avoid xanthine derivatives? - Xanthine derivatives block the effects of vasodilating agents. 2. Name three xanthine derivatives that must be avoided during a pharmacologic stress test. - Theophylline, aminophylline, and caffeine. 3. What is the alternative me...

1. Why should pharmacologic stress tests avoid xanthine derivatives? - Xanthine derivatives block the effects of vasodilating agents. 2. Name three xanthine derivatives that must be avoided during a pharmacologic stress test. - Theophylline, aminophylline, and caffeine. 3. What is the alternative medication for use during a pharmacologic stress test? - Dobutamine is another option for use during a pharmacologic stress test. 4. What are the effects of dobutamine on the heart? - Dobutamine increases heart rate, myocardial contractility, and blood pressure. 5. Why is dobutamine the agent of choice when echocardiography is used? - Dobutamine alters myocardial wall motion due to enhanced contractility. 6. Why is dobutamine used for patients who have bronchospasm or pulmonary disease? - These patients cannot tolerate having doses of theophylline withheld. 7. What are the nursing interventions in preparation for a pharmacologic stress test? - Instruct the patient not to eat or drink anything for at least 3 hours before the test. 8. What should the patient refrain from eating or drinking for 24 hours before the pharmacologic stress test? - The patient should avoid chocolate or caffeine-containing liquid or food. 9. What medications should be avoided before a pharmacologic stress test? - Medications containing caffeine, including caffeine-free coffee, tea, and carbonated beverages. 10. What happens if caffeine is ingested before a stress test using vasodilating agents? - The test will have to be rescheduled. 11. For how long should patients stop taking aminophylline, theophylline, or dipyridamole before a pharmacologic stress test? - Patients should stop taking these medications for 24 to 48 hours before the test if tolerated. 12. What transient sensations may occur during infusion of the vasodilating agent? - Flushing or nausea, which will disappear quickly. 13. What should the patient do if any other symptoms occur during the test? - The patient should report the occurrence of any other symptoms to the cardiologist or nurse. 14. How long does a stress test typically take? - About 1 hour, or up to 3 hours if imaging is performed. 15. What are radionuclide imaging studies used for? - To evaluate coronary artery perfusion, detect myocardial ischemia and infarction, and assess left ventricular function. 16. What are radioisotopes? - Unstable atoms that give off small amounts of energy in the form of gamma rays as they decay. 17. How are radioisotopes detected during radionuclide imaging studies? - A gamma scintillation camera positioned over the body detects the energy emitted by the radioisotopes. 18. What are tracers in radionuclide imaging studies? - Radioisotopes that are injected into the bloodstream. 19. What is myocardial perfusion imaging used for? - To determine if arterial perfusion to the heart is compromised during activity and to evaluate the extent of myocardial damage. 20. What are the two types of techniques used in myocardial perfusion imaging? - Single photon emission computed tomography (SPECT) and positron emission tomography (PET). 21. When is myocardial perfusion imaging commonly performed? - After an acute MI or to evaluate if myocardial ischemia from CAD is the cause of chest pain or other CAD-related symptoms. 22. What do fixed defects indicate in myocardial perfusion imaging? - No perfusion in the area of the myocardium, which is the case after an MI. 23. What do reversible defects indicate in myocardial perfusion imaging? - Reduced perfusion to that area of the heart, which disappears with rest. 24. What is recommended after a positive stress test result? - Cardiac catheterization to determine the severity of obstructions caused by CAD. 25. What is the purpose of a baseline scan in echocardiography? - The purpose of a baseline scan is to obtain clear images of the heart. 26. How long does a baseline scan usually take? - A baseline scan usually takes about 30 minutes. 27. What is injected into the IV during the echocardiography scan? - A tracer is injected into the IV during the scan. 28. Why is the patient's glucose level monitored throughout the procedure? - The patient's glucose level is monitored to ensure safety during the scan. 29. How long does it take to complete the echocardiography scan? - The scan takes from 1 to 3 hours to complete. 30. What is echocardiography used to measure? - Echocardiography is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures. 31. What is the traditional approach for transthoracic echocardiography? - The traditional approach involves applying a handheld transducer to the front of the chest. 32. What does an echocardiogram with Doppler techniques show? - An echocardiogram with Doppler techniques shows the direction and velocity of blood flow through the heart. 33. When is echocardiography considered positive during a stress test? - Echocardiography is considered positive if abnormalities in ventricular wall motion are detected during stress but not during rest. 34. What are the nursing interventions before transthoracic echocardiography? - Nursing interventions include informing the patient about the test, applying gel to transmit sound waves, and periodically asking the patient to turn or hold a breath. 35. What is the significant limitation of transthoracic echocardiography? - The poor quality of the images produced is a significant limitation of transthoracic echocardiography. 36. What is transesophageal echocardiography (TEE) used for? - TEE is used as a first-line diagnostic tool for evaluating patients with various types of CVD. 37. What is used to provide clearer images in transesophageal echocardiography? - Ultrasound waves pass through less tissue in transesophageal echocardiography, providing clearer images. 38. What is used during transesophageal echocardiography to reduce discomfort? - Topical anesthetic agent and sedation are used to reduce discomfort during transesophageal echocardiography. 39. What is the requirement for positioning the transducer in the esophagus during TEE? - The patient is asked to swallow several times until the transducer is positioned in the esophagus during TEE. 40. What is the purpose of cardiac stress testing? - To evaluate myocardial ischemia and higher myocardial oxygen requirement. 41. What are the non-invasive ways to perform cardiac stress testing? - Exercise stress test, pharmacologic stress test, and radionucleotide imaging studies. 42. What happens to coronary arteries affected by atherosclerosis during stress? - They dilate less, compromising blood flow to the myocardium. 43. What are the potential complications of stress testing? - MI, cardiac arrest, HF, bradycardia, and tachycardia with hemodynamic compromise. 44. What should testing facilities have ready in case of complications? - Staff and equipment for advanced cardiac life support. 45. What is the most common exercise method for exercise stress testing? - Walking or running on a treadmill. 46. What is monitored during an exercise stress test? - ECG leads, heart rate, rhythm, ischemic changes, BP, skin temperature, physical appearance, perceived exertion, and symptoms. 47. When is the exercise stress test stopped? - When the target heart rate is achieved or if the patient experiences signs of myocardial ischemia. 48. What are abnormal findings during an exercise stress test? - Chest pain, ventricular arrhythmia, ST-segment depression, lack of heart rate or BP elevation. 49. What are the nursing interventions for the exercise stress test? - Instructing the patient to fast, avoid stimulants, hold certain medications, and wear suitable clothes and shoes. 50. What is the purpose of pharmacologic stress testing? - To identify stenotic arteries that cannot vasodilate. 51. What vasodilating agents are used in pharmacologic stress testing? - Dipyridamole, adenosine, or regadenoson. 52. What are the side effects of vasodilating agents? - Chest pain, headache, flushing, nausea, heart block, and dyspnea. 53. How can the effects of vasodilating medications be reversed if necessary? - With IV aminophylline. 54. What is used in conjunction with radionuclide imaging techniques? - Vasodilating medications. 55. What is the post-test monitoring period for patients? - 10 to 15 minutes until vital signs and assessment findings return to normal. 56. What should a patient undergoing myocardial perfusion imaging be prepared for? - The type of stressor to be used (exercise or medication) and details of what to expect during imaging. 57. What is the first stage of myocardial perfusion imaging? - Taking resting images. 58. What is inserted into the patient to administer the radioisotope during myocardial perfusion imaging? - An IV. 59. What should women who are nursing, pregnant, or think they are pregnant do? - They should not undergo myocardial perfusion imaging. 60. What should the nurse do if a patient is nursing, pregnant, or thinks they are pregnant? - Alert the primary provider. 61. What is the most common technique of myocardial perfusion imaging? - Single Photon Emission Computed Tomography (SPECT). 62. What is the ability of SPECT to detect myocardial ischemia? - Between 80% and 90%. 63. What is the position of the patient during SPECT imaging? - Supine with arms over their head. 64. How long does the SPECT procedure typically take? - Approximately 30 minutes. 65. What is the nurse's primary role during SPECT imaging? - To prepare the patient and insert/assess an IV catheter. 66. What is Positron Emission Tomography (PET) used for? - Obtaining images using a radioactive tracer chemical. 67. How do PET images generally compare to SPECT images? - They have higher resolution. 68. Where is PET technology likely to be found? - At large or academic medical centers. 69. What is used to determine blood flow and metabolic function during PET? - Injected tracers. 70. What does PET determine by comparing glucose metabolism to blood flow? - Viability of the myocardium. 71. What should the patient's blood glucose level be before PET testing? - Within the normal range. 72. What should patients refrain from using before undergoing PET? - Alcohol and caffeine. 73. Why should patients with diabetes on insulin discuss insulin doses and food restrictions with the primary provider before PET? - To manage their condition during testing. 74. What should the nurse assess patients for before PET? - Fear of closed spaces or claustrophobia. 75. How can patients with claustrophobia be helped during PET? - Medications can be given to help them relax. 76. What is the nurse's role in preparing the patient for PET? - Inserting an IV or assessing the existing IV catheter, and describing the procedure to the patient. 77. How should the patient be positioned during PET? - On a table with hands above the head. 78. What conditions can place a patient at risk for atrial or ventricular thrombi? - HF, valvular heart disease, arrhythmias, and other conditions 79. What can pharmacologic stress testing using dobutamine and TEE be performed for? - To monitor the response of the heart during cardiac surgery 80. What are the potential complications of TEE? - Complications include respiratory depression, aspiration, vasovagal response, and esophageal perforation. 81. What should the nurse do prior to the TEE test? - Provide preprocedure education, ensure clear understanding, check for informed consent, insert or assess IV line, and remove dentures. 82. What should the nurse monitor during the TEE test? - Monitor level of consciousness, BP, ECG, respiration, and oxygen saturation. 83. What should the patient do during the recovery period after TEE? - Maintain bed rest with the head of the bed elevated to 45 degrees. 84. When can food and oral fluids be given to the patient after TEE? - After the effects of the topical anesthetic agent are reversed, usually 2 hours after the procedure. 85. What should patients be instructed to report after TEE? - They should report persistent sore throat, shortness of breath, or difficulty swallowing. 86. Who must be available to transport the patient home if TEE is performed in an outpatient setting? - A family member or friend must be available. 87. What is the purpose of continuous cardiac monitoring? - To detect changes in heart rate, rhythm, and conduction, and to detect life-threatening arrhythmias. 88. What are the functions of a cardiac monitor? - To display heart rate and rhythm, sound alarms, and provide rhythm strips. 89. When should alarms on a cardiac monitor be ignored or turned off? - Alarms should never be ignored or turned off. 90. Which patients may require cardiac monitoring? - Patients with chest pain, palpitations, acute coronary syndrome, following major surgery, major trauma, cardiac/respiratory arrest, acute medical conditions, unexplained syncope episodes, or undergoing a specific treatment. 91. What are telemetry and central cardiac monitors used for? - To allow continuous ECG, RR, and SpO2 monitoring. 92. What is telemetry? - Telemetry is a portable device that continuously monitors patient ECG, respiratory rate, and/or oxygen saturations while transmitting information to a central monitor. 93. What does ECG stand for? - ECG stands for Electrocardiogram, which is a diagnostic tool that measures and records the electrical activity of the heart. 94. What is an arrhythmia? - An arrhythmia is an irregular or abnormal rhythm in which the heart beats. 95. What is the purpose of external pacing? - External pacing is a temporary means of pacing a patient's heart. 96. What does collapse refer to in this guideline? - Collapse refers to circulatory/hemodynamic collapse in this guideline. 97. What should be done prior to commencing telemetry monitoring? - A baseline 12 or 15 lead ECG should be taken as per the cardiac team. 98. How often should a patient on telemetry be visualized? - A patient on telemetry should be visualized hourly. 99. Why is accurate lead placement and good skin preparation important? - It will reduce false readings in the monitoring. 100. Why is daily assessment of skin important in telemetry monitoring? - It helps prevent skin excoriation and pressure area injury at the site of electrodes.