Cholesterol Goals (after overnight fast):
TOTAL SERUM cholesterol
Desirable = < 200 mg/dL
Cholesterol Goals (after overnight fast):
LDL cholesterol (“lousy”/bad lipids)
Optimal if < 100 mg/dL
@ risk if only < 70 mg/dL (???)
Cholesterol Goals (after overnight fast):
HDL cholesterol (good lipids)
Desirable = > 40 mg/dL
Cholesterol Goals (after overnight fast):
Triglycerides
Desirable = < 150 mg/dL
Lab Values:
CAD
–homocystine
(amino acid that INCREASES w/ HD)
–C-reactive protein
(responds to inflamm.; ELEVATED in CAD)
Lab Values:
CHF
–BNP
INCREASES w/ CHF ( pump failure )
** NORMAL = < 100 **
CLIN. SIGNIF. = > 500
Lab Values:
MI
CK is an enzyme found in brain, skeletal, & cardiac muscles. Levels INCREASE w/ DAMAGE TO TISSUES.
- CK-MB is SPECIFIC TO CARDIAC MUSCLE; it is the most sensitive indicator of MI
- —NORMAL = 0 - 3 %
- ——** positive indicator of MI = > 5 % **
- -detected in 4 - 8h // peak @ 18 -24h // lasts 72h
Troponins are proteins that are released during MI that are sensitive to myocardial damage
- -released w. NECROSIS of heart muscle
- -can detect MI very early (better than CK)
- -can time when person had heart attack
- -*CHF makes heart stretch (damages a few muscles) so it may bump the troponin level
type T: detect 2-4h // peak 24-36h // lasts 10-14 days
type I: detect 2-4h // peak 24-36h // lasts 7-10 days
COAGULATION studies:
PTT (partial thromboplastin time)
aPTT monitors the effectiveness of HEPARIN therapy
and detects coagulation d/o
Baseline: 20 - 39 seconds
THERAPEUTIC: 2 - 3x the base line (60-70 seconds)
COAGULATION studies:
PT (prothrombin time)
PT monitors the effectiveness of COUMADIN therapy and detects coagulation d/o
Baseline: 9.5 - 12 seconds
COAGULATION studies:
INR
** most important of PT/INR **
reported WITH PT eliminate variation of PT results
Baseline: < 1 second
THERAPEUTIC: 2 - 3 seconds (want 2-3x the normal)
Serum Electrolytes (4)
regulate electrical impulses
(affect ability of myocardium to contract)
1) Na: 135 - 145
2) K: 3.5 - 5.5
3) Mg: 1.5 - 2.5 ( 2-3 )
4) Ca: 8.5 - 10.5 ( 9-11 )
Arterial Blood Gases
** perform the Allen test PRIOR TO ABGs to check for collateral circulation **
Post-ABG:
–apply pressure for 5 MINS to prevent hematoma
(for 15 mins if pt is on anticoagulants)
–check arm for swelling, discoloration, pain, numbness, or tingling
VALUES:
pH: 7.35 - 7.45
CO2: 45 - 35
HCO3: 22 - 26
Ultrasound Echocardiogram
non-invasive sounds waves used to determine cardiac structures (pictures and pumping action of <3)
**pt is positioned slightly on LEFT-SIDE (by rad. tech.)
teaching:
- -chest will be exposed
- -gel applied to chest will be cold
Exercise Stress Test
Used to assess cardiac response to increased workload
PREPARATION:
- -monitor EKG & VS throughout
- -fast for at least 4h prior (NPO)
- -no stimulants (coffee/tobacco)
- -need patent IV access
- -MEDS TO HOLD:
- -Nitrates,
- -Beta-Blockers,
- -Caffeine containing meds,
- -Theophylline
teaching:
- -pt will be walking on treadmill, bike, or stairs
- -IF UNABLE TO TOLERATE EXERCISE:
- -the following drugs may be used to STRESS the <3
- -dipyridamole (Persantine)
- -adenosine
- -dobutamine
POST-PROCEDURE:
- -monitor EKG & VS for 15 mins
- -if NEG = pt d/c home
- -if POS»_space; chest pain, EKG changes = pt sched. for CARDIAC CATH. for a definitive diagnosis
Ankle Brachial Index (ABI)
indicates ATHEROSCLEROSIS of extremeties
- -compare SPB in brachil, PT, & DP
- —divide SBP of ankle BY SPB of arm
- ** ABI that is < 0.9 in either leg = PVD & CAD ***
Central Venous Pressure (CVP) monitoring
–measurement of effective blood volume &
efficiency of cardiac pumping
–indicates ability of R-side of heart to manage fluid load
–CVP is also a guide to fluid replacement
–the catheter is threaded into the RA; placement confirmed w/ X-ray
–transducer should be leveled with access point;
–HOB 0-45
–monitor for hematoma
–ACCESS POINTS: Jugular, Subclavian, or Antecubital
NORMAL = 3 - 12cm water
HYPERvolemia / poor cardiac ctx = > 12
HYPOvolemia = < 3
Post-procedure:
- -dry, sterile, air occlusive dressing; change daily
- -inspect daily for s/s of infx
- -have pt HOLD BREATH when withdrawn (or inserted or when tubing is changed) TO PREVENT AIR EMBOLISM
Complications: Air embolism, pneumothorax, infection at insertion site
Cardiac Catheterization
Cath in chamber to evaluate ventricular function and obtain chamber pressure
PREP:
- -NPO 8-12h
- -consent
- -EMPTY BLADDER
- -check pulses
- -ensure IV access
- -*teaching: sensations»_space; flushing w/ contrast, pressure w/ balloon
- -EKG baseline
- -Labs: BUN, creat., PT/INR, aPTT, H&H, platelet, elect.
- **pts are HEPARINIZED during procedure»_space; chk PTT
Angiography
used to evaluate specific areas of arterial system for NARROWING or OBSTRUCTION; usually used w/ cardiac Cath. (uses dye to look at perfusion)
PREP:
- -Allergies?»_space;shellfish, iodine (use antihistamines if so)
- -remove all jewelry
Cardiac Cath & Angiography:
Teaching and assessment
- -catheter inserted in femoral artery and guided to <3
- -contrast dye injected into arteries while x-rays taken (feel heat, flush, desire to cough, or salty taste)
- -will lie of hard table for < 2h
- -sedation & pain meds: Versed & Fentanyl
AFTER PROCEDURE:
–SHEATH REMOVAL:
—-remove sheath LAST; hold PRESSURE @ SITE for 20m
—-keep atropine at bedside (for Brady)
—-HAVE TO LAY FLAT 6 - 8H AFTER
—-DO NOT BEND at waist or STRAIN for 24H
(may dislodge clot and could bleed to death)
—-avoid tub baths until site healed
—-CALL MD FOR: bleeding, swelling, new bruising, pain at procedure site, or temp >/= 101.5
Cardiac Cath & Angiography:
Post-procedure Assessment
- *q 15 min x 8, …then q 30 min x 2, …THEN q 1 hour x 3
- -check VS
- *q 30 min x 6, …then q 1 hour x 3
- -check distal pulses for perfusion
- -check sensation,
- -check bleeding at insertion site
**compare skin temp, color, and sensation in extremities
continuous EKG
bed rest (6-8hours) w/ insertion site VERY STRAIGHT
HOB < 30
pt helped w/ 1st out of bed experience
Cardiac Cath & Angiography:
complications
- -rxn to dye
- -thrombosis
- -infection
- -hematoma
- -contrast agent-induced nephropathy
- -usually reversible
- -risk: DM, HF, renal disease, hypotension, dehydration elderly
- -prevention: HYDRATION (pre & post); Acetylcystine (mucomyst)»_space; acidifies urine and makes it more protective of kidneys
