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Cardiovascular problems of the Adult Client; Diagnostic & Procedures -…
Cardiovascular problems of the Adult Client; Diagnostic & Procedures
Cardiac markers
Troponin
composed of 3 proteins-troponin C, cardiac troponin 1, a cardiac trponin T
Tropnin 1 especially has a high affinity for myocardial injury; it rises 3 hours and persists for up to 7-10 days
Normal values are low, with troponin1 being less than 0.35ng'mL (less than 0.35mcg/L) and troponin T being less than 0.1ng/mL (less than 0.1mcg/L); thus, any rise can indicate myocardial cell damage
CK-MB (creatinine kinase, myocardial muscle)
elevation in value indicates myocardial damage
elevation occurs within hours and peaks at 18 hours following an acute ischemic attack
normal value for CK-MB (CK-2) is 2-6ng/mL (2-6 mcg/L) for males & 2-5 ng/mL (205mcg/L) for females
myoglobin
an oxygen binding protein found in cardiac and skeletal muscle
level rises within 2 hours after cell death, with a rapid decline in the level after 7 hours; however, it is not cardiac specific
Complete blood count
RBC count decreases in rheumatic heart disease & infective endocarditis & increases in conditions characterized by inadequate tissue oxygenation
white blood cell count increases in infectious and inflammatory diseases of the heart & after MI, because large numbers of white blood cells are needed to dispose of the necrotic tissue resulting from the infarction
elevated hematocrit level can result from vascular volume depletion
Decreases in hemaglobin & hematocrit levels can indicated anemia
blood coagulation factor
an increase in coagulation factors can occur during and after MI (myocardial infarction), which places the client at greater risk for thrombophlebitis & formation of clots in the coronary arteries
Blood Coagulation factors: an increase in coagulations factors can occur during & after MI, which places the client at greater risk for thrombophlebitis and formation of clots in the coronary arteries
Serum lipids
lipid profile measures serum cholesterol, triglyceride, & lipoprotein levels
lipid profile is used to asses the risk of developing coronary artery disease
Lipoprotein-a / Lp(a), a modified form of low density lipoprotein (LDL), increases atherosclerotic plaques & increases clots; value should be less than 30mg/dl (300 mg/L)
Homocysteine
elevated levels may increase the risk of cardiovascular disease; normal value is 4.-11.0 mcmol/L, age and gender dependent
serum lipids
lipid profile measures serum cholesterol, triglyceride, & lipoprotein levels
lipid profile is used to assess the risk of developing coronary artery disease
lipoprotein
-a
of
Lp (a)
, a modified form of low density lipoprotein (LDL), increases atherosclerosis plaques & increases clots; value should be less than 30mg/dL (300mg/L)
homocysteine
elevated levels may increase the risk of cardiovascular disease; normal value is 4.5-11.9mcmol/L
homocysteine
elevated levels may increase the risk of cardiovascular disease; normal value is 4.-11.9 mcmol/L, age and gender dependent
hsCRP
highly sensitive c-reactive protein
detects an inflammatory process such as that associated with the development of atherothrombosis; a level less than 1mg/L is considered low risk, & a level greater than 3mg/L places the client at high risk for heart disease
microalbuminuria
a small amount of protein in the urine has been a marker for endothelial dysfunction in cardiovascular disease
electrolytes
potassium
hypokalemia causes increased cardiac electrical instability, ventricular dysrhythmia, & increased risk of digoxin toxicity
hypokalemia - the electrocardiogram (ECG) show flattening & inversion of the T wave, the appearance of a U wave & ST wave
hyperkalemia causes asystole and ventricular dysrhythmias
ECG may show tall peaked t waves, widened QRS complexes, prolonged PR intervals/ flat P waves
sodium
the serum sodium level decreases with the use f diuretics
serum sodium level decreases in heart failure, indicating water excess
calcium
hypocalcemia can cause ventricular dysrhythmia, prolonged SY and QT intervals, and cardiac arrest
hypercalcemia can cause a shortened ST segment and widened T wave, atrioventricular block, tachycardia, or bradycardia, digitalis hypersensitivity, and cardiac arrest
phorsphorus
should be interpreted with the calcium levels, because the kidneys retain/ excrete one electrolyte in an inverse relationship to the other
magnesium
low magnesium level can cause ventricular tachycardia & fibrillation
electrocardiographic changes that ,ay be observed with hypomagnesemia include tall T waves and depressed ST segments
high magnesium level can cause muscle weakness, hypotension, & bradycardia
electrocardiaographic changes that may be observed with hypermagnesemia include a prolonged PR interval & widened QRS complex
blood urea nitrogen
BUN nitrogen level is elevated in heart disorders such as heart failure & cardiogenic shock that reduce renal circulation
blood glucose
acute cardiac episode can elevate the blood glucose level
B-type natriuretic peptide (BNP)
is released in response to atrial & ventricular stretch; it serves as a marker for heart failure
should be less than 100ng/mL (less than 100mch/L); the higher the level, the more severe the heart failure
chest x-ray
radiography of the chest is done to determine anatomical changes such as the size, silhouette, and position of the heart
intervention
prepare the client, explaining the purpose & procedure
remove jewelry
ensure the client is not pregnant
electrocardiography
common noninvasive diagnostic test records the electrical activity of the heart & is useful for detecting cardiac dysrhythmias, location and extent of MI, and cardiac hypertrophy, & for evaluation of the effectiveness of cardiac medications
interventions
determine the client's ability to lie still; advise the client to lie still, breathe normally, and refain from talking during the test
reassure the client that an electrical shock will not occur
document any cardiac medications the client is taking
Holter Monitoring
description
a noninvasive; the client wears a monitor and an electrocardiographic tracing is recorded continuously over a period of 24 hours or more while the client performs her or his activities of daily living
monitor identifies dysrhythmias if they occur and evaluates the effectiveness of anti-dysrhythmics or pacemaker therapy
interventions
instruct the client to resume normal daily activities & to maintain a diary documenting activities and any symptoms that may develop for correlation with the electrocardiographic tracing
instruct the client using a wired monitor to avoid tub baths, showers, or swimming , because they will interfere with the electrocardiographic recorder device
Echocardiography
