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CH 35 Cardiac Mod IV
MOD IV Ch5 Diagnostic tests
| Question | Answer |
|---|---|
| allows study of the electrical activity going thru the heart | ECG |
| In an ECG what is placed on the surface of the skin that picks up impulses of the heart? | Electrodes |
| ECG is graphed on standardized paper or viewed by what type of scope? | Oscilloscope |
| what letters represent one cardiac cycle? | P, Q, R, S, T waves |
| a normal finding on the ECG graph is called what? | Normal sinus rhythm |
| ECG is used to detect abnormal rates, ____, and _____ conduction | rhythm, impulse |
| ECG detect abnormalities/changes caused by ___ to the heart. | damage |
| Pre-op care: ECG | 1) Tell the pt what to expect. 2) Painless procedure. 3) No special preparations is needed. |
| Post op care: ECG | 1)Remove from skin 2)No special care needed |
| Summary of ECG uses | abnormal rhythm ie. a-fib, damege ie. MI, conduction exam ie. irregularity, abnormal rate ie. V-tach. Heart blocks |
| a portalble device ECG machine | Holter monitor/Ambulatory ECG |
| holter monitors provide continuous or intermittent monitoring for how many hours? | continuous, 24-48hrs |
| how are holter monitors and ECGs similar in uses? | used to detect dysrhythmias |
| what is the main difference in uses between holter and ECGs? | ECG's are to monitor abnormalities happening right now. Holter is for 24-48 hrs because the dysrhythmia may not be happening right now but happens infrequently |
| When listening to a pt's apical you hear an irregular heart beat that returned to normal after 1 minute and remained regular. Which diagnostic test would you use and why? | Holter Monitor (you can use an ECG right there but it may not pick up the irregularity since it resolved). With an holter monitor it can happen again w/in 24 hours and can be recorded, and the pt can do normal activities w/o being admitted. |
| Holter moniters are also used assess effects of ____ and for ____ purposes | medications, research purposes |
| where does pt record activities that occur during the monitoring? | in a dairy |
| what activities are recorded in a diary | walking, stair climbing, sleeping, and sexual activities. |
| Aside from computer scanning, how else can holter monitor results be sent for review? | transtelephonic: audio signal sent over telephone lines. |
| Mrs. Gorcyca's main emphasis of Holter monitor are two things, name them: | pt. should not shower and push event button when symptomatic. |
| what did Mrs. Gorcyca say we should avoid w/ a holter monitor and what type of clothes are appropriate? | 1) magnetic fields. 2) Loose clothing |
| Pre-op care for Holter Monitor: | tell pt. to wear loose clothing, 2) sponge bath only 3) avoid magnets andmetal detectors, 4) monitore placement of electrodes 5) diary 6)push event button when symptomatic |
| post care for Holter: | return at scheduled time..ECG recording will be retrieved for inspection |
| rhythms are saved on a memory loop and is used for monitoring the heart for a longer period than ECG and Holter monitor is called: | Implantable loop recorder (ILR) |
| ILR monitors are useful to monitor pts especially during what episodes | syncopal episodes |
| The device (ILR) is implanted where in the skin in what part of the body? | just under the skin, in the chest area. |
| pre op for ILR: | tell pt/family to activate recorder when symptoms occur; keep a written record of events |
| post op for ILR: | same as Holter monitor |
| visualizes and records the size, shape, position, and behavior of heart's internal structures | Echocardiogram |
| echocardiograms: what did Mrs. Gorcyca say about the main use of Echocardiogram | i measures the valves of the heart: tricuspid, pulmonary, mitral, aortic vales |
| Pt. asks how do they inspect my heart w/ an echocardiogram and where is this performed. Nurse is correct by stating | Ultrosonic waves are beamed into the heart and the echoes are recorded, you can be at the bedside or a laboratory. |
| Echocardiogram: what is applied to the skin and what device is used to put results on video tape? | gel; transducer |
| Echo: the transducer is moved over the peri___ to pick up waves. | pericardium |
| pt's are often worried about things being beamed into their heart. For an echocardiogram, what can you tell the pt. about the procedure to reduce their anxiety about pain. | procedure is painless |
| echocardiograms create an image of what organ | heart |
| doctor wants to inspect for left ventricular hypertrophy, hypertrophic cardiomyopathy, and abnormal valve activities. Nurse knows the test that will be used is | Echocardiogram |
| Pre op for echo | none; just tell pt. it is painless |
| post op for echo | remove gel from skin; no special care needed |
| what is used when echocardiogram is not diagnostic? | transesophageal echocardiogram (TEE) |
| probe of TEE is insterted through esophagus down to what organ? and behind or infront of the heart? | stomach, behind heart |
| what is the purpose of TEE | valves: same as echo |
| pre-op for TEE: | tell pt to expect throat to be locally anestizied, and may have IV....SIGNED CONSENT |
| post op for TEE: | monitor VS, gag reflex if sedated, level of consciousness. |
| For TEE: Mrs. Gorcyca told us told us to remember patient needs to be NPO or not NPO (not sure of this) | NPO |
| TEE: local anesthesia is given for? | decreasing gag reflex |
| TEE: IV sedatives given for? | reducing anxiety |
| Provides 3-d image of body structures | MRI |
| Nurse shows understanding that 3d image can be seen w/ or w/o bone in the image results and created w/ or w/o raditation | cardiac tissue is imaged w/o lung or bone interference. No radiation |
| Important thing about MRI is: | NO METAL, it interferes w/ the MRI |
| artificial heart valves before what year is not allowed in MRI | 1964 |
| how long will a pt be in the MRI chamber for imaging of the heart? | 5 minutes |
| pre op care for MRI: | tell pt what to expect i.e clangning sounds, may be sedated, if unable to keep still or anxious, all metals removed |
| post op care for MRI: | no special care, safety precautions if sedative is needed. |
| Radioactive material is injected IV and helps evaluate heart. | MUGA |
| what does MUGA stand for | Multi-gated acquisition scanning |
| MUGA is a procedure that injects radioactive substance that concentrate around what type of heart tissue | Necrotic tissue = AMI |
| MUGA is used to scan for 5 things | 1) ventricular structure and function 2)evaluate myocardial wall motion 3) detect shunting 4) assess valve desease 5) indentify size and location of AMI |
| MUGA: what medication may be administered and how? | nitro; sublingually to assess for ventricular function |
| pre op for MUGA: | tell what to expect: radioactive; can be done at rest or exercise; NPO 2hrs B4 test; IV infusion; SIGNED consent |
| MUGA post op: | no special care needed |
| non invasive procedure to assess presence of CAD through exercise during ECG | Stress test |
| What did Mrs. Gorcyca say about which test always goes with stress test? | ECG: continuous |
| When is the stress test stopped? | 1) symptoms of CAD; 2) pt stops for whatever reason; 3) maximum heart rate achieved (220 - pts age = maximum heart rate); 4) significant changes found in ECG |
| Stress test: what should you monitor aside from the ECG strip | BP |
| Nurse was told that two pts that went through a stress test had false negative and false positive results. The nurse interprets this as: | common: test is not flawless |
| T or F: Because stress tests has flaws it is not the best noninvasive test for CAD. | False, it remains the best noninvasive test. Invasive test would be cardiac cath |
| T or F: stress tests can cause symptoms of CAD | true: increased exercise can deplete oxygen to the myocardium |
| During a stress test what symptoms observed stops the procedure | angina, dsypnea, dizziness, dysrhythmias, falling BP. THINK OF ACRONYM BADDD = Bp Angina Dsypnea Dizziness dysrhythmias |
| for stress tests and symptoms of CAD what does BADDD stand for? | Blood pressure, Angina, Dsypnea, Dizziness, Dysrhythmias |
| what must be available for a stress test in case pt declines | CPR equipment |
| Stress test contraindications | acute systemic illness, sever aortic stenosis, CHF uncontrolled, severe hypertension, angina at rest, significant dysrhythmias |
| stress test pre-op | 1) BP monitoring; 2)NPO 2 hour before test; 3) no caffeine; 4) give beta-blocker if prescribed; 5) loose clothing and comfortable shoes; 6) signed consent |
| stress test post op: | no special care needed |
| provides info on presence of CAD, its location, and extent of ischemic and infarted myocardium | Perfusion scanning |
| perfusion scanning is done in conjunction with what other tests | stress tests meaning there is also an ECG |
| common radioactive tracer used for perfusion scanning: | Thallium 201 |
| a type of perfusion scanning using thallium is called | Thallium imaging |
| uses of thallium imaging | 1) assess myocardial blood flow; 2) detect old and new myocardial ischemia 3) evaluate coronary artery bypass grafts |
| T or F: Thallium imaging only detects new myocardial ischemia | false: detects old and new |
| What did Mrs. Gorcyca mean when she said you see cold spots during a thallium imaging test | thallium doesn't enter infarcted (necrotic) or scarred areas and will show as a cold spot (imaging will show that thallium stopped at that area) |
| T or F: Scar-induced ischemia resolves with rest | False: Exercise ischemia resolves w/ rest, scar does not |
| scar induced ischemia can be caused by what disorder | AMI |
| if a patient is not able to exercise during a thallium imaging test, what is done? | Persantine/dpyridamole is given to mimic effect of exercise. |
| how does persantine work | mimics exercise by increasing vasodilation of coronary arteries ->increases blood flow to well perfused areas-> then steals blood from ischemic areas = differences in flow will show up in scan |
| T or F: Thallium imaging can be done only at rest and during exercise | False: can be done at rest (probably due to diprydamole/persantine) and after exercise |
| thallium imaging pre-op: | 1) Tell pt. radiation is given via IV and is a small dose and eliminated quickly.2) Same as stress test: NPO 2hrs before, no caffeine. BP monitoring, loose clothing and comfortable shoes. Beta blocker if prescribed. SIGNED CONSENT |
| thallium post-op | no special care needed |
| Fast form of imaging not affected by movement of the heart. Mrs. Gorcyca says "no blurring" | Ultrafast CT |
| Ultrafast CT uses: | 1) assess MYOCARDIAL perfusion 2) Right and left ventricular muscle mass 3) MEASURES CALCIUM DEPOSITS in coronary arteries |
| T or F: Ultrafast Ct is a substitute for Cardiac catherization | false |
| Ultrafast CT pre-op | tell what to expect: 1) lie on table 2) hold very still 3) hold breath a few seconds at a time 4) no special prep |
| ultrafast ct post-op | no special care needed |
| Procedure in which a catheter is inserted into a vein or artery and threaded to a chamber or coronary artery: | Cardiac catherization |
| What scope is used during cardiac cath | fluroscopy |
| The contrast dye in injected where during a cardiac cath? | catheter |
| what are monitored during cardiac cath | VS and ECG readings |
| Right cardiac cath is inserted into a vein or artery | vein |
| Right cardiac cath inspects what areas | RA, RV, pulmonary arteries (for pressure determination on all 3) and right valves: tricuspid and pulmonic |
| left cardiac cath inspects | LV and coronary arteries, mitral and aortic valves: checks for CAD. |
| complications of cardiac cath | hemmorrhage, hematoma formation, infection, embolus formation |
| what are symptoms of hematoma | i don't know yet lol |
| Cardiac cath: vital signs q __ for 1 hour and q ___ etc. | 15 mins; 30 mins |
| what interventions did Mrs. Gorcyca emphasize for cardiac cath post-op? | bed rest and legs flat for 8 hours |
| cardiac catherization pre-op: | 1) done in special room 2) tell what to expect 3) assess ALLERGIES TO SEAFOOD AND IODINE and inform radiologist 4) NPO for specified time b4 procedure 5) TELL TO EXPECT FLUSHING WHEN DYE IS INJECTED 6) give sedative if ordered 7) signed consent |
| cardiac catherization post-op: | 1) puncture site; maintain pressure per protocol if sealing device is not used. 2) VS and peripheral pulses on affected extremity 3) enforce bed rest as ordered |
| catheter with electrodes to assess and record electrical activities of the heart. | EPS: electrophysiology study |
| EPS requires insertion of catheter in ___ ____, and is passed into which side of the heart. | femoral vein, right side |
| EPS pre op | 1) NPO for 6 hours b4 2) premedicate w/ sedative prescribed 3) Signed consent |
| EPS post op | same as cardiac catherization |
| What did Mrs. Gorcyca tell us never to do w/ a cardiac cath pt | DON't REAIS HOB, don't sit up to eat |
| if you can't sit up to eat w/ cardiac cath, what is the best position | side lying |
| THE | END |
Created by:
Jgar2007
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