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Cardiac Assessment and Diagnostic Procedures


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									Cardiac Assessment
  and Diagnostic
      NPN 200
   Medical Surgical 1
• Subjective Interview
  – Why did you seek medical attention?
  – What symptoms are you having?
    • Weight gain, dyspnea, fatigue, cough,
      palpitations, chest pain (describe), syncope,
      dark urine, edema
  – Previous medical history
  – Any family history of ^ B/P, heart
    disease, diabetes?
  – How has this illness affected your
  – Smoking history, diet, physical activity
• Physical or objective
  – Height, weight
  – Heart sounds
    • Aortic, pulmonic, tricuspid, and mitral
    • Listen for extra sounds , S3 and S4
    • Murmurs, rubs (best heard over the left sternal
  – Vital signs
    • B/P lying, sitting and standing
    • apical and radial pulse with the quality according
      to scale of 0-4
    • Respirations, effort and skin color, with breath
         Assessment, cont
• Skin
  – Color
  – Hair distribution
  – Capillary refill

• Extremities
  – Inspect and palpate for:
     • Color
     • Edema- 1+, 2+, 3+, 4+
     • Warmth- lowered in heart failure, PVD, and
     • Pulse quality- strong, weak, thready
     • Clubbing
   Venous and Arterial
• Check Jugular vein distention
• Must assess all major peripheral
• Will indicate hypovolemia, decreased
  cardiac output
• Must check for symmetry
• Can auscultate the carotid, and the
  Diagnostic Procedures
• Electrocardiogram (ECG)
  – Studies the conduction system
  – Electrodes placed on the skin pick up
    the electric impulses
  – Placement of pads determines the area
    of the hearts electrical activity
  – The cardiac cycle is represented by a
    wave ( P,Q,R,S )
Normal Sinus Rhythm
    Diagnostic Procedures,
• Holter monitor
• Echocardiogram
• Transesophageal Echocardiogram
• MUGA (multiple-gated acquisition
• Stress Test
• Cardiac Cath
• EPS (electrophysiology study)
          CARDIAC CATH
• Prep for Cardiac Cath
  –   May be done as and outpatient
  –   Chest x-ray, EKG, CBC, coagulation studies
  –    NPO or light breakfast
  –   Shave, & cleanse
  –   Check for allergies
  –   Total assessment
  –   Teach client
  –   Mild sedative may be given
  –   Post care- lie flat, bedrest, may use a closure device,
      vital signs, CMS, cath site
 Diagnostic Procedures,
• Laboratory Tests
  – ABG’s
  – Pulse oximetry
  – Cardiac enzymes or CPK isoenzymes
    • CPK (creatinine phosphokinase) – found in
      high concentrations in skeletal, brain and
      heart muscle
       – CPK-MB – found in heart tissue, rises in 4-6 hours
         after damage to heart muscle, and peaks in 12-24
         hours at more than 6 x the normal value, then
         returns to normal in 2-3 days
 Diagnostic Procedures,
• Cardiac enzymes
  – LDH (lactate dehydrogenase)
    • High concentrations in the heart, skeletal,
      and brain tissue.
    • Used as an indicator of damage to heart
      muscle, along with other labs
     Complete Blood Count
•   WBC is used to determine if there is inflammation or infection
    (AMI leads to inflammation and endocarditis is infection)
•   RBC’s,HGB & HCT indicates the O2 carrying ability of the blood
•   Platelets are necessary for coagulation and the count may be
    increased in some acute infections and heart disease
•   Myoglobin released soon after cardiac muscle damage
     – 1-4 hrs after symptoms
     – May also be elevated in skeletal muscle
•   Troponin is a protein and is used in muscle contraction
     – 2 subtypes are found in the blood after an MI
     – Levels rise in 3-6 hours after symptoms, peak in 24 hrs and may be
       found up to 2 wks
     – Results available quickly (15 to 20 min) in the ER
               Lipid Profile
• Composed of : Cholesterol, triglycerides, serum
  lipids, and phospholipids
• Considered a risk factor for CVD
   – ^ B/P, and MI
• Cholesterol may be non-fasting
   –   Produced by the liver
   –   CAD risk ^ 3x if greater than 260
   –   Must work to keep below 200
   –   HDL and LDL
• Triglycerides need to be drawn after 12 hrs

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