LABS TO KNOW
What does BNP measure? What is the normal level for BNP? What is an elevated BNP? What does BNP help distinguish?
BNP is elevated in people who have heart failure
Normal: Less than 100
Elevated: Greater than 400
BNP helps distinguish cardiac from respiratory causes of dyspnea
What are the 5 points of listening to the heart?
All People Eat Too Much
Aortic
Pulmonic
Erbs point
Tricuspid
Mitral
What is Angina Pectoris? What causes it (6)?
Angina pectoris is chest pain brought on by myocardial ischemia
Causes: physical exertion, intense emotion, extreme temperatures, tobacco use, stimulants, coronary artery narrowing.
Naproxen
NSAID
Pulmonary Embolism manifestations
pleuritic chest pain, dyspnea/hypoxia/tachypnea, tachycardia and DVT
What is the normal level for hematocrit for females and males?
What is INR? What is normal range?
What is PTT? What is normal range? What is normal in anticoagulation therapy?
- Females: 35-47% ; Males: 39 - 50%
- INR aka PT measures the time for the blood to clot; INR:0.8-1.1 OR 11-13.5 sec
- PTT measure the same as INR/PT but is used to monitor responses to blood thinners; PTT: 25 - 35 sec; Anticoagulation therapy: 1.5-2 times the normal reference.
What is PMI? Where do you listen to PMI? What sound do you hear?
PMI is point of maximal impulse. This is found at the tip of the heart known as the apex, aka apical pulse. You listen to this at the mitral point: 5th intercostal at MCL.
Sound: S1 "lub"
What is CVP? What does elevated CVP indicate? What are some signs and symptoms (7)?
CVP is the measurement of right ventricular preload and reflects fluid volume problems.
Elevated CVP can indicate right ventricular failure or fluid overload.
Signs and symptoms: peripheral edema, increased urine output, rapid weight gain, jugular venous distention, S3 heart sounds, tachypnea/dyspnea/crackles in the lungs, bounding pulses.
Lisinopril ; what can it cause?
ACE inhibitor, used to prevent ventricular remodeling and progression of heart failure. May cause hyperkalemia and hypotension (only administer if those are normal)
What is Trigeminal Neuralgia? What cranial nerve does it affect? What are the manifestations?
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain.
Cranial nerve V (trigeminal nerve)
electric shock-like pain in the lips and gums, severe pain along the cheekbone.
What is the normal range for platelets?
White blood cell: 4,000 - 11,000
Platelets: 150,000 - 450,000
Where are the tricuspid valve sounds best auscultate? What sound do you hear?
5th ICS to the lower left sternal border.
Sound: S1 "lub"
What is Chronic Venous Insufficiency? What is the biggest sign/symptom?
Chronic venous insufficiency occurs when your leg veins don't allow blood to flow back up to your heart causing chronic increased venous pressure.
S/S: brownish skin discoloration along with chronic edema and inflammation causing the tissue to Harden and appear leathery.
Atorvastatin ; what should you monitor?
Lipid lowering medication; monitor for muscle weakness and pain
What is Bells palsy? What cranial nerve does it affect? What are the manifestations?
An unexplained episode of facial muscle weakness or paralysis.
It affects the VII cranial nerve (facial)
Manifestations: inability to close eye, alteration in tear duct, flattening of nasolabial fold, inability to smile or frown symmetrically
What does MAP measure? How do you find MAP? What are the normal values for MAP?
What does CVP measure? What are the normal values?
-MAP measures the Mean Arterial Pressure
- Systolic + (Diastolic x 2) / 3
- MAP: 70 - 105 mm Hg
-Central venous pressure measures the pressure in the vena cava
-CVP: 2-8 mm HG
Where are the aortic valve sounds best auscultated? What sound do you hear?
Where are the pulmonic valve sounds best auscultated? What sound do you hear?
Aortic: 2nd ICS to the RIGHT sternal border; Sound: S2 "dub"
Pulmonic: 2nd ICS to the LEFT sternal border; Sound: S2 "dub"
What is cardiac tamponade? What is the first sign? What is Pulsus paradoxes? What is the BEC's triad?
The pericardia; sac fills with blood or fluid which then puts pressure on the heart causing it to stop beating.
First sign: Low oxygen (restlessness/confusion, dizziness, fatigue, SOB, tachycardia)
Pulsus paradoxus: systolic drop by 10 mmHg upon respiration
BEC's triad: Big jugular vein distention, Extremely low blood pressure, Can't hear heart sounds (muffled)
Nifedipine
Calcium channel blocker used to treat hypertension.
Left sided heart failure vs right sided heart failure; what are the mnemonics?
Left sided heart failure: LUNGS have edema (Left is Lung)
CHOP (Cough, hemp, orthopenia, pulmonary congestion)
Right sided heart failure: BODY has edema (Right is Rest)
HEAD (Hepatomegaly, Edema, Ascites and Distended neck veins)
What does Troponin measure?
What is the normal value for Troponin I?
What is the normal value for Troponin T?
-Troponin is released when the heart has been damaged (Ex: HEART ATTACK)
- Troponin I: <0.5 ng/mL
-Troponin T: <0.1 ng/mL
At what point can you hear both the S1 and S2 sounds? Where is it located?
Erb's point. The 3rd ICS to the left sternal border.
What is infective endocarditis? What is a complication? What are the five things that can happen due to this complication and what are the signs and symptoms?
An infection of the inner lining of the heart muscle.
Complication: The vegetations over the valves can break off and travel to other organs of the body
1. Stroke (paralysis on one side)
2. Spinal cord ischemia (paralysis of both legs)
3. ischemia to the extremities (pain, pallor, and cold foot or arm)
4. intestinal infarction (abdominal pain)
5. splenic infarction (left upper quadrant pain)
Adenosine ; what does it do?
antiarrhythmic ; converts PSVT to normal sinus rhythm when vagal maneuvers are unsuccessful
Tracheostomy care, What is open-suction technique? What are the 3 steps?
Promotes gas exchange and prevents alveolar collapse.
1.) Preoxygenate with 100% oxygen and allow for deoxygenation periods between suction
2.) Use sterile technique, insert suction catheter without suctioning
3.) Apply intermittent or continuous suction ONLY while withdrawing the catheter. Limit suction passes to less than 10 seconds.