MEDICAL

1. 2/7/2023
By Zewude M 1
INSTITUTE OF HEALTH SCIENCE
SCHOOL OF NURSING AND MIDWIFERY
DEPARTMENT OF NURSING
PRESENTATION ON ACUTE COMPLICATIONS OF
UROLOGIC PROCEDURES AND DEVICES
By : Zewude M.

2. 2/7/2023
By Zewude M 2
Cardiovascular lab studies
By Zewude M
Turn around time :30 minutes

3.  Objectives of the presentation
 Cardiovascular lab-studies
 Reference
2/7/2023
By Zewude M 3

4. At the end of this session ,the learner will be able to:
 List Cardiovascular lab-studies.
 Interpret CBC results
 Describe cardiac markers
 Define cardaic stress test
2/7/2023
By Zewude M 4

5. BRAINSTORMING
What are the Cardiovascular lab that
nurses should be familiar with?
2/7/2023
By Zewude M 5

6.  Cardiovascular lab that nurses should be familiar with
include:
Cardiac biomarkers
 CBC
 Cardiac Stress testing
Angiography
 cardiac catheterization
Electrocardiography(ECG
2/7/2023
By Zewude M 6

7.  Data obtained by history and physical assessments and
confirmed by diagnostic tests and procedures
 All tests should be explained to the patients.
 Some may need special preparation before they are
performed and need special monitoring after the
procedure.
2/7/2023
By Zewude M 7

8.  Reason
To assists in diagnostic acute MI
To identify abnormalities in the blood.
To assess the degree of inflammation
To screen for risk factors associated with
atherosclerotic coronary artery disease
To determine baseline values before performing
therapeutic intervention
2/7/2023
By Zewude M 8

9.  In cardiac function Blood cells have crucial role
 Blood used as transport medium for oxygen, glucose,
electrolytes, plasma proteins, hormones, and medications.
And also a vesicle for removal of waste products
 Changes in blood cell integrity and total cell count may
reflect specific disorders of the cardiac system.
2/7/2023
By Zewude M 9

10.  Is a commonly used laboratory test to support the diagnosis of
several diseases.
 The values of hematological parameters are varies by a number
of factors even in apparently healthy individuals. These include
age, sex, nutritional, environmental and social factors with
cultural backgrounds.
 Some hematological parameters show extensive variation in
different period of life.
2/7/2023
By Zewude M 10

11.  Used to evaluate your overall health
 Detect a wide range of disorders, including anemia,
infection and leukemia.
 Blood consists of three types of cells suspended in
fluid called plasma:
 white blood cells (WBCs)
 Red blood cells (RBCs), and
 platelets (PLTs).
2/7/2023
By Zewude M 11

12.  They are produced and mature primarily in the bone
marrow and, under normal circumstances, are
released into the bloodstream.
2/7/2023
By Zewude M 12

13. Constituents of Red cell count
1) Red blood cell count (RBC)
 It's also known as an erythrocyte count.
 Is used to find out how many red blood cells (RBCs)
present in a patient's sample blood.
 Reference range:
Men: 4.5-5.9 x 106/microliter,
Women: 4.1-5.1 x 106/microliter
2/7/2023
By Zewude M 13

14. Causes of low result in red blood cell count
 Anemia.
 Acute or chronic bleeding
 RBC destruction (e.g., hemolytic anemia,etc.)
 Nutritional deficiency (e.g., iron deficiency,vitamin
Bl2 or folate deficiency)
 Chronic inflammatory disease
 Bone marrow disorders or damage
2/7/2023
By Zewude M 14

15. Examples of causes of high result
 Living at high altitude
 Smoking
 Polycythemia vera
 Dehydration
2/7/2023
By Zewude M 15

16. 2. HAEMOGLOBIN
 Hb is the protein which carries oxygen in the blood.
REFERENCE RANGE:
Men: 14-17.5 g/dL
Women: 12.3-15.3 g/dL
3. HEMATOCRIT (HCT).
 Also known as Packed Cell Volume (PCV); Volume percentage of red
blood cells in the blood.
REFERENCE RANGE:
2/7/2023
By Zewude M 16
Men:41.5 %-50.4% Women: 35.9-44.6%

17. 4. RBC INDICES.
 Are blood tests that provide information about the
hemoglobin content and size of red blood cells
 They are used to help diagnose the cause of anemia, a
condition in which there are too few red blood cells and
other disorders of RBC.
These are:
i. Mean corpuscular/cell volume (MCV),
ii .Mean corpuscular hemoglobin (MCH),
Iii.Mean corpuscular hemoglobin concentration (MCHC),
2/7/2023
By Zewude M 17

18.  Also called leukocytes, that the body uses to maintain a healthy
state and to fight infections or other causes of injury
 There are five different types of WBCs,
 These are :
 Neutrophils
 Lymphocytes
 Basophils,
 Eosinophils and
 monocytes
2/7/2023
By Zewude M 18

19.  They are present in the blood at relatively stable numbers.
 These numbers may temporarily shift higher or lower
depending on what is going on in the body.
WHITE BLOOD CELL DIFFERENTIALS
1.NEUTROPHIL COUNT
 Neutrophils are a type of white blood cell (WBC or
granulocyte) that protect a body against infections,
 Are the first cells to arrive on the scene when we experience
a bacterial infection.
2/7/2023
By Zewude M 19

20.  If neutrophils are below and above normal values it is Known
as leukopenia and leukocytosis respectively.
Example if the pt has sign and syptom of cardiac problem and
neutrophils is raised we suspect endocarditis .
2.LYMPHOCYTE COUNT
 Lymphocytes are type of white blood cell (leukocyte) that is of
fundamental importance in the immune system,
 They are made in the bone marrow and found in the blood and
lymph tissue.
2/7/2023
By Zewude M 20

21.  They are the main type of cell found in lymph, which
prompted the name "lymphocyte".
 Lymphocytes help your immune system remember every antigen
it comes in contact with.
 Are the first cells to arrive on the scene when we experience
a viral infection
 If lymphocyte are below and above normal values it is Known
as lymphocytopenia and lymphocytosis respectively.
 Example if the pt has myocarditis there may be lymphocytosis
2/7/2023
By Zewude M 21

22. 3.MONOCYTE COUNT
 Monocytes are the largest type of leukocyte and can differentiate
into macrophages and myeloid lineage dendritic cells.
 monocytes are important in the immune system's ability to destroy
invaders, but also in facilitating healing and repair.
 Examples of Causes of high count
chronic infections like:a
 fungal infections
 tuberclosis
Infection within the heart (bacterial endocarditis)
2/7/2023
By Zewude M 22

23. 4.EOSINOPHIL COUNT
Most often indicates a parasitic infection, an allergic reaction
or cancer
5.BASOPHIL COUNT
 are involved in immediate hypersensitivity reactions as well as
chronic inflammatory or immunologic responses.
2/7/2023
By Zewude M 23

24.  Platelets, also called thrombocytes, are special cell fragments
that play an important role in normal blood clotting.
 A person who does not have enough platelets may be at an
increased risk of excessive bleeding and bruising
 REFERENCE RANGE:
SI Units :150-450 x 109/L
2/7/2023
By Zewude M 24

25. 2/7/2023
By Zewude M 25

26. 2/7/2023
By Zewude M 26

27.  Cardiac enzymes also know as cardiac biomarker.
 Are those found in cardiac tissue release into the bloodstream
when the heart is damaged or stressed.
 These tests are most useful in diagnosing myocardial infarction
(heart attacks)
 The markers are normally present at all time, however, they are
significantly elevated during a damage of the heart muscle.
2/7/2023
By Zewude M 27

28. 2/7/2023
By Zewude M 28

29. 2/7/2023
By Zewude M 29

30.  Used for diagnosing cardiac disease along other tests.
 Use this four enzyme diagnosis:-
Cardiac Troponin I& T
Creatine Kinase
Myoglobin
Lactate dehydrogenase(LDH)
2/7/2023
By Zewude M 30

31.  Also known as creatine phosphokinase (CPK) or phosphocreatine
kinase.
 A test to know the concentration of CPK in the serum.
 The level of total CK in plasma usually becomes abnormal 6 to 8
hours after onset of MI and peaks in 24 - 28 hours.
 But because levels of CK can go up in many other conditions
besides a heart attack, it is not very specific.
2/7/2023
By Zewude M 31

32.  Found in cells of heart , skeletal muscles and brain.
 Three creatine kinase (CK) isoenzymes
CK-MM: skeletal muscle-specific isoenzyme
CK-MB: heart muscle-specific isoenzyme
CK-BB: brain tissue-specific isoenzyme
 Normal range
55-170units /L for men
30-135 units/L for women
2/7/2023
By Zewude M 32

33.  CK-MB rises 4 to 6 hours after a heart attack, but generally back
to normal within a day or two.
 Increases only when there has been damage to cardiac cells: acute
MI, Myocarditis, CHF,
 Recurrent elevation suggests re-infarction or extension of ischemic
damage
 Elevation diminishes as the disease progresses and muscle mass
decreases
2/7/2023
By Zewude M 33

34.  There is LDH1 and LDH2, normally LDH2 is greater than LDH1
 Found in: heart, liver, skeletal muscle, kidney, lung, fat and red
blood cells. Due to that no longer considered a specific test for MI.
 LDH is used to help diagnose:
Myocarditis,
Liver and renal dysfunction,
Skeletal muscle disorders or trauma
2/7/2023
By Zewude M 34

35.  May be abnormally elevated in various conditions,
including:
Hemolytic anemia;
Pulmonary infarction;
Renal infarction;
Hepatic disorders (hepatitis and hepatic congestion);
Skeletal muscle disorders.
 Normal ratios are:-LDH-1:- 17%-27%
:-LDH-2:- 27%-37%
2/7/2023
By Zewude M 35

36. Is muscle protein with high sensitivity but low specificity(also
elevated during other muscle injury) detection of ischemic
muscle damage.
Appears in the serum earlier than CK (in 1 to 3 hours) after
onset of symptoms, usually peaks in 2 to 4 hours.
Normal value:-(17.4-105.7ng/ml)
2/7/2023
By Zewude M 36

37.  Regulates the myocardial contractile process
 Highly specific for cardiac muscle
 Detectable as cardiac troponin I & troponin T .
Troponin I
found only in cardiac muscle
Rising in the blood 4-6 hours post infraction
Peaks in 12-24 hours
Come to baseline within 10-14 days
Range Norman individual: <0.001ng/ml.
Therefore it has good utility for retrospectively diagnsing AMI
2/7/2023
By Zewude M 37

38. Troponin T
 Found in cardiac and skeletal muscle,
 Also elevated during kidney and skeletal damage
 Highly sensitive to detect minor myocardial injury
2/7/2023
By Zewude M 38

39. 2/7/2023
By Zewude M 39

40.  It demonstrates the ability of the myocardium to respond to increased
oxygen demand by increasing blood flow to the coronary arteries.
 We get information about the pumping function of the heart and
specifically about the vessels which supply the blood flow to the
heart, whether or not there are significant blockages
 Stress testing can be life-threatening with potential occurrence of MI,
cardiac arrest, HF, and severe dysrhythmias thus, testing facilities
must have staff and equipment ready to provide treatment, including
advanced cardiac life support.
2/7/2023
By Zewude M 40

41.  Cause of chest pain,
 Functional capacity of the heart after MI or heart surgery,
 Effectiveness of anti angina or antiarrhythmic medications,
 Dysrhythmias that occur during physical exercise,
2/7/2023
By Zewude M 41

42.  Severe aortic stenosis,
 Acute myocarditis or pericarditis,
 Severe hypertension,
 HF, and
 Unstable angina
2/7/2023
By Zewude M 42

43. Can be:
1. Mental or emotional stress test
2. Pharmacologic stress test
3. Exercise stress test
Mental or emotional stress test
 Patient exposed to an emotional stressor (The death of a loved
one, dismissal from work) using a standardized mental stress
test,
 Then, heart pictures examined whether reduced blood flow
(ischemia) occurred during mental stress.
2/7/2023
By Zewude M 43

44.  Vasodilation agents (dipyridamole and adenosine) administered
IV
 used to mimic the effects of exercise by maximally dilating
the coronary arteries
 Is used in combination with imaging modalities such as
echocardiography.
 General indication
 Elderly patients with decreased functional capacity and
possible CAD
 Younger patients with functional impairment
2/7/2023
By Zewude M 44

45. 2/7/2023
By Zewude M 45

46.  Advise the patients to be fast for 4 hours before the test
 Avoid stimulants: like tobacco and caffeine
 Medications may be taken with sips of water
 Certain cardiac medications may not be taken, such as beta
blocking agents, before the test
 Wear clothes and sneakers or rubber-soled shoes suitable for
exercising
2/7/2023
By Zewude M 46

47.  During the test, the following are monitored
 ECG changes for heart rate, rhythm, and ischemic changes;
• BP;
• Skin temperature;
• Physical appearance;
• Symptoms: chest pain, dyspnea, dizziness, leg cramping, and
fatigue.
2/7/2023
By Zewude M 47

48.  Patient experiences:
 Chest pain,
 Extreme fatigue,
 Decrease in BP or pulse rate,
 Serious dysrhythmias or st-segment changes
 ECG changes
2/7/2023
By Zewude M 48

49.  When significant ECG abnormalities occur during the stress test
 ST-segment depressions or elevations
2/7/2023
By Zewude M 49

50. 1. Michael swash, hutchison’s clinical methods, 9th edition,2003
2. Janice L.Hinkle and Kerry H.Cheever (2018) Medical-Surgical,
nursing.14th edition, 2018
3. www.google. com
2/7/2023
By Zewude M 50

51. 2/7/2023
By Zewude M 51