ADV. MED-SRG. HESI REVIEW

ADV. MED-SRG. HESI REVIEW Cardiovascular 1. ACS- cardiac enzymes  ACS: Acute Coronary Syndrome  Troponin T (<0.20 ng/ml), Troponin I (<0.03ng/ml) creatinine kinase-MB (0% of total CK), and myoglobin (<90 mcg/L) 2. Anti-coagulant therapy  For valvular heart diseases, pt. will be on anticoagulants for life if they had a mechanical valve replacement.  Warfarin (Coumadin) o Teach pt. about bleeding precautions such as using a soft bristled toothbrush, an electric razor, no contact sports. o Monitor PT and INR o Lab ValuesPT: 10-14 sec; INR: 2.0-3.0 o Antidote: Vitamin K o Avoid green, leafy vegetables, ginseng, ginger, herbs and St. John’s Wart  Heparin (Lovenox) o Teach bleeding precautions as well o Monitor PTT o Lab Values PTT: 25-35 sec. o Antidote: Protamine Sulfate o Pts. will not go home on heparin, they will be weaned off it in the hospital and started on Coumadin. 3. Raynaud’s disease  Triggered by cold and/or stress  Caused by vasospasm of the arterioles and arteries of the upper and lower extremities, usually unilaterally.  As a result of vasospasm, the superficial skin vessels are constricted and blanching of the extremity occurs, followed by cyanosis.  Smoking is the #1 risk factor  Teach pt. to avoid cold situations such as wearing gloves when in freezer section of grocery store, and keeping the room temperature warm.