Unit 4: Alterations in Cardiovascular Function
Blueprint with Student Learning Outcomes
Labs to Know
● Troponin
o Normal: < 0.04 ng/mL
o Borderline: 0.04-0.39 ng/mL
o Cardiac injury: > 0.40 ng/mL
● CKMB
o Normal 0-3 ng/mL
o Elevated: > 3-5 ng/mL
● BNP
o Normal: < 100 pg/mL
o HF: > 100 pg/mL
Diagnostics to Know
Transthoracic ECG
o What is it?
▪ A non-invasive ultrasound of the heart that uses high-frequency sound waves to create
moving images of the heart
o What does it measure?
▪ Size, thickness, and function of the heart chambers
▪ Ejection fraction
▪ Pericardial effusion of the pericardium
▪ Blood flow patterns
▪ Evaluates for damage after MI
o Nursing Considerations
▪ Pre-procedure
▪ Explain procedure
▪ Remove clothing from chest
, ▪ Ensure consent
▪ During procedure
▪ Ensure the patient lies in a left lateral position to bring the heart closer to the chest
wall
▪ Monitor for discomfort
▪ Attach ECG leads to synchronize images with the rhythm
▪ Post-Procedure
▪ Resume normal activity immediately
▪ Document findings
▪ Provide emotional support if abnormal findings are discussed
● Transesophageal ECG
o What is it?
▪ A semi-invasive ultrasound procedure that uses a flexible probe inserted through the
mouth into the esophagus to get images of the heart
o What does it measure?
▪ Identifies aneurysms
▪ Cardiac function: ejection fraction and wall motion
▪ Prosthetic valve function
▪ Endocarditis evaluation
o Nursing Considerations
▪ Pre-procedure
▪ NPO for 6 hours before procedure
▪ Remove dentures
▪ Establish IV access for sedation
▪ Baseline vital signs
, ▪ Assess for swallowing difficulties or esophageal disorders
▪ During procedure
▪ Left lateral position
▪ Administer sedation and a topical anesthetic to the throat
▪ Monitor airway, SPO2, HR, and vital signs
▪ Have suction equipment available
▪ Post-procedure
▪ Monitor until fully awake
▪ NPO until gag reflex is confirmed
▪ Monitor for sore throat, perforation, or bleeding
▪ Document procedure and tolerance
▪ Resume oral intake only when safe
● Stress Test
o What is it?
▪ Evaluates how well the heart responds to physical exertion or pharmacologic stress
o What does it measure?
▪ Heart rate/rhythm
▪ BP response to exercise
▪ O2 consumption
▪ Presence of ischemia
▪ Exercise capacity/tolerance
▪ Symptoms: chest pain, dyspnea, dizziness, fatigue during exertion
o Nursing Considerations
▪ Pre-procedure
Blueprint with Student Learning Outcomes
Labs to Know
● Troponin
o Normal: < 0.04 ng/mL
o Borderline: 0.04-0.39 ng/mL
o Cardiac injury: > 0.40 ng/mL
● CKMB
o Normal 0-3 ng/mL
o Elevated: > 3-5 ng/mL
● BNP
o Normal: < 100 pg/mL
o HF: > 100 pg/mL
Diagnostics to Know
Transthoracic ECG
o What is it?
▪ A non-invasive ultrasound of the heart that uses high-frequency sound waves to create
moving images of the heart
o What does it measure?
▪ Size, thickness, and function of the heart chambers
▪ Ejection fraction
▪ Pericardial effusion of the pericardium
▪ Blood flow patterns
▪ Evaluates for damage after MI
o Nursing Considerations
▪ Pre-procedure
▪ Explain procedure
▪ Remove clothing from chest
, ▪ Ensure consent
▪ During procedure
▪ Ensure the patient lies in a left lateral position to bring the heart closer to the chest
wall
▪ Monitor for discomfort
▪ Attach ECG leads to synchronize images with the rhythm
▪ Post-Procedure
▪ Resume normal activity immediately
▪ Document findings
▪ Provide emotional support if abnormal findings are discussed
● Transesophageal ECG
o What is it?
▪ A semi-invasive ultrasound procedure that uses a flexible probe inserted through the
mouth into the esophagus to get images of the heart
o What does it measure?
▪ Identifies aneurysms
▪ Cardiac function: ejection fraction and wall motion
▪ Prosthetic valve function
▪ Endocarditis evaluation
o Nursing Considerations
▪ Pre-procedure
▪ NPO for 6 hours before procedure
▪ Remove dentures
▪ Establish IV access for sedation
▪ Baseline vital signs
, ▪ Assess for swallowing difficulties or esophageal disorders
▪ During procedure
▪ Left lateral position
▪ Administer sedation and a topical anesthetic to the throat
▪ Monitor airway, SPO2, HR, and vital signs
▪ Have suction equipment available
▪ Post-procedure
▪ Monitor until fully awake
▪ NPO until gag reflex is confirmed
▪ Monitor for sore throat, perforation, or bleeding
▪ Document procedure and tolerance
▪ Resume oral intake only when safe
● Stress Test
o What is it?
▪ Evaluates how well the heart responds to physical exertion or pharmacologic stress
o What does it measure?
▪ Heart rate/rhythm
▪ BP response to exercise
▪ O2 consumption
▪ Presence of ischemia
▪ Exercise capacity/tolerance
▪ Symptoms: chest pain, dyspnea, dizziness, fatigue during exertion
o Nursing Considerations
▪ Pre-procedure
