Medex Yakima Tech Skills Cardiac Lab Tests Objectives

Front 1

indications for lab tests:• Creatine kinase (CK) CK-MB isoenzyme

Back 1

any disease or injury to the myocardium causes CK-MB to spill out of the damaged cells and into the bloodstream, producing elevated CK-MB isoenzyme levels p205.

Front 2

indications for lab tests:
• Troponin T & I

Back 2

patients with chest pain determine if the pain is caused by cardiac ischemia p522

Front 3

indications for lab tests:
• Brain natriuretic peptide (BNP)

Back 3

used to identify and stratify patients with CHF

(peptides continuously released by heart muscle and low levels/BNP synthesized in cardiac ventricle/released in response to atrial and ventricular stretch/correlates to left ventricular pressures) p378 ho 5

Front 4

indications for lab tests:
• Cholesterol 7

Back 4

testing is used to determine the risk of coronary heart disease CHD. It is also used for evaluation of the hyperlipidemias page 16

Front 5

indications for lab tests:
• Lipoproteins:

Back 5

considered to be an accurate predictor of heart disease. Part of the lipid profile, tests are performed to identify risk of developing heart disease and monitor therapy if abnormalities are found page 351

Front 6

indications for lab tests:
• Triglycerides

Back 6

identify risk of developing coronary heart disease CHD. Tests as part of lipid profile includes: cholesterol and lipoproteins. page 514

Front 7

indications for lab tests:
• Prothrombin time (PT) and the international normalized ration (INR)

Back 7

the time for clot formation
(used to evaluate the adequacy of the extrinsic systems and common pathway in the clotting mechanism)

Front 8

indications for lab tests:
• Activated partial thromboplastin time (APTT)

Back 8

assess the intrinsic system in common pathway of clot formation also used to monitor heparin therapy.


page 388

Front 9

indications for lab tests:
2. Creatine kinase (CK) and CK-MB

Back 9

for supporting diagnosis of MI p201

Front 10

reference MI diagnosis:•
Identify when the CK-MB levels rise ?hrs, peak ?hrs, & return to normal ? Days

Back 10

rise 6hr, peak 18hr, & return to normal 2-3d

Front 11

reference MI diagnosis:••
Explain the effect exercise, surgery, and muscle mass have on CK-MB levels

Back 11

increase CK, threshold at different levels.

Front 12

reference MI diagnosis:•
• Explain the effect exercise, surgery, and muscle mass have on CK-MB levels

Back 12

increase CK, threshold at different levels.

Front 13

reference MI diagnosis:•
• Discuss the three clinical priorities listed in the textbook for CK-MB

Back 13

p204 60%
• Avoid IM injections for MI Pts,
• degree of MI & timing of MI,
• to determine appropriateness of thrombolytic therapy

Front 14

reference MI diagnosis:•
• Explain the clinical significance of increased levels of total CK & CK-MB

Back 14

MI, shock, malignant hyperthermia, myopathies, myocarditis p2 b,L

Front 15

3. Troponin T&I .... is a specific test to determine ?

Back 15

cardiac ischemia & muscle injury. p522

Front 16

3. Troponin T & I
•Identify when the Troponin levels
-rise ?hr @ MI,
-peak (cTnI) ? days and
-(cTnT) ? days, &
-return to normal ? days

Back 16

-rise 3hr @ MI,
-peak (cTnI) 7-10 days and
-(cTnT) 10-14 days, &
-return to normal 2 days

Front 17

3. Troponin T & I
•Explain the advantages of Troponins over CK-MB p4, LT:

Back 17

levels rise-last longer, fast turnaround, specificity to MI,

Front 18

3. Troponin T & I
•Describe the five clinical situations in which Troponins are used as listed in the textbook

Back 18

-Differentiate cardiac & non-cardiac ch-Px,
-Evaluate Pt w/unstable angina (only exercise),
-Detect reperfusion w/associate-coronary canalization.
-Estimate size of MI= big lab value the bigger the MI,
-See if MI occurred during surgery.
-No Troponin…. no infarction

Front 19

3. Troponin T & I
•Explain the clinical significance of increased Troponin levels. Page 525 0%

Back 19

-myocardial intracellular protein enters bloodstream after myocardial cell death from ischemia.
-Therefore levels rise.
-Normally no troponins are detected in the blood.

Front 20

4. Brain natriuretic peptide (BNP) is for what?

Back 20

Assess for CHF
p378

Front 21

(BNP)
•Describe the accuracy of BNP Ref: CHF

Back 21

most accurate test

Front 22

(BNP)
• Explain what BNP is a prognosticator of p5

Back 22

to determine CHF as cause of dyspnea.

Front 23

(BNP)
• List the interfering factors as related to baseline standards for men and women and geriatrics.

Back 23

-healthy men will have a standard baseline, women, and
-older patients will have a higher baseline

Front 24

(BNP)
• Recognize the clinical significance of increased levels of BNP p6,

Back 24

-CHF,
-MI,
-Systemic hypertension,
-fluid balance(edema) also changes with MI

Front 25

Explain the indications for the lab test:
5. Cholesterol



p6 br ,

Back 25

used to determine risk of Coronary artery disease.



pg 167.

Front 26

5. Cholesterol
• Describe the cholesterol sub-type that is most directly associated with increased CHD risk

Back 26

LDL p7b l

Front 27

5. Cholesterol
• Recall the three clinical priorities listed in the textbook for Cholesterol :

Back 27

•lipid protein (includes lipids & triglycerides)

•variations in cholesterol values-need to repeat lab for verification if elevated/

•12 to 14 hour fast after eating low-fat meal before blood draw p8, t L

Front 28

5. Cholesterol
• Explain the clinical significance of increased levels of cholesterol related to familial conditions

Back 28

lab #s can be below acceptable and still be hi for a particular individual

Front 29

6. Lipoproteins accurate predictor for

Back 29

Heart Disease Mosby's p351

Front 30

• Explain how smoking and alcohol affect HDL levels p9

Back 30

smoking & alcohol will decrease HDL(good)

Front 31

•Recall the three clinical priorities listed in the textbook for lipoproteins ho p10

Back 31

•predictors of heart disease and lab needs a 12-24 hr fast

•LDL high levels indicate increased risk of CHD

•HDL high levels indicate decreased risk of coronary heart disease

Front 32

•Explain the clinical significance of increased levels of HDL

Back 32

is called Good because the body takes it from the tissues --> to liver to be excreted.

Front 33

•Explain the clinical significance of increased levels of LDL and VLDL related to familial and alcoholic conditions

Back 33

-Alcohol dereases HDL causing LDL’s to seem high.
-lab #s can be below acceptable and still be hi for a particular individual

Front 34

7. indications for lab tests:

Triglycerides p513

Back 34

predictor if you are at risk of heart disease

Front 35

• Explain how food, alcohol, and pregnancy affect triglycerides10 b, R

Back 35

-Alcohol may elevate VLDLs.

-Pregnancy elevates triglyceride levels,

-Fatty meals also Elevates TriG.

Front 36

8. Prothrombin time (PT) and the International normalized ration (INR) Are used for what?

p441 ho11(ho handout / PP power point)

Back 36

evaluating blood-clotting mechanism

Front 37

•Explain how the PT is used in monitoring coumadin therapy

Back 37

PT is used to dose coumadin

Front 38

•Describe the difference between PT and INR

Back 38

is Time based for coagulation & INR is a ratio.

Front 39

•Describe the agent used to reverse a high coumadin effect

Back 39

Vit-K

Front 40

•Identify what kind of diet can shorten PT times

Back 40

foods with K or green leafy veggies.

Front 41

•Discuss the three Home Care Responsibilities listed in the textbook for Coumadin. PP p12

Back 41

-coumadin can be regulated by PTs

-inform Pt to self evaluate for bleeds, bruising, petechia, back-pain, bleeding gums.

-meds must be approved by PA

Front 42

• Discuss how liver disease and Vitamin K deficiency affect PT levels P13 T L

Back 42

It would increase the PT time.

Front 43

Partial thromboplastin time (PTT) 387 PP p13

Back 43

used to evaluate clotting mechanism

Front 44

• Explain how the PTT is used in monitoring heparin therapy

Back 44

is the intrinsic clot path and takes 4-6 hrs.

Front 45

• Describe the agent used to reverse a high heparin effect

Back 45

protamine sulfate via intramuscular p389

Front 46

• Discuss how: liver cirrhosis &, Vitamin K deficiency, heparin therapy , and coumadin therapy affect PT levels:

Back 46

•Discuss how: liver cirrhosis &, Vitamin K deficiency: affect PT levels:

-liver makes most clot fct for synthesis, of those same clot fct, vit-K is required…PTT is prolonged,

-heparin therapy inhibits the intrinsic system at several points: PTT is prolonged, and

-coumadin therapy: greater impact on PTT, does inhibit fnct of factors of # 2,9,10: result is PTT is prolonged.