Thallium Imaging

THALLIUM IMAGING is a very simple procedure. It is done in a resting state or after stress. The purpose of this is to know the extent of MI, also to evaluate the patency of the graft after surgery. It needs consent, and check for allergies.

The Thallium is injected to the body. 10 minutes later take a look at the heart under fluoroscopy for the areas. The thallium should be taken up by all the blood vessels. The areas of thallium which is not taken up appear a white spot and that is the area of infarcts.

CABG- Coronary Artery Bypass Graft. What we do is bypassing the occlusion of the coronary artery so they’ll do a thallium test after wards to make sure that the area that previously showed as a white spot no longer shows as a white spot.

CVP monitoring

A catheter is inserted to the right atrium of the heart to determine fluid balance. The normal functioning of the heart, all the fluids that come to the heart is pump out from the heart.

If it does not happen you’ll have Congestive Heart Failure. We try to figure out how the heart handles the volume of blood coming in.
The measuring point of the CVP is in the right atrium. What you should do is level up the right atrium with the manometer. Make sure that the manometer is the same level with the right atrium. Use a lever to balance it out.

NCLEX Q – Patient with CVP if the head of the bed is adjusted you have to adjust the manometer otherwise you will get a false reading.
Normal CVP reading 5-10 cm H20. More than 10cm is indicative of overload. Less than 5cm patient is dry or dehydrated.

Always check the level of the manometer. Check the insertion site of the catheter for bleeding and other complication like pneumothorax or hemothorax. Signs and symptoms is shortness of breath.

Cardiac catheter

CARDIAC CATHETER Is done to visualize the left side of the heart. It is an invasive procedure, needs consent, uses radio opaque dye. Doctor will obtain the consent. Nurses are just witnessing the signature.
The purpose is to look and blood supply of the heart if there are any anomalies.
The catheter is inserted in the femoral artery mostly but sometimes in the brachial all the way up into the heart passing through the abdominal and thoracic cavity. It is going to the artery. What artery is doing a whole lot? It loves to bleed.
NSG CARE:
In ER - If patient came in reporting of chest pain immediately hook up the cath. Don’t care if he is NPO or not. It is an emergency procedure now.
PRE:
In NCLEX – NPO 6 hours before the procedure.
• Check for allergies (shellfish and seafood)
• Check medication allergies
• Check if on anticoagulant therapy. Heparin is usually stop 1 day before the Coumadin 5-7 days. But still up to the doctor.
• Check baseline ECG, lab work
POST:
• compare the result to the base line
• Keep the leg straight for 6-8 hours after the procedure
• Apply pressure to the site, remember it’s an artery
• Watch allergic reaction. Rationale: reaction occur later
• Patient on bed rest 6-8 hours and head of the bed flat. The most you can raise the bed is 30 degrees.
• Force fluids. Rationale: to get rid of the dye.

Holter monitor

It records the electrical activity of the heart for 24 hours or longer as the patient is doing his routine. It is not an invasive procedure. It does not need signed consent. We simply use it because the ECG when the patient comes in, the ECG may or may not pick up the problem.

EKG is a very good tool because it records the electrical activity of the heart. The downside of it unless the problems occur like right now it will not get it or capture it. Halter Monitor also use to evaluate whether the medication like anti-arrythmic drugs is working or not. We also put the patient on H.M. who just recovered form MI to know if the medication is working.

Holter Monitor is benign, with patches like EKG, a machine like the size of a tape recorder. Nurses must tell the patient that it is important that is she/he will not take a shower while she has the H.M on. It is very important also that she will have a log or a little book. In this book she has to log down everything that she does while she has H.M. on. Like for example:
6 am – woke up, 6:30am – took a dump
6:35 am brush my teeth

You need to explain to the patient why is using H.M. Explain what the uses are and tell her not to use electrical blanket while on H.M. Rationale: it will look like the patient has a huge defib for 8 hours.

If patient sees the light comes on in the monitor/ machine or tape recorder what she needs to do is just push each electrodes right in the center because it just means something is loose.

We can detect also the causes sometimes. Let’s say she documents 6:45am taking a dump and you see 6:45am there’s a slowing of the heart, guess what she was doing?... Valsalva manuever. Bowel straining. What happen when you really strain? You are doing valsalva manuever and it slows the heart down.

Remember the vagus nerve. It slows the heart. 7am – brushing hair. Then the heart slows down guess what she does? She is also doing valsalva manuerver. If you raise your hand over your head you tend to hold your breath a little bit then when you are brushing your hair that too is valsalva manuever.

In fact, where is most MI happens? At home right? Where exactly what room in the home? In the bathroom! And what activity? Taking a shower, washing their hair that’s where most MI occurs.

NSG CARE:
PRE: teach about it. Should wear a loose shirt with buttons up the front. Rationanale: if you use sweater on then when you got wet it is uncomfortable to take it out. Avoid magnet or electrical blanket
POST: remove all the electrodes wrap up the H.M. And bring it back along with the book.

Action of calcitonin

Calcitonin is a hormone that produced by a thryroid that takes the calcium from your blood and put it into the bones. So if you get too much calcium or hypercalcemia that sits in your blood you take the calcium and put it on the bones. That is the action of calcitonin.

Sucralfate or Mylanta first?

If you are to give Sucralfate and Mylanta at the same time, it is confusing which one is given first.
Sucralfate does not coats the stomach. It coats the area of ulceration and it helps the area of ulceration to heal, it does not attach to the intact membranes of the gastric cavity. It only attaches to the area that has ulcer. So you always give the Sucralfate first so it can attach to the area, if you give Mylanta first- Mylanta coats everything. So if you give Mylanta first and then give the Sucralfate there is no point is there?

How Kidney failure cause hypocalcemia

The glomerulus in the kidneys have a nice membrane that generally does not permit calcium to go through what happento kidney failure, the glomerular pores get large and calcium can get through and loss it.

Normally you don’t loss a lot of calcium through the urine because the filter is intact and the membranes are intact. The glumerulus however in Renal Failure you get to end up getting holes and membranes permits a lot of calcium to go through.

The funny thing here is that because of selective filtration while it permits a large molecule of calcium to go through it does not allow the small Potassium to go through. Remember that everything in our body is selective filtration, it permits this to go through and not that to go through.