Diagnosis: A series of diagnostic testing will be complete from the findings found during the extensive history and physical. Laboratory tests that should be ordered are a complete blood count, looking for anemia and or an inflammatory process. Urinalysis will be complete looking for spilling of ketones or an infection. Electrolytes plus a calcium and magnesium, as electrolyte imbalances can affect how well the heart is able to meet the demands of the body. Creatinine will assess the function of the kidneys, while a fasting glucose will identify if diabetes plays a role in the risk factors. Fasting lipid profile to assess for hyperlipidemia which can lead to coronary artery disease. Liver function tests and thyroid stimulating hormone will be drawn to rule out other factors or to check body involvement for staging of heart failure. Biomarkers are gaining popularity in the medical field as they are able to show different aspects of heart failure. Biomarkers include BNP (B-type natriuretic peptide) and NT-proBNP
Pathopharmacological Foundation 10 (N-terminal pro-B-type natriuretic peptide and is used to identify the presence and severity of HF and can be used in any care setting (ACCF/AHA, 2013). The biomarkers are peptides that are directly released from the heart. BNP reference range of 100-400pg/ml indicates a disease process and would require additional testing and work up to confirm a diagnosis. A BNP normal range is 5-30pg/ml. The pro-BNP less than 300pg/ml for a normal range. A pro-BNP of 1200pg/ml indicate a heart failure component. Biomarkers should be initially evaluated and monitored regularly as part of ongoing care. As part of the diagnostic work-up for heart failure the practitioner will order a series of noninvasive cardiac imagining beginning with a chest x-ray to evaluate the lungs and the size of the heart. Electrocardiogram (ECG) will be ordered to review the electrical waves of the heart, to see if there is an electrical problem with the hearts function. As evaluation for heart failure is underway, the practitioner is also looking for the cause of the heart failure in order to prescribe the appropriate medical management. Pending the results of the x-ray and ECG, the practitioner may also consider ordering a transthoracic echocardiogram which is an ultrasound of the heart to look at the muscle, the valves, and calculate the ejection fraction. A stress test may be ordered to see how the heart responds to exercise. A nuclear medicine test called a radionuclide ventriculography may be considered to look more at the vessels and arteries of the heart to evaluate how the heart muscle is supplied with oxygen rich blood. This test will also look at the heart chambers to inspect if an area has been damaged. National standards lean towards the assessment, early detection and correct diagnosis is key to selecting the appropriate treatment plan which in return reduces mortality and increase quality of life. Invasive cardiac testing may be warranted which includes a left or right heart catheterization to visualize the arteries and veins that feed the heart.
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- Spring '16
- Nursing, diastolic heart failure, Pathopharmacological Foundation