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Keep abreast of diagnostic tests 33

Reassure the client that electrical shock wont occur. Apply the electrodes to clean, dry skin. Interpret the electrocardiogram (ECG) for changes, such as life-threatening arrhythmias or ischemia.

24-hour record of the heartAmbulatory ECG, also known as Holter monitoring, is a noninvasive test that records the hearts electrical activity and cardiac events over a 24-hour period.

Nursing actions Explain the purpose of Holter monitoring. Instruct the client to keep an activity diary. Advise the client not to bathe or shower, operate machinery, or use a microwave oven or an electric shaver while wearing the monitor.

View through a catheterCardiac catheterization and arteriography (also called angiography) involve an injection of radiopaque dye through a catheter, after which a fluoroscope is used to examine the coronary arteries and intracardiac structures. The procedure is also used to monitor major intracardiac pressures, oxygenation, and cardiac output.

Nursing actionsBefore the procedure Withhold the clients food and fluids after midnight. Administer daily medications as ordered by the physician. Discuss any anxiety the client may have about the procedure. Assess and record baseline vital signs and peripheral pulses. Make sure that written, informed consent has been obtained. Inform the client about possible nausea, chest pain, flushing of the face, or a sudden urge to urinate from the injection of radi-opaque dye. Note the clients allergies to seafood, iodine, or radiopaque dyes.After the procedure Monitor vital signs, peripheral pulses, and the injection site for bleeding.

Maintain a pressure dressing and bed rest as ordered after the procedure. Encourage fluids unless contraindicated. Monitor for complaints of chest pain, and report any complaints immediately. If bleeding occurs at the site, apply manual pressure until the bleeding stops.

Echoing heart structuresEchocardiography is a noninvasive examina-tion of the heart that uses echoes from sound waves to visualize intracardiac structures and monitor the direction of blood flow.

Nursing actions Determine the clients ability to lie still for 30 to 60 minutes. Explain the procedure to the client.

Jog and monitorAn exercise ECG, also known as a stress test, is a noninvasive test that studies the hearts electrical activity and monitors for ischemic events during levels of increasing exercise.

Nursing actions Explain the procedure to the client. Withhold food and fluids for 2 to 4 hours before the test. Instruct the client to wear loose-fitting clothing and supportive shoes. Perform a cardiopulmonary assessment. Tell the client to report chest discomfort, shortness of breath, fatigue, leg cramps, or diz ziness immediately if it occurs during the test.

No fallout hereNuclear cardiology examines the heart using radioisotopes. After I.V. injection of the isotopes, a monitor is used to read images of myocardial perfusion and contractility.

Nursing actionsBefore the procedure Explain the procedure. Make sure that written, informed consent has been obtained. Determine the clients ability to lie still during the procedure.After the procedure Examine the injection site for bleeding.

Cardiac catheterization

is an invasive procedure. Be aware of the complications

that may occur.

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