The central role of the nurse in process improvement relating to pharmacologic stress testingNancy P Coats et al. J Cardiovasc Nurs. 2012 Jul-Aug. Show
AbstractPharmacologic stress myocardial perfusion imaging is a noninvasive method for evaluating coronary artery disease in patients unable to exercise sufficiently to achieve a heart rate high enough to facilitate satisfactory imaging. The nuclear cardiology nurse is an invaluable member of the laboratory team that performs these tests. In this specialist role, the nurse must have a thorough knowledge of the different pharmacologic stress agents (dipyridamole, adenosine, regadenoson, and dobutamine) that can be used. This should comprise an understanding of their mechanisms of action, contraindications, drug-drug interactions, adverse effects, and administration protocols. By drawing on this knowledge, the nurse is able to verify that the right agent has been selected for each patient based on his/her medical history. The nurse also can help patients follow pretest instructions (such as withholding caffeine and certain medications) by explaining that the measures are necessary for a safe and successful procedure and that violation may result in test cancellation or postponement. On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination. Responsibilities include explaining the entire procedure to the patients, notably, what they will be asked to do, the effect of the stress agent, the timing of each step, the adverse effects that they may experience, how any adverse events will be managed, and the importance of remaining still during imaging. This central role of the nuclear cardiology nurse in overseeing the practical aspects of the pharmacologic stress test has important implications in terms of optimizing the productivity and efficiency of their noninvasive cardiology laboratory and nuclear medicine department. Similar articles
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aSymphony Health Solutions, NonRetailSource, January 2021, based on Astellas market definition of pharmacologic stress agents, as used in single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). INDICATION AND IMPORTANT SAFETY INFORMATIONIndicationLexiscan® (regadenoson) injection is a pharmacologic stress agent indicated for radionuclide myocardial perfusion imaging (MPI) in patients unable to undergo adequate exercise stress. IMPORTANT SAFETY INFORMATIONContraindicationsDo not administer Lexiscan to patients with second- or third-degree AV block or sinus node dysfunction unless these patients have a functioning artificial pacemaker. Warnings and PrecautionsMyocardial Ischemia Sinoatrial and Atrioventricular Nodal Block Atrial Fibrillation/Atrial Flutter Hypersensitivity, Including Anaphylaxis Hypotension Hypertension Bronchoconstriction Seizure Cerebrovascular Accident (Stroke) Adverse ReactionsIn clinical trials, the most common adverse reactions (≥5%) to Lexiscan were dyspnea, headache, flushing, chest discomfort, angina pectoris or ST-segment depression, dizziness, chest pain, nausea, abdominal discomfort, dysgeusia, and feeling hot. Most adverse reactions began soon after dosing, and generally resolved within approximately 15 minutes, except for headache, which resolved in most patients within 30 minutes. Aminophylline was used as a reversal agent in 3% of patients. In postmarketing experience, the following additional adverse reactions have occurred: supraventricular tachyarrhythmias, acute coronary syndrome (ACS), tremor, QTc prolongation, abdominal pain in association with nausea, vomiting, or myalgias, diarrhea, fecal incontinence, wheezing and musculoskeletal pain. How would you prepare a patient for an exercise stress test?On the Day of Your Test
For two hours prior to your test: Do not eat or drink. Take your usual medications unless otherwise directed by your physician. Bring all of your medications with you in the original bottles. Wear comfortable clothes and shoes that are suitable for walking on a treadmill.
What is the nurses responsibility during a stress test?On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination.
What should you hold before a stress test?Common Names of Medications to Hold Prior to Stress Testing (Nuclear and Standard Stress). Bisoprolol (Zebeta, Ziac). Metoprolol (Lopressor, Toprol, Lopressor HCT). Nadolol (Corgard, Corzide). Nebivolol (Bystolic). Pindolol (Visken). Propranolol (Inderal, Inderide). Carvedilol (Coreg, Coreg CR). Labetalol (Trandate). What is the protocol for treadmill stress testing?Treadmill protocol
In the standard Bruce protocol, the starting point (ie, stage 1) is 1.7 mph at a 10% grade (5 METs). Stage 2 is 2.5 mph at a 12% grade (7 METs). Stage 3 is 3.4 mph at a 14% grade (9 METs). This protocol includes 3-minute periods to allow achievement of a steady state before workload is increased.
What is the most commonly used protocol for maximal stress testing?The Bruce protocol is the most common one used during treadmill exercise stress testing.
Which is contraindicated for an exercise stress test?Absolute contraindications to cardiac stress testing include acute myocardial infarction (including the presence of new left bundle branch block [LBBB]), high risk unstable angina, symptomatic severe aortic stenosis, uncontrolled arrhythmia causing symptoms or haemodynamic instability, unstable heart failure, acute ...
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Which nursing interventions are appropriate when preparing a client for an exercise stress test?
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