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2 Minute EBP Challenge

Friday, March 12, 2010
Lessening Stroke Risk in Hypertension
Less variability in systolic blood pressure is associated with better outcomes in stroke risk from hypertension.  Which medication leads to less systolic variability?

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

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Home > 2 Minute EBP Challenge > BNP and Respiratory Distress

BNP and Respiratory Distress

Monday, November 16, 2009

Stay up-to-date the easy way!

How would you answer this question?

Ms. Leslie has a Brain-Natiuretic Peptide (BNP) level of 1273 picograms/mL, as her nurse you should suspect:

a. Acute ischemic stroke
b. Acute renal failure
c. Heart failure
d. Hip fracture

The correct answer is "c" heart failure.

Brain-Natiuretic Peptide (BNP) is a protein produced by the heart in response to stretching of the ventricular wall.  Through a variety of mechanisms, BNP improves cardiac function by decreasing fluid overload on the heart.  The level of BNP measured in the blood can alert nurses to the extent of heart failure that exists.  Elevated BNP levels can also help nurses to differentiate between cardiac and noncardiac conditions that cause respiratory distress such as COPD and pulmonary edema.

For most patients a BNP level of >100 pg/mL is considered to be elevated and indicative of acute heart failure.  However, a study by Rogers, et al. recommended using the following cutoff levels in specific patient populations:
>184 pg/mL in patients >75 years of age
>150 pg/mL in patients with atrial fibrillation
>449 pg/mL in patients with an elevated creatinine (>2 mg/dL)
>25 pg/mL in obese patients with a BMI >35 kg/m2

In the question above Ms. Leslie has a BNP level of 1273 which is clearly elevated and would indicate heart failure.  This information would be useful if Ms. Leslie had a complicated symptom presentation, such as what often occurs in patients with multiple cardiac and pulmonary medical conditions.

From: Rogers, R.K., et al. (2009). Usefulness of adjusting for clinical covariates to improve the ability of B-type natiuretic peptide to distinguish cardiac from noncardiac dyspnea.  Am. J Cardiol, 104:689.

Congratulations to Patricia Mullins who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Patricia!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

Today's question comes from our brand new PCCN Success program.

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