00:00
An MRA is a magnetic resonance angiogram.
00:05
So it's a type
of magnetic resonance imaging or MRI.
00:08
Okay, so let's talk
about what an MRA is.
00:12
Now, notice, there's a different vowel
at the end of that,
that's because an MRA can be done
with the same machine as an MRI.
00:19
It uses a magnetic field
and pulses of radio wave energy
to provide pictures of the blood vessels
inside the body.
00:26
So your patient is going to go
to the same place for an MRA,
but it's a little bit different
than an MRI.
00:33
Now we're going to get
some great pictures
to look at that blood supply.
00:37
So an MRA of the head is done
to look at the blood vessels
leading to the brain.
00:41
Now what they're going to be looking for
is they look for a bulge,
that could be an aneurysm.
00:45
they'll look for a clot
or even a narrowing
because from stenosis,
because of plaque.
00:50
So, essentially,
it's the same kind of concept.
00:53
When we're checking out
the blood supply for the heart,
we're looking for similar things.
00:57
We also want a good blood supply
to the brain.
01:00
That's why the MRA can show us
about clots, aneurysm, stenotic areas,
because of plaque.
01:07
So, the patient will lie on the table
and the table moves
into the MRI machine.
01:13
Now, remember,
we're doing an MRA,
but it's in the same MRI machine.
01:18
The test usually is completed
in about 30 to 60 minutes.
01:21
Now here's a side note,
your patient may not know
they're claustrophobic
until they get inside the tube.
01:28
So, that's a question
you definitely want to ask your patient
before they go down for a test:
an MRA or an MRI.
01:34
Because sometimes this can be
really traumatic for the patient
and you may need to request
the healthcare provider
to probably order something,
it could help the patient
relax a little bit.
01:43
The problem is going to be
if it's a neurological test
we're not gonna want to sedate them
because we want to keep an eye
on any neural symptoms.
01:51
So, it may be something you have
to help your patient work through
without the use of any medications.
01:57
A CTA is a CAT scan angiogram.
02:01
So it's computed tomography,
that's what CT stands for,
and we just say CAT,
but a CTA
is a computed tomography angiogram
So this test uses X-rays
and it gives us a really detailed picture
of the heart and the blood vessels.
02:15
So we can look at the blood vessels
that go to the heart, the lung,
brain, kidneys, head,
neck, legs, and arms.
02:22
Yeah. So we listed everything out.
02:25
What will show you,
it'll just tell us detailed pictures
of the blood supply
just about everywhere.
02:30
The test is non-invasive,
so that's super cool,
but it does involve dye,
and that's what I want
to talk to you about.
02:38
When we say dye,
it's called contrast media.
02:40
Now the patient
will receive it in their IV,
so the vessels
are easier to scan.
02:45
So that's a good thing.
02:46
But some people have
some real problems with the dye.
02:49
Now if you've ever had this dye in,
sometimes it makes you feel really warm.
02:53
So usually the person
who's administering the test or the dye
will let the patient know,
"This might make you feel
a little weird at first,"
but as long as the patient expects it,
they're usually okay.
03:04
But if the patient is taking
a medication called metformin,
now this is a very commonly
prescribed medication, oral medication,
that controls blood sugar.
03:15
So type 2 diabetics take metformin.
03:18
Women with PCOS,
polycystic ovarian syndrome,
take metformin.
03:23
So it's meant to control
their blood sugar.
03:26
The problem is metformin
cannot be in the system
when someone receives
this type of dye
or it could be really lethal
to their kidneys.
03:35
So you always want to ask a patient
before they receive dye
if they're taking metformin, specifically.
03:41
So you ask them
if they're taking that medication.
03:43
If they are, you need to postpone
the test for a couple days
because you want to have
one- to two-day window
in between the last time
they took the metformin and the test.
03:53
And then, after the test,
you want another one- to two-day window
depending on the patient
before they start taking metformin again.
04:01
So they're going to have to work
with the healthcare provider
to decide how he can best
provide glucose,
blood glucose control
during that time
when it's not best
for that patient's kidneys
to receive their metformin.
04:13
Also, any renal patient,
anybody whose kidneys are struggling,
if they're getting dye,
we need to monitor them very closely.
04:21
We want to make sure
you do kidney labs
before you take them down for the test
when they receive the dye
to see what the status
of their kidneys are.
04:27
You want to make sure
they get lots of fluids,
maybe IV fluids and oral fluids,
and you want to watch
their renal numbers after the exam.
04:35
A transcranial Doppler
is another non-invasive test.
04:39
Whoo-hoo!
Patients don't mind this
because they don't hurt.
04:43
It's painless
and it's a neural vascular ultrasound
that uses high-frequency
sound waves.
04:49
So think about when a woman
has an ultrasound,
you can do an ultrasound of the heart,
ultrasound of a baby.
04:54
This is a transcranial Doppler.
04:57
So, it measures the rate
in the direction of blood flow
inside the arteries
of the circle of Willis
Look at this graphic.
I think this is pretty cool.
05:06
You can see you've got a graphic
of the transcranial Doppler
right there on the skull
and you see inside the skull--
Now you and I both know
there's more in your head than that.
05:15
But we've highlighted
the circle of Willis in red
just to remind you
about that critically important
blood supply in your brain.
05:23
Now transducers are placed
on the patient's skin at the temples,
and at the base of the skull,
at the back of the neck,
or on the closed eyelids.
05:32
Now TCD can be done
and helped diagnose a TIA,
a stroke which we also call a CVA,
a cerebrovascular accident,
or a subarachnoid hemorrhage.
05:43
Okay, so we're talking
about a lot of tests here.
05:47
Why does this matter?
Because these are widely used tests.
05:51
As a nurse, you need to anticipate
what type of testing
might be done for your patient.
05:55
You need to understand
what the test is like
as you can help prepare your patient.
05:59
You need to know which tests are done
and what they can rule out.