Microsoft word - dobu instructions.doc

NAME: ___________________________________________________________________ DATE: (_______)_____________________TIME: ________________________[ ]AM [ ]PM You are scheduled for a Dobutamine Nuclear Stress Test. This test will be performed at: [___] 1202 S. Cedar Crest Blvd., Jaindl Family Pavilion, Suite 500, Allentown, PA. 18106 / (610) 770-2200 [___] 858 Interchange Road, Lehighton, PA. 18235/ (610) 377-9303 THIS TEST WILL TAKE ANYWHERE FROM 4-6 HOURS (Bring a book to read or something else to help pass the time.) SPECIFIC INSTRUCTIONS FOR YOUR TEST INCLUDE THE FOLLOWING: 1. MEALS: A. Eat a light meal prior to arriving at the office *Cereal, toast, fruit, etc. * Milk, juice, and water are okay anytime prior to the test – please drink plenty of fluids to aid in starting your IV line. * Dialysis patients: Please limit fluid intake to 8 oz prior to arrival at our office. B. NO CAFFEINE, DECAF, CHOCOLATE, OR CARBONATED BEVERAGES 24 HOURS PRIOR TO THE TEST! This includes coffee and tea (regular or decaf), soft drinks such as colas or Mountain Dew, chocolate, cocoa, and over the counter medications containing caffeine. (Anacin, Excedrin). 2. SMOKING: Nicotine raises the blood pressure and the heart rate. DO NOT SMOKE for at least 2 hours prior to the test. 3. ATTIRE: Wear loose fitting, lightweight clothes, short sleeve if possible. Please wear comfortable shoes or sneakers. Women should wear slacks or shorts; gowns will be provided. You may change clothes here. 4. MEDICATIONS: No beta-blockers (see list below) for 24 hours prior to the test, however, please bring your beta-blocker with you to the office to take after the stress portion of your test is complete: - Atenolol (Tenormin) - Bisoprolol (Zebeta/Ziac) - Carvediolol (Coreg) - Labetalol (Normodyne) - Metoprolol Succinate (Toprol XL) - Metroprolol Tartrate (Lopressor) - Nadolol (Corgard) - Propranolol (inderal) Have a list of all current medications and dosed you are currently taking for this appointment. YOUR MEDICATION INSTRUCTIONS ARE: ________________________________________________________ __________________________________________________________________________________________ 5. INSULIN: Take 1/2 dose of insulin in the morning; please eat a light, low fat breakfast If you use an insulin pump – no special instructions Oral diabetes medications – take as usual 6. INHALERS: May continue to use Serevent and Albuterol inhalers and/or steroid inhalers. Bring your inhaler. 7. SKIN: When showering/bathing on the day of the stress test, DO NOT use any body lotions, powders, or oils on chest area as this interferes with the skin preparation. Underarm deodorant is permitted. 8. INSURANCE: If your insurance requires precertification, please let us know so we can obtain the necessary clearance for you to have this test done. If you have insurance that requires a referral form for this test, (such as HMO) it is YOUR responsibility to obtain this referral form prior to the test from your primary care physician. 9. QUESTIONS OR CANCELLATIONS: If you need to cancel this appointment, it is extremely important to notify us at least 24 hours prior to this appointment as the dose of Nuclear Medicine is ordered specifically for you. Please make every effort to notify us to cancel this appointment so there are no extra costs to you. If the patient requires special assistance, or has a language barrier, please have a family member or friend over the age of 18 accompany and stay with the patient for the entire duration of the test. ***************************************************************************************** PURPOSE OF THE TEST: This heart scan is a closely monitored test to evaluate the ability of the coronary arteries to provide your heart muscle with blood. 1. When you arrive in our office, please register with the receptionist. Bring your insurance card; we will verify your coverage and update our files. If your primary care physician referred you, please bring your prescription for your test. If a referral form was necessary from your primary care physician, please give this to the receptionist. You may also be asked to complete a patient information form and a history & physical form. 2. A diagnostic staff member will escort you to the testing area. Your medical history will be reviewed. 3. A diagnostic staff member will start an intravenous line. The nuclear technologist will inject the Sestamibi/Cardiolite. This medicine attaches to the red blood cells, tracing the blood flow to your heart muscle. 4. After the injection, you will wait in the waiting room for approximately 1 hour while the medicine circulates. Then 5. In the nuclear scanning room, you will lie on a table and place your arms above your head. The scan lasts 6. After the scan, you will be brought into a stress room where a diagnostic staff member will place electrodes on your chest to monitor your heart rate and rhythm while you receive the Dobutamine. 7. Dobutamine increases heart rate and blood pressure, mimicking the body’s response to exercise. Sestamibi/Cardiolite will be given again when your heart rate reaches a certain point. The Dobutamine is stopped and your heart rate and blood pressure are monitored as they return to pre-test levels. 8. After the Dobutamine infusion, you will wait about 60 minutes before your second scan; this scan will take approximately 15 minutes. Smoking is not allowed until after the second scan. 9. You are now ready to check out with our receptionist. If another appointment is necessary, it will be scheduled at IF YOU ARE OF CHILD BEARING AGE AND SUSPECT YOU COULD BE PREGNANT, PLEASE NOTIFY US IMMEDIATELY. **Preferably before arriving for the test SPECIAL INSTRUCTIONS: _____________________________________________________________________________ FOLLOW-UP APPOINTMENT FOR RESULTS: ________________________________________________________

Source: http://www.heartcaregroup.com/ForPatients/PatientForms/DobuInstructions.pdf