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Med Surg 1 > 26 > Flashcards

26 Flashcards

1
Q
A
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2
Q

what is the weight and size of the heart influenced by?

A

age gender body weight physical exercise heart disease

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3
Q

3 layers of the heart

A

endocardium myocardium epicardium

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4
Q

Blood flow through the heart

A

superior/inferior vena cave > R atrium > tricuspid valve > R ventricle > pulmonic valve > L pulmonary artery > Lungs > pulmonary veins > L atrium > mitral valve > L ventricle > aortic valve > aorta> Body https://www.khanacademy.org/science/health-and-medicine/human-anatomy-and-physiology/heart-introduction/v/flow-through-the-heart

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5
Q

Diastole

A

all chambers relax allowing ventricles to fill in preparation for contraction

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6
Q

systole

A

atrial and ventricular contraction

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7
Q

oxygenated vs. deoxygenated blood

A

deoxygenated blood from the R side of the heart is distributed to the lungs for oxygenation then oxygenated blood is returned to the L side of the heart

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8
Q

the pulsation, known as point of maximal impulse, created during normal ventricular contraction is _______ ________

A

apical impulse

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9
Q

_____ ______ is inadequate O2 supply

A

myocardial ischemia

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10
Q

_____ _____ ____ generates and transmits electrical impulses that stimulate contraction of the myocardium

A

cardiac conduction system

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11
Q

the conduction system stimulates the atria then ventricles. this allow ventricles to fill completely before ejection which maximizes _______ ______

A

cardiac output

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12
Q

electrical cells (nodal and purkinje cells) responsible for the electrical impulse of the atria and ventricle work by _________, _________, __________

A

automaticity excitability conductivity

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13
Q

_______ is the ability to initiate an electrical impulse

A

automaticity

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14
Q

_______ is the ability to respond to an electrical impulse

A

excitability

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15
Q

_______ is the ability to transmit an electrical impulse from one cell to another

A

conductivity

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16
Q

what is known as the primary pacemaker of the heart?

A

SA node

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17
Q

_____ _____ are responsible for supplying arterial blood to the heart

A

coronary arteries

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18
Q

electrical activation of a cell caused by influx of Na+ into the cell while K+ exits the cell is known as ___________

A

depolarization

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19
Q

____ ____ ___ is a rupture of an atheromatous plaque in a diseased coronary artery

A

acute coronary syndrome

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20
Q

return of cell to resting state caused by re-entry of K+ into the cell while Na+ exits is known as ____________

A

repolarization

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21
Q

phases of cardiac action potential

A

phase 0- rapid depolarization of atrial and ventricular myocytes, Na+ moves out of cell through fast channels, cells of SA/AV node depolarize when Ca+ enters cell through slow channels phase 1- early repolarization as K+ exit cell phase 2- plateau phase, repolarization slows down, Ca+ enters

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22
Q

phases of cardiac action potential

A

phase 3- return of resting state, completion of repolarization phase 4- resting phase before next depolarization

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23
Q

_____ ______ is the time which myocardial cells must completely repolarize before they depolarize again

A

refractory period

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24
Q

_____ refractory period is when the cell is unresponsive to any stimulus and incapable of depolarizing. related to phase 0 - middle of phase 3

A

effective

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25
Q

if a electrical stimulus is stronger than normal than _______ refractory period occurs and the cell may depolarize prematurely.

A

relative

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26
Q

early depolarization of the atrium or ventricular cause premature contractions and place the person at risk for ____________

A

dysrhythmias

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27
Q

______ ______ rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the sinus node and travels through the normal conduction pathway

A

normal sinus (Legaspi said to know this, not sure if it is on test but its located in Ch 27)

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28
Q

Characteristics of normal sinus

A

ventricular/atrial rate: 60-100 ventricular/atrial rhythm: regular QRS shape and duration: normal or regularly abnormal P wave: normal and consistent shape, always in front of QRS PR interval: consistent interval b/w 0.12 and 0.20 seconds P: QRS ratio 1:1

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29
Q

______ ________ rapid irregular twitching of the muscular wall of the atria. common in ppl with hypertension/diabetes/structural heart disease/sleep apnea etc

A

atrial fibrillation

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30
Q

_______ ________ is disorganized rhythm that causes quivering of the ventricles. commonly caused by CAD and acute MI and there is no atrial activity seen on the ECG

A

ventricular fibrillation

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31
Q

3 or more premature ventricular complexes in a row more than 100 bpm result in a pt being unresponsive and pulseless. this is known as _______ ________

A

ventricular tachycardia

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32
Q

if a pt has absent cardiac activity with no heartbeat/pulse/ or respirations. this is known as _________ and can be fatal.

A

asystole

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33
Q

blood flows from an area of high pressure to low pressure and this is known as _______ _________. pressures responsible for blood flow in the normal circulation are generated during systole and diastole

A

cardiac hemodynamics

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34
Q

pumping action of the heart including systole and diastole is known as the ______ ________ and it occurs from one heart beat to the next

A

cardiac cycle https://www.youtube.com/watch?v=5tUWOF6wEnk

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35
Q

_____ _____ is the amount of blood pumped by each ventricle during a given period. the average is about 5 L/min in a resting adult

A

cardiac output

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36
Q

what can have an effect on cardiac output?

A

stroke volume or heart rate

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37
Q

cardiac output = stoke volume x heart rate

A

CO = SV x HR

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38
Q

the amount of blood ejected per heart beat is ____ _____

A

stroke volume

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39
Q

what is the average resting SV and HR

A

70 ml and 60-80 bpm

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40
Q

changes in HR are affected by reflex controls of the ______ nervous system, ______ nervous system, and ________ activity

A

central/ autonomic/ baroreceptor

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41
Q

_______ impulses slow the HR and _______ impulses increase the HR

A

parasympathetic/ sympathetic

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42
Q

how does the sympathetic nervous system increase the HR

A

by increased level of catecholamines and excess thyroid hormone which produces a catecholamine like effect

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43
Q

_______ specialized nerved cellls located in the aortic arch and in right and left carotid arteries

A

baroreceptors

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44
Q

during _________ baroreceptors increase their rate of discharge and transmit impulses to the medulla. this initiates parasympathetic activity and inhibits sympathetic activitylowering the BP and HR

A

hypertension

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45
Q

_______ results in less baroreceptor activity, decreases in paraysmpathetic activity and increased sympathetic activity resulting in vasoconstriction and increased HR and BP

A

hypotension

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46
Q

what determines stroke volume?

A

preload afterload contractility

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47
Q

_____ is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. the colume of blood returning to the heart increases resulting in stronger contraction and greater stroke volume

A

preload

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48
Q

what is preload commonly referred to?

A

left ventricular end diastolic pressure b/c the volume of blood w/in the ventricle at the end of diastole determines preload and directly affects stroke volume

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49
Q

The Frank Starling law (related to preload)

A

the greater the initial length or stretch of the cardiac muscle cells the greater the degree of shortening that occurs

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50
Q

what factors reduce preload?

A

diuresis nitrates excessive loss of blood dehydration

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51
Q

how can you control preload?

A

IV blood transfusion

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52
Q

______ is resistance to ejection of blood from the ventricle, also determines stroke volume

A

afterload

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53
Q

systemic vascular resistance?

A

resistance of systemic BP to left ventricular ejection

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54
Q

pulmonary vascular resistance?

A

resistance of pulmonary BP to right ventricular ejection

55
Q

_____ force generated by the contracting myocardium

A

contractility

56
Q

what enhances contractility?

A

circulating catecholamines, sympathetic neuronal activity, and meds (digoxin, dopamine?

57
Q

what depresses contractility?

A

hypoxemia, acidosis, meds (beta blockers)

58
Q

_____ ______ is the percent of end diastolic blood volume ejected with each heart beat and is used to measure myocrdial contractility.

A

ejection fraction

59
Q

ejection fraction less than 40% indicates the patient has _______ left ventricular function and should be treated for heart failure

A

decreased

60
Q

barriers to seeking cardiovascular care

A

lack of knowledge about symptoms of heart disease symptoms belonging to a benign source denying symptoms significance embarrassment of symptoms

61
Q

nurse duty during health history for cardiac system

A

nurse needs to determine if pt. and family are able to recognize symptoms of acute cardiac problems (ACS/HF)

62
Q

common s/s of CVD

A

CHEST PAIN or discomfort SOB or dyspnea peripheral edema weight gain sbdominal distention palpitations vital fatigue/exhuastion dizziness syncope altered LOC

63
Q

cadiac assessment

A

health history family/genetic history cultural/social factors risk factors (weight, diet, genes, ethnicity) ABC’s and OLDCART

64
Q

prodromal symptoms of ACS

A

symptoms: fatigue SOB sleep disturbances anxiety chest discomfort

65
Q

what are common restriction of diets for people with cardiac problems?

A

low sodium, fat, cholesterol, and calories

66
Q

why is noocturia (awake @ night to urinate) common in patients with HF?

A

fluid collected in the extremities during the day (edema) redistribute into the circulatory system once the pt. is recumbent at night. the increased circulatory volume is excreted by the kidneys resulting in increased urine production.

67
Q

pts. taking meds that affect blood are screened for _____ _____ or _______

A

bloody urine or stools

68
Q

which nonprescription med is commonly taken once a day that improves CAD?

A

aspirin

69
Q

which sleep and rest patterns indicate worsening HF?

A

sleeping upright tin chair instead of bed increased number of pillows used awakening w/ SOB at night or awakening w/ angina

70
Q

what are findings to consider in a physical cardiac assessment?

A

LOC mental status SOB distress size of pt skin color, temp, texture BP

71
Q

common skin findings associated with cardiac disease

A

pallor peripheral cyanosis central cyanosis ecchymosis xanthelasma thinning of skin arround pacemaker or ICD cold/cool and moist skin

72
Q

________ yellowish spots or plaques along nasal portion or eye lids

A

xanthelasma

73
Q

_________ is a bruise on the skin

A

ecchymosis

74
Q

pulse pressure = systole / diastole

A

pulse pressure = systole / diastole less than 30 mm Hg needs to be further assessed

75
Q

postural (orthostatic) hypotension

A

BP decrease when pt goes from sitting to standing

76
Q

normal postural responses

A

increase HR of 5-20 bpm above the resting rate unchanged systolic pressure or slight decrease of up to 10 mm Hg slight increase of 5 mm Hg in diastolic pressure

77
Q

_________ _______ is when the pulse rate is increased during inhalation and slow during exhalation

A

sinus arrhythmia

78
Q

what do you do if the pulse rhythm is irregular?

A

auscultate apical pulse for a full minute while palpating the radial pulse at the same time

79
Q

pulse deficit

A

difference between apical and radial pulse

80
Q

when do pulse deficits commonly occur?

A

A fib Atrial flutter premature ventricular contractions heart block

81
Q

pulse rating scale

A

0: pulse not palpable or absent 1: weak thready, difficult to palpate, disappear w/ pressure 2: diminished pulse, does not disappear (obliterate) 3: easy to palpate, full pulse, does not obliterate 4: strong bounding pulse, may be abnormal

82
Q

S1 first heart sound

A

tricuspid and mitral valve closure “lub” heard loudest over apical area

83
Q

S2 second heart sound

A

closure of pulmonic and aortic valve “dub” loudest over aortic and pulmonic areas

84
Q

when you can distg=inguish between the closure of aortic and pulmonic valves it is known as ____ ___

A

split S2

85
Q

S3

A

early is diastole lub dub DUB normal in children and adults 35-40

86
Q

S4

A

late in diastole LUB lub dub

87
Q

____ ____ is when all 4 heart sound occur together resulting in LUb lub dub DUB

A

summation gallop

88
Q

normally there is no sound when valves open. but diseased valves create a sound call ____ ____ which is abnormal diastolic sounds heard during the opening of the AV valve

A

opening snaps

89
Q

____ ____ is the opening of of a rigid and calcified aortic or pulmonic valve during ventricular contraction

A

systolic click

90
Q

created by turbulent flow of blood _____ are described by their timing in the cardiac cycle, location on chest wall, intensity, pitch, quality, pattern of radiation

A

murmurs

91
Q

a harsh grating sound that can be heard in systole and diastole is called ____ ____. it is caused by abrasion of the inflammed pericardial surfaces from pericarditis

A

friction rub

92
Q

which positive test helps confirm the diagnosis of HF

A

hepatojugular reflux test

93
Q

Lab test for cardiac system

A

cardiac biomarkers CK, CK-MB myoglobin troponon T and I lipid profile Brain (B type) natriuretic peptide C- creactive protein homocysteine

94
Q

What information does a lipid profile provide?

A

a persons risk for artherosclerosis or to diagnose a specific lipoprotein abnormality

95
Q

when should the blood specimen for a lip profile be obtained?

A

after a 12 hour fast

96
Q

what is the normal cholesterol level

A

less than 200 mg/dl

97
Q

normal levels of LDL

A

less than 160 mg/dl

98
Q

LDL levels for people with CAD or diabetes

A

less than 70 mg/dl

99
Q

normal range for HDL

A

men = 35-70 mg/dl women = 35-85 mg/dl

100
Q

normal range of triglycerides

A

100-200 mg/dl

101
Q

brain ( b type) natriuretic peptide (BNP) is a neurohormone that helps regulate ___ and ___ ____. it is primarily secreted from the ventricles in response to increase preload and increased ventricular pressure. this test is helpful in diagnosis HF

A

BP and fluid volume

102
Q

BNP greater than ______ pg/ml suggest HF

A

100

103
Q

How is homocysteine levels linked to the development of atherosclerosis?

A

because it can damage the endothelial lining of arteries and promote thrombus formation

104
Q

____ ____ is used to determine the size, contour, and position of the heart. it reveals cardiac and pericardial calcification, demonstrate physiologic alterations in the pulmonary circulatio, and confirms placement of pacemakers and pulmonary artery catheters

A

chest x ray

105
Q

_________ is an x ray technique allowing visualization of heart on a screen and uses a moveable x ray source

A

flluoroscopy

106
Q

a graphic representation of the electrical currents of the heart is done with a _____. disposable electrodes are placed on the skin of the chest wall and extremities

A

ECG

107
Q

ECG recordings can be obtained by using _____. these are specific views of the electrical activity of the heart.

A

leads

108
Q

__ ____ ____ is used to diagnose dysrhythmias, conduction abnormalities, chamber enlargment, and myocardial ischmia, injury, or infarction.

A

12 lead ECG

109
Q

___ ___ ___ adds 3 additional chest leads across the right precordium and is used for early diagnosis of right ventricular and left posterior infarction

A

15 lead ECG

110
Q

___ __ ___ adds 3 posterior leads to the 15 lead and is used for early detection of myocardial ischemia and injury

A

18 lead ECG

111
Q

pts who are at high risk for dysrhythmias require ____ ___ ____ which detects abnormalities in the heart rate and rhythm

A

continuous ECG monitoring

112
Q

2 types of continuous ECG monitoring

A

hardware cardiac monitoring telemetry

113
Q

does continuous ECG monitoring detect SOB, chest pain, or other ACS symptoms?

A

no so pts must report new or worsening symptoms immediately

114
Q

what is the benefit of using telemetry ECG monitoring?

A

the system is wireless so pts can ambulate while one or two ECG leads are monitored

115
Q

3 lead system vs 4 lead system vs 5 lead system

A

3 lead provides 3 options and 4 lead provides 6 options and 5 lead provides 7 options

116
Q

what two leads are most often selected for continuous ECG monitoring

A

leads II and V1

117
Q

applying electrodes

A

clean skin with soap and water clip hair (do not shave) if needed apply benzoin if pt is sweaty but not where the electrode is placed connect electrodes to wire prior to placing them on the chest make sure center of electrode has gell apply electrode with pressure change electrodes ever 24-48 hrs

118
Q

_____ electrocardiography is used during outpatient and pt. wears it for 24 hours and keeps a diary noting the time and symptoms occurs

A

ambulatory

119
Q

______ monitoring is ECG monitoring where the pts is home and placesa telephone mouthpiece over the transmitter box

A

transtelephonic

120
Q

wireless mobile cardiac monitoring can monitor a pt ____ ____ ______

A

24 hours 7 days a week

121
Q

____ ____ ___ is a non invasive way of evaluating the response of the cardiovascular system to stress

A

cardiac stress test

122
Q

what does the cardiac stress test help determine?

A

CAD cause of chest pain functional capacity of heart after MI or heart surgery effectiveness of meds dysrhythmias during exercise goals for physcial fitness program

123
Q

how long should a pt fast before a stress test

A

4 hours before

124
Q

_________ is a ultrasound test used to measure ejection fraction and examine the size/shape/motion of the cardiac structures

A

echocardigraphy

125
Q

__________ echocardiography requires threading a small transducer through the mouth and into the esophagus

A

transesophageal

126
Q

______ __________ is an invasive procedure which catheters are introduced into blood vessels of the heart to measure pressure and O2 sat

A

cardiac catheterization

127
Q

assessment prior to cardiac catheterization

A

allergies (specifically to iodine) blood work (hematocrit, HG, BUN, creatinine, INR, PT, aPTT, platelet count, electrolytes)

128
Q

how long do outpatients have to be on bed rest after cardiac catheterization before they can ambulate?

A

2-6 hours

129
Q

______ is a technique which a contrast agent is injected into the vascular system to outline the heart and blood vessels

A

angiography

130
Q

Assessment for a pt post procedure of cardiac catheter

A

Circulation Potential for bleeding and dysrhythmias Activity restrictions b/c of bleeding

131
Q

_________ is a measurement of the pressure in the vena cava or R atrium or preload

A

Central venous pressure monitoring (CVP)

132
Q

What is the most common problem that cause elevated CVP?

A

Hypervolemia or R sided HF

133
Q

____ ____ pressure monitoring is used in critical care for assessing left ventricular function, diagnosing shock and evaluating the pts response to medical interventions

A

pulmonary artery

134
Q

___________ blood pressuring monitoring is used to obtain direct and continuous BP measurements in critcally ill pts who have severe hypertension or hypotension

A

intra-arterial

Med Surg 1 (5 decks)

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