Assessment of Cardiac Function- Exam 1 Flashcards
3 layers of the heart muscle
Endocardium, myocardium, epicardium
4 chambers of the heart
R atrium and ventricle, L atrium and ventricle
2 atrioventricular valves
tricuspid and mitral
2 semilunar valves
aortic and pulmonic
What is the primary pacemaker for the myocardium?
sinoatrial node
What is the secondary pacemaker of the heart?
atrioventricular node
What kind of cells are the SA and AV node made of?
nodal cells
Electrical activation of cell caused by influx of sodium and potassium exits cell
depolarization
Return of cell to resting state caused by reentry of K+ into cell while NA+ exits
Repolarization
2 types of refractory periods
effective/absolute refractory period
relative refractory period
3 parts of a Cardiac Action Potential
Depolarization
Repolarization
Refractory Periods
Type of refractory period that describes the phase in which cells are incapable of depolarizing
effective/absolute refractory period
Type of refractory period describing the phase in which cells require stronger-than-normal stimulus to depolarize
Relative refractory period
Phase 1 of the Cardiac Action Potential Cycle
Rapid repolarization
Phase 0 of the Cardiac Action Potential Cycle
Rapid depolarization
Phase 3 of the Cardiac Action Potential Cycle
Final repolarization
Phase 4 of the Cardiac Action Potential Cycle
Resting
Refers to the events that occur in the heart from the beginning of one heartbeat to the next
cardiac cycle
The number of cardiac cycles depends on what?
heart rate
Each cardiac cycle has what 3 major sequential events?
Diastole
Atrial systole
Ventricular systole
Percent of end diastolic volume ejected with each heart beat (L ventricle)
ejection fraction
The ejection fraction refers to what chamber of the heart?
left ventricle
The amount of blood pumped by ventricle in L/min
cardiac output
Equation for Cardiac Output
CO = SV x HR
The amount of blood ejected with each heartbeat
Stroke volume
The degree of stretch of cardiac muscle fibers at end of diastole
Preload
The resistance to ejection of blood from ventricle
Aferload
The ability of cardiac muscle to shorten in response to electrical impulse
Contractility
3 parts of stroke volume
Preload
Afterload
Contractility
What are the influencing factors of cardiac output?
Control of heart rate
Control of stroke volume
What systems control heart rate?
Autonomic nervous system
Baroreceptors
The Frank-Starling Law refers to controlling what part of the stroke volume?
Preload
What specifically affects the control of the afterload?
Affected by systemic vascular resistance, pulmonary vascular resistance
Contractility is increased by what?
Catecholamines, SNS, and certain medications
Increased contractility results in increased ?
stroke volume
Decreased contractility is caused by ?
Hypoxemia, acidosis, and certain medications
Which of the following best defines stroke volume?
a. the amount blood ejected with each heartbeat
b. amount of blood pumped by the ventricle in liters per min
c. degree of stretch of the cardiac muscle fibers at the end of diastole
d. ability of the cardiac muscle to shorten in response to an electrical impulse
a. the amount of blood ejected with each heartbeat
What information do you want to collect as the nurse assessing the cardiovascular system?
-health hx, demos, family/genetic hx, cultural/social factors, risk factors
2 types of risk factors in cardiac health
modifiable
nonmodifiable
Common symptoms associated with cardiac health
Chest pain/discomfort
Pain/discomfort in other areas of the body
SOB/dyspnea
Peripheral edema
Weight gain
Abdominal distention
Palpitations
Unusual fatigue
Dizziness
Syncope
Change in LOC
What is assessed during the physical assessment portion of the cardiac assessment?
(how many times can you say assess in one sentence?)
General appearance
Skin/extremities
Pulses
BP and orthostatic changes
Jugular vein pulses
Heart inspection, palpation, auscultation
Lab tests for cardiac events/health
Cardiac biomarkers
Blood chemistry, hematology, coagulation
Lipid profile
BNP
CRP
Homocysteine
Describe how to perform a physical cardiac stress test
-Pt walks on treadmill with intensity progressing
-Monitor ECG, V/S, symptoms
-Test ends when target HR is achieved
How is a pharmacologic stress test performed?
Vasodilating agents are given to mimic exercise
Diagnostic Radionuclide Imaging Tests
Myocardial perfusion imaging
Positron emission tomography
Ventricular function tests
CT
MRA
Noninvasive ultrasound test that is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures
echocardiography
What does an echocardiogram measure?
the ejection fraction, size, shape, and motion of cardiac structures
2 types of echocardiographys
Transthoracic
Transesophageal
An invasive procedure used to diagnose structural and functional diseases of the heart and great vessels
Cardiac catheterization
Type of catheterization that uses pulmonary artery pressure and O2 sats and a possible biopsy of myocardial tissue
Right heart catheterization
Type of catheterization that involves use of contrast agent
Left heart catheterization
Nursing interventions for cardiac events
Observe cath site bleeding, hematoma
Assess pulses
Eval temp, color, cap refill
Screen for arrhythmias
Maintain bed rest of 2-6 hrs
Instruct pt to report chest pain, bleeding
Monitor for contrast-induced nephropathy
Ensure pt safety
What does hemodynamic monitoring measure?
Central venous pressure
Pulmonary artery pressure
Intra-arterial BP monitoring
Minimally invasive CO monitoring
Central venous pressure is a measurement of the pressure in which area of the heart?
Vena cava or right atrium
The pressure in the vena cava, right atrium, and right ventricle is equal at the end of?
Diastole
Central venous pressure also reflects filling pressure of?
The right ventricle (preload)
What is the normal central venous pressure range?
2-6 mm Hg
Decreased blood flow and oxygen to the heart muscle
Ischemia
Tissue is deprived of oxygen and nutrients causing death of tissue
Infarction
The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
Atherosclerosis
What is the most prevalent cardiovascular disease in adults?
CAD
Clinical manifestations of atherosclerosis are caused by what specifically?
myocardial ischemia
Symptoms and complications of atherosclerosis are related to what?
The location and degree of vessel obstruction
What is the most common manifestation of atherosclerosis?
Angina pectoris
What causes angina?
hypoxia
Clinical manifestations of atherosclerosis
Angina
Epigastric distress
Pain radiating to jaw or left arm
SOB
Atypical symptoms in women
MI
HF
Sudden cardiac death
4 Modifiable Risk Factors for CAD
Cholesterol abnormalities
Tobacco use
HTN
Diabetes
All risk factors for CAD
Cholesterol abnormalities
Tobacco use
HTN
Diabetes
Elevated LDL
Metabolic syndrome
hS-CRP elevation
How can CAD be prevented?
Control cholesterol
Dietary measures
Physical activity
Medications
Cessation of tobacco use
Manage HTN
Control diabetes
6 types of lipid-lowering agents
Statins
Nicotinic acids
Fibric acids
Bile acid sequestrants
Cholesterol absorption inhibitors
Omega-3 acids
The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin. What serum levels should be monitored in this patient?
Liver enzymes
A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
Angina pectoris
How might a patient describe angina pain?
Tightness, choking, or a heavy sensation
What frequently accompanies the pain of angina?
Anxiety
Where might anginal pain radiate to?
Neck, jaw, shoulders, back or arms
What other symptoms, aside from pain, may be seen with angina?
Dyspnea
SOB
Dizziness
Nausea
Vomiting
If a patient’s chest pain is alleviated with rest, what kind of angina is this?
stable angina
If a patient’s chest pain is increased in frequency and is not relieved by rest and nitroglycerin, what kind of angina is this?
Unstable angina
Unstable angina requires what?
Medical intervention
Gerontologic considerations for angina
Diminished pain transition
Teach them to recognize their “chest pain-like” symptoms such as weakness
Pharmacologic stress testing; cardiac cath
Medications and cautions
How do we treat angina?
Medications
O2
Reduce and control risk factors
Reperfusion therapy if appropriate
What does treatment of angina seek to do?
Decrease myocardial oxygen demand and increase oxygen supply
Meds that can be used for angina
Nitroglycerin
Beta blockers
Calcium channel blockers
Antiplatelet and anticoagulants
Aspirin
Clopidogrel and ticlopidine
Heparin
Glycoprotein IIb/IIIa
The nurse is caring for a pt who has severe chest pain after working outside on a hot day and is brought to the ED. The nurse administers nitroglycerin to help alleviate chest pain. Which side effect should concern the nurse the most?
a. Dry mucous membranes
b. HR of 88 bpm
c. BP of 86/58 mm Hg
d. Complaint of headache
C - BP of 86/58
Emergency situation characterized by an acute onset of myocardial ischemia that results in myocardial death
MI
What does STEMI stand for?
ST elevated MI
What does NSTEMI stand for?
non-ST elevated MI
What information do you want from a patient suffering from angina?
Symptoms and activities, especially preceding attacks
Risk factors, lifestyles, health promotion activities, medications, allergies
Pt and family knowledge
Adherence to care plan
What other cardiac problems may a patient with angina experience?
ACS or MI or both
Arrhythmias
Cardiac arrest
HF
Cardiogenic shock
What outcome goals are there for patients with angina?
Immediate and appropriate treatment
Prevention of angina
Reduction of anxiety
Aware of disease process
Understanding and adherence to care plan
Absence of complications
Interventions for angina
Decide priority treatment
Stop all activities and rest in semi-Fowlers
Administer oxygen 2L/min by nasal cannula
Assess pt - ECG, VS, resp distress, pain
Admin medications
Reassess pain and BP
What does a MAP of <60 mean?
Decreased perfusion
Interventions to reduce anxiety during angina
Calm manner
Stress reduction
Education
Address spiritual needs any other pt or family needs
Interventions for preventing angina pain
Identify level of activity that causes symptoms
Plan activities accordingly
Alternate activities with rest periods
Education
What education should the nurse provide their patient with angina?
Balance activity with rest
Follow prescribed exercise regimen
Avoid exercise in extreme temps
Emotional support resources
Avoid OTC meds that increase HR or BP before asking doctor
Stop smoking
Diet in low fat and high fiber
Carry NTG everywhere - how to take
Recognizing symptoms and when to call 911
BP and glucose control
Symptoms of acute coronary syndrome
Sudden chest pain despite rest and meds
SOB
Indigestion
Nausea
Anxiety
Cool, pale skin
Increased HR and BP
ECG changes
What ECG changes can be seen with an ACS?
Elevation in the ST segment in two contiguous leads
Other health problems often seen with ACS
Acute pulmonary edema
HF
Cardiogenic shock
Arrhythmias and cardiac arrest
Pericardial effusion and cardiac tamponade
Outcome goals for a patient with ACS
Relief of pain or ischemia
Prevent of myocardial damage
Maintenance of effective perfusion
Reduce anxiety
Adherence to care plans
Early recognition of symptoms
How quickly does the patient need to be at the cath lab after an MI?
90 min
Interventions for ACS
O2 and meds
Frequent VS assessment
Rest in bed in semi-Fowlers
Pain relief to decrease workload on heart
Monitor I & O and perfusion
Frequent position changes to prevent resp complications
Report changes in condition
Evaluate interventions
The nurse is caring for a pt after cardiac surgery. Which nursing intervention is appropriate to help prevent complications arising from venous stasis?
a. encourage crossing of legs
b. use pillows in the popliteal space to elevate the knees in bed
c. discourage exercising
d. apply sequential pneumatic compression devices
D. compression devices
4 invasive coronary artery procedures
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery stent
Coronary artery bypass graft (CABG)
Cardiac surgery
What veins are commonly used for bypass graft procedures?
Iliofemoral, great and small saphenous, and intact communicating veins
