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nursing 105 > Assessment of Cardiac Function- Exam 1 > Flashcards

Assessment of Cardiac Function- Exam 1 Flashcards

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1
Q

3 layers of the heart muscle

A

Endocardium, myocardium, epicardium

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2
Q

4 chambers of the heart

A

R atrium and ventricle, L atrium and ventricle

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3
Q

2 atrioventricular valves

A

tricuspid and mitral

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4
Q

2 semilunar valves

A

aortic and pulmonic

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5
Q

What is the primary pacemaker for the myocardium?

A

sinoatrial node

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6
Q

What is the secondary pacemaker of the heart?

A

atrioventricular node

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7
Q

What kind of cells are the SA and AV node made of?

A

nodal cells

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8
Q

Electrical activation of cell caused by influx of sodium and potassium exits cell

A

depolarization

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9
Q

Return of cell to resting state caused by reentry of K+ into cell while NA+ exits

A

Repolarization

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10
Q

2 types of refractory periods

A

effective/absolute refractory period
relative refractory period

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11
Q

3 parts of a Cardiac Action Potential

A

Depolarization
Repolarization
Refractory Periods

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12
Q

Type of refractory period that describes the phase in which cells are incapable of depolarizing

A

effective/absolute refractory period

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13
Q

Type of refractory period describing the phase in which cells require stronger-than-normal stimulus to depolarize

A

Relative refractory period

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14
Q

Phase 1 of the Cardiac Action Potential Cycle

A

Rapid repolarization

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15
Q

Phase 0 of the Cardiac Action Potential Cycle

A

Rapid depolarization

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16
Q

Phase 3 of the Cardiac Action Potential Cycle

A

Final repolarization

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17
Q

Phase 4 of the Cardiac Action Potential Cycle

A

Resting

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18
Q

Refers to the events that occur in the heart from the beginning of one heartbeat to the next

A

cardiac cycle

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19
Q

The number of cardiac cycles depends on what?

A

heart rate

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20
Q

Each cardiac cycle has what 3 major sequential events?

A

Diastole
Atrial systole
Ventricular systole

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21
Q

Percent of end diastolic volume ejected with each heart beat (L ventricle)

A

ejection fraction

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22
Q

The ejection fraction refers to what chamber of the heart?

A

left ventricle

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23
Q

The amount of blood pumped by ventricle in L/min

A

cardiac output

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24
Q

Equation for Cardiac Output

A

CO = SV x HR

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25
Q

The amount of blood ejected with each heartbeat

A

Stroke volume

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26
Q

The degree of stretch of cardiac muscle fibers at end of diastole

A

Preload

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27
Q

The resistance to ejection of blood from ventricle

A

Aferload

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28
Q

The ability of cardiac muscle to shorten in response to electrical impulse

A

Contractility

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29
Q

3 parts of stroke volume

A

Preload
Afterload
Contractility

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30
Q

What are the influencing factors of cardiac output?

A

Control of heart rate
Control of stroke volume

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31
Q

What systems control heart rate?

A

Autonomic nervous system
Baroreceptors

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32
Q

The Frank-Starling Law refers to controlling what part of the stroke volume?

A

Preload

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33
Q

What specifically affects the control of the afterload?

A

Affected by systemic vascular resistance, pulmonary vascular resistance

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34
Q

Contractility is increased by what?

A

Catecholamines, SNS, and certain medications

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35
Q

Increased contractility results in increased ?

A

stroke volume

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36
Q

Decreased contractility is caused by ?

A

Hypoxemia, acidosis, and certain medications

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37
Q

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

a. the amount of blood ejected with each heartbeat

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38
Q

What information do you want to collect as the nurse assessing the cardiovascular system?

A

-health hx, demos, family/genetic hx, cultural/social factors, risk factors

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39
Q

2 types of risk factors in cardiac health

A

modifiable
nonmodifiable

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40
Q

Common symptoms associated with cardiac health

A

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

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41
Q

What is assessed during the physical assessment portion of the cardiac assessment?
(how many times can you say assess in one sentence?)

A

General appearance
Skin/extremities
Pulses
BP and orthostatic changes
Jugular vein pulses
Heart inspection, palpation, auscultation

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42
Q

Lab tests for cardiac events/health

A

Cardiac biomarkers
Blood chemistry, hematology, coagulation
Lipid profile
BNP
CRP
Homocysteine

43
Q

Describe how to perform a physical cardiac stress test

A

-Pt walks on treadmill with intensity progressing
-Monitor ECG, V/S, symptoms
-Test ends when target HR is achieved

44
Q

How is a pharmacologic stress test performed?

A

Vasodilating agents are given to mimic exercise

45
Q

Diagnostic Radionuclide Imaging Tests

A

Myocardial perfusion imaging
Positron emission tomography
Ventricular function tests
CT
MRA

46
Q

Noninvasive ultrasound test that is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures

A

echocardiography

47
Q

What does an echocardiogram measure?

A

the ejection fraction, size, shape, and motion of cardiac structures

48
Q

2 types of echocardiographys

A

Transthoracic
Transesophageal

49
Q

An invasive procedure used to diagnose structural and functional diseases of the heart and great vessels

A

Cardiac catheterization

50
Q

Type of catheterization that uses pulmonary artery pressure and O2 sats and a possible biopsy of myocardial tissue

A

Right heart catheterization

51
Q

Type of catheterization that involves use of contrast agent

A

Left heart catheterization

52
Q

Nursing interventions for cardiac events

A

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

53
Q

What does hemodynamic monitoring measure?

A

Central venous pressure
Pulmonary artery pressure
Intra-arterial BP monitoring
Minimally invasive CO monitoring

54
Q

Central venous pressure is a measurement of the pressure in which area of the heart?

A

Vena cava or right atrium

55
Q

The pressure in the vena cava, right atrium, and right ventricle is equal at the end of?

A

Diastole

56
Q

Central venous pressure also reflects filling pressure of?

A

The right ventricle (preload)

57
Q

What is the normal central venous pressure range?

A

2-6 mm Hg

58
Q

Decreased blood flow and oxygen to the heart muscle

A

Ischemia

59
Q

Tissue is deprived of oxygen and nutrients causing death of tissue

A

Infarction

60
Q

The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

A

Atherosclerosis

61
Q

What is the most prevalent cardiovascular disease in adults?

A

CAD

62
Q

Clinical manifestations of atherosclerosis are caused by what specifically?

A

myocardial ischemia

63
Q

Symptoms and complications of atherosclerosis are related to what?

A

The location and degree of vessel obstruction

64
Q

What is the most common manifestation of atherosclerosis?

A

Angina pectoris

65
Q

What causes angina?

A

hypoxia

66
Q

Clinical manifestations of atherosclerosis

A

Angina
Epigastric distress
Pain radiating to jaw or left arm
SOB
Atypical symptoms in women
MI
HF
Sudden cardiac death

67
Q

4 Modifiable Risk Factors for CAD

A

Cholesterol abnormalities
Tobacco use
HTN
Diabetes

68
Q

All risk factors for CAD

A

Cholesterol abnormalities
Tobacco use
HTN
Diabetes
Elevated LDL
Metabolic syndrome
hS-CRP elevation

69
Q

How can CAD be prevented?

A

Control cholesterol
Dietary measures
Physical activity
Medications
Cessation of tobacco use
Manage HTN
Control diabetes

70
Q

6 types of lipid-lowering agents

A

Statins
Nicotinic acids
Fibric acids
Bile acid sequestrants
Cholesterol absorption inhibitors
Omega-3 acids

71
Q

The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin. What serum levels should be monitored in this patient?

A

Liver enzymes

72
Q

A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow

A

Angina pectoris

73
Q

How might a patient describe angina pain?

A

Tightness, choking, or a heavy sensation

74
Q

What frequently accompanies the pain of angina?

A

Anxiety

75
Q

Where might anginal pain radiate to?

A

Neck, jaw, shoulders, back or arms

76
Q

What other symptoms, aside from pain, may be seen with angina?

A

Dyspnea
SOB
Dizziness
Nausea
Vomiting

77
Q

If a patient’s chest pain is alleviated with rest, what kind of angina is this?

A

stable angina

78
Q

If a patient’s chest pain is increased in frequency and is not relieved by rest and nitroglycerin, what kind of angina is this?

A

Unstable angina

79
Q

Unstable angina requires what?

A

Medical intervention

80
Q

Gerontologic considerations for angina

A

Diminished pain transition
Teach them to recognize their “chest pain-like” symptoms such as weakness
Pharmacologic stress testing; cardiac cath
Medications and cautions

81
Q

How do we treat angina?

A

Medications
O2
Reduce and control risk factors
Reperfusion therapy if appropriate

82
Q

What does treatment of angina seek to do?

A

Decrease myocardial oxygen demand and increase oxygen supply

83
Q

Meds that can be used for angina

A

Nitroglycerin
Beta blockers
Calcium channel blockers
Antiplatelet and anticoagulants
Aspirin
Clopidogrel and ticlopidine
Heparin
Glycoprotein IIb/IIIa

84
Q

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

A

C - BP of 86/58

85
Q

Emergency situation characterized by an acute onset of myocardial ischemia that results in myocardial death

A

MI

86
Q

What does STEMI stand for?

A

ST elevated MI

87
Q

What does NSTEMI stand for?

A

non-ST elevated MI

88
Q

What information do you want from a patient suffering from angina?

A

Symptoms and activities, especially preceding attacks
Risk factors, lifestyles, health promotion activities, medications, allergies
Pt and family knowledge
Adherence to care plan

89
Q

What other cardiac problems may a patient with angina experience?

A

ACS or MI or both
Arrhythmias
Cardiac arrest
HF
Cardiogenic shock

90
Q

What outcome goals are there for patients with angina?

A

Immediate and appropriate treatment
Prevention of angina
Reduction of anxiety
Aware of disease process
Understanding and adherence to care plan
Absence of complications

91
Q

Interventions for angina

A

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

92
Q

What does a MAP of <60 mean?

A

Decreased perfusion

93
Q

Interventions to reduce anxiety during angina

A

Calm manner
Stress reduction
Education
Address spiritual needs any other pt or family needs

94
Q

Interventions for preventing angina pain

A

Identify level of activity that causes symptoms
Plan activities accordingly
Alternate activities with rest periods
Education

95
Q

What education should the nurse provide their patient with angina?

A

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

96
Q

Symptoms of acute coronary syndrome

A

Sudden chest pain despite rest and meds
SOB
Indigestion
Nausea
Anxiety
Cool, pale skin
Increased HR and BP
ECG changes

97
Q

What ECG changes can be seen with an ACS?

A

Elevation in the ST segment in two contiguous leads

98
Q

Other health problems often seen with ACS

A

Acute pulmonary edema
HF
Cardiogenic shock
Arrhythmias and cardiac arrest
Pericardial effusion and cardiac tamponade

99
Q

Outcome goals for a patient with ACS

A

Relief of pain or ischemia
Prevent of myocardial damage
Maintenance of effective perfusion
Reduce anxiety
Adherence to care plans
Early recognition of symptoms

100
Q

How quickly does the patient need to be at the cath lab after an MI?

A

90 min

101
Q

Interventions for ACS

A

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

102
Q

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

A

D. compression devices

103
Q

4 invasive coronary artery procedures

A

Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery stent
Coronary artery bypass graft (CABG)
Cardiac surgery

104
Q

What veins are commonly used for bypass graft procedures?

A

Iliofemoral, great and small saphenous, and intact communicating veins

nursing 105 (11 decks)

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