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Nursing 202 > Assessment of the Cardiovascular System > Flashcards

Assessment of the Cardiovascular System Flashcards

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1
Q

Heart muscle =

A

myocardium

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2
Q

What is the leading cause of death for women?

A

CVD

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3
Q

Each beat of the heart pumps how much?

A

60 mL of blood or 5 L/min

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4
Q

The heart is protected by the

A

pericardium

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5
Q

Right Atrium (RA) receives

A

deoxygenated venous blood

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6
Q

The right ventricle (RV) is

A

muscular pump located behind the sternum that closes the TRICUSPID valve

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7
Q

After blood is reoxygenated in the lungs. it

A

flows freely from the 4 pulmonary veins into the left atrium

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8
Q

When the left ventricle is full, the left atrium

A

contracts, pumping the remaining blood volume into the left ventricle

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9
Q

With systolic contraction, the

A

left ventricle generates enough pressure to close the mitral valve and open the aortic valve

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10
Q

The pressure of blood in the aorta of a young adult averages about

A

100 to 120 mm Hg

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11
Q

Pressure of blood in the RA averages about

A

0 to 5 mm Hg

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12
Q

AV valves do what

A

separate the atria from the ventricles

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13
Q

The tricuspid valve does what

A

separates the RA from the RV

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14
Q

The mitral (bicuspid) valve does what

A

separates the LA from the LV

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15
Q

During systole, the valves close to prevent back flow called

A

valvular regurgitation of blood into the aorta

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16
Q

The semilunar valves are the

A

pulmonic valve and aortic

they prevent blood from flowing back into the ventricles during diastole

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17
Q

The pulmonic valve does what

A

separates the right ventricle from the pulmonary artery

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18
Q

The aortic valve does what

A

separates the left ventricle from the aorta

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19
Q

MAP=

A

60-70 mm Hg

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20
Q

Left main artery divides into two branches:

A

Left anterior descending branch (LAD)

Left circumflex branch (LCX)

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21
Q

The right coronary artery (RCA) originates from

A

the right sinus of Valsalva

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22
Q

Electrophysiologic properties of the heart muscle are responsible for

A

regulating heart rate (HR) and rhythm

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23
Q

Cardiac Output (CO) depends of relationship between

A

HR and SV (Stroke volume)

CO= HR x SV

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24
Q

Cardiac index:

A

can be determined by dividing the CO by the body

normal range: 2.7 to 3.2 L/min/m2

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25
Q

Preload:

A

refers to the degree of the myocardial fiber stretch at the end of diastole and just before contraction

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26
Q

Vascular system purposes:

A
  • Provides a route for blood to travel from the heart to nourish the various tissues of the body
  • Carries cellular wastes to the excretory organs
  • Allows lymphatic flow to the drain tissue fluid back into the circulation
  • Returns blood to the heart for re circulation
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27
Q

Arterial system: By the time blood enters the right atrium, the BP is about

A

0-5 mm Hg

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28
Q

BP=

A

CO x Peripheral Vascular resistance

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29
Q

3 mechanisms mediate and regulate BP

A

Autonomic nervous system (ANS)
Kidneys
Endocrine system

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30
Q

Baroreceptors:

A

arch of the aorta and at the origin of the internal carotid arteries are stimulated when the arterial walls are stretched by an increased BP

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31
Q

Peripheral chemoreceptors:

A

Several 1- to 2- mm collections of tissue have been identified in the carotid arteries and along the aortic arch

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32
Q

The central chemorecptors in the respiratory center of the brain are also stimulated by

A

hypercapnia (increase in CO2)

and acidosis

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33
Q

Stretch receptors are

A

sensitive to pressure or volume changes

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34
Q

The venous system completes

A

the circulation of blood by returning blood from the capillaries to the right side of the heart

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35
Q

Gravity exerts an increase in

A

hydrostatic pressure in the capillaries when the patient is in an upright position, delaying venous return

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36
Q

Cardiovascular changes associate with Aging:

A

loss of cardiac reserve

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37
Q

Record history of smoking in pack-years=

A

number of packs per day multiplied by the number of years the patient has smoked

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38
Q

Obesity is a problem for

A

African American women
Mexican Americans
Native Hawaiians

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39
Q

Cardiovascular changes associate with Aging: Cardiac valves

A

Calcification and mucoid degeneration occur

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40
Q

Cardiovascular changes associate with Aging: Conduction system

A

Pacemaker cells decrease in number
Few muscles fibers remain in the atrial myocardium and bundle of His
Conduction time increases

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41
Q

Cardiovascular changes associate with Aging: Left ventricle

A

Size increases
Becomes stiff and less distensible
Fibrotic changes decrease the speed

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42
Q

Cardiovascular changes associate with Aging: Aorta and Other large arteries

A

Thicken and become stiffer and less distensible
Systolic pressure increases
Systemic vascular resistance increases
Left ventricle pumps greater resistance = ventricular hypertrophy

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43
Q

Cardiovascular changes associate with Aging: Baroreceptors

A

become less sensitive

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44
Q

Note patient’s medical history:

A

Any major illness such as diabetes mellitus, renal disease, anemia, hypertension, bleeding disorders, etc

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45
Q

Social history =

A

information about patient’s living situation, domestic partner, other members, environment, and occupation

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46
Q

Nutritional history=

A

24 hr recall

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47
Q

Family history to indicate

A

genetic risk

48
Q

Current Health problems such as

A

Pain or discomfort: traditional
Dyspnea: both cardiac and pulmonary disease
Dyspnea on exertion (DOE): indicates heart failure
Orthopnea: measured by pillows to provide restful sleep
Paroxysmal nocturnal dyspnea: after hrs of lying down
Fatigue: indicates heart disease in women
Palpitations: feeling of fluttering/irregular heart beat
Sudden increase in weight 1kg=excess fluid
Edema
Syncope: brief loss of consciousness
Near syncope: dizziness w/ inability to remain upright position
Intermittent claudication: mod-severe cramping in legs/buttocks when walking - decreased arterial tissue perfusion

49
Q

Extremity pain may be caused by two conditions:

A

Ischemia from atherosclerosis

Venous insufficiency of the peripheral blood vessels

50
Q

Angina pain:

A

squeezing, viselike pain
Left side of chest w/o radiation
Relieving factors: Rest, nitrate adm, or O2

51
Q

Myocardial infarction pain:

A

Intense stabbing, viselike pain or pressure, severe
May spread throughout anterior chest and to arms, jaw, back, or neck
Relieving factors: morphine, cardiac drugs, O2

52
Q

Pericarditis pain:

A

sharp, stabbing, mod-severe
Spreads to the left side or the back
Relieving factors: sitting upright, analgesia, or adm of antiinflammatory agents

53
Q

Pleuropulmonary pain:

A

moderate ache, worse on inspiration
Lung fields
Relieving factors: rest

54
Q

Esophageal-gastric pain:

A

squeezing, heartburn, variable severity
May spread to shoulders or the abdomen
Relieving factors: Antacid adm, food intake, sitting postition

55
Q

Anxiety pain:

A

dull ache to sharp stabbing, numbness in fingers
Not well located, no radiation
Relieving factors: last few minutes

56
Q

Poor cardiac output and decreased cerebral perfusion may cause

A

confusion, memory loss, and slowed verbal responses, especially in older adults

57
Q

Late signs of severe right-sided heart failure=

A

ascites
jaundice
anasarca (generalized edema) result of prolonged congestion of the liver

58
Q

If there is normal blood flow to a given area in light colored skin=

A

appears pink, rosy, and is warm

59
Q

Decreased perfusion manifested as

A

cold, pale (anemia), and moist skin

60
Q

2 types of cyanosis:

A

Central: arterial blood in the lungs and appears as a bluish tinge of the conjunctivae and the mucous membranes of the mouth and tongue - indicate impaired lung function

Peripheral: when blood flow to the peripheral vessels is decreased by peripheral vasoconstriction

61
Q

Rubor=

A

dusky redness that replaces pallor in a dependent foot suggests arterial insufficiency

62
Q

Clubbing=

A

nail straightens out to an angle of 180 degrees and the base of the nail becomes spongy

63
Q

Paradoxical blood pressure:

A

exaggerated decrease in systolic pressur eby more than 10 mm Hg during the inspiratory phase of the respiratory cycle (normal= 3-10)

64
Q

Difference of systolic and diastolic values is referred to as

A

pulse pressure

65
Q

What can be used to assess the vascular status of the lower extremities

A

Ankle Brachial index (ABI)

66
Q

ABI normal values:

A

1 or higher because BP in the legs is usually higher than in the arms
Values less than 0.8 indicates moderate vascular disease
Less than 0.5 indicate severe vascular compromise

67
Q

What may be performed instead of or in addition to the ABI to determine arterial perfusion in the feet and toes?

A

Toe Brachial pressure index (TBPI)

68
Q

An increase in Jugular venous pressure (JVP) causes

A

Jugular venous distention (JVD)

69
Q

Arterial pulses provide info about

A

vascular integrity and circulation

70
Q

Hypokinetic pulse is a

A

weak pulse indicative of narrow pulse pressure

71
Q

Swishing sounds that may occur from turbulent blood flow in narrowed or atherosclerotic arteries

A

Bruit

72
Q

pulses in the Mitral area (apex) =

A

apical or point of maximal impulse (PMI)

73
Q

Splitting of S2, wider split heard on expiration=

A

paradoxical splitting

74
Q

S3 =

A

ventricular gallop

75
Q

S4 =

A

atrial gallop

76
Q

originates from the pericardial sac and occurs with the movements of the heart during the cardiac cycle=

A

pericardial friction rub

77
Q

Acute myocardial infarction (MI) also known as acute coronary syndrome can be confirmed by

A

abnormally high levels of certain proteins or isoenzymes

Serum studies are refered to as cardiac markers and include troponin, creatine kinase - MB, and myoglobin

78
Q

Troponin is a

A

myocardial muscle protein released into the bloodstream with injury to myocardial muscle

79
Q

Creatine Kinase (CK) =

A

Enzyme specific to cells of the brain, myocardium, and skeletal muscle

80
Q

Myoglobin=

A

low-molecular-weight heme protein found in cardiac and skeletal muscle, is the earliest marker detected, as early as 2 hours after an MI w/ rapid decline after 7 hours

81
Q

Serum lipids =

A

Cholesterol, triglycerides, the protein components of high-density lipoproteins (HDLs) and low density lipoproteins (LDLs) are evaluated to assess the risk for CAD

82
Q

Other lab test= an amino acid that is produced when proteins break down

A

Homocysteine

83
Q

Most studied marker of inflammation =

A

Highly sensitive C-reactive protein (hsCRP)

84
Q

Small amounts of protein in the urine, has been shown to be a clear marker of widespread endothelial dysfunction in cardiovascular disease (along w/ elevated CRP)

A

Microalbuminuria

85
Q

Used when initiating and maintaining therapy w/ oral anticoagulants such as sodium warfarin=

A

PT and INR

86
Q

Assessed in patients who are receiving heparin=

A

PTT

87
Q

Obtained in patients with CVD:

A

ABG

88
Q

RBC count is usually low in

A

rheumatic fever and infective endocarditis

89
Q

Decreased hematocrit and hemoglobin levels caused by

A

hemmorrhage or hemolysis from prosthetic valves

90
Q

An invasive diagnostic procedure that involves fluoroscopy and the use of contrast media =

A

Arteriography

91
Q

Cardiac catherterization studies include

A

studies of the right or left side of the heart and the coronary arteries

92
Q

Common complications of coronary arteriography:

A 
MI
Stroke
Arterial bleeding
Thromboembolism
Lethal dysrhythmias
Arterial dissection
Death
93
Q

What is catheterized first and may be the only side examined?

A

Right side of the heart

94
Q

In a left sided heart catheterization, the cardiologist

A

advances the catheter against the blood flow from the femoral, brachial, or radial artery up the aorta, across the valve and into the left ventricle

95
Q

What is the same technique for left sided catherterization?

A

coronary arteriography

96
Q

An alternative to injecting a medium into the coronary arteries is ____________ which introduces a flexible catheter w/ a miniature transducer at the distal tip to view the coronary arteries

A

Intravascular ultrasonography (IVUS)

97
Q

Follow up care for catheterization

A

HOB up to 30 degrees during period of bed rest

Monitor vitals every 15 min for 1 hr, then every 30 min for 2 hr until vitals are stable, and then every 4 hr

98
Q

An invasive procedure during which programmed electrical stimulation of the heart is used to cause and evaluate lethal dysrhythmias and conduction abnormalities

A

Electrophysiologic study (EPS)

99
Q

What assesses cardiovascular response to an increased workload

A

Exercise electrocardiography

Exercise tolerance or Stress Test

100
Q

Stress test: Patient exercise until one of these findings occur

A

A predetermined HR is reached and maintained
Signs and symptoms of chest pain
Significant ST-segment depression or T wave inversion
20 min protocol is completed

101
Q

Stress test: follow up care

A

avoid a hot shower for 1-2 hours after the test

-may cause hypotension

102
Q

What uses ultrasound waves to assess cardiac structure and mobility, particularly of the valves

A

Echocardiography

103
Q

Prep for Echocardiography

A

inform patient that the test is painless and takes 30-60 min to complete

104
Q

During Echocardiography

A

small transducer lubricated with gel to facilitate movement and conduction is placed on the patient’s chest at the level of the third or fourth intercostal space near the left sternal border

105
Q

Slightly more aggressive Echocardiography is called ________ using either dobitamine or dipyridamole

A

pharmacologic stress echocardiogram

106
Q

Examines cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach

A

Transesophageal Echocardiography (TEE)

107
Q

Studies useful for detecting myocardial infarction (MI) and decreased myocardial blood flow and for evaluating left ventricle ejection
-Cardiovascular abnormalities can be viewed, recorded, and evaluated using radioactive tracer substances

A

Myocardial nuclear perfusion imaging (MNPI)

108
Q

Before a MNPI, advise patient to avoid

A

cigarettes and caffeinated food or drinks for 4 hours before adm of the vasodilator

109
Q

Radioisotopes accumulate in damaged myocardial tissue, which appears as a “hot spot” during the scan

A

Technetium scan

110
Q

During a _________ scan, necrotic or ischemia tissue does not absorb the radioisotope and appears as “cold spots” on the scan

A

Thallium imaging

111
Q

Thallium imaging scan may be performed during

A

an exercise test or w/ patient at rest

112
Q

If patient cannot exercise on a bike or treadmill,

A

dipyridamole or dobutamine hydrochloride is adm to stimulate the effects of exercise

113
Q

Noninvasive test for evaluating cardiac motion and calculating ejection fraction

A

Cardiac blood pool imaging

114
Q

The computer breaks the time between R waves on the ECG into fractions of a second, called “gates”

A

Multigated blood pooling scanning

115
Q

Used to compare cardiac perfusion and metabolic function and differentiate normal from diseased myocardium

A

Positron emission tomography (PET)

116
Q

Another noninvasive diagnostic option, image of the heart or great vessels =

A

MRI

Nursing 202 (20 decks)

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