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Nursing: 201 > Cardiac 32 > Flashcards

Cardiac 32 Flashcards

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0
Q

Fibroserous sac around heart

A

Pericardium

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1
Q

Layers of the heart

A

Endocardium
Myocardium
Epicardium

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2
Q

Amount of pericardial fluid between layers of the heart that prevents friction between the surfaces as the heart contracts

A

10 to 15mL

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3
Q

Path of blood flow through the heart

A

Inferior and superior venae cavae ➡️ right atrium ➡️ right ventricle ➡️ lungs by pulmonary artery ➡️ returned left atrium by pulmonary vein ➡️ left ventricle ➡️ aorta ➡️ systemic circulation

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4
Q

Valve between the right atrium and right ventricle

A

Tricuspid valve

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5
Q

Valve between right ventricle and pulmonary artery

A

Pulmonary valve

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6
Q

Blood flows from the lungs to the left atrium via

A

Pulmonary veins

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7
Q

Valve between left atrium and left ventricle

A

Mitral valve

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8
Q

Valve from left ventricle into the aorta

A

Aortic valve

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9
Q

What does the P wave mean?

A

Depolarization of the atria

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10
Q

What does the QRS complex represent?

A

Depolarization of the ventricles

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11
Q

What does the T wave represent?

A

Repolarization of the ventricles

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12
Q

What does the U wave represent (if present)?

A

Repolization of the Purkinje fibers or maybe associated with hypokalemia

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14
Q

What do the intervals between the waves (PR, QRS, and QT intervals) reflect?

A

the time it takes an impulse to travel from one area of the heart to another

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15
Q

the electrical impulse is initiated by what?

A

the SA node (aka pacemaker of the heart)

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16
Q

Electrical impulse travels from the atria to the AV node via?

A

intermodal pathways

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17
Q

From the AV node, where does the electrical impulse travel?

A

through the bundle His and the left and right bundle branches

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18
Q

what are the two fascicles of the left bundle brach?

A

anterior and posterior

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19
Q

What do Purkinje fibers do?

A

diffuse the electrical impuse through both ventricles

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20
Q

what is the climax of the cardiac cycle?

A

ejection of blood into the pulmonary and systemic circulations

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21
Q

how does the conduction system “end”?

A

the repolarization- when the contractile fiber cells and conduction pathway cells regain their polarized condition

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22
Q

depolarization triggers ___________?

A

mechanical activity

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23
Q

define systole

A

contraction of myocardium which results in ejection of blood from the ventricles

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24
Q

define diastole

A

relaxation of myocardium, allowing for filling of ventricles

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25
Q

define cardiac output

A

the amount of blood pumped by each ventricle in 1 minute

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26
Q

how is cardiac output calculated?

A

stroke volume times heart rate

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27
Q

what is the range for “normal” CO

A

4 to 8 L/min

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28
Q

define stroke volume?

A

the amount of blood ejected from the ventricle with each heartbeat

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29
Q

how is Cardiac index calculated?

A

Cardiac output divided by BSA

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30
Q

what is the normal CI (Cardiac index) range?

A

2.8 to 4.2 L per minute per meter squared

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31
Q

define preload

A

the volume of blood in the venricles at the ends of the distole, before the next contraction

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32
Q

define afterload

A

the peripheral resistance against which the left ventricle must pump

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33
Q

define cardiac reserve

A

the ability of the cardiovascular system to respond to the demands created by health and illness by altering CO threefold or fourfold

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34
Q

What does preload determine?

A

preload determines the amount of stretch placed on myocardial fibers

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35
Q

what affects afterload?

A

size of the ventricle, wall tension and aterial blood pressure

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36
Q

what regulates heart rate?

A

autonomic nervous system

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37
Q

name factors effecting Stroke volume

A

preload, contractility, and afterload

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38
Q

heart rate can increase to what rate for short periods of time without harmful effects?

A

180 beats/minute

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39
Q

increasing of the workload of the myocardium does what?

A

increases the oxygen demand

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40
Q

name the three types major blood vessels

A

arteries, veins, capillaries

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41
Q

what do arteries do?

A

carry blood away from the heart and except for the pulmonary artery, carry oxygenated blood

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42
Q

what do veins do?

A

carry blood towards the heart and except for the pulmonary vein, carry deoxygenated blood

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43
Q

name the order of blood vessels starting from the left side of the heart

A

arteries, arterioles, capillaries, venules and veins then back to the right side of the heart

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44
Q

large arteries are composed of?

A

elastic tissue and some smooth muscle

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45
Q

why is elastic tissue important in arteries?

A

cushions the impact of pressure created by ventricular contraction and preovides recoil that propels blood forward into the circulation

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46
Q

examples of large arteries include?

A

aorta and pulmonary artery

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47
Q

describe arterioles compaired to arteries

A

less elastic tissue and more smooth muscle

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48
Q

what controls arterial blood pressure and distribution of blood flow?

A

arterioles

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49
Q

name two conditions that cause arterioles that cause dilation or constriction

A

low oxygen or increased CO2

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50
Q

what is the inner most lining of the artery called

A

endothelium

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51
Q

what does endothelium do?

A

maintains hemostatsis, promote blood flow, and under normal conditions inhibit blood coagulation

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52
Q

describe a capillary

A

thin wall, no elastic or muscle tissue, where exchange of nutrients and metabolic end producs take place

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53
Q

describe a vein

A

large diameter thin walled vesses that return blood to the right atrium

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54
Q

describe the venous system

A

low pressure, high volume system

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55
Q

what type of valves do large veins have

A

semilunar

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56
Q

what are semilunar valves for?

A

to help maintain blood flow toard the heart and prevent backward flow

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57
Q

the amount of blood in the venous system is affected by

A

arterial flow, compression of veins by skeletal muscle, alterations in thoracic and abdominal pressures and right atrial pressure

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58
Q

largest veins

A

superior vena cava and inferior vena cava

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59
Q

superior vena cava

A

returns blood to the heart from the head, neck, and arms

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60
Q

inferior vena cava

A

returns blood from the lower part of the body

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61
Q

what affects veins

A

the pressure in the right side of the heart

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62
Q

a resistance to blood flow may result in

A

distended neck veins or liver engorgement

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63
Q

venules are

A

relatively small vessels made up of small muscle and connective tissue

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64
Q

the autonomic nervous system consists of

A

the sympathetic nervous system and the parasympathetic nervous system

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65
Q

stimulation of the sympathetic nervous system

A

increases HR, the speed of impulse conduction through the AV node, and force of atrial and ventricular contractions

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66
Q

what sites on the heart mediate the stimulation of the sympathetic nervous system

A

beta adrenergic receptors

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67
Q

beta adregergic receptors are affected by

A

norepi and epi

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68
Q

parasympathetic system is mediated by

A

vagus nerve

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69
Q

parasympathetic stystem stimulation causes

A

decrease in HR, by slowing SA node rate thus conduction through AV node

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70
Q

the source of nerual control of blood vessels is

A

the sympathetic nervous system

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71
Q

where are alpha 1 adrenergic receptors located?

A

vascular smooth muscles

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72
Q

stimulation of alpha 1 adrengeric receptors cause

A

vasoconstriction

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73
Q

decreased stimulation of alpha 1 adregneric receptors cause

A

vasodilation

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74
Q

blood vessels in skeletal muscle do not receive parasympathetic input because

A

parasympathetic nerves have selective distrubtion in blood vessels

75
Q

baroreceptors are found in

A

the aortic arch and carotid sinus (at the origin of the carotid artery)

76
Q

what do baroreceptors do?

A

sensitive to stretch or pressure within the arterial system

77
Q

what does stimulation of baroreceptors do

A

send information to vasomotor center in the brainstem which temporary inhibits sympathetic nervous system and ehances the parasympathetic

78
Q

decreased arterial pressure causes

A

increased HR and peripheral vasoconstriction

79
Q

increased arterial pressure causes

A

decreased HR and peripheral vasodilation

80
Q

chemoreceptors are located

A

in the aorta and carotid bodies

81
Q

what do chemoreceptors do?

A

initiate changes in HR and arterial pressure in response to increased arterial CO2 pressure and (to a lesser degree) decreased arterial O2 pressure and decreased pH

82
Q

when chemoreceptor reflexes are stimulated, they also stimulate

A

the vasomotor center to increase cardiac activty

83
Q

define aterial BP (aka BP)

A

measure of pressure exerted by blood against the walls of the arterial system

84
Q

SBP

A

peak pressure exerted against arteries when heart contracts

85
Q

DBP

A

residual pressure in the arterial system during ventricular relaxation (or filling)

86
Q

two main factors influencing BP

A

CO and SVR (systemic vascular resistance)

87
Q

Systemic vasuclar resistance

A

is the force opposing the movement of blood (created in small arteries and arteriols)

88
Q

Normal BP

A

SBP <80

89
Q

invasive BP meausrement

A

catheter into an artery, attached to a transducer

90
Q

noninvasive BP measurement

A

sphygmomanometer and stethoscope. Use brachial artery

91
Q

pulse pressure

A

difference between SBP and DBP (normally approx 1/3 of SBP)

92
Q

what causes an increase of pulse pressure?

A

during exericise or individuals with atherosclerosis of larger arteries

93
Q

what causes a decrease of pulse pressure?

A

heart failure or hypovolemia

94
Q

MAP - mean arterial pressure

A

average pressure within the arterial system, remember diastole is longer than systole at normal HRs

95
Q

equation for MAP

A

(SBP+2DBP)/3

96
Q

greatest risk for cardiovascular dz

A

age

97
Q

leading cause of death of adults older than 85

A

cardiovascular dz

98
Q

most common cardiovascular dz

A

coronary artery dz secondary to atherosclerosis

99
Q

Age related difference in assessment findings for kyphosis

A

altered chest landmarks for palpation, percussion and ausculation, distant heart sounds

100
Q

Age related difference in assessment findings for myocardial hypertrophy

A

decreased cardiac reserve, heart failure

101
Q

Age related difference in assessment findings for downward displacement of heart

A

difficulty in isolating apical pulse

102
Q

Age related difference in assessment findings for decreased CO, HR, SV in response to stress or exercise

A

slowed, decreased response to exercise and stress, slowed recovery from activity

103
Q

Age related difference in assessment findings for cellular aging and fibrosis of conduction system

A

decreased amplitude of QRS complex and slight lengthening of PR, QRS, and QT intervals, irregular cardiac rhythms, decreased maximal HR, decreased HR variability

104
Q

Age related difference in assessment findings for valvular regidity from calcification, sclerosis, or fibrosis, impending complete closure of valves

A

systolic murmor, possible w/o indication of Cardiovascular pathology

105
Q

Age related difference in assessment findings for arterial stiffening caused by loss of elastin in arterial walls, thickening of intim of arteries and progressive fibrosis of media

A

increase in SBP and possible increase or decrease of DBP, widened pulse pressure, diminshed pedial pulses, increase intermittent claudication

106
Q

Age related difference in assessment findings for venous tortuosity increased

A

inflamed, painful, or cordlike caricositie, dependent edema

107
Q

age related change at the SA node

A

number of pacemaker cells decrease

108
Q

orthostatic hypertension (how common and why?)

A

more than 30% of patients over 70 with systolic HTN, maybe related to meds or decreased baroreceptor function

109
Q

age related change regarding autonomic nervous system control

A

number and function of B-adrenergic receptors in heart decrease

110
Q

postprandial hypotension is

A

decrease in BP of at least 20mmHg that occurs 75 minutes after eating

111
Q

Past medical history related to cardiovascular

A

ask patient about hx of chest pain, SOB, fatigue, alcoholism and tobacco use, anemia, rhematic fever, strept throat, congential heart dz, stroke, palpations, dizziness, syncope, HTN, thrombophlembitis, intermittent claudication, varicosities and edema

112
Q

major cardiovascular risk factors

A

elevated serum lipid, HTN, tobacco use, sedientary lifestyle, obesity

113
Q

what is a necessary question prior to any cardiac cath

A

any allergy to selfish (iodine dye)

114
Q

ADR: anticancer drugs- daunorubicin/doxorubicin

A

dysrthythmias, cardiomyopathy

115
Q

ADR: antipsych- chlorpromazine/haloperidol

A

dysrthythmias, orthostatic hypotension

116
Q

ADR: corticosteroids- cortisone/prednisone

A

hypotension, edema, K+ depletion

117
Q

ADR: herbal supplements: ma haung

A

HTN, tachycardia, palpitations, angina

118
Q

ADR: HRT/OCP: estrogen+progestin

A

MI, thromboembolism, stroke, HTN

119
Q

ADR: NSAIDs

A

HTN, MI, stroke

120
Q

ADR: psychostimulants- cocaine, amphetamines

A

tachycardia, angina, MI, HTN, dysrhythmias

121
Q

ADR: tricyclic antidepressants- amitiriptyline, doxepin

A

dysrthythmias, orthostatic hypotension

122
Q

Normal orthostatic bp (change) and HR

A

20mmHg drop from sitting to standing in BP, no more than 20 beats per minute from sitting to standing

123
Q

Edema in extremities may be caused by

A

Gravity, interruption of venous return, right sided heart failure

124
Q

What is a thrill?

A

Palpable vibration of a blood vessel

125
Q

What is a bruit?

A

The buzzing or humming caused by abnormal blood flow

126
Q

What causes distended neck veins?

A

Elevated right atrial pressure, right sided heart failure

127
Q

Possible cause of central cyanosis

A

Inadequate O2 sat of arterial blood due to pulmonary or cardiac disorders

128
Q

Possible cause of peripheral cyanosis

A

Reduced blood flow because of heart failure, vasoconstriction, cold environment

129
Q

Possible cause of splinter hemorrhages (small red to black streaks under fingernails)

A

Infective endocarditis

130
Q

Possible causes of clubbing of nail beds

A

Endocarditis, congenital defects, prolonged O2 deficiency

131
Q

What causes ulcers?

A

Poor venous return, varicose veins, incompetent venous

132
Q

possible causes for bounding pulse

A

hyperkinetic state, anemia, hyperthyroid

133
Q

possible causes for thready pulses

A

blood loss, decreased CO, aortic valve dz, peripheral arterial dz

134
Q

possible causes for irregular pulses

A

cardiac dysrhythmias

135
Q

possible causes for pulsus alternans

A

heart failure, cardiac tamponade

136
Q

possible causes for absent pulse

A

atherosclerosis, trauma, embolus

137
Q

possible causes for a thrill

A

aneurysm, aortic regurgitation, arteriovenous fistula

138
Q

possible causes for for venous rigidity

A

atherosclerosis

139
Q

possible causes for tachycardia

A

exercise, anxiety, shocck, need for increased CO, hyperthyroidism

140
Q

possible causes for bradycardia

A

rest/sleep, SA or AV node damage, athletic conditioning, side effect of drug, hypothyroidism

141
Q

possible causes for displaced point of maximal impulse

A

left ventricular dilation

142
Q

possible causes for unusually warm extremities

A

possible thyrotoxicosis

143
Q

possible causes for cold extremities

A

intermittent claudication, peripheral arterial obstruction, low CO, severe anemia

144
Q

possible causes for pitting edema

A

interruption of venous return to the heart, fluid in tissues

145
Q

possible causes for abnormal cap refill

A

possibly reduced arterial capillary perfusion, anemia

146
Q

possible causes for asymmetry in limb circumference

A

VTE, varicose veins, lymphedema

147
Q

possible causes for abnormal cardiac borders

A

cardiac enlargement due to coronary heart dz, heart failure, cardiomyopathy

148
Q

possible causes for pulse deficit

A

cardiac dysrhythmias, most commonly a fib

149
Q

possible causes for arterial bruit

A

arterial obstruction or aneurysm

150
Q

possible causes for a third heart sound

A

left ventricular failure, volume overload, mitral, aortic or tricuspid regurgitation, HTN (possible)

151
Q

possible causes for a forth heart sound

A

foreceful atrial contraction from resistance to ventricular filling

152
Q

possible causes for cardiac murmurs

A

cardiac valve disorders, abnormal blood flow patterns

153
Q

possible causes for pericardial friction rub

A

pericarditis

154
Q

description of CK-MB

A

cardiospecific isozyme that is released in the presence of myocardial tissue injury

155
Q

normal results for CK-MB

A

less than 4%-6% of total CK

156
Q

Nursing teaching for CK-MB

A

explain to the patient the purpose of serial sampling (every 6-8 hr x3) in conjunction with serial ECGs

157
Q

description of troponin (cardiac)

A

contractile proteins that are released following an MI, both troponin T and troponin I are highly specific to cardiac tissue

158
Q

normal interval for Troponin I

A

less than 0.5ng/mL

159
Q

normal interval for Troponin T

A

less than 0.1 ng/mL

160
Q

nursing teaching for Troponin

A

rapid point of care assays are available. Serial sampling often done in conjuction with CK-MB and ECGs

161
Q

description for myoglobin

A

low molecular weight protein that is 99%-100 sensitive for myocardial injury.

162
Q

how long for serum myoglobin concentration to rise following MI

A

30-60 minutes

163
Q

normal results for myoglobin

A

15.2-91.2 mcg/L (male), 11.1-to 57.5 mcg/L (female)

164
Q

nursing teaching for myoglobin

A

cleared from the circulation rapidly and most diagnostic if measured within first 12 hours of onset of chest pain

165
Q

description of C-reactive protein

A

marker of inflammation that can predict the risk of cardiac dz and cardiac events even in patients with normal lipid values

166
Q

Risk level and value for CRP

A

c-reactive protein lowest risk less than 1mg/L, moderate risk 1-3 mg/L, high risk above 3 mg/L

167
Q

nursing teaching for CRP

A

stable levels that can be measured nonfasting and anytime during the day. May be more predictive risk factor of cardiac dz than LDL in women

168
Q

description of homocysteine

A

aminio acid produced during protein catabolism that has been identified as a risk factor for cardiovascular dz. May cause damange to endothelium or have a role in formation of thrombi

169
Q

normal values for homocysteine

A

male: 5.2 to 12.9 micromol/L, female: 3.7 to 10.4 micromol/L

170
Q

nursing teaching for homocysteine

A

hyperhomocysteinemia resulting from dietary deficiencies is treated with folic acid, vit B6, and vit B12 supplements

171
Q

describe serum lipid: cholesterol

A

blood lipid, elevated cholesterol is considered a risk factor for atherosclerotic heart dz

172
Q

nursing teaching for cholesterol

A

cholesterol levles can be obtained in a nonfasting state

173
Q

describe serum lipid: triglycerides

A

triglycerides are mixtures of fatty acids. Elevation are assocated with cardiovascular dz and diabetes

174
Q

triglycerides reference intervals

A

less than 150mg/dL

175
Q

nursing teaching for triglycerides

A

must be obtained fasting (at least 12 hours) and alcohol should be withheld for 24 hours before testing

176
Q

HDL reference value

A

male above 40mg/dL, female above 50 mg/dL- above 60 low risk for CAD, below 40 high risk CAD

177
Q

LDL reference value

A

less than 100mg/dL optimal, near optimal 100-129mg/dL, moderate risk for CAD: 130-159 mg/dL, high risk for CAD: above 160 mg/dL

178
Q

nursing responsibility for lipoproteins

A

risk for cardiac dz is assessed by dividing the total cholesterol levels by the HDL level and obtaining a ratio. Low risk, less than 3, average 3-5, high above 5

179
Q

description of chest x ray

A

x ray where two upright positions to examine the lung fields and size of the heart

180
Q

nursing responsibility regarding chest x ray

A

inquire about frequency of x ray and possible pregnancy. Provide lead shielding, remove any metal that block the view

181
Q

ECG

A

monitor and record cardiac electrical activity from different views. Can detect rhythm of the heart, activity, of pacemake, conduction abnormalities, position of heart, size of atria and ventricles, presence of injury and hx of MI

182
Q

ECG nursing responsibility

A

prepare skin, apply electrodes and leads. Inform patient of there should be no discomfort. Instruct not to move

183
Q

holter monitor teaching

A

tell patient that no bath or shower can be taken during monitoring and skin irriration may develop from electrodes. Keep a diary of activites and symptoms

184
Q

Th auscultatory area in the left midclavicular line at the level of the fifth ICS is the

A

Mitral area

Nursing: 201 (6 decks)

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