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NUR 201 Week 5 > Cardiac Assessment > Flashcards

Cardiac Assessment Flashcards

1
Q

The right atrium receives venous blood from the inferior & superior vena cavae and the coronary sinus

Blood then passes through tricuspid valve into right ventricle

W/each contraction, right ventricle pumps blood through the pulmonic valve into the pulmonary artery & to the lungs

A

Blood flows from the lungs to the left atrium by way of pulmonary veins

Then passes through the mitral valve & into left ventricle

As heart contracts, blood is ejected through the aortic valve into the aorta and thus enters systemic circulation

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2
Q

A visual representation of the cardiac cycle

A

Cardiac Valves

  1. Tricuspid valve
  2. Mitral valve
  3. Pulmonic valve
  4. Aortic valve
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3
Q

Cusps of mitral & tricuspid valves are attached to thin strands of fibrous tissue termed chordae tendineae

Chordae are anchored in the papillary muscles of the ventricles

This support system prevents eversion of the leaflets into the atria during ventricular contraction

A

Pulmonic & aortic valves (also known as semilunar valves) prevent blood from regurgitating into the ventricles @ end of each ventricular contraction

! Perfusion (heart ↔ blood ↔ vessels ↔ lungs)

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4
Q

Patient History - Risk Factors

  • Smoking, obesity
    > Excess weight (around abdomen?)
  • HTN, diabetes
    > Kidney failure?
  • Hyperlipidemia
  • Age/gender/EO
    > Occupation
  • Postmenopausal
    > Post-meno are 2-3x more likely than pre-meno to have CVD
A
  • Family history
    > Domestic partner; other household members; environment; support/support system(s)
  • Psychosocial
    > Psychological stress?
  • Modifiable vs non-modifiable risk factors
  • Specifics of smoking history
    > Age at start; duration of habit; # cigs/day
  • A pos fhx for CAD in a first-deg relative is a major risk factor that’s more significant than other factors like HTN, obesity, DM, or sudden cardiac death
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5
Q

Cardiovascular System Assessment

  • Current health problems
  • Pain, discomfort
  • Dyspnea, DOE, orthopnea, PND
  • Fatigue
  • Palpitations
  • Edema
  • Syncope
  • Extremity pain
A
  • General appearance
  • Skin/temp, color
    > Skin color can reflect perfusion and if there’s adequate cardiac output (CO); why assessing radial & pedal pulses matters
  • Cyanosis, rubor extremities
  • Clubbing, edema
  • BP
  • Hypotension & HTN (if BP too low, CO will be low)
  • Postural (orthostatic) hypotension
  • Presence or absence of JVD
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6
Q

?

Anatomically, this is the area of the anterior chest wall over the heart

A

Precordium

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7
Q

Precordium - Assessment

  • Inspection (is the chest uneven or misshapen)
  • Palpation (to see what you feel; shouldn’t elicit pain)
  • Percussion (normally a dull sound)
  • Auscultation
    > Normal heart sounds vs abnormal
    > Gallops & murmurs
    > Pericardial friction rub
A
  • Precordial CP can be an indication of a variety of illnesses like costochondritis & viral pericarditis (vs cardiac CP)
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8
Q

Gerontological Consideration

  • Age alters the cardiovascular response to physical & emotional stress
  • Heart valves become thick & stiff
  • Frequent need for pacemakers
  • Increase in SBP; decrease or no change in DBP
A
  • With increased age, the amt of collagen in heart increases & elastin decreases
  • These changes affect the contractile and distensible properties of the myocardium
  • 1 of the major age-associated alterations in cardiovascular response to physical or emotional stress is a decrease in CO & SV caused by decreased contractility & HR response to increased stress
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9
Q

Cardiac valves become thicker & stiffer from lipid accumulation, degeneration of collagen, & fibrosis

__ and __ valves are most frequently affected

A

Aortic, mitral

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10
Q
  • # of pacemaker cells in SA node dec w/age
  • # & function of beta-adrenergic receptors in heart dec w/age (therefore, older adult has dec response to physical & emotional stress)
A
  • Arterial & venous blood vessels thicken & become less elastic w/age
    > Arteries inc their sensitivity to vasopressin (ADH); both these changes add to a progressive dec or no change in DBP w/age

HTN guidelines:
Ppl >60 systolic over 150 is considered HTN as opposed to under 60 which is >140 systolic

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11
Q

Serum Markers of Myocardial Damage

  • Troponin: Troponin T and troponin I
  • Creatine kinase (CK)
  • Myoglobin
  • Serum lipids
  • Homocysteine
  • Highly sensitive CRP
A
  • Troponin T & I are the most used labs to indicate whether or not someone has had a heart attack; are most heart-specific
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12
Q

Lab Assessment

  • Microalbuminuria
  • Coagulation studies (PT/INR/PTT)
  • ABG
  • Fluids & electrolytes (F&E)
  • Erythrocyte count
  • H&H
  • Leukocyte count
A

Diagnostic Assessment

  • PA & lateral CXR
  • Angiography
  • Arteriography
  • Cardiac catheterization
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13
Q

Cardiac Catheterization

  • Typical site accessed via femoral artery but could also be done through a radial artery
A

Other Diagnostic Assessment

  • ECG, aka EKG
  • Electrophysiologic study (EPS)
  • Stress test
  • Echocardiography
    > Pharmacologic stress echo
    > TEE
  • Myocardial nuclear perfusion imaging (MNPI)
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14
Q

! Best indicator of fluid balance is weight

2.2 lb = 1 kg = 1 L of fluid

A

If your pt weighs 4 or 5 lbs more than 2 days ago, he/she could have an EXTRA 2 L of fluid retained

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15
Q

?

Is the amount of blood pumped from the left ventricle per minute

In adults, ranges from 4-7L/min

A

Cardiac output (CO)

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16
Q

B/c CO requirements vary according to body size, the cardiac index is calculated to adjust for differences in body size

A
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17
Q

The cardiac index can be determined by dividing the __ by the __

A

CO; body surface area

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18
Q

?

Refers to the # of times the ventricles contract each minute

Normal for an adult is between 60-100 bpm

A

Heart rate (HR)

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19
Q
  • Increases in rate increase myocardial oxygen demand
  • The HR is extrinsically controlled by the ___, which adjusts rapidly when necessary to regulate cardiac output
A

autonomic nervous system (ANS)

20
Q

The ___ slows the HR, ___ increases the HR

A

parasympathetic (vagus nerve) system; sympathetic stimulation

21
Q

?

Is the amount of blood ejected by the left ventricle during each contraction

A

Stroke volume (SV)

22
Q

Dub = S2 = ?

Lub = S1 = ?

A

Diastole

Systole

23
Q

S1 represents the opening of which valves?

A

pulmonic, aortic

24
Q

S1 represents the closing of which valves?

A

tricuspid, mitral

25
Q

S2 represents the closing of which valves?

A

pulmonic, aortic

26
Q

S2 represents the opening of which valves?

A

tricuspid, mitral

27
Q

5 areas for listening to the heart

APE TO MAN

All People Enjoy Time Magazine

A
28
Q

?

At the left 2nd ICS

A

Pulmonic

29
Q

?

S1,S2; at the left 3rd ICS

A

Erb’s Point

30
Q

?

At the lower left sternal border 4th IC

A

Tricuspid

31
Q

?

At the right 2nd ICS

A

Aortic

32
Q

?

At the left 5th IC, medial to midclavicular line

A

Mitral

33
Q

S1

Represents ___

__ and __ closes

__ and __ open

Hear loudest at the apex, mitral, & tricuspid

__ pitch - diaphragm

A

systole

mitral, tricuspid

aortic, pulmonic

High

34
Q

S2 (louder than S1)

Represents ___

__ and __ close

__ and __ opens

Hear best at the base - aortic & pulmonic

__ pitch - diaphragm

A

diastole

aortic, pulmonic

mitral, tricuspid

High

35
Q

S3

Represents issues with filling into the ventricular __-diastole

___ gallop: lung not compliant; vibrations

Seen in HF as pathologic or mitral valve regurgitation, normal w/young adults

Hear best in L side lying position - mitral

__ pitch - bell

S3 may be the earliest sign of ?

  • Shortly after S2
A

mid

Ventricular

Low

HF, dilated CM, end-stage ischemic heart disease, valvular heart disease (VHD)

36
Q

S4

Represents issues with filling in __ diastole (before S1)

___ gallop; lung not compliant; vibrations

LV hypertrophy, ischemia

Hear best L lying side decubitus - mitral

__ pitch - bell

  • Common cause is HTN, AS, cardiomyopathy, ischemic heart disease
A

late

Atrial

Low

37
Q

Murmurs

  • Crescendo (increases in intensity) vs decrescendo (decreases in intensity)
  • Quality (harsh, blowing, whistling, rumbling, or squeaking)
  • Pitch (high or low)
A
38
Q

?

Originates from the pericardial sac & occurs w/the movements of the heart during the cardiac cycle

A

Pericardial friction rub

  • Usually transient; sign of inflammation, infection, or infiltration
  • May be heard in pts w/pericarditis resulting from MI, cardiac tamponade, or post-thoracotomy
39
Q

Murmurs

Location - where do you hear it loudest?

Quality - harsh, blowing, whistling, rumbling, or squeaking

Pitch - usually high or low

A
40
Q

?

Refers to the average pressure within the arterial system that is felt by organs in the body

Normal 70-110 mmHg
Need at least 60-70 to perfuse major organs
Under 60 - ! bad

A

Mean Arterial Pressure (MAP)

MAP = [(2 x DBP) + SBP] / 3

41
Q

Example: BP 130/80; SBP = 130; DBP = 80

[(2 x 80) + 130] / 3 = 96.666 or 97 mmHg

A

Pulse pressure (PP) is the difference between the SBP & DBP

<40 >60

  • This value can be used as an indirect measure of CO
42
Q

Narrowed PP is rarely normal & results from

  • increased peripheral vascular resistance or
  • decreased SV in pts w/HF
  • hypovolemia
  • shock; it can also be seen in those w/mitral stenosis or regurgitation
A

Increased PP may occur in pts w/

  • slow heart rates
  • aortic regurgitation
  • atherosclerosis
  • HTN
  • aging
43
Q

?

Is the difference between apical pulse & peripheral pulse

A normal finding would be that they’re essentially the same

A

Pulse Deficit

! If they’re different, there’s a problem. The apical is the SOURCE when it gets to the pulses effectively, it should be the same as at the source

44
Q

Decreased Cardiac Output/Ineffective tissue perfusion

Head
* Impaired orientation, dizziness, syncope, diaphoresis, lightheadedness, cyanosis, pallor

Neck
* Carotid, JVD

Chest
* Pain, dyspnea, PND, orthopnea, palpitations, cough, frothy sputum, blood, murmurs, heart sounds, lung sounds

A

Abdomen
* N/V, nocturia

Peripheral
* Pain, pulses, hypokinetic?, edema, cyanosis

General
* Fatigue, anxiety, weight

45
Q

Factors Affecting Cardiac Output

  • Preload
    > Volume of blood in ventricles at the end of diastole
  • Contractility
A
  • Afterload
    > Peripheral resistance against which the left ventricle must pump
46
Q

Preload determines the amount of stretch placed on myocardial fibers

A

Contractility can be increased by epinephrine and norepinephrine released by the SNS. Increasing contractility raises the SV by increasing ventricular emptying

47
Q

Afterload is affected by size of the ventricle, wall tension, and arterial BP

A

If arterial BP is elevated, ventricles will meet increased resistance to ejection of blood, increasing the work demand. Eventually, this results in ventricular hypertrophy, an enlargement of cardiac muscle tissue without an increase in CO or the size of the chambers

NUR 201 Week 5 (5 decks)

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