Cardiac Assessment Flashcards
1
Q
position of the heart
A
front and the side
2
Q
Location of the heart
A
the 2nd and 6th clavicles
3
Q
Right chamber is responsible for
A
pulmonary circulation
4
Q
Left chamber responsible for
A
systemic circulation
5
Q
semilunar valve helps
A
prevent the backflow
6
Q
The SVC-superior vena cava and the IVC=inferior vena cava are responsible for
A
coronary circulation
7
Q
Average liters pumped from heart is
A
5-7 per minute or 2000 gallons per day
8
Q
Cardiac Output is defined as the
A
amount of blood pumped by a ventricle in a given time
9
Q
CO=
A
CO=SV X HR
stroke volume times heart rate is cardiac output
10
Q
define stroke volume
A
the amount of blood ejected with one heart beat
11
Q
Average Stroke Volume number
A
with each heart beat th heart pumps about 60-80
12
Q
Between the ages of 20-60 the cardic output decreases by
A
30 percent
13
Q
what system controls the heart rate
A
autonomic nervous system–The autonomic nervous system consists of sensory neurons and motor neurons that run between the central nervous system (especially the hypothalamus and medulla oblongata) and various internal organs such as the:
heart
lungs
viscera
glands (both exocrine and endocrine)
14
Q
what are the chemical agents that affect heart rate
A
catecholemines-The major catecholamines are dopamine, norepinephrine, and epinephrine (which used to be called adrenalin).==> released from adrenals in times of stress
15
Q
CNS an baro receptor activities
A
The most important arterial baroreceptors are located in the carotid sinus (at the bifurcation of external and internal carotids) and in the aortic arch (Figure 1). These receptors respond to stretching of the arterial wall so that if arterial pressure suddenly rises, the walls of these vessels passively expand, which stimulates the firing these receptors. If arterial blood pressure suddenly falls, decreased stretch of the arterial walls lead to a decrease in receptor firing.
16
Q
preload
A
amount of blood in ventricles at the end of diastole
17
Q
Afterload is
A
the amount of resistance for ejection
18
Q
What is SVR
A
systemic vascular resistance-from left side
19
Q
what is PVR
A
pulmonary vascular resistnce-from the right side
20
Q
What controls the Heart Rate
A
Baroreceptors
catecholamines
autonomic nervous system
21
Q
what affects stroke volume
A
preload
afterload
contractility
22
Q
what is ejection fraction
A
the percentage of end diastolic that is ejected with each stoke
23
Q
what are key componets to an assessment
A
health history
physical exam
labs
diagnostics
24
Q
who is the best person to obtain a health history
A
the patient or past medical records or family can be helpful
25
what are some key componets to a health history
```
family history
age
gender
symptoms
impression of how they are doing
```
26
History of present illness-general health status questions
cv-history- when did this start
review of present illness
survey of life style ==> lots of salt or drugs
27
Cardiac clues we need to be looking for
complaining of chest pain, dizziness, shortness of breath, palpitations, change in LOC(not enough 02 getting in brain), weight gain
28
how much weight gain should we be alarmed about
5-10 pounds in 2 weeks
29
Assessment questions for pain
P:position location what makes it worse, when did it start
Q:quality of the pain-sharp, dull, relieved w/ rest
R:radiate anywhere
S:severity on a scale of 1-10
T: timing when did this start
30
How long should a physical exam last
10 minutes/10 areas
31
what should occur in a physical exam
inspect, palpitate, and ausculate
32
what are the ten areas we should assess in a physical exam?
1. General Appearance
2. Cognition
3. Skin
4. Blood Pressure
5. Arterial pulses
6. jugular vein distention
7. Heart
8. Extremeties
9. Lungs
10. abdomen
33
define pallor
decrease in color used when assessing skin
34
define cyanosis
blue color can be central lips or peripherral in arms nd legs
35
what is blood pressure
the pressure excerted on the walls of the arteris during systole and diastole
36
what factors affect BP
cardiac output-amount of blood pumped by ventricles
velocity-how fast
viscosity-how thick
37
normal range of BP is
100/60 to 135/185
38
Formula for mean arterial pressure
As blood is pumped out of the left ventricle into the arteries, pressure is generated. The mean arterial pressure (MAP) is determined by the cardiac output (CO), systemic vascular resistance (SVR), and central venous pressure (CVP) according to the following relationship, which is based upon the relationship between flow, pressure and resistance:
MAP = 2 X Diastolic + systolic divided by 3
39
what is a pulse pressure
the difference between the systolic and diastolic pressures
40
what is the average range for a pulse pressure
30-40
41
a wide pulse pressure such as 140/90=50
| indicates:
vasodilation
42
a narrow pulse pressure such as 124/79=45
| indicates
narrow=indicate vasoconstriction
43
What is Pulsus Paradoxus
| what does this indicate
decrease in systolic BP on inspiration(greater than 10 mmHg)
| this indicates there may be effusion or tamponade-pt will have ann increased work of breathing
44
what is a postural BP
significant decease in Bp after a patient assumes upright position
45
Common causes of orthostatic BP
decreased volume or inadequate vasoconstrictors
46
Clinical signs typically seen in orthostatic BP
dizzy lightheaded
| typically their HR w/ increase by 20 and their systolic decrease> 15 and diastolic decrease >10
47
How will we measure orthostatic hypotenion
lying
wait 2 minutes
sit
stand
48
in volume depletion and inadequate vasoconstrictors what compensation mechanisms will we see
an increase in Heart Rate
49
if someone has an autonomic insufficiency what kind of compensation will we see when measuring the orthostatic hypotension
none-Heart is not able to compensate
50
where will we see arterial pulses.
```
Carotid, Brachial, Radial, Femoral, Popliteal(behind the knee)
Dorsalis Pedis( upper aspect of foot)
Posterior tibuli(side of ankle)
```
51
what should we be looking for when cking pulses
the rate, rhythm, and quality
52
A normal pulse rate is
norm is 50-100
| in athletes this will be on the lower side of things
53
when speaking of rythym you may find your patient has sinus arrythmia
sinus arrythmia is when rate increases during inhalation and decreases during exhalation-most commin in young adults
54
if pts pulse is irregular we would
ck the apical rate for one full minute while palpating the radial pulse
55
Pulse deficit is when************************
their is a difference in apical and apex rate
not all beats are palpable
progressive stage of pulsus alterans
56
Quality of pulse can be 0-4
```
0-absent
1-weak, thready, difficult to palpitate
2-diminished
3- easy to palpitate
4-strong and bounding
```
57
Define Pulsus Alternans
| -sign of?
a variation in the strength f a contraction resulting in alternating pulse strength
sign of-left ventricular failure
58
Pulsus Paradoxus
decrease in ampliuse in inspiration and increase with expiration
associated with pericardial tamponade, and adb=vnced HF-pericarditis
59
```
When assessing a patient for jugular venous distension, the appropriate position to assess them is?
a.
45° semi-sitting position
b.
High-Fowlers position (sitting upright)
c.
Supine with head supported on pillows
d.
Trendelenberg or feet raised on pillows
3 years ago Report Abuse
```
a- 45
60
what will happen to the jugular in a rt sided heart failure pt if te pt is supine?
45-90
supine-you will see a very distended jugular
45-90- obvious increase in blood flow
---see increase in one cm every time you increase the head
61
what creates the heart sound
opening and closing of valves
62
what normally initias the electrical activity
the sa node
63
depolarization is reflected by
contraction
64
repolarization is relected by
resting
65
areas of auscultation
| A---
Aortic
2nd ICS-right sternal border
we hear DUBB
66
areas of auscultation-P
Pulmonic
2nd ICS
left strenal border
67
where would we listen for tricuspid?
in the 4th and 5th ICS
| left sternal border
68
where would we listen to mitral?
```
Apex
point of maximal impulse
5th ICS
MCL
this is the base
WE hear LUBB
```
69
what is MPI
point of maximal impulse-apical impulse
| -place on the heart where heart contractions can be heard best
70
where would we listen for PMI at
ask pt to lie on left to get mist blood flow
| locate at 5 ics to the left of the sternum at the midclavicular line
71
bell of stethescope used for
low frequencies
72
the diaphram of the stethescope used to listen for
higher frequencies
73
time between s1 and s2
| s2-s1
longer and shorter-respectivly
74
S1 heart sound
caused by
Heard best at
occurs just after
caused by : closure of mtral and tricuspid valves
Heard best at : the apex of the heart
occurs just after: the qrs complex
75
S2 heart sound
caused by
Heard best at
occurs just after
DUB sound
caused by: closing of the arotic and pulmonic valves
Heard best at : the base f the heart
occurs at the end of the T wave of ECG *******
76
S1 split
what is it:
what causes this:
when can this be heard best:
what is it: closure of mitral and tricuspd at different times
what causes this: it widens when Right ventricle is delayed such as in a RBBB
when can this be heard best on inspiration
77
S2 split
causes: abnormal valvular dysfunction and/or alteration in blood flow(mitral valve prolapse)
- short--and higher than s1
78
S2 split can be best heard
normal inspiration on pulmonc
abnormalon expiration on ERBS
common in pulmonic stenosis
79
when would we hear gallop sounds
s3 and s4
80
what would cause galloping sounds
ventricular thickening
slow left ventricle relaxation
reduced blood flow velocity
common in older pts
81
where is s3 and s4 best heard
best heard with bell
| s3 immediatly after s2 and s4 immediatly before s1
82
s3 sound is often reffered to as - - -
Ken tuc ky
| Lub-Dub-By
83
s4 is commonly reffered to as _ _ _
Ten-nes-see
84
What causes friction rubs
pericarditis- pericardial surfaces rub together
85
what kind of sound is produced by friction rub
harsh grating high pitched sound
86
how can friction rub be heard best
lowdest over tricuspid and zyphoid areas
heard best by aking pt is lean forward-this puts pressure o the heart walls
87
What are murmurs created by
turbulent flow of blood
88
How are murmurs characterized?
-characterized by location of where they are heard the lowdest
-radiating
-high/low
-intensity
timing
89
Edema
| depression 1+ 2+ 3+ 4+
```
bilateral or lateral
1=2mm
2=4mm
3=6mm
4-8mm
```
90
what are abnoral things that we can find in the lungs
crackles-whhezes-hemoptysis
91
Abdomen-Hepatojugular Reflex**********
| what is this and what does this mean?
This is liver engorgement
--(R) heart is unable to compensate due to volume
we will see JVD
test by pushing on right side of the abdomen
92
abdomen-Bladder Distension
| what are we looking for
palpate for any masses in suprapubic areas
could be an indicator of CO
look for urine output less than 30 ml/hr
93
Abdominal aortic aneurism*******************
what is it
what causes it
and what are we looking for to Dx it?
this is a wealk oartic wall and distended lumen
we will see pulsating mass in the periumbilical area
pt will feel abdominal tenderness on deep palpate.
94
what are some lab test we will be ordering and looking at?
CK-MB
Triponin T
Myoglobin
95
what is CK-MB
```
lab that indicates Mi-injury to heart
show up 1-3 hours post MI
peaks in 24 hours
normal 2-3 days
1st to rise
```
96
Triponin T
shows up 3-4 hours post MI
peaks in 24-48
elevated up to 3 weeks
97
Myoglobin
1-3 hours post acute onset Mi
peaks in 12 hours
rapidly excreted in urine w/ 24 hours
98
why would a chest x-ray be used
used to determin, size, contour, and position of the heart
DOES NOT DIAGNOSE MI-BUT CAN HELP DIAGOSE COMPLICATIONS
99
what are the functions of an EKG
records electrical activity
| timing and amplitude of heart activity
100
what are special considerations when looking at EKG
age, gender, meds, blood pressure, clinical symptoms
101
what is exercise stress test
asked to run on treadmill to see the stamina of teh heart
102
what is a pharmalogical stress test
these can be used especially on the elderly. pt is given med like dobitamine
103
what is a mental or emotional stress test?
pt is asked to read or do math problems to see the stamina on the heart
104
What are contraindications to stress test
if the patient has severe aoritc stenosis, acute mycarditis, pericarditis, severe HTN, ledt main CAD, and/or unstable angina
105
Nursing management for stress test
no stimuating drinks
do not take beta blockers
wear comfortable shoes and clothes
106
what is a echo
non-ivasive exam of the heart
looks at size, shape, and motion of cardiac structures
WE CAN SEE THE FLOW AND EJECTION FRACTION
107
Why would we do an echo
to see mitral stenosis, regurgitation, herat failure, cardiomyopathy, cardiac tamponade
108
what is an angiography?
injection of contrast agent into vascular system to outline heart and blood vessels
109
common sites of angiography?
aortography
coronary
right hert cath
left heart cath
110
Cardiac Cath Pre-op NI
NPO for 8-12 hours
inform patient what to expect
don't give specific time
111
Left Side cath will go through
femoral artery
112
Right side cath
go through femoral vein
113
Post OP Nursing iterventions for cardiac cath
```
assess site
peripheral pulse(dopple), temp, color
encourage rehydration
bedrest4-6 hours
monitor BUN and Creatine
w/h metformin
```
114
Pt discharge
```
limited activities for 24 hours
do not lift more than 5 pounds
avoid baths and showers
call if temp above 101.5
lifestyle changes
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