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Test 2 > Cardiac Assessment > Flashcards

Cardiac Assessment Flashcards

1
Q

position of the heart

A

front and the side

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2
Q

Location of the heart

A

the 2nd and 6th clavicles

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3
Q

Right chamber is responsible for

A

pulmonary circulation

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4
Q

Left chamber responsible for

A

systemic circulation

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5
Q

semilunar valve helps

A

prevent the backflow

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6
Q

The SVC-superior vena cava and the IVC=inferior vena cava are responsible for

A

coronary circulation

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7
Q

Average liters pumped from heart is

A

5-7 per minute or 2000 gallons per day

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8
Q

Cardiac Output is defined as the

A

amount of blood pumped by a ventricle in a given time

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9
Q

CO=

A

CO=SV X HR

stroke volume times heart rate is cardiac output

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10
Q

define stroke volume

A

the amount of blood ejected with one heart beat

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11
Q

Average Stroke Volume number

A

with each heart beat th heart pumps about 60-80

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12
Q

Between the ages of 20-60 the cardic output decreases by

A

30 percent

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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)

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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

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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.

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16
Q

preload

A

amount of blood in ventricles at the end of diastole

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17
Q

Afterload is

A

the amount of resistance for ejection

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18
Q

What is SVR

A

systemic vascular resistance-from left side

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19
Q

what is PVR

A

pulmonary vascular resistnce-from the right side

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20
Q

What controls the Heart Rate

A

Baroreceptors
catecholamines
autonomic nervous system

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21
Q

what affects stroke volume

A

preload
afterload
contractility

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22
Q

what is ejection fraction

A

the percentage of end diastolic that is ejected with each stoke

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23
Q

what are key componets to an assessment

A

health history
physical exam
labs
diagnostics

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24
Q

who is the best person to obtain a health history

A

the patient or past medical records or family can be helpful

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25
Q

what are some key componets to a health history

A 
family history
age
gender
symptoms
impression of how they are doing
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26
Q

History of present illness-general health status questions

A

cv-history- when did this start
review of present illness
survey of life style ==> lots of salt or drugs

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27
Q

Cardiac clues we need to be looking for

A

complaining of chest pain, dizziness, shortness of breath, palpitations, change in LOC(not enough 02 getting in brain), weight gain

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28
Q

how much weight gain should we be alarmed about

A

5-10 pounds in 2 weeks

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29
Q

Assessment questions for pain

A

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

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30
Q

How long should a physical exam last

A

10 minutes/10 areas

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31
Q

what should occur in a physical exam

A

inspect, palpitate, and ausculate

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32
Q

what are the ten areas we should assess in a physical exam?

A
  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
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33
Q

define pallor

A

decrease in color used when assessing skin

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34
Q

define cyanosis

A

blue color can be central lips or peripherral in arms nd legs

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35
Q

what is blood pressure

A

the pressure excerted on the walls of the arteris during systole and diastole

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36
Q

what factors affect BP

A

cardiac output-amount of blood pumped by ventricles
velocity-how fast
viscosity-how thick

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37
Q

normal range of BP is

A

100/60 to 135/185

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38
Q

Formula for mean arterial pressure

A

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

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39
Q

what is a pulse pressure

A

the difference between the systolic and diastolic pressures

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40
Q

what is the average range for a pulse pressure

A

30-40

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41
Q

a wide pulse pressure such as 140/90=50

indicates:

A

vasodilation

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42
Q

a narrow pulse pressure such as 124/79=45

indicates

A

narrow=indicate vasoconstriction

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43
Q

What is Pulsus Paradoxus

what does this indicate

A

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

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44
Q

what is a postural BP

A

significant decease in Bp after a patient assumes upright position

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45
Q

Common causes of orthostatic BP

A

decreased volume or inadequate vasoconstrictors

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46
Q

Clinical signs typically seen in orthostatic BP

A

dizzy lightheaded

typically their HR w/ increase by 20 and their systolic decrease> 15 and diastolic decrease >10

47
Q

How will we measure orthostatic hypotenion

A

lying
wait 2 minutes
sit
stand

48
Q

in volume depletion and inadequate vasoconstrictors what compensation mechanisms will we see

A

an increase in Heart Rate

49
Q

if someone has an autonomic insufficiency what kind of compensation will we see when measuring the orthostatic hypotension

A

none-Heart is not able to compensate

50
Q

where will we see arterial pulses.

A 
Carotid, Brachial, Radial, Femoral, Popliteal(behind the knee)
Dorsalis Pedis( upper aspect of foot)
Posterior tibuli(side of ankle)
51
Q

what should we be looking for when cking pulses

A

the rate, rhythm, and quality

52
Q

A normal pulse rate is

A

norm is 50-100

in athletes this will be on the lower side of things

53
Q

when speaking of rythym you may find your patient has sinus arrythmia

A

sinus arrythmia is when rate increases during inhalation and decreases during exhalation-most commin in young adults

54
Q

if pts pulse is irregular we would

A

ck the apical rate for one full minute while palpating the radial pulse

55
Q

Pulse deficit is when******

A

their is a difference in apical and apex rate

not all beats are palpable

progressive stage of pulsus alterans

56
Q

Quality of pulse can be 0-4

A 
0-absent
1-weak, thready, difficult to palpitate
2-diminished
3- easy to palpitate
4-strong and bounding
57
Q

Define Pulsus Alternans

-sign of?

A

a variation in the strength f a contraction resulting in alternating pulse strength

sign of-left ventricular failure

58
Q

Pulsus Paradoxus

A

decrease in ampliuse in inspiration and increase with expiration
associated with pericardial tamponade, and adb=vnced HF-pericarditis

59
Q 
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

a- 45

60
Q

what will happen to the jugular in a rt sided heart failure pt if te pt is supine?
45-90

A

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
Q

what creates the heart sound

A

opening and closing of valves

62
Q

what normally initias the electrical activity

A

the sa node

63
Q

depolarization is reflected by

A

contraction

64
Q

repolarization is relected by

A

resting

65
Q

areas of auscultation

A—

A

Aortic
2nd ICS-right sternal border
we hear DUBB

66
Q

areas of auscultation-P

A

Pulmonic
2nd ICS
left strenal border

67
Q

where would we listen for tricuspid?

A

in the 4th and 5th ICS

left sternal border

68
Q

where would we listen to mitral?

A 
Apex
point of maximal impulse
5th ICS
MCL
this is the base
WE hear LUBB
69
Q

what is MPI

A

point of maximal impulse-apical impulse

-place on the heart where heart contractions can be heard best

70
Q

where would we listen for PMI at

A

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
Q

bell of stethescope used for

A

low frequencies

72
Q

the diaphram of the stethescope used to listen for

A

higher frequencies

73
Q

time between s1 and s2

s2-s1

A

longer and shorter-respectivly

74
Q

S1 heart sound
caused by
Heard best at
occurs just after

A

caused by : closure of mtral and tricuspid valves
Heard best at : the apex of the heart
occurs just after: the qrs complex

75
Q

S2 heart sound
caused by
Heard best at
occurs just after

A

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
Q

S1 split
what is it:
what causes this:
when can this be heard best:

A

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
Q

S2 split

A

causes: abnormal valvular dysfunction and/or alteration in blood flow(mitral valve prolapse)
- short–and higher than s1

78
Q

S2 split can be best heard

A

normal inspiration on pulmonc
abnormalon expiration on ERBS
common in pulmonic stenosis

79
Q

when would we hear gallop sounds

A

s3 and s4

80
Q

what would cause galloping sounds

A

ventricular thickening
slow left ventricle relaxation
reduced blood flow velocity
common in older pts

81
Q

where is s3 and s4 best heard

A

best heard with bell

s3 immediatly after s2 and s4 immediatly before s1

82
Q

s3 sound is often reffered to as - - -

A

Ken tuc ky

Lub-Dub-By

83
Q

s4 is commonly reffered to as _ _ _

A

Ten-nes-see

84
Q

What causes friction rubs

A

pericarditis- pericardial surfaces rub together

85
Q

what kind of sound is produced by friction rub

A

harsh grating high pitched sound

86
Q

how can friction rub be heard best

A

lowdest over tricuspid and zyphoid areas

heard best by aking pt is lean forward-this puts pressure o the heart walls

87
Q

What are murmurs created by

A

turbulent flow of blood

88
Q

How are murmurs characterized?

A

-characterized by location of where they are heard the lowdest
-radiating
-high/low
-intensity
timing

89
Q

Edema

depression 1+ 2+ 3+ 4+

A 
bilateral or lateral
1=2mm
2=4mm
3=6mm
4-8mm
90
Q

what are abnoral things that we can find in the lungs

A

crackles-whhezes-hemoptysis

91
Q

Abdomen-Hepatojugular Reflex**

what is this and what does this mean?

A

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
Q

abdomen-Bladder Distension

what are we looking for

A

palpate for any masses in suprapubic areas
could be an indicator of CO
look for urine output less than 30 ml/hr

93
Q

Abdominal aortic aneurism*********
what is it
what causes it
and what are we looking for to Dx it?

A

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
Q

what are some lab test we will be ordering and looking at?

A

CK-MB
Triponin T
Myoglobin

95
Q

what is CK-MB

A 
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
Q

Triponin T

A

shows up 3-4 hours post MI
peaks in 24-48
elevated up to 3 weeks

97
Q

Myoglobin

A

1-3 hours post acute onset Mi
peaks in 12 hours
rapidly excreted in urine w/ 24 hours

98
Q

why would a chest x-ray be used

A

used to determin, size, contour, and position of the heart

DOES NOT DIAGNOSE MI-BUT CAN HELP DIAGOSE COMPLICATIONS

99
Q

what are the functions of an EKG

A

records electrical activity

timing and amplitude of heart activity

100
Q

what are special considerations when looking at EKG

A

age, gender, meds, blood pressure, clinical symptoms

101
Q

what is exercise stress test

A

asked to run on treadmill to see the stamina of teh heart

102
Q

what is a pharmalogical stress test

A

these can be used especially on the elderly. pt is given med like dobitamine

103
Q

what is a mental or emotional stress test?

A

pt is asked to read or do math problems to see the stamina on the heart

104
Q

What are contraindications to stress test

A

if the patient has severe aoritc stenosis, acute mycarditis, pericarditis, severe HTN, ledt main CAD, and/or unstable angina

105
Q

Nursing management for stress test

A

no stimuating drinks
do not take beta blockers
wear comfortable shoes and clothes

106
Q

what is a echo

A

non-ivasive exam of the heart
looks at size, shape, and motion of cardiac structures
WE CAN SEE THE FLOW AND EJECTION FRACTION

107
Q

Why would we do an echo

A

to see mitral stenosis, regurgitation, herat failure, cardiomyopathy, cardiac tamponade

108
Q

what is an angiography?

A

injection of contrast agent into vascular system to outline heart and blood vessels

109
Q

common sites of angiography?

A

aortography
coronary
right hert cath
left heart cath

110
Q

Cardiac Cath Pre-op NI

A

NPO for 8-12 hours
inform patient what to expect
don’t give specific time

111
Q

Left Side cath will go through

A

femoral artery

112
Q

Right side cath

A

go through femoral vein

113
Q

Post OP Nursing iterventions for cardiac cath

A 
assess site
peripheral pulse(dopple), temp, color
encourage rehydration
bedrest4-6 hours
monitor BUN and Creatine
w/h metformin
114
Q

Pt discharge

A 
limited activities for 24 hours
do not lift more than 5 pounds
avoid baths and showers
call if temp above 101.5
lifestyle changes

Test 2 (11 decks)

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