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NSC 386 > Cardiac Assessment > Flashcards

Cardiac Assessment Flashcards

1
Q

3 Layers of the Heart

A

Endocardium - inner
Myocardium - muscle itself
Epicardium - outer layer

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2
Q

Pericardium is

A

Sac around the heart

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3
Q

2 Layers of the Pericardium

A 
Visceral = inner
Parietal = outer
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4
Q

Pericardial fluid purpose

A

Lubricate pericardial space

Prevent friction as the heart contracts

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5
Q

Coronary arteries

A
  1. Left coronary artery

2. Right Coronary artery

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6
Q

2 branches of the LCA and what do they supply

A
  1. Left Anterior Descending (LAD)
  2. Left Circumflex (Main) Artery (LCA)
    Both supply LA, LV, interventricular septum, portion of RV
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7
Q

What does the RCA supply?

A

RA, RV, and part of the wall of LV

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8
Q

What is the widow maker?

A

LCA = 100% blocked

LCA blockage = ischemia to left side of heart = muscle death = no CO = death

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9
Q

Conduction though the heart

A

SA Node -> Atria -> AV Node -> Bundle of His -> Bundle Branches -> Purkinje Fibers (ventricular contraction)

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10
Q

How does cardiac impulse control heart rate?

A

Further down the impulse starts, the slower the heart rate

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11
Q

What is the formula for Cardiac Output (CO)

A

CO = Stroke volume (SV) x Heart Rate (HR)

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12
Q

What is normal cardiac output?

A

4-8 L per minute

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13
Q

Cardiac Index is

A

CO divided by body surface area (BSA)

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14
Q

Normal Cardiac Index (CI) =

A

2.5 - 4 L/min

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15
Q

Factors that affect cardiac output

A

Starling’s law
Preload
Contractility
After load

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16
Q

Starling’s law

A

More the heart fibers are stretched the greater the force of contraction

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17
Q

Preload

A

Volume issue; amount of blood in th ventricles at the end of diastole

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18
Q

Decreased preload can indicate?

A

Dehydration

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19
Q

Increased preload can indicate?

A

Hypertension or Heart failure

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20
Q

Contractility of the heart is

A

How effectively does it contract

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21
Q

Afterload is

A

Pressure/Resistance issue; resistance agains what the left ventricle must pump to the body

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22
Q

Regulation of the cardiovascular system is controlled by

A

Autonomic Nervous System; more importantly the sympathetic nervous system (SNS)

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23
Q

What is the function of the sympathetic nervous system

A

Increase HR and atrial and ventricular contraction

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24
Q

Alpha andrenergic receptors

A

Leads to vasoconstriction

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25
Q

Beta adrenergic receptors

A

Increase heart rate and contractility

26
Q

What is blood pressure?

A

Measures force of blood ejected from the heart

27
Q

Formula for BP

A

BP = CO X SVR (systemic vascular resistance)

28
Q

What is systolic BP

A

Pressure in the arteries when the heart is beating (depolarization of the ventricles)

29
Q

What is diastolic BP

A

Pressure in the arteries when heart is at rest (repolarization of ventricles)

30
Q

Average pressure in the arterial system that is felt by organs in the body

A

Mean Arterial Pressure (MAP); also can be perfusion pressure

31
Q

MAP Formula

A

MAP = (SBP + 2DBP)/ 3

32
Q

What is the normal range for MAP

A

60-100 mmHg

33
Q

What is pulse pressure

A

Difference between SBP & DBP

34
Q

Occurs when tricuspid and mitral valves close

35
Q

Occurs when aortic and pulmonic valves close

36
Q

S3 Heart sound

A

Ventricular gallop (abnormal)

37
Q

S4 Heart Sound

A

Atrial Gallop (abnormal)

38
Q

Graded from I - IV and an indication of valvular problems in the heart

39
Q

3 Cardiac Biomarkers (Cardiac Enzymes)

A
  1. CKMB
  2. Troponin
  3. Myoglobin
40
Q

CKMB (Creatinine Kinase Myocardial Band)

A

Elevated in 3-6 hours
Peaks in 12-14 hours
Return to baseline in 12-48 hours

41
Q

Bio marker of choice for MI diagnosis and why?

A

Troponin; lasts 10-14 days in blood after MI (longer than CKMB)

42
Q

Troponin values

A

Elevated w/in 4-6 hrs after MI
Peaks 10-24 hours
Detectable 10-14 days

43
Q

Lipid profile test

A

Must be fasting

Looking at LDL, HDL, Triglycerides

44
Q

Chest X-ray as a cardiovascular diagnostic tool shows

A

How big the heart is and if there is fluid in the chest

45
Q

What are the responsibilities of the nurse when pt is ordered for chest x-ray

A

Ask about pregnancy
Remove jewelry
Lead shielding

46
Q

ECG Nursing responsibilities

A

Patient must be still

Proper positioning of leads

47
Q

Holter monitor is used for

A

24-48 hours as ambulatory ecg monitoring

48
Q

Nursing responsibilities for Holtor monitor

A

Ask pt to keep diary of activity

No bathing or showering while wearing monitor

49
Q

Nursing responsibilities for Stress testing

A

Educate patient to wear comfortable shoes; NPO after midnight; watch for chest pain; no caffeine/smoking; may need to hold meds

50
Q

Nursing Responsibilities Echocardiogram

A

Patient must be on left side

51
Q

Nursing Responsibilities: TEE

A

NPO 4-6 hours
IV Sedation
Throat numbed - NPO until return of gag reflex
Monitor v/s and SpO2 on every patient that gets sedated q15 for the 1st hour

52
Q

Complications of TEE

A

Esophageal tear, hemorrhage, hypoxemia, vasovagal reaction (not common but possible)

53
Q

Nuclear Cardiology: Nursing Responsibilities

A

IV Line

No Radiation precautions (dependent on dose)

54
Q

Cardiac catherization entry locations

A

Right Side of heart = vein

Left Side of heart= artery

55
Q

Nursing Responsibilities: Cardiac Cath

A 
Check allergies (particularly iodine)
Renal Function - dye is harsh on kidneys
NPO at least 6 hours before
IV Sedation - patent; functioning IV
Establish baseline v/s; Educate patient - IV dye = warm feeling, catheter placed = fluttering feeling
56
Q

Nursing responsibilities s/p cardiac cath

A 
Positioning - lay flat
Circulation check to extremity
Hematoma check
ECG, V/S
Increase PO fluids to flush dye; Watch for complications
57
Q

What are some complications s/p cardiac cath

A

Bleeding at site; allergic reaction to die; infection; dysrhythmias; stroke; embolism

58
Q

EP Study: Nursing Responsibilities

A

Same as heart catheterization: V/S, continuous ECG monitoring, watch puncture site, circulation checks

59
Q

Normal BUN values

60
Q

Normal Creatinine values

NSC 386 (11 decks)

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