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Nursing Adult Health II > Cardio Exam 2 > Flashcards

Cardio Exam 2 Flashcards

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1
Q

The heart has 3 layers what are these layers

A

epicardium
myocardium
endocardium

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2
Q

Epicardium

A

outside protective layer

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3
Q

Myocardium

A

middle layer of specialized cardiac muscle

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4
Q

Endocardium

A

endothelial lining of of chambers

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5
Q

What is the pericardium

A

protective sac encasing the heart;

2 fibrous layers with small amout of serous fluid separating layers for lubrication

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6
Q

Upper chambers of the heart

A

artium

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7
Q

lower chambers of the heart

A

ventricle

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8
Q

atria are smaller than

A

ventricles

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9
Q

Blood flows

A

body into right atrium and from lungs into left atrium

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10
Q

Atrial contraction

A

blood is pumped from atria into ventricles

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11
Q

Ventricular contraction

A

blood is pumped from righ ventricle into pulmonary artery and lungs, and left ventricle into aorta and arterial circulation

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12
Q

AV (atrioventricular) valves

A
  • separate atria from ventricles

- they control blood flow between atria and ventricles

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13
Q

Tricuspid valve

A

between right atrium and right ventricle

has 3 leaflets

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14
Q

Mitral valve

A

between left atrium and left ventricle

has 2 leaflets

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15
Q

Leaflets of AV valves are connected to

A

papillary mucles by chordae tendons to prevent backflow

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16
Q

s1

A

first heart sound, is heard when AV valves close

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17
Q

Semilunar valves separate .

A

cardiac chambers from great vessels and control blood flow out of cardiac chambers

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18
Q

pulmonic valve

A

between right ventricle and pulmonic artery and deoxygenated blood flows through the valve to lungs

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19
Q

Aortic valve is between

A

left ventricle and aorta and oxygenated blood is pumped from heart through this valve into systemic circulation

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20
Q

Each semilunlar valve has

A

3 cusps that prevent backflow

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21
Q

s2

A

second heart sound is heard when semilunar valve close

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22
Q

Circulation

A

each side of the heart acts as a pump to circulation blood through lungs or through body to perfuse tissues

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23
Q

Double pump

A

right side responsible for pulmonary circulation, left side responsable for systemic circulation

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24
Q

Right heart circulation

A 
deoxygenated blood 
Venous system (1 and 2) ->
right atrium ( 3)   ->
right ventricle (4) ->
lungs for oxygenation via pulmonary artery (5)
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25
Q

Left Heart circulation

A 
oxygenated blood 
Lungs via pulmonary veins (6) ->
left ventricle (8) ->
aorta (9) ->
systemic circulation for tissue perfusion
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26
Q

Coronary arteries

A

brance off aorta to supply oxygenated blood to heart electricle impulses through heart, stimulate depolarization and resulting muscle contraction of chambers in a specific sequence, and initiate pumping action of heart

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27
Q

Sinoatrial (SA) node

A

natural pacemaker

  • concentration of cells responsible for initiating conduction impulse in a healthy heart; located in right atrium at junction with superior vena cava
  • 60-100 bpm in healthy adult
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28
Q

Internodal pathways

A

carry impulse from SA node to AV node through both right and left atria

  • impulse initates process of depolarization in both atria
  • depoilzarization results in myocardial contraction of both atria
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29
Q

AV node

A

located in the base of the atrial septum

  • slows impulse
  • allows atria to fully empy before initiating depolarization of ventricles
  • when sac node is functioning, can initiate an impulse at 40-60bpm
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30
Q

Bundle of HIs

A

short branch of conductive cells connecting AV node to bundle branches at intraventricular septum

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31
Q

Bundle branches

A

Right (RBB) and Left (LBB) split off on either side of intraventricular septum; carry impulse to Purkinije Fibers

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32
Q

Purkinje Fibers

A

diffuse network of conduction pathways

  • are terminal branches of conduction system
  • conduct impulses rapidly throughout ventricles
  • initiate rapid depolarizatio wave throughout myocardium and resulting ventricular contractin
  • when SA and AV nodes fail, can initiate impulses at rate of 20-40bpm
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33
Q

Cardiac Cycle

A

each cardiac cycles one complete heartbeat

  • includes 2 parts
    1. ventricular contraction
    2. diastole (relaxation and ventricular refilling)
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34
Q

Systole

A

portion of cardiac cycle when ventricles depolarize and contract to pump blood into pulmonary adn systemic circulation; begins with closure of AV valves ends with closure of semilunary valves

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35
Q

Diastole

A

portion of cardiac cycle when ventricles repolarize and refill with blood; begins with closure of semilunar valves; ends with closure of AV valves

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36
Q

Atrial systole

A

depolarization and contraction

- is part of late ventricular diastole and atrial diastole occurs during ventricular systole

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37
Q

Cardiac Output (CO)

A
  • volume of blood in liters ejected by heart each minute
  • indicator of pump function of heart
  • Normal adult CO 4-8L/min
  • Co is measured directly by PA catheter
  • clinical indicators of decreased CO include signs of decreased tissure perfusion such as a change in level of consciousness (early) and decreased blood pressure (late)
  • CO=HRxSV
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38
Q

Heart Rate

A

number of complete cardiac cycles per min

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39
Q

Stroke Volume (SV)

A

volume of blood ejected from left ventricle with each cardiac cycle; stroke volume and ultimately CO are influenced by preload; afterload and contractility

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40
Q

Preload

A

degree of myocardial fiber stretch at end of ventricular diastole
- infulenced by ventricular filling volume and myocardial compliance

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41
Q

Afterload

A

resistance that ventricles must overcome to eject blood into systemic circulation; directly related to atrial BP

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42
Q

Contractility

A

strength of contraction regardless of preload; decreased by hypoxia and some drugs (for example, beta blockers, and calcium channel blockers)
- increased by drugs (example digoxin, dopamine)

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43
Q

Autonomic nervous system

A

regulates cardiac function and BP; balance exits between sympathetic and parasympathetic brances

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44
Q

sympathetic nerve stimulation

A
  • produces epinephrine and norepinephrine and norepinephrine
  • results in increased HR
  • increased myocardial contractility
  • increased peripheral vasoconstriction
  • results in increased atrerial BP
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45
Q

Parasympathetic nerve stimulation

A
  • produces acetylocholine
  • results in lowered HP and decreased contractility
  • is the opposite effect of sympathetic stimulation
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46
Q

Changes in sympathetic and parasympathetic activity

A

occur in response to sensory receptors in body, chemoreceptors, baroreceptors, and stretch receptors

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47
Q

Chemoreceptors

A

located in aortic arch and carotid bodies

  • sense chemical changes in blood
  • primarily hypoxia and to a lesser degree hypercapina
  • respond by inducing vasoconstriction
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48
Q

Baroreceptors

A

provide a rapid response to changes in pressure
- sensation of low pressure initiates sympathetic stimulation, resulting in increased HR, vasoconstriction and consequently increased pressurel sensation of increased pressure sends impulses to medulla decreasing HR and BP
(vagal response)

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49
Q

infarction

A

damage to myocardium from decreased oxygenation

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50
Q

creatine kinase (CK)

A

formerly known as creatine phosphokinase (CPK)
elevation indicates muscle injury
- CK-MB is isoenzyme specific to myocardial muscle
- Rises within 6 hrs of injury
- peaks at 18 hrs postinjury and returns to normal in 2-3 days
- useful in myocardial infarction (MI)

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51
Q

Troponin

A

onset is before CK-MB in MI

  • peaks at 24 hrs and returns to normal around 2 weeks
  • provides early sensitivity
  • extended blood levels
  • is more specific to cardiac injury for diagnosis of MI
  • test 8 hrs for 24 hrs
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52
Q

Lactic dehydrogenase (LDH)

A

found in may body tissues

  • cardiac origin is confirmed with analysis of isoenzymes
  • elevation is detected within 24-72 hours after MI
  • peaks in 3-4 days
  • returns to normal in around 2 weeks
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53
Q

Brain natriuretic peptide (BNP)

A

is a hormone found in left ventricle
- elevated in heart failure (normal 0-99)
- but my be higher with aging and in women
CHF

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54
Q

Drug levels

A

blood tests to detect toxic levels of cardiac medications

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55
Q

Digoxin

A 
therapeutic rage is 0.5-2
early signs of toxicity include nausea, vomiting, anorexia, abdominal
Bradycardia (HR less than 60bpm)
dysrhythmia
and visual dysrhytmias
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56
Q

Quinidine

A

therapeutic range is 2-6mcg
signs of toxicity include tinnitus hearing loss visual distruabnces nausea dizziness widened QRS
ventricular dysrhymias

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57
Q

Electrolytes

A

normal levels are essential for proper cardiac function; some medications, renal or cardiac conditions may contribute to electrolye imbalance

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58
Q

Potassium (K+) Normals

A

3.5-5.1

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59
Q

Hypokalemia

A

can occur with diretic therapy (especially loop diuretics such as furosemide)

  • cardiac effects include increased risk of digoxin toxicity ventricular dysrhythmias, flattening and inversion of T wave or presence of U wave
  • is usually related to renal dysfunction or intake of excess potassium dietary supplements
  • cardiac effects include ventricular dysrhymthmias tall peaked T waves on ECG and asystole
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60
Q

Sodium (Na+) normal

A

135-145

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61
Q

Hyponatremia

A

with long term diuretic therapy

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62
Q

Hypernatremia

A

may result in dehydration

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63
Q

hypo-or hypernatremia

A

may result in tachycardia (HR greater than 100 beats per min)

64
Q

Calcium (CA) norms

A
  1. 5-5.5

- blood levels are affected by hormonal imbalances, renal failure and several meds

65
Q

Cardiac effects of hypocalcemia

A

ventricular dysrhythmias
prolonged QT interval
cardiac arrest

66
Q

Magnesium Mg

A
  1. 5 - 2.5
    - cardiac effects of decreased Mg include ventricular tachycardia and fibrillation
    - Cardiac effects of increased Mg include bradycardia, hypotension, prolonged PR and QRS intervals
67
Q

Serum lipid profile

A

aid to determine risk of developing atherosclerosis

68
Q

total serum lipds nomrals

A

400-800

69
Q

triglycerides

A

lipids stored in fat tissue, readily available for energy production
normal serum vale is 10-190 (without elevated cholesterol up to 250 my be acceptable)

70
Q

cholesterol

A

main lipid associated with atherosclerosis disease, norm is less than 200

71
Q

lipoproteins

A

proteins in blood to transport cholesterol; triglycerides and other fats;

72
Q

high density lipoproteins (HDL)

A
  • happy cholesterol
  • transport cholesterol to liver for excretion
  • HDL/ total cholesterol ratio should be at least 1:5, 1:3 more ideal
73
Q

low density lipoproteins (LDL)

A

ransport cholesterol to peripheral tissues associated with increased risk of coronary heart disease

74
Q

preprocedure for lipoprotein tests

A

fast for 12-14 hrs before testing

75
Q

Electrocardiography

A

-recording of the electrical activity of the heart electrodes on body surface

76
Q

12 lead or resting ECG

A

recording of electrical activity of heart from 12 different views
- used to determine cardiac rhythm, as well as ischemia , injury, infarction, hypertrophy, electrolyte imbalance and drug effects

77
Q

Holter monitoring

A

continuous ambulatory ECG monitoring over time ( usually 24)

78
Q

Stress test

A

continuous multilead ECG monitoring during ocntrolled and supervised exercise, usually on treadmill
- clients who can not tolerate exercise cardic stress can be drug induced Dobutamine (Dobutrex)

79
Q

stress test prep

A 
obtain written consent 
explain procedure
instruct to eat a light meal 1-2 hrs before exam (no caffeine, alcohol, or smoking ) 
wear comfortable clothing 
rubber soled walking shoes
80
Q

Nursing care during stress test

A

secure electrodes
obtain baseline vidal signs
monitor ECG continuously
record at frequent ST segments or cardiac rhythm

81
Q

Echocardiography

A
  1. is an ultrasound of heart to evaluate structure and function of chambers and valves
  2. client preparation: instruct to remain still during test, secure electrodes for simulationeous ECG tracing
  3. explain that is typically painless
  4. tell patient the gel will be cool
82
Q

Photocardiography

A
  1. is a graphic recording of heart sounds with simultaneous ECG
  2. Client preparation; instruct to remain quiet and still during the test
    no pain or electrical shocks
  3. no postproceudre nursing care
83
Q

Coronary angiography/arteriography

A
  1. is an invasive procedure during which cardiologist injects dye into coronary arteries and immediately records a series of x-ray films
  2. client prep: obtain written consent; explain procedure assess for history of allergies to contrast dye or iodine; initiate IV access; begin fluids as prescribed
  3. Postprocedure nursing care; same as for cardiac catherterization
84
Q

Radionuclide tests

A

are safe methods of evaluating left ventricular muscle function and coronary artery blood distribution; can provide some of the same information as radiographic angiography with less risk to client

85
Q

ejection fraction (EF)

A

portion of blood ejected during systole, compared with total ventricular filling volume
- normal 55-65%

86
Q

PET positron emission tomography scan

A

evaluates cardic metabolism and assess tissue perfusion

87
Q

Hemodynamic monitoring

A

is measurement of pressures in heart and calculation of hemodynamic parameters

88
Q

Central venous pressure (CVP) monitoring

A

appropriate for clients who require accurate monitoring of fluid volume status do not require more invasive PA pressure monitoring
- normal CVP 2-6

89
Q

PA pressure monitoring

A

appropriate for critically ill clients requiring more accurate assessments of left heart pressures including those undergoing cardiac surgery shock or with serious MI

90
Q

Normal Sinus Rhythm

A 
rate 60-100
Regular rhythm
P:QRS 1:1
PR INTERVAL: 0.12-0.20 SEC
QRS: 0.06 -0.10 sec
91
Q

Sinus tachycardia

A 
rate 101-150 bpm
regular rthythm
P:QRS 1:1 ( P wave may be hidden in preceding T wave with fast rate) 
PR Interval 0.12-20 sec
QRS 0.06-0.10 sec
92
Q

sinus tach treatment

A

treat only if client is symptomatic or is at risk for myocardial damage
- beta blockers or verapamil

93
Q

sinus bradycardia

A 
Rate 60-100 bpm
regular 
P:QRS 1:1
PR Interval 0.12-0.20 sec
QRS 0.06-0.10
94
Q

Sinus bradycardia treatment

A

treat only if client is symptomatic

intravenous atropine and/or pacemaker therapy may be used

95
Q

Sinus arrhythmia

A

60-100bpm
Rhythm: irregular, varies with respiration
P:QRS 1;1
PR interval 0.12-0.20 sec but may be prolonged
QRS 0.06.0.10

96
Q

Sinus arrhythmia treatment

A

generally none; considered a normal rhythm in very young and very old

97
Q

Premature atrial contractions (PAC)

A

rate: variable
rhythm: irregular, underlying normal rhythm interrupted by early atrial ectopic ebats
P:QRS 1:1
PR interval 0.12-0.20 but may be prolonged
QRS 0.06-0.10

98
Q

PAC treatment

A

usually require no treatment

advise client to reduce alcohol and caffeine and reduce stress and stop smoking

99
Q

Paroxysmal supraventricular tach. (PSVT)

A 
100-280 (usually 200 bpm)
regular
p waves often not identifiable 
PR is not measured 
QRS 0.06-0.10
100
Q

PSVT treatment

A

treat if client is symtomatic many include vagal maneuvers

oxygen therapy. adenosine, varapamil, procainamide, propranolol and esmolol and synchronized cardioversion

101
Q

Atrial flutter

A

atrial 240-360 ventricular rate depends on degree of AV block and usually is less than 150 bpm
rhythm: atrial regular ventriular usually regular
P:QRS 2:1, 4:1 may vary
pr interval not measured
QRS 0.06 -0.10 sec

102
Q

atrial flutter treatment

A
103
Q

Atrial fibrillation

A 
atrial 300-600 (too rapid to count) 
ventricular 100-180 in untreated clients
irrgegular
PQRS variable
PR not measured
qrs 0.06-0.10
104
Q

treatment for A fib

A

syncronized cardioversion
drugs to convert rhythm ( amidoarone) or reduce ventricular response rate, verapamil propranolol digoxin anticoagulants to reduce risk of clot formation and stroke

105
Q

First degree av block

A 
usually 60-100 bpm 
regular 
pqrs 1:1 
pr interval greater than 0.20 seconds
QRS 0.06 -0.10 sec
requires no treatment
106
Q

Premature ventricular contractions (PVC)

A 
variable rate
irregular PVC interrupts underlying rhythm and is followed by compensatory pause
No P wave
PR absent with PVC
QRS complex wide greater than 0.12 ec
107
Q

treatment for PVC

A

treat client if experiencing symptoms
advise against stimulant use
drugs include lidocaine, procainamide, quinidine propranolol phenytoin, bretylium

108
Q

VENTRICULAR TACHYCARDIA (VT AND V Tach)

A 
100-250 
regular 
p waves usually identifiable 
PR not measured 
QRS 0.12 sec or longer bizarre shape
109
Q

treatment for VT and V tach

A

treat if VT is sistained or if client is symptomatic

treatment includes procainamide amiodarone or lidocaine and immediate defib if client is unconscious or unstable

110
Q

Ventricular fib

A

too rapid to count
grossly irregular
no identifable P waves
IMMEDIATE DEFIBRILLATION

111
Q

Percutaneous transluminal coronary angioplasty (PTCA)

A

procedure to increase coronary artery blood flow by inserting a balloon tipped catheter into a narrowed segment of affected artery inflating ballon to expand arterial lumen and removing the catheter , may also include insertion of expandable intracoronary stent

112
Q

Coronary artery bypass grafting (CABG)

A

surgical treatment of CHD for clients with more than 50% occlusion in left main coronary artery or several blockage in several vessels

113
Q

Myocardial infarction

A

myocardial injury from sudden restriction of blood supply to a portion of heart is a potentially life threating condition
- main cause CAD

114
Q

Coronary artery disease

A

the buildup of atherosclerotic plauqe in coronary arteries that restricts blood flow to heart

115
Q

CAD nonmodifiable risk factors

A

age, gender, family history, ethnic background

116
Q

CAD modifiable risk factors

A

smoking obesity stress elevated holesterol diabetes and hypertension

117
Q

Stable angina

A

predictable response to increased activity

118
Q

unstable angina

A

unpredictable occurance and increasing severity

119
Q

prinzmetal angina

A

caused by arterial spasm and often awakening client from sleep; treated with calcium channel blockers

120
Q

Medication therapy

A

MONA morphine oxygen nitroglycerine aspirin

121
Q

Heart failure (HF)

A

the inability of heart to pump adequate blood to meet metabolic needs of body

122
Q

Causes of HF

A

damage from MI, incompetent valves, inflammatory conditions of heart, cariomyopathy, pulmonary, hypertension

123
Q

Right side HF

A

has reduced capacity to pump blood into pulmonary circulation, causing back op of blood into venous circulation ( jvd, full body edema)

124
Q

Left side HF

A

left ventricle has reduced capacity to pump blood into systemic circulation causing decreased CO and black up of blood in pulmonary ciruclation

125
Q

signs of pulmonary edema

A

restlessness, anxiety, crackles, tachypenia, tachycardia, pink frothy sputum decreased SO2 and PO2

126
Q

ACE inhibitors

A

to reduce after load and consequently increase CO

127
Q

ARBs

A

interrupt vasoconstrictor andaldosterone secreting effects of angeiotension II prescribed for similar reasons as ACE inhibitors

128
Q

Diuretics

A

decrease preload pulmonary congston which degrease cardic work and increase CO monitor potassium

129
Q

vasodilators

A

nitroglycerine to reduce preload mointor for hypotension

130
Q

morphine

A

sedate and vasodilate decreasing cardiac workload monitor or hypotension or resp. depression

131
Q

digoxin

A

improve contractility and correspondingly increase stroke volume, and CO . take apical pulse for 1 full min and withhold dose if HR is below 60-120

132
Q

inotropic agents

A

dopamine (intropin) and dobutamine (dobutrex) are used in critical care when decompresation of CO leads to hypotension

133
Q

Endocarditis

A

inflammation of inner layer and heart usually involves cardiac values

134
Q

Endocarditis

A

caused by microorganisms in blood

risk factors are IV drug use, structure dects of heart or valves

135
Q

acute endocarditis

A

sudden onset with staph aureus as most common organism

136
Q

subacute endocaritis

A

gradual onset with strep viridans or other less virulent bacteria

137
Q

microorganisms in bloodstream

A

colonize on fibrin and platelet strands in endothelium multiply and develop new strands seen as vegetation attached to endothelum particularly valves causing valve damage segments of vegetation may break off and travel to extremities manifeted as petechine

138
Q

endocarditis assessment

A
  • high fever with chills signs of HF and WBC elevation
  • subacute - fever of unknown origin, cough, dyspena , anorexia, malaise normal WBC anemia and elevated erthyrocyte sedimentation
  • both positive blood cultures , or new murmur or change in previous murmur
139
Q

stenosis

A

heart valve leaflets are fused together opening is narrow stiff and unable to open or close properly

140
Q

regurgitation

A

there is improper or incomplete closure of heart valves resulting in backflow of blood

141
Q

Causes of Valvular disorders

A

rheumatic heart diseases (most common) congential MI and Endocarditits
- calcium depositis or car tissue from MI or endocarditits cause stiffening

142
Q

Mitral stenosis

A

low pitched rumbling diastolic
common in young women
Atrial dystrthmias

143
Q

mitral regurgitation

A

murmur high pitched blowing systolic
usually asymptomatic
A-fib common with low incidence of embolization
(diuretics, nitrates, ACE inhibitors maintain sodium restricted diet)

144
Q

mitral prolapse

A 
murmur systolic click
most clients asymptomatic
may have PVCs and palpitations
syncope, weakness and anxiety
* give beta blockers for syncopy 
* prophylactic antibiotics
145
Q

Aortic stenosis

A

murmur harsh systolic
late course symptoms angina S3 and S4
-restrict activity
-symptomatic aortic stenosis has a poor prognosis without surgery

146
Q

aortic regurgitation

A

murmor blowing diastolic widened pulse pressure palpitations tachycarda and PVC
- medical management

147
Q

valvular disorders meds

A

treat with anticoagulatns

148
Q

Cardiomyopathy

A

an abnormality of the heart muscle that leads to functional changes in heart

149
Q

causes of cardiomyopathy

A

unknown

may be linked to vital infections alcohol abuse pregnancy

150
Q

types of cardiomyopathy

A
  1. dilated- most common enlargement of all four chambers of the heart
  2. hypertrophic- unexplained progressive thickening of ventricular muscle mass
  3. restrictive cardiomyopathy excessively rigid ventricular walls not stretch during diastolic filling external dyspnea syncope angina
    SUDDEN DEATH
  4. restrictive dyspnea-right side heart failure , rigid ventricular walls not strech duringdiastolic filling
151
Q

assessment of cardiomyopathy

A

Fatigue with all types

dilated weaknes s S3 and S4 heart sound

152
Q

Pericarditis

A

inflammation of the pericardium

153
Q

acute pericaditis

A

may have many causes including infections , viral are most common, post MI, trauma,

154
Q

chronic pericarditis

A

causes fibrous thickening of pericardium constricting cardiac walls movement and strestircting diastolic filling

155
Q

pericarditis assessment

A

substernal pain, radiatig to neck aggravated by breathing or cough

Nursing Adult Health II (6 decks)

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