Cardiovascular Assessment Flashcards
cardiovascular changes associated with aging
noticed best when the body has increased metabolic needs- exercise, stress, etc. Changes lead to loss of cardiac reserve and are present when there are increased demands on body.
changes in cardiac valves with aging
calcification and degeneration (mitral and aortic valves). monitor for murmurs.
changes in conduction system with aging
pacemaker cells decrease in number. fibrous tissue and fat in the sinoatrial node increase. few muscle fibers in the atrial myocardium and bundle. conduction time increases. increased risk for atrial dysrhythmias.
changes in left ventricle with aging
increase in size, becomes stiff, and less distensible. Fibrotic changes decrease speed of early diastolic filling by 50%. decrease stroke volume, ejection fraction, and cardiac output. less able to meed oxygen demands.
changes in aorta and other large arteries with aging
thicken, stiffer and less distensible. systolic BP increases. systemic vascular resistance increases. left ventricle pumps against greater resistance. left ventricular hypertrophy, monitor for HTN
changes in baroreceptors with aging
receptors related in the blood vessels: become less sensitive, monitor for orthostatic hypotension.
assessment methods for cardiac assessment
patient history, nutrition history, family and genetic history, current health concerns, functional history, physical assessment.
patient history for cardiac assessment
focus on risk factors and symptoms, assess non modifiable risk factors (age, gender, ethnicity, family history. men and post menopausal women at higher risk for CAD), assess modifiable risk factors (obesity, smoking, inactivity, psychological stress), assess for chronic disease (diabetic patients at higher risk).
nutrition history for cardiac assessment
high sodium, fat and cholesterol can increase risk for CV disease.
family and genetic history for cardiac assessment
screen first degree relative history of CAD, HTN, sudden cardiac death
current health concern/symptoms for cardiac assessment
chest pain or discomfort, dyspnea, fatigue, palpitations, edema, syncope, extremity pain
functional history for cardiac assessment
used to gauge severity when someone already has heart disease.
physical assessment for cardiac assessment
general appearance, skin, extremities, BP, venous and arterial pulses, precordium
skin assessment for cardiac assessment
color, temp, nail beds, mucous membranes, conjunctival mucosa, decreased perfusion- cool, pale, cyanotic, gray and or moist skin
extremity assessment for cardiac assessment
assess for dehydration- skin turgor, assess for edema- location and extent, vascular changes- paresthesia, muscle fatigue, pain, numbness, coolness, loss of hair
BP assessment for cardiac assessment
hypertension (systolic greater than 140, diastolic greater than 90), med management for HTN, BP less than 90/60 may not be adequate for providing enough oxygen and sufficient nutrition to body cells.
Postural hypotension (orthostatic)- decrease of more than 20 in SBP or more than 10 in DBP and 10-20% increase in HR with position changes.
Pulse pressure- difference between systolic and diastolic values, used an indirect measures of cardiac output.
venous and arterial pulses assessment for cardiac assessment
venous pulsations in neck assess for JVD. Assess all major peripheral pulses. Auscultate carotid for bruits- normally there are no sounds if the artery has uninterrupted blood flow.
Precordium: area over the heart- inspection and auscultation (S1 Mitral and tricuspid valve closing, S2 pulmonic and aortic valve closing, Abnormal: splitting of S2, S3,S4 murmurs, pericardial friction rub)
hypokinetic pulse
weak pulse
hyperkinetic pulse
bounding pulse
Lab assessments cardiac markers
cellular injury causes a release of enzymes and those enzyme levels are used to diagnose Acute Coronary Syndrome.
troponin, creatine kinase, CK-MB, myoglobin
troponin
myocardial muscle protein released when there is injury to myocardial muscle. Normal: T less than 0.10 ng/mL and I less than 0.03 ng/mL
Creatine Kinase
enzyme specific to cells of the brain, myocardium, and skeletal muscle. CK indicates tissue necrosis or injury. Normal= females 30-135 units/L and males 55-170 units/L
CK-MB
specially found in myocardial muscle. normal=0% of total CK
Myoglobin
protein found in cardiac and skeletal muscle. normal= less than 90 mcg/L
lab assessments cardiac serum lipid
elevates level of increase risk for CAD.
cholesterol, triglycerides, HDL, LDL, HDL:LDL ratio
cholesterol level
less than 200 mg/dL
triglycerides levels
between 40 and 160 mg/dL for men and between 35 and 135 mg/dL for women
HDL levels
less than 45 mg/dL for men and less than 55 mg/dL for women. considered good cholesterol
LDL levels
less than 130 mg/dL
HDL:LDL ratio
3:1
Lab assessments cardiac miscellaneous
BNP, Coagulation studies, homocysteine, c-reactive protein, microalbuminuria.
BNP
will be elevated and used for diagnosing HF (greater than 100 is diagnostic). produced and released by the ventricles when they are stretched and fluid overload. Natriuretic peptides are neurohormones that promote vasodilation and diuresis through sodium loss in the renal tubules.
Coagulation studies
evaluates the ability of blood to clot, monitor when patients on anticoagulants.
homocysteine
amino acid produced when proteins break down. elevated levels indicates increase the risk for cardiac disease. normal is less than 14 mmol/dL
c-reactive protein
any inflammatory process can produce CRP in the blood. normal is less than 1.0 mg/dL. greater than 3mg/dL indicates high risk for heart disease. Elevations are also seen with HTN, infection and smoking.
Microalbuminuria
small amounts of protein in the urine, indicates endothelial dysfunction.
lab assessments cardiac electrolytes
hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia.
hypokalemia
increased electrical instability, ventricular dysrhythmias, increased risk for digitalis toxicity
hyperkalemia
slowed ventricular conduction, peaked T waves on the ECG, and contraction followed by asystole.
Hypocalcemia
ventricular dysrhythmias, a prolonged QY interval, cardiac arrest
Hylercalcemia
Shortens the QT interval and causes AV black, digitalis hypersensitivity and cardiac arrest.
Hypomagnesium
prolongs the QT interval causing a specific type of ventricular tachycardia.
Diagnostic testing of cardiac
CXR, Angiography or Arteriography, ECG, Echo, Exercise electrocardiography, trans-esophageal echocardiography, myocardial nuclear perfusion imaging, MRI, Cardiac Cath
CXR
examine size, silhouette and position of heart
Angiography and arteriography
uses contrast dye and fluoroscopy to examine arterial vessels. Prep: screen for allergy to dye; sedation required; usually NPO
ECG
very common and valuable diagnostic, examines electrical activity of heart, no prep required.
Echo
uses ultrasound to assess cardiac structure and mobility, specifically looks at valves, no prep required.
Exercise electrocardiography (EPS)
“stress test”, assess cardiovascular response to increased workload.
Prep: encourage rest the night before the procedure, light meal 2 hours before test, avoid smoking, alcohol, and caffeine containing beverage on the day of the test. hold beta blockers and calcium channel blockers, wear comfortable clothing and rubber soled supportive shoes.
Trans-esophageal echocardiography
examines cardiac structures and function using ultrasound that is placed behind the heart in the esophagus or stomach. sedation is required, prep: similar to upper GI endoscopic exam
Myocardial nuclear perfusion imaging
radioactive tracer substances used to view cardiovascular abnormalities, can view myocardial blood flow and left ventricular function. Prep: NPO, no caffeine or cigarettes 4 hours prior
MRI
magnetic and radio waves used to view cardiac wall thickness, heart chambers, valve and ventricular function, and blood movement. Prep: screen for metallic object.
Cardiac Catheterization
studies of the right or left side of the heart and the coronary arteries using fluoroscopy and contrast dye
cardiac cath prep
renal protection from contrast dye: fluids may be given 12-24 hours before the procedure for meal protection and administer acetylcysteine. CXR, CBC, Coagulation screen, and ECG done. NPO after midnight or liquid breakfast if procedure scheduled in the afternoon. Assess patient for contrast dye allergy, sedative may be given, hold digitalis or diuretic prior to procedure.
cardiac cath post op
bed rest and keep insertion site extremity straight, monitor vital signs, assess insertion site for drainage or hematoma, assess for peripheral pulses, tremors, color in affected extremity, maintain I&O maintain hydration, observe for complications.
The nurse is assessing a 62 year-old woman. She is postmenopausal, diabetic for 10 years, smokes 1 pack of cigarettes for 20 years, walks twice a week for 30 minutes, and describes her lifestyle as sedentary. For her weight and height she has a body mass index of 32 (healthy weight is 18.5 to 24.9). Which risk factors for this patient are controllable for cardiovascular disease? (Select all that apply)
1. Smoking
2. Age
3. Obesity
4. Postmenopausal
5. Sedentary lifestyle
1,3,5
What term describes the difference
between systolic and diastolic values,
which is an indirect measure of
cardiac output?
1. Stroke volume
2. Pulse pressure
3. Ankle-brachial index
4. Normal blood pressure
2
True or False
A client admitted to the hospital with
an elevated HDL requires a cardiac
workup to evaluate for
cardiovascular disease.
false
When is B-type natriuretic peptide
(BNP) produced and released for a
patient with heart failure?
1. When a patient has an enlarged liver
2. When a patient has fluid overload
3. When a patient’s ejection fraction is
lower than normal
4. When a patient has ventricular
hypertrophy
2
What is included in post-procedural care of a patient after a cardiac catheterization? (Select all that apply)
1. Patient remains on bedrest for 12 to 24 hours
2. Patient is placed in a high-Fowler’s position
3. Dressing is assessed for bloody drainage or hematoma
4. Peripheral pulses in the affected extremity, as well as skin temperature and color, are monitored with every vital sign check
5. Adequate oral and IV fluids are provided for hydration
6. Vital signs are monitored every hour for 24 hours
3,4,5
Which test is the best tool for
diagnosing heart failure?
1. Echocardiogram
2. Troponin level
3. Electrocardiogram
4. Coronary angiography
1
