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Adult Health 1 > Cardiovascular Assessment > Flashcards

Cardiovascular Assessment Flashcards

1
Q

cardiovascular changes associated with aging

A

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.

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2
Q

changes in cardiac valves with aging

A

calcification and degeneration (mitral and aortic valves). monitor for murmurs.

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3
Q

changes in conduction system with aging

A

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.

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4
Q

changes in left ventricle with aging

A

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.

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5
Q

changes in aorta and other large arteries with aging

A

thicken, stiffer and less distensible. systolic BP increases. systemic vascular resistance increases. left ventricle pumps against greater resistance. left ventricular hypertrophy, monitor for HTN

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6
Q

changes in baroreceptors with aging

A

receptors related in the blood vessels: become less sensitive, monitor for orthostatic hypotension.

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7
Q

assessment methods for cardiac assessment

A

patient history, nutrition history, family and genetic history, current health concerns, functional history, physical assessment.

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8
Q

patient history for cardiac assessment

A

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).

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9
Q

nutrition history for cardiac assessment

A

high sodium, fat and cholesterol can increase risk for CV disease.

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10
Q

family and genetic history for cardiac assessment

A

screen first degree relative history of CAD, HTN, sudden cardiac death

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11
Q

current health concern/symptoms for cardiac assessment

A

chest pain or discomfort, dyspnea, fatigue, palpitations, edema, syncope, extremity pain

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12
Q

functional history for cardiac assessment

A

used to gauge severity when someone already has heart disease.

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13
Q

physical assessment for cardiac assessment

A

general appearance, skin, extremities, BP, venous and arterial pulses, precordium

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14
Q

skin assessment for cardiac assessment

A

color, temp, nail beds, mucous membranes, conjunctival mucosa, decreased perfusion- cool, pale, cyanotic, gray and or moist skin

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15
Q

extremity assessment for cardiac assessment

A

assess for dehydration- skin turgor, assess for edema- location and extent, vascular changes- paresthesia, muscle fatigue, pain, numbness, coolness, loss of hair

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16
Q

BP assessment for cardiac assessment

A

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.

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17
Q

venous and arterial pulses assessment for cardiac assessment

A

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)

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18
Q

hypokinetic pulse

A

weak pulse

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19
Q

hyperkinetic pulse

A

bounding pulse

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20
Q

Lab assessments cardiac markers

A

cellular injury causes a release of enzymes and those enzyme levels are used to diagnose Acute Coronary Syndrome.
troponin, creatine kinase, CK-MB, myoglobin

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21
Q

troponin

A

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

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22
Q

Creatine Kinase

A

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

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23
Q

CK-MB

A

specially found in myocardial muscle. normal=0% of total CK

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24
Q

Myoglobin

A

protein found in cardiac and skeletal muscle. normal= less than 90 mcg/L

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25
Q

lab assessments cardiac serum lipid

A

elevates level of increase risk for CAD.
cholesterol, triglycerides, HDL, LDL, HDL:LDL ratio

26
Q

cholesterol level

A

less than 200 mg/dL

27
Q

triglycerides levels

A

between 40 and 160 mg/dL for men and between 35 and 135 mg/dL for women

28
Q

HDL levels

A

less than 45 mg/dL for men and less than 55 mg/dL for women. considered good cholesterol

29
Q

LDL levels

A

less than 130 mg/dL

30
Q

HDL:LDL ratio

A

3:1

31
Q

Lab assessments cardiac miscellaneous

A

BNP, Coagulation studies, homocysteine, c-reactive protein, microalbuminuria.

32
Q

BNP

A

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.

33
Q

Coagulation studies

A

evaluates the ability of blood to clot, monitor when patients on anticoagulants.

34
Q

homocysteine

A

amino acid produced when proteins break down. elevated levels indicates increase the risk for cardiac disease. normal is less than 14 mmol/dL

35
Q

c-reactive protein

A

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.

36
Q

Microalbuminuria

A

small amounts of protein in the urine, indicates endothelial dysfunction.

37
Q

lab assessments cardiac electrolytes

A

hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia.

38
Q

hypokalemia

A

increased electrical instability, ventricular dysrhythmias, increased risk for digitalis toxicity

39
Q

hyperkalemia

A

slowed ventricular conduction, peaked T waves on the ECG, and contraction followed by asystole.

40
Q

Hypocalcemia

A

ventricular dysrhythmias, a prolonged QY interval, cardiac arrest

41
Q

Hylercalcemia

A

Shortens the QT interval and causes AV black, digitalis hypersensitivity and cardiac arrest.

42
Q

Hypomagnesium

A

prolongs the QT interval causing a specific type of ventricular tachycardia.

43
Q

Diagnostic testing of cardiac

A

CXR, Angiography or Arteriography, ECG, Echo, Exercise electrocardiography, trans-esophageal echocardiography, myocardial nuclear perfusion imaging, MRI, Cardiac Cath

44
Q

CXR

A

examine size, silhouette and position of heart

45
Q

Angiography and arteriography

A

uses contrast dye and fluoroscopy to examine arterial vessels. Prep: screen for allergy to dye; sedation required; usually NPO

46
Q

ECG

A

very common and valuable diagnostic, examines electrical activity of heart, no prep required.

47
Q

Echo

A

uses ultrasound to assess cardiac structure and mobility, specifically looks at valves, no prep required.

48
Q

Exercise electrocardiography (EPS)

A

“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.

49
Q

Trans-esophageal echocardiography

A

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

50
Q

Myocardial nuclear perfusion imaging

A

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

51
Q

MRI

A

magnetic and radio waves used to view cardiac wall thickness, heart chambers, valve and ventricular function, and blood movement. Prep: screen for metallic object.

52
Q

Cardiac Catheterization

A

studies of the right or left side of the heart and the coronary arteries using fluoroscopy and contrast dye

53
Q

cardiac cath prep

A

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.

54
Q

cardiac cath post op

A

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.

55
Q

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

A

1,3,5

56
Q

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

A

2

57
Q

True or False
A client admitted to the hospital with
an elevated HDL requires a cardiac
workup to evaluate for
cardiovascular disease.

A

false

58
Q

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

A

2

59
Q

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

A

3,4,5

60
Q

Which test is the best tool for
diagnosing heart failure?
1. Echocardiogram
2. Troponin level
3. Electrocardiogram
4. Coronary angiography

A

1

Adult Health 1 (16 decks)

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