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AHI > CARDIOVASCULAR ASSESSMENT QUESTIONS > Flashcards

CARDIOVASCULAR ASSESSMENT QUESTIONS Flashcards

1
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

Answer: 1, 3, 5
controllable/modifiable
All risk factors but not all controllable

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2
Q

Patient History
Nutrition History
Family and Genetic History
Physical Assessment
Venous and arterial pulses
BP and HR
Precordium (area over heart)
Current Health Concerns/Symptoms
Functional History

A

Assessment methods

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3
Q

Focus on risk factors and symptoms: risk factors - huge for CV disease processes: ask questions about fam history and risk factors; know about modifiable because help change them
Assess non-modifiable risk factors: know have these need do closer monitoring
Assess modifiable risk factors
Assess for chronic diseases

A

Patient History

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4
Q

Age, sex, ethnicity, family history
Ex. men and post menopausal women (lose estrogen) at higher risk for coronary artery disease (CAD)

A

Assess non-modifiable risk factors: know have these need do closer monitoring

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5
Q

Obesity, smoking, inactivity, psychological stress

A

Assess modifiable risk factors

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6
Q

Ex. Diabetic patients at higher risk (high levels of BG viscosity affected and damages blood vessel: microvascular and macrovascular changes that happens with high BG levels - macrovascular put at risk for CV disease)

A

Assess for chronic diseases

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7
Q

Ex. High sodium, fat and cholesterol can increase risk for CV disease - Na and water moves together: limit Na if have HTN; fat and cholesterol: CVD because of atherosclerosis

A

Nutrition History

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8
Q

Screen first degree relative for history of CAD, hypertension, sudden cardiac death
Fam History of CVD/MI before 40; earlier onset higher risk for CVD

A

Family and Genetic History

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9
Q

General appearance
Skin
Extremities

A

Physical Assessment

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10
Q

Assess color and temperature
Assess nail beds, mucous membranes, and conjunctival mucosa
Decreased perfusion can be manifested as cool (indics perfusion), pale (indics perfusion), cyanotic, gray (chronic hypoxia) and/or moist skin

A

Skin

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11
Q

Assess for dehydration – skin turgor - fluid volume
Assess for edema
Vascular changes

A

Extremities

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12
Q

Grade: Location and extent (1+, 2+, 3+, 4+); pitting; tells not circulating blood effectively throughout body

A

Assess for edema

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13
Q

Paresthesia, muscle fatigue, pain, numbness, coolness, loss of hair - not getting oxygenated blood: issues with arterial sys

A

Vascular changes

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14
Q

Venous pulsations in neck assess for jugular venous distention (JVD): pulses check: have fluid overload
Assess all major peripheral pulses
Quality of peripheral pulses (weak or bounding (increased blood volume) pulse): Peripheral pulses: thready or bounding: increased heart volume
Auscultate carotid for bruits – normally there are no sounds if the artery has uninterrupted blood flow: bruits means restricted blood flow/turbulence going on

A

Venous and arterial pulses

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15
Q

Inspection
Auscultation

A

Precordium (area over heart)

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16
Q

S1-Mitral and tricuspid valve closing
S2-Pulmonic and aortic valve closing
Abnormal (splitting of S2; S3, S4, murmurs, pericardial friction rub)
Listen to lung (HF) and heart sounds

A

Auscultation

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17
Q

Chest pain or discomfort
Dyspnea
Fatigue - big
Palpitations - feel PVCs sometimes as these
Edema
Syncope - decreased perfusion
Extremity pain
chest pain, SOB - s/s of decreased perfusion

A

Current Health Concerns/Symptoms

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18
Q

Mobility: ADLs, used hx. to grade HF pats: how much limiting daily life

A

Functional History

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19
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

Answer: 2
INDIRECT
Shows force of contraction
SV: amount blood ejected from ventricle with each contraction
Ankle-brachial index: used to assess vascular status of the lower extremities; checking perfusion and comparing that between extremities
CO: SVxHR - amount blood ejected from LV/min; how much heart able push out; IMP VALUE
EF: goes with SV: when LV fills have volume blood in there and then ventricle contracts and then ejects some of the blood; EF is % blood ejected from LV; never 100%; typ 60-70%

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20
Q

Blood pressure (BP)
Postural (orthostatic) hypotension
Pulse pressure

A

Assessment methods

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21
Q

Hypertension
BP < 90/60 may not be adequate for providing enough oxygen and sufficient nutrition to body cells

A

Blood pressure (BP)

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22
Q

Systolic blood pressure (SBP) >140 mm Hg
Diastolic blood pressure (DBP) > 90 mm Hg
Considered hypertensive

A

Hypertension

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23
Q

Need MAP (mean arterial pressure) at least 60-70 mmHg to perfusion organs

A

BP < 90/60 may not be adequate for providing enough oxygen and sufficient nutrition to body cells

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24
Q

Decrease of more than 20 mm Hg of the SBP or more than 10 mm Hg of the DBP and 10-20% increase in HR with changes in position; drop BP when changing positions

A

Postural (orthostatic) hypotension

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25
Q

Difference between systolic and diastolic values, used an indirect measure of cardiac output

A

Pulse pressure

26
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
Cholesterol imp lab values for CAD
Elevated levels (cholesterol/tri) increase risk for CAD/atherosclerosis

27
Q

<200 mg/dL

A

Cholesterol

28
Q

Between 35-160 mg/dL

A

Triglycerides

29
Q

> 45 mg/dL
Considered “good cholesterol”

A

HDL

30
Q

<130 mg/dL

A

LDL

31
Q

3:1 ratio
Imp: ratio of good cholesterol to blood cholesterol
More HDL to LDL

A

HDL:LDL ratio

32
Q

Cellular injury causes a release of enzymes and those enzyme levels are used to diagnose Acute Coronary Syndrome (ACS)
Troponin
Creatine kinase (CK)
CK-MB
Myoglobin

A

Laboratory assessments: cardiac markers

33
Q

Myocardial muscle protein released when there is injury to myocardial muscle
Done more often now
Normal=T <0.10 ng/mL and I < 0.03 ng/mL
MI/Lack perfusion to heart muscle
Classic lab for MI eval
Protein release when damage to heart muscle; never detectable; if increased damage to heart muscle
Specifically sensitive to heart damage
Specifically sensitive to cardiac muscle

A

Troponin

34
Q

Enzyme specific to cells of the brain, myocardium, and skeletal muscle
CK indicates tissue necrosis or injury
Elevated if any muscle damage
Normal=females 30-135 units/L and males 55-170 units/L

A

Creatine kinase (CK)

35
Q

Specially found in myocardial muscle
Normal =0% of total CK
Specific to myocardial muscle; not as sensitive as tropin

A

CK-MB

36
Q

Protein found in cardiac and skeletal muscle
Normal= < 90 mcg/L

A

Myoglobin

37
Q

Coagulation Studies
C-reactive protein (CRP)
Brain natriuretic peptide (BNP)
Homocysteine
Microalbuminuria

A

Laboratory assessments: miscellaneous

38
Q

Evaluates the ability of blood to clot
Monitor when patients on anticoagulants
Hypercoagability naturally in body risk for blood clots; PT, INR, PTT, fibrinogen, then platelet count in CBC - causes them stick together to cause occlusion in vascular sys; high: less likely clot
Make predisposed for clots; before pre-op, after admin of anticoag meds

A

Coagulation Studies

39
Q

Any inflammatory process can produce CRP in the blood
Inflammatory lab
Normal: < 1.0 mg/dL
Not seen as much
> 3mg/dL indicates high risk for heart disease

A

C-reactive protein (CRP)

40
Q

Protein released by the heart
For HF: when ventricles stretched releases protein; HF and not eject all blood heart muscle stretched more and protein is released
>100 abnorm
Elevations indicate heart failure

A

Brain natriuretic peptide (BNP)

41
Q

Not seen as much
Amino acid produced when proteins break down
Elevated levels indicates increase the risk for cardiac disease
Normal: < 14 mmol/dL

A

Homocysteine

42
Q

Small amounts of protein in the urine
Not seen as much
Indicates endothelial dysfunction

A

Microalbuminuria

43
Q

Any abnorm electrolyte put at risk for dysrhythmias: K, Ca, Mg
Aggressively treat abnormalities to decrease risk of dysrhythmias, esp K
High: slows conduction
Low: speeds conduction
Messing up electrical conduction

A

Lab assessments: electrolytes

44
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

Answer: 2

45
Q

Studies of the right or left side of the heart and the coronary arteries using fluoroscopy and contrast dye
Preparation:
Way go in and look at heart and look at coronary arteries that feed heart
Post procedure care

A

Cardiac catheterization - Diagnostic testing

46
Q

A catheter is inserted in the femoral vein for a right sided heart cath
A catheter is inserted into the femoral or radial artery for a left sided heart cath and coronary arteriography - most commonly seen
Visualize what going on in heart and arteries accessing that heart
Might use dye and if have dye allergy but have possible MI will do this to open vessels; need vessels open; premedicate before to prevent rxn - know might have rxn
Protect kidneys because lot dye giving: give fluid ahead and give fluids post and flushing dye through kidneys
See if vessels occluded and loss circ to heart muscle
Check pressures in pulm arteries

A

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

47
Q

Renal protection from contrast dye
fluids may be given 12-24 hours before the procedure for renal protection
Administer acetylcysteine
CXR, CBC, Coagulation screen (no risk bleeding), and ECG done
NPO after midnight or liquid breakfast if procedure scheduled in the afternoon - for 6 hrs
Assess patient for contrast dye allergy (antihistamine or steroid may be given)
Sedative

A

Preparation: - Cardiac catheterization

48
Q

Bed rest and keep insertion site extremity straight: femoral access points
From 2-6 hours
Radial preferred choice; can do interventions if needed; diagnostic and intervention - get cath lab ASAP to open arteries; femoral better if have lot things do
Monitor vital signs
Ex. every 15 minutes x 1 hour, 30 minutes x 2hours, then every hour for 4 hours, then q4hrs
Assess insertion site for drainage or hematoma: bleeding restart with all checks because common have bleeding and oozing at site
Assess peripheral pulses, temperature, and color in affected extremity
Monitor I & O/ Maintain hydration
Observe for complications

A

Post procedure care - Cardiac catheterization

49
Q

What is included in post-procedural care of a patient after a cardiac catheterization that has a femoral access? (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

Answer: 3, 4, 5
Typ 4-6 hours bed rest
High-fowlers: Concerned about risk for bleeding; break coag going on
Skin color and temp tells on perfusion; each VS check need do peripheral vascular check: pulses, cap refill, skin color, movement, sensation
Monitored more frequently initially when come out: VS and peripheral vascular checks

50
Q

Which test is the best tool for diagnosing heart failure?
1.transthoracic Echocardiogram
2.Pulmonary artery catheter
3.Electrocardiogram
4.Multigated angiographic (MUGA) scan

A

Answer: 1
US of heart; on outside of heart; no sedation/prep and on bedside; see structure and func of heart; valves checked and structure and func; EF given from it - looking at it for HF

51
Q

CXR
Angiography or arteriography
Electrocardiogram (ECG)
Echocardiogram (Echo)
Exercise electrocardiography (EPS)
Transesophageal echocardiography (TEE)
Myocardial nuclear perfusion imaging
Magnetic resonance imaging (MRI)
Thallium - post MI if have damage to func

A

Diagnostic testing

52
Q

Examine size, silhouette and position of heart
Shows heart; HF: heart looks enlarged

A

CXR

53
Q

Uses contrast dye and fluoroscopy to examine arterial vessels
Preparation: Screen for allergy to dye; Sedation required; usually NPO
Using Contrast dye to look at arterial vessels

A

Angiography or arteriography

54
Q

Very common and valuable diagnostic
Examines electrical activity of heart: 12-lead: diagnostic: shows electrical activity through diff places of heart; use diagnosis where MI might be
Very useful
Noninvasive
Preparation: None required

A

Electrocardiogram (ECG)

55
Q

Uses ultrasound to assess cardiac structure and mobility
Specifically looks at valves
Ejection fraction measured (EF-% of left ventricular volume that is ejected with each contraction)
Preparation: None required
Regular transthoracic

A

Echocardiogram (Echo)

56
Q

“Stress test”
Looking at Heart rxn to increased workload; typ exerting self: exercise to point where HR elevates where heart under stress; typ outpat
Give drugs to simulate exercise
Assesses cardiovascular response to an increased workload
Patient Preparation

A

Exercise electrocardiography (EPS)

57
Q

Used to evaluate for asymptomatic CAD, dysrhythmias, or evaluate the effectiveness of antidysrhythmic meds

A

Assesses cardiovascular response to an increased workload - Exercise electrocardiography (EPS)

58
Q

Encourage rest the night before the procedure
Light meal 2 hours before the test (depends on physician order)
Avoid smoking (vasoconstriction), alcohol, and caffeine-containing (increases HR) beverages on the day of the test
Beta blockers - decrease SNS and falsely keep HR down - and calcium channel blockers usually held
To allow heart rate to increase with stress
Wear comfortable clothing and rubber-soled supportive shoes

A

Patient Preparation - Exercise electrocardiography (EPS)

59
Q

Examines cardiac structure and function using ultrasound that is placed behind the heart in the esophagus or stomach
Scope in esophagus and then US heart
Esophagus behind heart - look back heart and not through bone structures; commonly used for vegetation on heart valves; precardioversion if have afib - not want cardiovert blood clot and it moves so want make sure not there
Sedation is required
Preparation: similar to upper GI endoscopic exam
Numbed: gag there before eat

A

Transesophageal echocardiography (TEE)

60
Q

Radioactive tracer substances used to view cardiovascular abnormalities
Can view myocardial blood flow and left ventricular function
Preparation: NPO, no caffeine or cigarettes 4 hours prior

A

Myocardial nuclear perfusion imaging

61
Q

Magnetic and radio waves used to view cardiac wall thickness, heart chambers, valve and ventricular function, and blood movement
Preparation: screen for metallic objects

A

Magnetic resonance imaging (MRI)

AHI (77 decks)

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