Cardiovascular System Flashcards
1
Q
What is the purpose of the cardiovascular system
A
To perfuse the organs and tissues with oxygenated blood
2
Q
What three protective layers make up the pericardial sac?
A
Fibrous pericardium
Parietal pericardium
Visceral pericardium (Epicardium)
3
Q
What is the fibrous pericardium?
A
A loose fitting sac that outlines and hold the heart
4
Q
What is the parietal pericardium?
A
A serous membrane, fluid lines this area & helps reduce friction
5
Q
What is the visceral pericardium (epicardium)
A
The inner most protective layer of the pericardial sac
Covers the heart muscle directly
The outermost cardiac layer
Prevents friction as the heart beats
6
Q
Name the cardiac layers
A
Epicardium
Myocardium
Endocardium
7
Q
What is the myocardium
A
Thick layer of muscle within the heart
Aides in contraction of the heart
8
Q
What is the endocardium
A
The inside cardiac chamber
Lines the inside of the heart
Lines all cardiac chambers and valves
9
Q
What are coronary arteries?
A
Arteries that surround the heart and provide the heart with oxygenated blood
Oxygenated blood travels from the aorta to the cardiac arteries
Without the coronary arteries, the heart wouldn’t receive oxygenated blood and would not function / would die
10
Q
Name the four cardiac chambers
A
Superior Chambers:
Right Atrium
Left Atrium
Inferior Chambers:
Right Ventricle
Left Ventricle
11
Q
What is the purpose of cardiac valves?
A
Prevent the back flow of blood
Keep blood moving in a forward direction
12
Q
What are the two classes of cardiac valves?
A
Atrioventricular valves (AV Valves) Semilunar Valves
13
Q
What are the two atrioventricular valves?
A
Right Atrioventricular Valve (Tricuspid Valve)
Left Atrioventricular Valve (Bicuspid Valve)
Always “tri” to do the “right” thing
14
Q
What are the two semilunar valves?
A
Pulmonary/Pulmonic Valve
Aortic Valve
15
Q
When blood is flowing from the atria to the ventricles, what valves are open?
A
The atrioventricular valves (tricuspid and bicuspid)
The semilunar valves are closed (pulmonic and aortic)
16
Q
When blood is flowing from the ventricles to the lungs and body, what valves are open?
A
The semilunar valves (pulmonic and aortic)
The atrioventricular valves are closed (tricuspid and bicuspid)
17
Q
In order, list the structures that blood flows through in the heart
A
Inferior/Superior Vena Cava » Right Atrium » Tricuspid Valve » Right Ventricle » Pulmonic/Pulmonary Valve » Pulmonary Artery » Lungs (oxygenation occurs) » Pulmonary Veins » Left Atrium » Mitral Valve » Left Ventricle » Aortic Valve » Aorta » Body Tissue/Organs
18
Q
The only vein within the body that carrys oxygenated blood is what?
A
Pulmonary vein
19
Q
The only artery within the body that carrys deoxygenated blood is what?
A
Pulmonary artery
20
Q
Which cardiac chamber has the greatest workload and greatest demand? Because of this, what can result?
A
Left ventricle
It can fail first if overworked too long
21
Q
It is vital for electrolytes to be in appropriate range for which cardiac system to run effectively?
A
Cardiac Electrical System / Cardiac Conduction Pathway
22
Q
Name the parts of the Cardiac Conduction Pathway in order
A
- Sinoatrial (SA) Node
- Interatrial Node/Pathway/Bundle (Bachmann’s Bundle)
- Atrioventricular (AV) Node
- Bundle of His
- Right and Left Bundle Branches
- Purkinje Fibers
23
Q
Where is the Sinoatrial Node located?
A
In the wall of the right Atrium
24
Q
The rate of the Sinoatrial Node is dictated by what?
A
The needs of the body
25
Which part of the Cardiac Conduction Pathway is known as the "pacemaker" of the heart?
Sinoatrial Node
26
If the Sinoatrial Node fails, which part of the Cardiac Conduction Pathway will initiate a heartbeat? What is the rate?
Atrioventricular Node at a rate of 40 to 60 beats per minute
27
One cycle of cardiac activity can be divided into what two phases?
Systole and Diastole
28
Define systole
Systole is when the chambers are contracting (squeezing)
| Blood is being pushed from the chambers
29
Define diastole
Diastole is when the chambers are relaxing (filling with blood)
Blood is filling into the chambers
30
While systole is happening with one set of chambers, what is happening with the other set of chambers?
Diastole
31
If the right atrium is in systole, what other chamber is in systole?
Left atrium
32
If the right atrium is in diastole, what other chamber is in diastole?
Left atrium
33
If the left atrium is in diastole, what other chamber is in diastole?
Right atrium
34
If the left atrium is in systole, what other chamber is in systole?
Right atrium
35
If the right ventricle is in systole, what other chamber is in systole?
Left ventricle
36
If the right ventricle is in diastole, what other chamber is in diastole?
Left ventricle
37
If the left ventricle is in diastole, what other chamber is in diastole?
Right ventricle
38
If the left ventricle is in systole, what other chamber is in systole?
Right ventricle
39
What is occurring during atrial systole?
Atria are contracting, squeezing blood out
Atrioventricular valves (tricuspid and bicuspid) are open, allowing blood to flow from atria to ventricles
Ventricles are in diastole, filling with blood sent from atria
Semilunar valves (pulmonic and aortic) are closed, to keep blood in ventricles
40
What is occurring during atrial diastole?
```
Atria are relaxing and filling (blood is flowing from the body via inferior and superior vena cava)
Atrioventricular valves (tricuspid and bicuspid) are closed, to keep blood in the atria
Ventricles are in systole, contracting and squeezing blood into the lungs and body
Semilunar valves (pulmonic and aortic) are open, allowing blood to flow out of the ventricles
```
41
What is occurring during ventricular systole?
Ventricles are contracting, squeezing blood out
Semilunar valves (pulmonic and aortic) are open, allowing blood to flow out of the ventricles
Atria are relaxing and filling (blood is flowing from the body via inferior and superior vena cava)
Atrioventricular valves (tricuspid and bicuspid) are closed, to keep blood in the atria
42
What is occurring during ventricular diastole?
Ventricles are relaxing, filling with blood from the atria
Semilunar valves (pulmonic and aortic) are closed, to keep blood in ventricles
Atria are contracting, squeezing blood out
Atrioventricular valves (tricuspid and bicuspid) are open, allowing blood to flow from atria to ventricles
43
Heart sounds are made from what?
Closure of valves
44
The first heart sound heard, S1, known as the "lubb" sound, is made from what?
Closure of the atrioventricular valves
45
The second heart sound heard, S2, known as the "dubb" sound, is made from what?
Closure of the semilunar valves
46
What is the equation for cardiac output?
Cardiac Output = Stroke Volume * Heart Rate
CO = SV * HR
47
What are the units of measurement for cardiac output?
mL/min
or
L/min
48
What is stroke volume? What are its units of measurement?
The amount of blood pumped out of the left ventricle in one beat
mL/beat
49
What is heart rate? What are its units of measurement?
The number of times the heart beats in one minute
| beats/minute
50
If the heart rate begins to increase, but stroke volume remains the same, will cardiac output:
increase, decrease, remain the same?
Increase
51
If stroke volume begins to decrease, what must happen in the body in order for the cardiac output to remain unchanged?
Heart rate must increase
52
Define preload
The amount of pressure stretching the ventricle at the end of ventricular diastole
53
Define afterload
The amount of resistance the heart/left ventricle must overcome to open the aortic valve and push the blood out in to systemic circulation
54
If afterload (i.e. systemic vascular resistance) is increased, what must increase to keep up with body's demands?
Cardiac workload
The heart has to work harder to overcome the resistance and push the blood into circulation
55
Define ejection fraction
Total amount of blood the left ventricle pumps out with each contraction
56
Ejection fraction is measured in what unit of measurement?
Percentage
57
Normal range for ejection fraction for a healthy adult?
55% to 70%
58
What does the following phrase mean:
| "Ejection fraction of 65%"
65% of the total amount of blood in the left ventricle is being pumped out with each contraction/squeeze of the ventricle
59
If an ejection fraction is less than 40%, what may be present?
Heart failure
60
What test is performed to determine the ejection fraction?
Echocardiogram
61
What affect does epinephrine and norepinephrine have on the heart?
Activates beta one receptors
```
Increases heart rate
Increases force of cardiac contraction
Increases cardiac output
Dilates coronary vessels
Blood pressure increases due to increased cardiac output
```
62
How does aldosterone work?
Tells the kidneys to hold on to sodium and release potassium
When sodium is retained, fluid follows
This increases intravascular volume within the body, thus increasing blood pressure
63
What organ regulates the Renin-Angiotensin-Aldosterone System?
Kidneys
The kidneys will release renin to activate RAAS
64
What conditions would cause the kidneys to activate the Renin-Angiotensin-Aldosterone System?
Decreased blood flow to the kidneys (decreased renal perfusion/renal ischemia)
Decreased arterial blood pressure (i.e. hypotension)
Decreased blood volume
Decreased serum sodium (hyponatremia)
Increased urine sodium
65
What is the purpose of the Renin-Angiotensin-Aldosterone System?
To retain sodium, thus retaining fluid
Increasing blood volume and increasing blood pressure
Increasing serum sodium levels
Increase renal perfusion
66
What are the steps of the Renin-Angiotensin-Aldosterone System?
1. Kidneys release Renin
2. Renin meets up with Angiotensinogen (which comes from the liver)
3. Chemical reaction occurs between Renin and Angiotensinogen --> Angiotensin I is created
4. Angiotensin Converting Enzyme (which comes from the lungs) converts Angiotensin I to Angiotensin II
5. Angiotensin II promotes vasoconstriction of the arteries/arterioles
6. Angiotensin II acts on the adrenal cortex, releasing aldosterone
7. Aldosterone acts on the kidneys to retain sodium
8. Retention of sodium causes fluid to be retained and potassium to be excreted
9. Blood volume increases, blood pressure increases, renal perfusion increases, serum sodium levels increases
10. When blood pressure is an appropriate level, the kidneys will stop releasing Renin and will stop RAAS
67
List what occurs within the cardiovascular system as a person ages
```
Atherosclerosis
Resting blood pressure increases
Left ventricle workload increases, causing the heart muscle to become less efficient
Vein valves are less competent
Resting heart rate decreases
Dysrhythmias are common
Heart sounds are distant due to kyphosis
```
68
If a patient presents with complaints of dizziness, fatigue, and chest tightness, what are the first assessments the RN should do?
Assess vital signs
Assess heart rhythm
Pain
Dyspnea, SOB
69
The nurse knows if blood pressure is taken on the leg, the reading will be..
About 10 mmHg higher
70
A nurse takes a blood pressure in both arms, which blood pressure is recorded? The higher or lower?
Higher blood pressure should be recorded
71
What is the purpose of a heart rate reading on the pulse oximeter?
To compare with a radial or apical heart rate, this determines if the pulse oximeter is accurate or not.
72
The student nurse assesses a radial pulse and it is 59 bpm. What do they do?
Take an apical pulse for a minute.
73
What is the purpose of palpating a pulse?
To assess volume and pressure quality
74
A pulse is palpated and the finding is "normal." How is this documented?
Strong, 2+
75
When assessing the right radial pulse, the nurse should also do what...?
Assess the left radial pulse. Assess for equality
76
Before performing orthostatic vitals, the nurse should gather what supplies?
A gait belt, possibly a partner for safety measures
77
Before performing orthostatic vitals, the nurse should ask what?
Ask about current dizziness
78
What are normal blood pressure and heart rate variations when body position is changed?
Systolic BP decreases up to 15 mmHg
Diastolic BP decreases up to 10 mmHg
HR increases up to 20 bpm
79
What vital sign changes indicate orthostatic hypotension is present?
Systolic BP decreases greater than 15 mmHg
Diastolic BP decreases greater than 10 mmHg
HR increases greater than 20 bpm
80
What must the nurse ask with each position change when performing orthostatic vital signs?
Ask about feeling dizzy/lightheaded
81
Why may a patient have orthostatic hypotension?
Dehydrated
Analgesic medication
Pain
82
When does dependent rubor occur
When there is decreased arterial blood flow to the lower extremities
83
If a patient has decreased arterial blood flow to the lower extremities, what position should be encouraged?
Keep legs in the dependent position
| Avoid elevating legs above the level of the heart, this will decrease blood flow
84
If a patient has venous blood flow problems to the lower extremities, what color will appear?
Brown discoloration, purple skin, possible cyanosis when in the dependent position
85
If venous blood flow problems of the lower extremities are present, what position should be encouraged?
Elevation of extremities above the heart
86
When does a cardiac murmur present?
When a cardiac valve doesn't close completely
87
If heart sounds are distant, what position can the patient be placed in?
Lean the patient forward or on their left side
88
A capillary refill < 3 seconds indicates what?
Appropriate arterial blood flow and oxygenation to the extremities
89
A capillary refill > 3 seconds indicated what?
A decrease in arterial blood flow and oxygenation to the extremities
90
What are the six P's in a neurovascular assessment?
```
Pain
Paresthesia
Pallor
Pulselessness
Paralysis
Poikilothermia
```
91
What is cardiac monitoring? What can it detect?
Continuous monitoring of cardiac activity
| It can detect changes in heart rate and heart rhythm immediately
92
When will a cardiac monitor be ordered?
If a patient has cardiac complaints
If a patient is receiving medications that can change cardiac activity
When a patient is acutely ill
When a patient is experiencing electrolyte imbalances
When a patient is receiving IV electrolyte replacement
93
A typical cardiac monitor has how many leads?
5
94
What does EKG/ECG stand for?
Electrocardiogram
95
What abnormalities can an Electrocardiogram identify?
```
Issues with:
Cardiac conduction
Heart rate
Heart rhythm
Heart chamber enlargement
Myocardial ischemia/infarction
Electrolyte imbalances
```
96
What is an Echocardiogram?
Ultrasound of the heart
97
What does an Echocardiogram record/determine?
Determines the ejection fraction
Determines blood flow through the heart
Shows heart size, heart shape, heart position
Shows motion of heart chambers and valves
98
What is the most concerning cardiac lab?
An elevated troponin.
| Shows acute myocardial damage
99
When is a cardiac troponin elevated?
During acute myocardial damage/ischemia
100
Other than a troponin, what elevation of what lab can show injury to cardiac muscle?
Creatine Kinase MB (CK-MB)
101
When is Brain Natriuretic Peptide (BNP) measured?
To identify and monitor individuals with chronic heart failure
To determine cause of SOB: cardiac (CHF) or pulmonary
102
Elevation of what labs can put a patient at risk for developing coronary artery disease (CAD)?
LDL
Total Cholesterol
Triglycerides
103
What is atherosclerosis
Plaque build up within arteries of the body
104
What is coronary artery disease
Plaque build up within the coronary arteries
Narrowed coronary arteries
Decreased blood flow and oxygen delivery to cardiac tissue
105
What therpeutic measures can be taken to improve cardiovascular health?
Improve diet
Exercise
Smoking cessation
Wear compression stockings
106
Coronary artery disease can lead to what issues?
Angina
Myocardial infarction
Sudden death
107
What are modifiable risk factors for coronary artery disease?
```
Excessive alcohol use
Obesity
Sedentary lifestyle
Emotional stress
Tobacco use
```
108
What medications can be prescribed to help with coronary artery disease?
```
Antiplatelet aggregator (Aspirin, Plavix)
Lipid lowering agent (Statins)
```
109
What lifestyle changes should be made to improve coronary artery disease?
Smoking cessation
Alcohol cessation
Low cholesterol diet and decreased saturated fats
Increase exercise
110
What is a normal BNP level?
<100 pg/nL
111
If BNP is elevated >400 pg/mL, what is the likely cause?
Heart failure
