Cardiovascular System (Exam One) Flashcards
When blood is flowing from the atria to the ventricles, what valves are open? What valves are closed?
- The atrioventricular valves are open(tricuspid & bicuspid)
- The semilunar valves are closed (pulmonic and aortic)
When blood is flowing from the ventricles to the lungs and body, what valves are open? What valves are closed?
- The semilunar valves are open (pulmonic and aortic)
- The atrioventricular valves are closed (tricuspid & bicuspid)
One cycle of cardiac activity can be divided into what two phases?
Systole and Diastole
Define systole.
- Systole is when the chambers are contracting (squeezing)
- Blood is being pushed from the chambers out to body
- Also known as period of ejection
Define diastole.
- Diastole is when the chambers are relaxing (filling with blood)
- Blood is filling into the chambers
What is occurring during atrial systole?
- Atria are contracting, squeezing blood out
- Atrioventricular valves (tricuspid & bicuspid) are open, allowing blood to flow from atria to ventricles
- Ventricles are in diastole, filling with blood sent from atria
- Semilunar valves (pulmonic & aortic) are closed, to keep blood in ventricles
What is occurring during atrial diastole?
- Atria are relaxing & filling (blood is flowing from the body via inferior and superior vena cava)
- Atrioventricular valves (tricuspid & 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 & aortic) are open, allowing blood to flow out of the ventricles
What is occurring during ventricular systole?
- Ventricles are contracting, squeezing blood out
- Semilunar valves (pulmonic & aortic) are open, allowing blood to flow out of the ventricles
- Atria are relaxing & filling (blood is flowing from the body via inferior and superior vena cava)
- Atrioventricular valves (tricuspid & bicuspid) are closed, to keep blood in the atria
What is occurring during ventricular diastole?
- Ventricles are relaxing, filling with blood from the atria
- Semilunar valves (pulmonic & aortic) are closed, to keep blood in ventricles
- Atria are contracting, squeezing blood out
- Atrioventricular valves (tricuspid & bicuspid) are open, allowing blood to flow from atria to ventricles
Name the parts of the Cardiac Conduction Pathway in order.
- Sinoatrial (SA) Node (in wall of right atrium) –>
- Interatrial Bundles –>
- Left and Right Atria begin to contract –>
- Internodal Bundles –>
- Atrioventricular (AV) Node –>
- Bundle of His –>
- Purkinje Fibers
- Right and Left Ventricles begin to contract
Which part of the Cardiac Conduction Pathway is known as the “pacemaker” of the heart?
Sinoatrial (SA) Node
What is the equation for cardiac output?
Cardiac Output = Stroke Volume * Heart Rate
CO = SV * HR
What is cardiac output? What is the average resting cardiac output?
- Amount of blood ejected from left ventricle in one minute
- 5L to 6L per minute (considered normal)
Define ejection fraction.
Total amount of blood the left ventricle pumps out with each contraction
Define preload.
The amount of pressure stretching the ventricle at the end of ventricular diastole
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
What are the signs and symptoms of hypertension?
HINT: The silent killer
-Often no s/sx
- Fatigue
- Dizziness
- Palpitations
- Angina
- Dyspnea
- Headaches
What is considered a more severe sign of hypertension?
Headache
What target organs are at an increased risk for developing complications due to hypertension?
- Heart
- Brain
- Peripheral vascular disease
- Kidneys
- Eyes
What blood pressure ranges fall under “prehypertension”?
- Systolic: 120-139
- Diastolic: 80-89
What blood pressure ranges fall under “stage one hypertension”?
- Systolic: 140-159
- Diastolic: 90-99
While performing blood pressure screening at a health fair, the nurse counsels which person as having the greatest risk for developing hypertension?
A. A 56-year-old man whose father died at age 62 from a stroke
B. A 30-year-old female advertising agent who is unmarried and lives alone
C. A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland
D. A 43-year-old man who travels extensively with his job and exercises only on weekends
A. A 56-year-old man whose father died at age 62 from a stroke
A patient’s BP has not responded consistently to prescribed drugs for hypertension. The first cause of this lack of responsiveness the nurse should explore is:
A. Progressive target organ damage.
B. The possibility of drug interactions.
C. The patient not adhering to therapy.
D. The patient’s possible use of recreational drugs.
C. The patient not adhering to therapy.
What education must a patient be provided with when starting on antihypertensive medication?
- Medication must be continued even if s/s are not present
- Get up slowly
- Change positions slowly
- Don’t abruptly discontinue medications
- Always ask if the patient is taking their medication and if they are taking it as directed
What medications fall under the drug class of a nonselective Beta Blocker?
HINT: “olol”
- Propranolol
- Nadolol
- Labetalol
- Carvedilol
What medications fall under the drug class of a cardioselective Beta Blocker?
HINT: MANBABE and “olol”
- Metoprolol
- Atenolol
- Nebivolol
- Bisoprolol
- Acebutolol
- Betaxolol
- Esmolol
How does a Beta Blocker work?
HINT: Think opposite of fight or flight
- Decrease response from sympathetic nervous system
- Blocks beta receptors from binding to epinephrine and norepinephrine, which causes:
Decreased heart rate
Decreased cardiac output
Decreased cardiac workload
Decreased blood pressure
What nursing considerations should be made when administering a beta blocker?
- Check heart rate and blood pressure prior to administration
- Monitor for bronchospasm/SOB
- Educate patient to rise slowly and do not stop abruptly
What medications fall under the drug class of Angiotensin-Converting Enzyme (ACE) Inhibitors?
HINT: “pril”
- Benazepril
- Enalapril
- Lisinopril
- Quinapril
- Ramipril
What medications fall under the drug class of Calcium Channel Blockers?
HINT: “pine”
- Diltiazem
- Verapamil
- Amlodipine
- Clevidipine
- Nifedipine
How does a Calcium Channel Blocker (CCB) work?
- Prevents movement of extracelluar calcium from entering the cell
- Promotes vasodilation
- Decreases afterload
- Slows cardiac conduction system
What should the nurse consider when administering a Calcium Channel Blocker?
- Check blood pressure and heart rate prior to administration
- Assess for angina
- Monitor digoxin levels and signs of toxicity
What are the side effects of Calcium Channel Blockers?
- Headaches
- Flushing
-Edema (only with amlodipine)
What is the preferred first line of therapy for hypertension in older adults?
Thiazide diuretic
Describe hypertensive urgency.
- It is a severe elevation of the blood pressure that develops slowly: hours to days
- There is no target organ dysfunction!!
Describe hypertensive emergency.
- It is a severe elevation of the blood pressure that develops rapidly
- Evidence of target organ dysfunction
Patients with these signs and symptoms are most at risk for developing a hypertensive crisis:
HINT: Think stroke s/sx
- Headache
- Nausea/vomiting
- Confusion
- Blurred vision
- Weakness
- Numbness
What is the equation used to calculate Mean Arterial Pressure (MAP?
(2DiastolicPressure + SystolicPressure) / 3
Calculate the mean arterial pressure (MAP) for the following blood pressure reading: 102/38
(2(38) + 102) / 3 = 59.33 = 59
Calculate the mean arterial pressure (MAP) for the following blood pressure reading: 155/98
(2(98) + 155) / 3 = 117
Calculate the mean arterial pressure (MAP) for the following blood pressure reading: 76/28
(2(28) + 76) / 3 = 44
Calculate the mean arterial pressure (MAP) for the following blood pressure reading: 120/80
(2(80) +120) / 3 = 93.33 = 93
What is the most common form of heart disease and most common cause cause of heart failure?
Coronary artery disease
What is arteriosclerosis?
- Thickening, loss of elasticity, and calcification of arterial walls
- Part of the aging process
What is atherosclerosis? Where does it occur?
- Fatty buildup in arteries
- Occurs in the lumen (space inside the artery)
What is coronary artery disease (CAD)?
Narrowing of one or more coronary arteries
Coronary artery disease is assocaited with a cholesterol level greater than what?
> 200
What are the normal HDL levels in men and women?
- Men: >40
- Women: >50
What is a normal LDL level?
<100
*The lower the better
Triglyceride levels should be less than what?
<150
Coronary artery occlusion of a __________ individual is usually more lethal.
Younger
What causes coronary artery disease?
Atherosclerosis
Coronary artery diease can cause what?
- Angina
- Myocardial Infarction
- Death
What are the signs and symptoms of coronary artery disease?
- Chest pain
- Stable angina
- Palpitations
- Dyspnea
- Syncope
- Cough
- Hemoptysis
- Fatigue
List the non-modifiable risk factors for developing coronary artery disease.
- Age 64 and up
- Male gender
- Caucasian
- Family history
- Genetics
What is the primary modifiable risk factor for coronary artery disease?
Serum lipids
Triglyceride levels exceeding ______ is indicative of coronary artery disease.
> 150
What is considered the gold standard of diagnostic testing for coronary artery disease and the only definitive way coronary artery disease can be diagnosed?
Cardiac catheterization
Total Cholesterol levels exceeding ______ is indicative of coronary artery disease.
> 200
What are the most common lipid lowering medication?
Statins
Statins are used to do what?
Reduce cholesterol synthesis
What medications fall under the drug class of Statins?
- Atorvastatin
- Pravastatin
- Simvastatin
- Rosuvastatin
What time of day should statins be taken? Why?
- Evening or night
- Body produces more cholesterol at night
What are considered serious side effects of statin medications?
- Rhabdomyolysis
- Severe headaches
What labs should be monitored when giving a statin?
- Liver function tests
- Lipid panel
What is the priority nursing assessment for a patient who is post-operative from a percutaneous transluminal coronary angioplasty (PCTA)? Is this assessment performed above or below the surgical site?
- Neurovascular assessment
- Below the surgical site
Should a patient experience chest pain post-operative from a percutaneous transluminal coronary angioplasty (PCTA)?
No
What is the treatment of choice for a patient who experiences chest pain following a percutaneous transluminal coronary angioplasty (PTCA)?
Nitroglycerin
How many doses of nitroglycerin may be administer to a patient experiencing chest pain?
- Up to 3 doses
- Each dose given 5 minutes apart
What is the priority nursing assessment(s) following the administration of a dose of nitroglycerin?
- Pain
- Blood pressure
- Heart rate
Angina lasting more than 10 minutes is indicative of what?
Myocardial infarction (MI)
What is the priority diagnostic test for a patient complaining of chest pain?
EKG
Troponin is an important lab to monitor during what time?
Acute cardiac injury
What is the normal value for Troponin?
<0.017
If a patient is scheduled to receive a CT Scan with contrast, what must the nurse ask?
Allergies to contrast dye or shellfish
A myocardial infarction (MI) can result in, or cause, what?
Cardiogenic Shock
How would a nurse determine if cardiac injury is currently occurring, according to the troponin laboratory level?
The value is continuing to elevate during subsequent laboratory draws
An ST segment elevation on an EKG is indicative of what?
Myocardial infarction (MI)
Within how many hours of the onset of chest pain can the nurse administer thrombolytics?
12 hours of onset
The nurse is caring for a patient who was admitted with chest pain 4 hours ago. After beginning thrombolytic therapy, the patient develops a rigid abdomen, is confused, and exhibits changes in level of consciousness. What is the priority nursing intervention?
Call the physician!
What nursing education should the nurse provide to the patient, who has had a myocardial infarction, regarding sexual activity?
- Can resume sexual activity when they can climb two flights of stairs without difficulty
- Take prophylactic nitroglycerin before sexual activity
In order for a patient’s death to be considered true ‘sudden cardiac death’, there cannot be any evidence of what?
Myocardial infarction (MI)
The nurse is caring for a patient who survived a sudden cardiac death. What should the nurse include in the discharge instructions?
A. “The most common way to prevent another arrest is to take your prescribed drugs.”
B. “Because you responded well to CPR, you will not need an implanted defibrillator.”
C. “Your family members should learn how to perform CPR and practice these skills regularly.”
D. “Since there was no evidence of a heart attack, you do not need to worry about another episode.”
C. “Your family members should learn how to perform CPR and practice these skills regularly.”
What beta-blocker is primarily given for coronary artery disease (CAD), angina, and myocardial infarction (MI)?
Diltiazem
What is an electrocardiogram (EKG)?
Recording of the electrical activity of the heart from various views
What is the cardiac conduction pathway? What affects these electrical impulses?
- Electrical impulses are used to generate the heartbeat
- Affected by electrolytes (i.e. sodium, potassium, magnesium, calcium)
What is the purpose of the cardiac conduction pathway?
Stimulate the mechanical cells of the heart to contract and perfuse the body
Name the parts of the cardiac conduction pathway in order.
- Sinoatrial (SA) Node (in wall of right atrium) –>
- Interatrial Bundles –>
- Left and right atria begin to contract –>
- Internodal Bundles –>
- Atrioventricular (AV) node –>
- Bundle of His –>
- Purkinje fibers –>
- Right and left ventricles begin to contract
If the sinoatrial (SA) node fails, which part of the cardiac conduction pathway will initiate a heartbeat? What is the rate? Is the body able to function regularly at this rate?
- Atrioventricular (AV) node
- Rate of 40 - 60 beats per minute
- Yes
If the sinoatrial (SA) node and the atrioventricular (AV) node fails, which part of the cardiac conduction pathway will initiate a heartbeat? What is the rate?
- Bundle of His
- Rate of 20 - 40 beats per minute
What is depolarization?
Period of contraction
What is repolarization?
Period of rest
The smallest box on an EKG represents how many millimeters/seconds?
1mm = 0.04 seconds
The largest box on an EKG represents how many millimeters/seconds?
5mm = 0.20 seconds
Where are the leads placed on the body of the patient for a 12-lead EKG?
- Right arm
- Left arm
- Right leg
- Left leg
- V1: 4th intercostal space to right of sternum
- V2: 4th intercostal space to left of sternum
- V3: directly between leads V2 and V4
- V4: 5th intercostal space at midclavicular line
- V5: level with V4
- V6: directly under midpoint of the armpit
On an EKG, within one normal cardiac cycle, there is what?
- P wave
- QRS complex
- T wave
Which wave is first in the cardiac cycle?
HINT: PQRST
P wave
What does a P wave indicate?
- The SA nose is firing
- Atrial depolarization
What are the normal characteristics of a P wave?
- Rounded, upright
- Occur regularly
- Should be 1 P wave for every 1 QRS complex
- Symmetrical throughout EKG
