ch 21 Flashcards
Pressures in all of the chambers are the lowest during
diastole, which facilitates ventricular filling
parasympathetic leads to vagus nerve, which
slows down heart
sympathetic speeds up heart via
beta 1 receptors in SA node
HR also influenced by baroreceptors - high bp
detect change in BP. if hypertension, they increase impulses to cerebral medulla which activates the parasympathetic system, slows down the heart.
baroreceptors - low bp
use vasoconstriction and increased HR
Stroke volume is primarily determined by three factors: (stroke before, after, and contract)
preload, afterload, and contractility.
Preload refers to the degree
of stretch of the ventricular cardiac muscle fibers at the end of diastole. last second of diastole when vetricles are totally full, before contraction. this is frank starling.
Afterload
resistance to ejection of blood from the ventricle
relationship between afterload and stroke volume (after is over)
inverse
symptoms of aging heart in older adults - (for peet’s sake, I have symptoms)
fatigue, shortness of breath, or palpitations and present with new physical examination findings
benefits of estrogen (ester is good for cholesterol)
(1) an increase in high-density lipoprotein (HDL) that transports cholesterol out of arteries; (2) a reduction in low-density lipoprotein (LDL) that deposits cholesterol in the artery; and (3) dilation of the blood vessels
common symptoms of CVD - don’t forget weight
chest pain, SOB or dypnea, peripheral edema or weight gain, palpitations, fatigue, dizzy, sycope, LOC
chest pain - not what it seems
The location of chest symptoms is not well correlated with the cause of the pain
severity of chest pain..
does not predict the seriousness of its cause.
Because many cardiac medications can cause gastrointestinal side effects or bleeding, the nurse asks about (anything to do with gastro)
bloating, diarrhea, constipation, stomach upset, heartburn, loss of appetite, nausea, and vomiting
Patients with worsening HF often experience (you’ve got it)
orthopnea, a term used to indicate the need to sit upright or stand to avoid feeling short of breath. use extra pillows.
pulse contour - the contour is either stiff or insufficient
aortic valve stenosis = weak pulse
aortic insufficiency = valve doesn’t close and backflow, excess blood so pulse is strong
right side heart function can be assessed by (pass the jug on the right hand side)
jugular, which is central venous pressure.
Obvious distention of the veins with the patient’s head elevated 45 to 90 degrees
indicates an abnormal increase in CVP (central venous pressure)
gallop (slow and low gallop)
diastole, very low-frequency sounds S3 or S4
S3 - normal up to what ages? and when is it heard?
early diastole. normal up to 35 - 40 years old. in older adult indicates HF
S4 (4 is always resistant)
late diastole, caused by ventricle resistance.
murmur
Murmurs are created by turbulent flow of blood in the heart
friction rub best heard in what position? (leather up!)
with the patient sitting up and leaning forward.
PTT - for what drug? (ptty about hep)
heparin
PT - what drug? (the other)
warafin
INR - always do with what other test?
always test with PT
hematocrit (hypocrit at 36 and 42)
men 42-52%
women 36-48%
hemoglobin (heman was cool from 12 to 14)
male - 14 - 17.4 g/dL
female 12 -16 g/dL
WBC count
4500 - 11000
homocysteine - promotes what? (H thrombing)
high levels linked to damage the endothelial lining of arteries and promote thrombus formation
12-lead ECG is used to diagnose (12 is the largest without O2, give me a heart attack)
arrhythmias, conduction abnormalities, and chamber enlargement, as well as myocardial ischemia, injury, or infarction.
cardiac stress test procedures
—the exercise stress test, pharmacologic stress test, and radionucleotide imaging studies—are noninvasive ways to evaluate if there is myocardial ischemia and higher myocardial oxygen requirement during these tests.
stress test - fast for how long before test and avoid what foods? (fasting is no stress with a stress test)
fast for several hours before the test and to avoid stimulants such as tobacco and caffeine. Medications may be taken with sips of water.
pharacologist stress test - how long to avoid chocolate or caffeine?
instructed not to eat or drink anything for at least 3 hours before the test. refrain from eating any liquid or food that contain chocolate or caffeine for 24 hours and to avoid taking medications that contain caffeine.
cardiac cathertization - blood tests (Cathy tests my electrolytes, sugar, and kidneys. it’s a pitty, my CBC also)
before - blood tests performed to evaluate metabolic function (electrolytes and glucose) and renal function (blood urea nitrogen and creatinine level. PTT, PT and INR. CBC.
catherization nursing interventions - how long to fast before? (Cathy can sure fast)
fast 8-12 hrs. lying on hard table less than 2 hrs.
catherization nursing responsibilities - what pulses?
observe site for bleeding - pulses - dorsalis pedis and posterior tibial pulses in the lower extremity, radial pulse in the upper extremity
arterial problem gets
cold, pale
venous problem gets
edema
if your kindeys aren’t being perfused
you can’t pee - this is a sign of a lack of perfusion
how long to hold meds before stress test? (stressing about my meds for 2 days now)
hold meds up to 48 hours.
how long to monitor pt after stress test?
monitored for 15 min after until vital signs are back to normal.
pharmacologic stress test - when to stop meds before?
stop meds 24 to 48 hrs before.
bed rest how long after catheterization?
After bed rest for 2-6 hrs.
catheterization - are palpitations normal?
palpations are normal during procedure.
catheterization - how often to assess pulses? (cathy’s pulse was in 1534)
every 15 minutes for 1 hour, every 30 minutes for 1 hour, and hourly for 4 hours or until discharge.
catheterization - check what vital signs and how long to restrict activity?
temp, cap refill. screen for arhtymias. activity restriction for 2 -6 hrs.
catherization - HOB
HOB no greater than 30 degrees
catheterization - if it’s the femoral artery?
if femoral artery - leg straight.
how long to avoid activities after catherization? and report what to provider?
avoid strenous activites for several days. report chest pain or bleeding.
electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia involves what?
the dysrhythmia will be reproduced under controlled conditions
P-R inteveral is what?
it shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node.
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?
QRS complex
what to do if a pt has a third-degree heart block
alert provider
where do cardiac arrhythmias NOT originate in the heart?
Bundle of His
