CH 25 Assessment of cardiovascular function

Question 1

The impulses of the heart are initiated by….

-If one of these has trouble firing the next one will send an impulse, HR decreases as it moves down the pathway

Answer 1

In this order SA node> AV node> Bundle of his> Right bundle branch> left bundle branch> purkinje fibers

Question 2

• Location of chest pain?
• Severity or duration of chest pain(1-10)?
• What other symptoms?
• Is it radiating to other areas?
• When did it start?
• what relieves it?

Answer 2

assessment of chest pain

Question 3

a symptom of worsening HF.
-A nighttime symptom of a sudden wakening with SOB. it is caused by the reabsorption of fluid from dependent areas of the body back into the circulatory system within hours of lying in bed.

Answer 3

paroxysmal nocturanal dsypnea

Question 4

the nurse evaluates the cardiovascular system for any deviations from normal with regard to the following

• The heart as a pump
• atrial and ventricular filling volumes and pressures(JVD, peripheral edema, ascites, crackles, postural changes in BP)
• CO ( reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, disorientation
• compensatory mechanisms( peripheral vasoconstriction, tachycardia)

Answer 4

physical assessment

Question 5

Looking for deviations in patients appearance

• LOC
• Mental status (oriented?)
• signs of distress (pain, SOB, anxiety?)
• size( normal, overweight, catchetic?)
• Skin

Answer 5

assessment of general appearance

Question 6

skin examination includes

• color
• temperature
• texture
• problems with circulation( hematomas, edema, prolonged cap refill, clubbing, hair loss, dry brittle nails)

Answer 6

assessment of skin

Question 7

• normal pulse pressure 30-40mm Hg
• indicates how well the patient maintains CO
• A pulse pressure less than 30 indicates a serious reduction in CO

Answer 7

Pulse pressure

Question 8

Most often caused due to a significant reduction in preload, which compromises CO.

Answer 8

orthostatic hypotension

Question 9

-Caused by right sided HF, due to hypervolemia, pulmonary hypertension, and pulmonary stenosis.

Answer 9

JVD

Question 10

1. Aortic area
2. Pulmonic area
3. Erb’s point
4. Tricuspid area
5. Mitral(apical) area
   6 Epigastric area

Answer 10

heart inspection and palpitation

Question 11

second intercostal space to the left of the sternum

Answer 11

pulmonic area

Question 12

third intercostal left of the sternum

Answer 12

Erb’s point

Question 13

fourth and fifth intercostal spaces to the left of the sternum

Answer 13

tricuspid area

Question 14

left fifth intercostal at the midclavicular line

Answer 14

mitral(apical) area

Question 15

below the xiphoid process

Answer 15

epigastric area

Question 16

The sound made when the tricuspid and mitral valve close. The “lub”

Answer 16

S1

Question 17

The sound made when the closure of the pulmonic and aortic valves close. the “dub”

Answer 17

S2

Question 18

This heart sound can be a normal finding in children and adults up to 35 or 40 years old. In older adults it is a significant finding.

Answer 18

S3

Question 19

It is a sound generated during atrial contraction as blood forcefully enters a noncompliant ventricle. It is caused by HTN, CAD, cardiomyopathies and others.

Answer 19

S4

Question 20

These findings are frequently present in patients with cardiac disorders

• Hemoptysis( frothy pink sputum)
• Cough( dry hackneying)
• Crackles
• Wheezes

Answer 20

Lung assessment

Question 21

These findings are important to assess for in patients with cardiovascular disorders

• Abdominal distension
• Hepatojugular reflex
• bladder distension

Answer 21

abdominal assessment

Question 22

• HTN is common in this population
• S4 heart sounds, murmurs, split S2
• Orthostatic Hypotension

Answer 22

Older adult cardiovascular assessment

Question 23

normal level is less than 100, primary goal for lipid management is less than 70
Carries cholesterol and triglycerides TO the cell.

Answer 23

LDL

Question 24

normal range is 35-70men 35-85 women. The goal is to be above 40.
Transports cholesterol AWAY from the cell.

Answer 24

HDL’s

Question 25

composed of free fatty acids and glycerol, it is stored in the adipose tissue and is a source of energy. Increases after meals and is affected by stress, alcohol, and obesity.
Normal range 150

Answer 25

Triglycerides

Question 26

Helps regulate BP and fluid volume.

Levels higher than 100 suggests HF.

Answer 26

BNP

Question 27

A protein produced by the liver in response to systemic inflammation. Used to predict CVD levels greater than 3 may indicate great risk for CVD. Moderate (1-3) low less than 1.

Answer 27

C- reactive protein

Question 28

an amino acid linked to the development of atherosclerosis. Elevated levels is thought to indicate high risk for CAD, CVA, and PVD. high risk greater than 15

Answer 28

Homocysteine

Question 29

determines size, contour and position of the heart.
-It reveals cardiac and pericardial calcifications and demonstrates physiologic alterations in the pulmonary circulation.
Doesn’t help diagnose MI, but can help to diagnose HF.

Answer 29

Chest X-ray and Fluroscopy

Question 30

Non invasive utlrasound test that is used to measure EF and examine the size, shape and motion of cardiac structures.
Particularly useful in diagnosing pericardial effusions; determining chamber sized the etiology of heart murmurs.

Answer 30

echocardiography

Question 31

A technique which involves threading a small transducer through the mouth into the esophagus. The patient will be given a topical anesthetic agent and moderate sedation.

Answer 31

TEE