Chapter 12 Exam 2 Flashcards
What are the interrelationships of concepts associated with perfusion?
- Oxygenation
- Pain
- Elimination
- Intracranial regulation
- Tissue integrity
- Motion
- Metabolism
- Nutrition
Blood flow supplies oxygen and nutrients continuously to tissues so they can perform their functions. This tissues include?
Skin, the kidneys to produce urine (e.g. caused by poor perfusion of blood to kidneys), the brain for intracranial regulation (e.g. confusion as a result of poor perfusion of oxygenated blood to brain), the gastrointestinal tract for metabolism, and muscles and nerves for motion (e.g poor perfusion of oxygenated blood limits motion because of activity intolerance and fatigue).
Pain results when?
Perfusion is interupted
The cardiovascular system transports?
Oxygen, nutrients, and other substances to body tissues and metabolic waste products to the kidneys and lungs. This dynamic system is able to adjust to changing demands for blood by constricting or dilating blood vessels and altering the cardiac output
The heart is a pump about the size of a fist that beats ___ to ____ times a minute w/out rest, responding to both external and internal demands such as?
60-100
Exercise, temperature changes, and stress
The right side of the heart
Receives blood from the superior and inferior vena cavae and pumps it through the pulmonary arteries to the pulmonary circulation (carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated blood back to the heart)
The left side of the heart
Receives blood from the pulmonary veins and pumps it through the aorta into the systemic circulation (carries oxygenated blood away from the heart to the body, and returns deoxygenated blood back to the heart)
The upper part of the heart is called the _____, and the lower left ventricle is called the ____
Base
Apex
The great vessels
The pulmonary arteries and aorta.
- Aorta curves upward out of the left ventricle and bends posteriorly and downward.
- Pulmonary arteries emerge from the superior aspect of the right ventricle near the third intercostal space
The heart wall has three layers
Pericardium
Myocardium
Endocardium
The heart is encased in the pericardium which has?
A fibrous pericardium or parietal layer, is a fibrous sac of elastic connective tissue that shields the heart from trauma and infection.
- One of the serous layers lies next to the fibrous pericardium, and the other lies next to the myocardium
- between the fibrous pericardium and the serous pericardium is the pericardial space, which contains a small amount of pericardial fluid to reduce friction as the myocardium contracts and relaxes
- serous pericardium (visceral layer or epicardium), covers the heart surface and extends to the great vessels
Middle layer of the heart, or the myocardium, is a?
Thick muscular tissue that contracts to eject blood from the ventricles.
The endocardium
lines the inner chambers and valves
What supplies blood to the pericardium and cardiac muscle?
Coronary arteries
Four valves govern blood flow through the four chambers of the heart.
The tricuspid valve on the right and mitral valve on the left are termed atrioventricular (AV) valves because they separate the atria from the ventricles
-the aortic valve opens from the left ventricle into the aorta; the pulmonic valve opens from the right ventricle into the pulmonary artery. The aortic and pulmonic valves are termed semilunar (SL) valves because of their half-moon shape
What happens during diastole?
The ventricles are relaxed and fill with blood from the atria. The movement of blood from the atria to the ventricles is accomplished when the pressure of the blood in the atria becomes higher than the pressure in the ventricles. The higher atrial pressures passively open the AV valves, allowing blood to fill the ventricles.
-Approximately 80% of blood from the atria flows into relaxed ventricles. A contraction of the atria forces the remaining 20% into the ventricles. This added atrial thrust is termed the atrial kick. At the end of diastole the ventricles are filled with blood
What happens during systole
The ventricles contract, creating a pressure that closes the AV valves, preventing the backflow of blood into the atria. This ventricular pressure also forces the semilunar valves to open resulting in ejection of blood into the aorta (from the left ventricle) and the pulmonary arteries (from the right ventricle)
-As blood is ejected, the ventricular pressure decreased, causing the semilunar valves to close. The ventricles relax to begin diastole
Describe the electric conduction
The heart is stimulated by an electric impulse that originates in the sinoatrial (SA), called cardiac pacemaker, node in the superior aspect of the right atrium and travels in internodal tracts to the AV node.
- SA node normally discharges between 60 and 100 impulses per minute
- the electric impulses stimulate contractions of both atria and then flow to the AV node in the inferior aspect of the right atrium
- impulses are then transmitted through a series of branches (bundle of His) and Purkinje fibers in the myocardium, which results in ventricular contraction.
- AV node prevents excessive atrial impulses from reaching the ventricles
- if SA node fails to discharge, the AV node can generate ventricular contraction at a slower rate, 40-60 impulses per minute
- If both SA and AV nodes are ineffective, the bundle branches may stimulate contraction but at a very slow rate of 20-40 impulses per minute
Peripheral vascular system
Arteries, capillaries, and veins provide blood flow to and from tissues. The tough and tensile arteries and their smaller branches, the arterioles, are subjected to remarkable pressure generated from the myocardial contractions. They maintain BP by constricting or dilating in response to stimuli.
- The veins and their smaller branches, the venules, are less sturdy but more expansible, enabling them to act as a reservoir for extra blood, if needed, to decrease the workload on the heart.
- Pressure w/in the veins is low compared with arterial circulation. The valves in each vein keep blood flowing in a forward direction toward the heart.
Lymph system
- Lymph system works in collaboration w/peripheral vascular system in removing fluid from the interstitial spaces
- As blood flows from arteries into venules, oxygen and nutrient-rich fluid are forced out at the arterial end of the capillary into the interstitial space and then into cells.
- Waste products from cells flow through the interstitial spaces to the venous end of the capillary
- excess fluid left in the interstitial spaces is absorbed by the lymph system and carried to lymph nodes throughout the body.
- Lymphatic fluid is clear, composed mainly of water and a small amount of protein, mostly albumin
- Lymph nodes are tiny oval clumps of lymphatic tissue, usually located in groups along blood vessels
- In the peripheral vascular system the lymph node locations of interest are the arm, groin, and leg
- The brachial (axillary) nodes receive lymph drainage from the neck, chest, axilla, and arm
- the epitrochlear nodes receive fluid via the radial, ulnar, and median lymph vessels
- in the upper thigh the inguinal lymph nodes are superficial; they receive most of the lymph drainage from the great and small saphenous lymphatic vessels in the legs
- in men lymph from the penile and scrotal surfaces drains to the inguinal nodes, but nodes of the testes drain into the abdomen
- In the posterior surface of the leg behind the knee are the popliteal nodes, which receive lymph from the medial portion of the lower leg
- Ducts from the lymph nodes empty into the subclavian veins
Present health status
-Do you have any chronic illnesses such as diabetes mellitus, renal failure, chronic hypoxemia, or hypertension? If yes describe
Chronic illnesses can cause symptoms affecting the cardiovascular system when they increase the workload of the heart by narrowing peripheral vessels (diabetes, hypertension), increasing the fluid volume to be pumped (diabetes, renal failure), increasing the HR, or causing pulmonary capillary vasoconstriction (chronic hypoxemia)
Have you been told that you have high levels of cholesterol or elevated triglycerides?
High levels of serum lipids line the arteries, which may impede blood flow to tissues and increase workload on the heart
Risk factors for hypertension
- Family history
- Age
- Gender
- Race: African american 2x likely over caucasions
- Lack of physical activity
- Poor diet, especially one that includes too much salt calories, fats, and sugars
- Overweight
- Alcohol
- Tobacco smoking: nicotine constricts blood vessels
Risk factors for coronary artery disease
- Family history
- Race: African Americans
- Gender: men greater risk
- Age
- Smoking: 2-4x greater risk
- High blood cholesterol
- Hypertension: high BP increases workload of heart causing myocardium to thicken and become stiffer. Also increases risk of myocardial infarction & heart failure
- Physical inactivity
- Obesity
- Diabetes mellitus
When dyspnea becomes worse on lying down what is the term called?
Orthopnea. It occurs when a person must sit up or stand to breath easily. The number of pillows necessary to relieve the orthopnea is documented (e.g two pillow orthopnea)
Coughing up blood is a symptom of?
mitral stenosis and pulmonary disorders
Coughing more when lying down may indicate?
Heart failure
Leg pain that occurs while walking and that is relieved by rest is termed
Intermittent claudication. This occurs when the artery is about 50% occluded
Chest pain: Stable angina Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Pressure, burning, dull, or sharp
Quantity of pain: Variable, usually worse w/activity
Associated manifestations: Dyspnea, diaphoresis, palpiations, nausea, weakness
Aggravating factors: Physical exertion, emotional stress, cold
Alleviating factors: Rest, nitroglycerin, beta-blocker, calcium channel blocker
Chest pain: Unstable angina/myocardial infarction MI Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Pressure, squeezing, crushing; burning, dull, or sharp
Quantity of pain: 10 of 10 on pain scale
Associated manifestations: Dyspnea, diaphoresis, palpitations, nausea, weakness
Aggravating factors: chest pain during exercise or at rest
Alleviating factors: Beta-blocker, heparin, oxygen
Chest pain: Cocaine-induced chest pain Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Sharp, pressure like, squeezing
Quantity of pain: Severe, 8 on pain scale
Associated manifestations: Tachycardia, tachypnea, hypertension
Aggravating factors: During and shortly after cocaine use
Alleviating factors: Nitroglycerin or calcium channel blockers
Chest pain: Mitral valve prolapse Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: variable, often sharp or “kick”
Quantity of pain: variable w/in same patient
Associated manifestations: often asymptomatic; palpitaitons when lying on left side, dyspnea, dizziness
Aggravating factors: Usually nonexertional, occasionally positional
Alleviating factors: Position change, nitroglycerin, analgesics
Chest pain: Acute pericarditis Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Boring, oppressive, pleuritic, or postional
Quantity of pain: moderate, 4 on pain scale
Associated manifestations: Fever, dyspnea, orthopnea, friction rub
Aggravating factors: Reclining
Alleviating factors: Leaning forward
Chest pain: Panic disorder Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Tightness, vague, diffuse; inrelated to exertion
Quantity of pain: may be described as disabling
Associated manifestations: hyperventilation, fatigue, anorexia, emotional strain
Aggravating factors: emotional strain
Alleviating factors: variable by patient
Chest pain: Peptic ulcer disease Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Burning, gnawing
Quantity of pain: moderate, 4 on pain scale
Associated manifestations: Nausea, abdominal tenderness
Aggravating factors: empty stomach
Alleviating factors: food, antacids, histamine blocker, proton pump inhibitor
Chest pain: Esophageal reflux Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Burning, pressure like, squeezing
Quantity of pain: moderate to severe
Associated manifestations: Dysphagia
Aggravating factors: Spicy or acidic meal, alcohol, lying supine
Alleviating factors: Oral fluids, belching, antacids, nitroglycerin, H2 blocker
Chest pain: Costochondritis (inflammation of rib or cartilage) Quality of pain Quantity of pain Associated manifestations Aggravating factors Alleviating factors
Quality of pain: Variable
Quantity of pain: variable
Associated manifestations: none
Aggravating factors: coughing, deep breathing, laughing, sneezing
Alleviating factors: Localized heat, analgesics, anti-inflammatory
Recommendations to reduce risk for cardiovascular disease (primary prevention) American Heart Association
- Smoking cessation
- Diet
- Blood lipid management: total cholesterol less than 200 mg/dL
- Fasting serum glucose: less than 100 mg/dl
- Weight: BMI between 18.5 and 24.9
- Physical activity: @ least 150 mins a week
Screening recommendations for cardiovascular disease (secondary prevention) U.S. Preventive Services Task Force
Blood pressure screening
Lipid screening level
Use of Aspirin
Cardiovascular examination
General Appearance - Inspect for general appearance, skin color, and breathing effort Peripheral vascular system - palpate the temporal and carotid pulses - inspect the jugular vein - measure BP - inspect and palpate upper extremities - palpate upper extremity pulses - inspect and palpate lower extremities Heart - inspect anterior chest wall - palpate apical pulse - auscultate heart sounds - calculate pulse deficit - interpret the electrocardiogram Techniques for special circumstances Peripheral vascular system - auscultate the carotid pulse - palpate the epitrochlear lymph nodes - palpate inguinal lymph nodes - measure leg circumference - calculate the ankle-brachial index Techniques performed by an APRN - Estimate jugular vein pressure - Assess for varicose veins - Palpate the precordium
Abnormal findings for general appearance
Dyspnea, cyanosis, pallor, and use of accessory muscles to breath
Abnormal findings when palpating the temporal and carotid pulses for amplitude
Pain and edema may be found in temporal arteries
