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MedSurg > Chapter 32: Cardiovascular System > Flashcards

Chapter 32: Cardiovascular System Flashcards

1
Q

Fibrous sac. Holds up to 15 mL fluid. Prevents friction.

A

Pericardium

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2
Q

Anchored to the papillary muscles of the ventricles. Prevent the eversion of the leaflets into the atria during ventricular contraction.

A

Chordae tendineae

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3
Q

Blood flow into the two major coronary arteries occurs primarily during _____.

A

Diastole

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4
Q

In 90% of people the AV node and the bundle of His receive blood supply from the ____ coronary artery. For this reason, blockage of this artery often causes serious defects in cardiac conduction (dysrhythmias)

A

Right

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5
Q

Contraction of the myocardium. Results in ejection of blood from the ventricles

A

Systole

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6
Q

Relaxation of myocardium. Allows for filling of the ventricles.

A

Diastole

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7
Q

Start of systole, “lub,” closure of tricuspid and mitral valves, radial or apical puse

A

S1.

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8
Q

Start of diastole, “dub,” closure of aortic and pulmonic valves

A

S2

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9
Q

Amount of blood pumped by each ventricle in 1 minute. Normal 4-8 L/min. Calculated by multiplying the amount of blood ejected from the ventricle with each heartbeat- the stroke volume (SV)- by the heart rate (HR) per minute

A

Cardiac output.

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10
Q

CO divided by body surface area, is adjusted for BSA and is a more precise measure of efficiency of the pumping action of the heart. Normal 2.8-4.2 L/min/m^2.

A

Cardiac index

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11
Q

Volume of blood (in mL) ejected with each heartbeat. Normal 50-100. Determined by preload, after load, and contractility

A

Stroke volume

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12
Q

Adjusted for BSA. Normal 25-45. Increased with volume overload, isotropy, hyperthermia, meds (ie. Digitalis, dopamine, dobutamine). Decreased with impairs cardiac contractility, valve dysfunction, CHF, beta blockers, MI.

A

Stroke volume index (SVI).

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13
Q

Stretch or filling pressure. Volume in the ventricle at the end of diastole. Increases with fluid overload (diuresis), MI, and aortic stenosis. Decreases with hypovolemia (fluids) and vasodilation.

A

Preload

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14
Q

Squeeze. Peripheral resistance against which the left ventricle must pump (SVR and PVR). Pressure to overcome forward flow. Blood pressure is an indirect measurement. Increases with hypertension, hardened arteries, CAD, pulmonary HTN (rt heart failure), hypoxia, catecholamines. Decreases with vasodilators, acidosis, oxygen

A

Afterload

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15
Q

Opposition encountered by the left ventricle. Increased with vasoconstrictors, low volume. Decreased with vasodilators, morphine, nitrates, high CO2.

A

Systemic vascular resistance

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16
Q

Opposition encountered by the right ventricle. Increased with pulmonary hypertension, hypoxia. Decreased with meds (i.e. calcium channel blockers, aminophylline, isoproterenol, oxygen).

A

Pulmonary vascular resistance

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17
Q

Strength of contraction. When increased, stroke volume and oxygen demand are increased. Increases with meds (i.e. epinephrine, norepinephrine, isoproteneronol, dopamine, dobutamine, digitalis). Decreases with heart failure, alcohol, calcium channel blockers, beta blockers, acidosis.

A

Contractility

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18
Q

A pt is receiving a drug that decreases after load. To evaluate the pt’s response to this drug, what is most important for the nurse to assess?

a) Heart rate
b) lung sounds
c) blood pressure
d. jugular venous distention

A

c) blood pressure

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19
Q

Measure ___ problems through lung sounds, jugular venous distention

A

Preload

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20
Q

Measure ____ problems through BP, skin temp, pulse pressure

A

afterload

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21
Q

Adrenaline. Epi, norepi. Speeds everything up (increases the heart rate, the speed of the conduction through the AV node, and the force of atrial and ventricular contractions). Vasoconstriction.

A

Sympathetic branch of the autonomic NS

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22
Q

Vagus nerve. Slows everything down (by decreasing the impulses from the SA node, and thus conduction through the AV node). Vasodilation.

A

Parasympathetic branch of the ANS

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23
Q

In the aortic arch and carotid sinus. Sensitive to stretch or pressure within the arterial system. Stimulation sends info to the brainstem which results in temporary inhibition of the SNS and enhancement of the parasympathetic influence, causing a decreased HR and peripheral vasodilation. Decreased arterial pressure causes the opposite effect.

A

Baroreceptors

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24
Q

Located in the aortic and carotid bodies and the medullar. Capable of causing changes in respiratory rate and BP in response to increased arterial CO2 pressure (hypercapnia) and, to a lesser degree, decreased plasma pH (acidosis) and arterial O2 pressure (hypoxia). When the chemoreceptors in the medulla are triggered, they stimulate the vasomotor center to increase BP.

A

Chemoreceptors

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25
Q

The peak pressure exerted against the arteries when the heart contracts

A

systolic BP

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26
Q

Residual pressure in the arterial system during ventricular relaxation (or filling pressure).

A

Diastolic BP

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27
Q

The difference between the SBP and the DBP. It is normally about 1/3 of the SBP. An increase d/t increase SBP may occur during exercise or in individuals with atherosclerosis of the larger arteries. A decrease may be found in heart failure or hypovolemia.

A

Pulse pressure

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28
Q

The average pressure within the arterial system that is felt by organs in the body. (SBP+2DBP)/3. >60 is needed to adequately perfuse and sustain the vital organs of an average person under most conditions.

A

MAP

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29
Q

Gerontologic considerations

A

Risk for CVD increases with age. CV changes results of aging, disease, environmental factors, and lifetime behaviors. Heart rate changes (no change in resting supine HR. Decreased HR response to stress). BP changes (HTN is NOT expected). Heart sound changes (murmur from regurgitation/narrowing of mitral and aortic valves). ECG changes (decrease pacemaker cells. Sinus and atrial dysrhythmias-a fib most common. Heart block- purkinje fibers. Abnormal resting ECG in 50%). Medication response changes (less sensitive to beta blockers. Increased sensitivity to vasopressin). Physical changes (dependent edema d/t incompetent venous valves).

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30
Q

BP changes in elderly

A

HTN is not expected. Increased SBP (decrease or no change in DBP). Increased pulse pressure b/c increase in SBP. Orthostatic hypotension. Postprandial hypotension=decrease in BP of at least 20 mm Hg that occurs within 75 minutes after eating (don’t give BP meds at meal time!)

31
Q

____ reminds the leading cause of death in adults older than age 85

A

CVD

32
Q

Subjective data in CV assessment

A

Health information: Hx of present illness. Past health hx (chest pain, SOB, smoking). Past and current medications. Surgery or other tx. Allergies to iodine. Familial disorders. Constipation (leads to straining- vagal rxn. can pass out). Exercise intolerance. PND (paroxysmal nocturnal dyspnea), orthopnea, sleep apnea. Sexual problems.

33
Q

Risk factors

A

Increased serum lipids. Hypertension. Smoking. Sedentary lifestyle. Obesity. Stress. Diabetes mellitus.

34
Q

Attacks of shortness of breath, especially ones at night that awaken the pt are called _____ and are associated with heart failure

A

Paroxysmal nocturnal dyspnea

35
Q

CV effects of anticancer agents (daunorubicin/Cerubidine; doxorubicin/Adriamycin)

A

Dysrhythmias, cardiomyopathy

36
Q

CV effects of antipsychotics (chlorpromazine/Thorazine; haloperidol/Haldol)

A

Dysrhythmias, orthostatic hypotension

37
Q

CV effects of corticosteroids (cortisone/Cortone; prednisone/Orasone)

A

Hypotension, edema, potassium depletion

38
Q

CV effects of hormone therapy, oral contraceptives (estrogen+progestin)

A

MI, thromboembolism, stroke, hypertension

39
Q

CV effects of NSAIDs

A

Hypertension, MI, stroke

40
Q

CV effects of tricyclic antidepressants (amitriptyline/Elavil; doxepin/Sinequan)

A

Dysrhythmias, orthostatic hypotension

41
Q

____ in the extremities can be caused by gravity, interruption of venous return, or right-sided heart failure

A

edema

42
Q

Distention and prominent pulsations of the internal and external jugular veins (jugular venous distention) can be cause by ____

A

right-sided heart failure

43
Q

An artery that is narrowed or has a bulging wall may create turbulent blood flow. This abnormal flow can create a buzzing or humming termed a ____, heard when a stethoscope is placed over the vessel.

A

Bruit

44
Q

Necrotic crater-like lesion usually found on lower leg at medial malleolus. Characterized by slow wound healing. Etiology/significance: poor venous return, varicose veins, incompetent venous valves/ arteriosclerosis, diabetes

A

Venous stasis ulcer

45
Q

Visible dilated, discolored, tortuous vessels in lower extremities. Etiology/significance: Incompetent valves in vein

A

Varicose veins

46
Q

When the ____ is below the fifth ICS and left of the midclavicular line, the heart may be enlarged.

A

PMI (point of maximal impulse)

47
Q

First heart sound. Associated with closure of the tricuspid and mitral valves. Soft lubb sound. Signals the beginning of systole.

A

S1. Have pt in left side-lying to better hear mitral area

48
Q

Second heart sound. Associated with closure of the aortic and pulmonic valves. Sharp dump sound. Signals the beginning of diastole.

A

S2. Have pt lean forward while sitting to better hear aortic and pulmonic areas

49
Q

If the apical and radial pulses are not equivalent, count the apical pulse while a second person simultaneously counts the radial pulse for 1 full minute. The difference between the two numbers is called a ______ and can indicate cardiac dysrhythmias

A

Pulse deficit

50
Q

Low-intensity vibration of the ventricular walls usually associated with decreased compliance of the ventricles during filling. May be normal in young adults. Pathologic in pts with left-sided heart failure or mitral valve regurg. Heard closely after S2 and is known as ventricular gallop.

A

S3

51
Q

Low-frequency vibration caused by atrial contraction. Precedes S1 of the next cycle and is known as atrial gallop. May be normal in older adults. Pathologic in pts with CAD, cardiomyopathy, left ventricular hypertrophy, or aortic stenosis.

A

S4

52
Q

Biomarker of choice in the diagnosis of MI. Contractile proteins that are released after an MI. Specific to cardiac tissue.

A

Troponin

53
Q

Cardiospecific isozyme that is released in the presence of myocardial tissue injury. Specific for myocardial injury or infarction.

A

Creatine kinase MB (CKMB)

54
Q

Low-molecular weight heme protein found in cardiac and skeletal muscle. Election is a sensitive indicator of very early myocardial injury but lacks specificity for MI.

A

Myoglobin

55
Q

Peptide that causes natriuresis. Elevation helps to distinguish cardiac vs. respiratory cause of dyspnea. Released from the ventricles

A

b-type natriuretic peptide (BNP)

56
Q

Marker of inflammation that can predict risk of cardiac disease and cardiac events, even in pts with normal lipid values. Risk factor for CAD.

A

C-reactive protein (CRP)

57
Q

Elevated levels increased for risk for CAD, peripheral vascular disease (PVD), and stroke. Amino acid produced during protein catabolism that has been identified as a risk factor for CAD> May cause damage to the endothelium or have a role in the formation of thrombi.

A

Homocysteine

58
Q

Elevations are strongly associated with CAD except HDL.

A

Serum lipids aka Lipoproteins

59
Q

A pt arrives at an urgent care center after experiencing unrelenting substernal and epigastric pain and pressure for about 12 hours. The nurse reviews laboratory results with the understanding that at this point in time, a myocardial infarction would be indicated by peak levels of

a) troponin T
b) homocysteine
c) creatine kinase MB
d) type b natriuretic peptide

A

a) troponin T

60
Q

A radiographic picture of the chest can show cardiac contours, heart size, and anatomic changes in individual chambers. Records any displacement or enlargement of the heart, extra fluid around the heart (pericardial effusion), and pulmonary congestion.

A

Chest x-ray

61
Q

Assess cardiac activity. Deviation from the normal sinus rhythm can indicate problems in heart function.

A

Electrocardiogram

62
Q

Cardiac sx frequently occur only with activity because of the demand on the coronary arteries to provide more O2. This type of testing is used to evaluate the heart’s response to physical stress, which helps to assess CVD

A

Exercise or stress testing

63
Q

Uses ultrasound waves to record the movement of the structures of the heart. With contrast to assist in defining the images. Can be without contrast. Provides info regarding the structures and motion of heart. Measures ejection fraction.

A

Echocardiogram

64
Q

The percentage of end-diastolic blood volume that is ejected during systole. This provides information about the function of the LV during systole. 50% is normal

A

Ejection fraction.

65
Q

Provides more precise echocardiography of the heart. Flexible endoscope probe with an ultrasound transducer in the tip for imaging of the heart and great vessels. The probe is passed into the esophagus to the level of the heart. Evaluation of mitral valve disease and for identification of endocarditis vegetation, source of cardiac emboli.

A

Transesophageal electrocardiography

66
Q

IV injection of radioactive isotope. Lay still for 20 minutes with arms up, may have repeat scans. Provides information on wall motion during systole and diastole, cardiac valves and EF

A

multigated acquisition (MUGA) or cardiac blood pool scan

67
Q

Noninvasive. Can’t do if they have a pacemaker or ICD. Can detect and find areas of MI. Sensitive enough to find even small MIs that are not apparent with CT imaging. Aids in the final dx of MI and the assessment of EF. Does not require any radiation to the pt.

A

Cardiovascular magnetic resonance imaging (CMRI)

68
Q

Visualizes heart anatomy, coronary circulation, and big vessels. Can be performed instead of a cardiac cath. Calcium can be seen in atherosclerotic plaques. Heart-imaging test that can be used with or without IV contrast.

A

Cardiac computed tomography (CT)

69
Q

Invasive outpt procedure. Angiography involves injection of dye, shows coronary lesions. Intracoronary ultrasound done with angiography, shows vessel walls/plaques. Fractional flow reserve measures pressure/flow, determines need for angioplasty. Electrophysiology study determines source of dysrhythmias.

A

Cardiac catheterization

70
Q

NPO for 6 hrs before. May require sedation. Check for iodine sensitivity. May be asked to cough or take a deep breath during dye injection. May have to stop antidysrhythmic meds if having EPS

A

cardiac cath

71
Q

Neurovascular checks q 15 min x 1 hr. Compression device over injection site. Close monitoring of VS and ECG

A

Post cardiac cath care

72
Q

Bleeding/hematoma, allergic rxn, infection, clot, aortic dissection, dysrhythmias, MI, stroke, puncture ventricles or lungs

A

Cx with cardiac cath

73
Q

A pt returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse?

1) pedal pulses 2+ bilaterally
2) apical pulse is 54 bpm
3) MAP is 72 mmHg
4) ST-segment elevation develops on the ECG

A

4) ST-segment elevation develops on the ECG

MedSurg (5 decks)

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