Chapter 32 CV Assessment Flashcards
What would cause a pulse deficit and how would you test for that problem?
Atrial heart rate exceeding peripheral heart rate. Etiology- cardiac dysrhythmias, most often atrial fibrillation/flutter or premature ventricular contractions. Auscultate apical pulse while palpating radial pulse, if different have one person count each one for a full minute.
Where is the anatomical location of the PMI? What does it mean when it is displaced?
PMI lies medial to the midclavicular line in the 4th or 5th ICS. When its below 5th ICS it could indicate that the heart is enlarged
Why do we do orthostatic BPs? How are they done?
OH is estimated to be present in more than 30% of patients over 70 w/systolic hypertension. May be related to medications and/or decreased baroceptor fxn. Take ortho BP while pt is supine, sitting w/legs dangling, and standing. Shouldnt decrease more than 20 mmHg from supine to standing
How do you listen to an abnormality in the mitral area?
Position pt in left side laying position to hear abnormality in mitral area.
What lab test do you look at to determine if difficulty breathing is due to heart failure instead of lung problems?
- Troponin is the most diagnostic. Test of MI specific to myocardial muscle, normally the level is very low so any rise is diagnostic of heart muscle injury, rises in 4-6 hours, peaks in 10-24 hours, normalizes in 10-14 days (do serial samples w/ecg and CKMB)
- BNP determines whether dyspnea is from a cardiac or respiratory disease. Also tells us if heart failure medications are working
What does a pulsation in the epigastric area indicate?
Epigastric area lies on either side of the midline just below the xiphoid process. In the thin person, you may see the pulsation of the abdominal aorta. Normally you can palpate it here
What do you know about cardiac catheratization?
Cardiac catheterization is an invasive procedure that involves insertion of a catheter into the right or left side of the heart. It shows the structure, pressures, CO, EF, coronary arteris (if dye used), wall motion
Cardiac Catherization contraindications
bleeding, hematoma, allergic reaction, infection, clot, aortic dissection, dusrhythmias, MI, stroke, puncture ventricles or lung
Cardiac Catherization pre-procedure
NPO for 6 hours before, requires sedation, check for iodine sensitivity, may be asked to cough or take a deep breath during eye injection, may have to stop antidysrhthmic meds if having EPS
Cardiac Catherization post procedure
neurovascular checks, compression device under injection site, close monitoring of VS and ECG
What is an angiogram?
Angiogram is done during left sided heart catheterization. Dye is injected into coronary arteries (may make pt feel flushed), to look for lesions, An intracoronary ultrasound is done w/the angiography, this shows the walls of the vessels to see if stent placement or artherectomy is working. Fractional flow reserve uses a wire to measure pressure and flow in the coronary artery to see if they need angioplasty or stenting. q
What is JVD? What is it caused by? How do you assess for it?
Inspect jugular veins while pt is in the supine position and elevated 30-45 degrees. JVD can be caused by right sided heart failure
Holter monitors
Recording of ECG rhythm 24-48 hours. Can be done outpatient or inpatient setting. Nursing Care: prepare skin and apply electrodes and leads. Explain importance of keeping an accurate diary of activities and sx. No bath shower can be taken during monitoring. Skin irritation may develop from electrodes.
What is a bruit? What is it caused by?
An artery thats narrowed or has a bulging wall may create turbulant blood flow. This abnormal blood flow can create a buzzing or humming. Its heard over vessel w/a stethescope
What is the most important lab for assessing an MI?
Troponin
