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NRSG 110: Med Surg 2 > [Exam 1] Chapter 25: Assessment of Cardiovascular Function (Page 671-705) > Flashcards

[Exam 1] Chapter 25: Assessment of Cardiovascular Function (Page 671-705) Flashcards

1
Q

Acute coronary syndrome definition

A

a constellation of signs and symptoms due to the rupture of atherosclerotic plaque and resultant partial or complete thrombosis within a diseased coronary artery; leads to unstable angina or acute myocardial infarction

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2
Q

Afterload definition

A

the amount of resistance to ejection of blood from the ventricle

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3
Q

Apical impulse definition

A

caused by contraction of left ventricle

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4
Q

Atrioventricular (AV) node definition

A

secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve

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5
Q

Baroreceptors definition

A

nerve fibers located in the aortic arch and carotid arteries that are responsible for control of the blood pressure

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6
Q

cardiac catheterization definiton

A

an invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries

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7
Q

Cardiac conduction system definition

A

specialized heart cells strategically located throughout the heart that are response for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells

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8
Q

Cardiac output definition

A

amount of blood pumped by each ventricle in liters per minute

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9
Q

Cardiac stress test definition

A

a test used to evaluate the functioning of the heart during a period of increased oxygen demand

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10
Q

Contractility definition

A

ability of the cardiac muscle to shorten in response ot an electrical impulse

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11
Q

depolarization definition

A

electrical activation of a cell cause dby the influx of sodium into the cell while potassium exits the cell

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12
Q

diastole definition

A

period of ventricular relaxation resulting in ventricular filling

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13
Q

ejection fraction definition

A

percentage of the end-diastolic blodo volume ejected from the ventricle with each heartbeat

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14
Q

hemodynamic monitoring definition

A

the use of pressure monitoring devices to directly measure cardiovascular function

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15
Q

hypertension definition

A

blood pressure greater than 140//90

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16
Q

hypotension definition

A

decrease in blood pressure less than 100/60

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17
Q

murmurs definition

A

sounds created by abnormal, turbulent flow of blood in the heart

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18
Q

myocardial ischemia definition

A

condition in wich heart muscle cells receive less oxygen than needed

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19
Q

myocardium definition

A

muscle layer of the heart responsible for the pumping action of the heart

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20
Q

opening snaps definition

A

abnormal diastolic sound generated during opening of a rigid atrioventricular valve leaflet

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21
Q

postural (orthostatic) hypotension definition

A

significant drop in blood pressure (20 mm systolic or 10 diastolic) after an upright posture is assumed

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22
Q

preload definition

A

degree of stretch of cardiac muscle fibers at the end of diastole

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23
Q

pulmonary vascular resistance definition

A

resistance to blood flow out of the right ventricle created by the pulmonary circulatory system

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24
Q

pulse deficit definition

A

difference between apical and radial pulse rates

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25
Q

radioisotopes definition

A

unstable atoms that give off small amounts of energy in the form of gamma rays as they decay

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26
Q

repolarization definition

A

returns of the cell to resting state, caused by reentry of potassium into the cell while sodium exits

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27
Q

s1 definition

A

first heart sound produced by closure of atrioventricular (mitral and tricuspid) valves

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28
Q

S2 definition

A

the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves

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29
Q

SA Node definition

A

primary pacemaker of the heart, in right atrium

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30
Q

stroke volume definition

A

amount of blood ejected from one of the ventricles per heartbeat

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31
Q

summation gallop definition

A

abnormal sounds created by the presence of an S3 and S4 during periods of tachycardia

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32
Q

systemic vascular resistance definition

A

resistance to blood flow out of the left ventricle created by teh systemic circulatory system

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33
Q

systole definition

A

period of ventricular contraction resulting in ejeciton of blood from the ventricles into the pulmonary artery and aorta

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34
Q

systolic click definition

A

abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve duing ventricular contraction

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35
Q

telemetry definition

A

process of continuous electrocardiographic monitoring by transmission of radio waves

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36
Q

Layers of the heart?

A

Endocardium (inner) -> Myocardium -> Epicardium

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37
Q

What is the pericardium?

A

A thin, fibrous sac that the heart is encased in

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38
Q

What is the diastole phase?

A

All four chambers relax simultaneously, which allow the ventricles to fill in preparation for contaction

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39
Q

What is the systole phase?

A

Refers to the events in the heart during contraction of the atric and ventricles. Artrial systole first, then ventricular systole

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40
Q

What are the SA and AV node composed of?

A

Nodal cells

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41
Q

Heart rate is determined by?

A

The myocardial cells with the fastest inherent firing rate. Under normal circumatances, the SA node has the highest rate

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42
Q

Branches of the parasympathetic nervous system travel to the SA node by

A

the vagus nerve

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43
Q

Stimulation of the vagus nerve does what to the heart

A

slows the heart rate

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44
Q

sympathetic nervous system increases heart rate by

A

inervation of the beta-1 receptor sites located within the SA node

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45
Q

Stroke volume is determined by what three factors

A

Preload, afterload, and contractility

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46
Q

Preload is decreased by

A

Diuresis

Denodilating agents

Excessive loss of blood

Dehydration

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47
Q

Preload is increased by

A

increasing the reutrn of circulating blood volume to the ventricles

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48
Q

CAD development for men adn women

A

CAD development occurs around 10 years later in women , due to the female hormone estrogen

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49
Q

The three major effects of estrogen are

A
  1. An increase in HDL that transports cholesterol out of arteries
  2. Reduction in LDL that deposits cholesterol in the artery
  3. Dilation of the blood vessels, which enhance blood flow to the heart
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50
Q

What does an ED nurse due for a patient that arrives with acute coronary syndrome (ACS)

A

Performs rapid and focused assesment. Diagnosis and treatment must be started within minutes

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51
Q

Age Related Changes: History and Physical Findings of Atria

A

Irregular heart rhythm from atrial dysrhythmias

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52
Q

Age Related Changes: History and Physical Findings of Left Ventricle

A

Fatigue, Decreased exercise tolernce

S&S of heart failure

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53
Q

Age Related Changes: History and Physical Findings of Valves

A

Murmurs may be present

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54
Q

Age Related Changes: History and Physical Findings of Conduction System

A

Bradycardia

Heart Block

ECG changes

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55
Q

Age Related Changes: History and Physical Findings of Sympathetic nervous system

A

Fatigue

Diminished exercise tolerence

Decreased ability to respond to stress

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56
Q

Age Related Changes: History and Physical Findings of Aorta and arteries

A

Progressive increase in systolic BP

Widening pulse pressure

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57
Q

Age Related Changes: History and Physical Findings of Baroreceptor response

A

Postural BP changes and reports of feeling dizze, fainting when moving from lying to sitting

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58
Q

The signs and symptoms experienced by people with CVD are related to

A

dysrhythmias and conduction problems; structural, infectious, and inflammatory disorders of the heart

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59
Q

Most common S&S of CVD

A

Chest pain and discomfort

Pain or discomfort in other areas

Shortness of breath or dyspnea

peripheral edema, weight gain, abdominal distenion

Palpitations

Unusual Fatigue

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60
Q

How does a nurse differentiate among the causes of chest pain?

A

Nurse asks pt to identify the quantity, location, and quality of pain

Asses for radiation of the pain to other areas of the body and determines if associated S&S are connected.

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61
Q

The location of chest symptoms is not well correlated with

A

the cause of pain

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62
Q

Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing what three major cardiovascular risk factors?

A

Hyperlipidemia,

Hypertension

Diabetes

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63
Q

What diets are commonly prescribed?

A

Diets that restrict sodium, fat, cholesterol, or calories

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64
Q

Angina Pectoris definition

A

Uncomfortable pressure, squeezing, or fullness in substernal chest area. Can radiate acros chest ot the medial aspect.

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65
Q

Angina Pectoris duration

A

5-15 minutes

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66
Q

Angina Pectoris can radiate across

A

chest to the medial aspect of one or both arms and hands, jaw, shoulders, upper back, or epigastrium.

Numbness, tingling, or aching

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67
Q

Angina Pectoris Percipitating Events

A

Physical exertion, emotional upset, eating large meal, or exposure to extremes in temperature

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68
Q

Angina Pectoris Alleviating Factors

A

Rest, Nitroglycerin, and Oxygen

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69
Q

ACS Character

A

Same as angina pectoris.

Pain or discomfort from ild to severe

Associated with shortness of breath, diaphoresis, palpitations, unusual fatigue

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70
Q

ACS Duration

A

> 15 minutes

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71
Q

ACS Precipitating Events

A

Emotional upset or unusual physical exertion occurs within 24 hours of symptom onset.

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72
Q

ACS Alleviating Factors

A

Morphine

Reperfusion of coronary artery with thrombolytic agent or percutaneous coronary intervention

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73
Q

Pericarditis Character

A

Sharp, sever substernal or epigastric pain

Can radiate to neck, arms, and back

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74
Q

Pericarditis S&S

A

Fever

Malaise

Dyspnea

Cough
Nausea

Dizziness

Palpitations

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75
Q

Pericarditis Duration

A

Intermittent

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76
Q

Pericarditis Precipitating Events

A

Sudden onset

Pain increases with inspiration, swallowing, coughing, and rotation of trunk

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77
Q

Pericarditis Alleviating Factors

A

Siting upright,

Analgesia

Anti-inflammatory medications

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78
Q

Pulmonary Disorders (Pneumonia Pulmonary Embolism) Character

A

Shartp, severe substernal or epigastric pain arising from inferior portion of pleura.

Patient may be able to localize the pain

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79
Q

Pulmonary Disorders (Pneumonia Pulmonary Embolism) Duration

A

> 30 minutes

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80
Q

Pulmonary Disorders (Pneumonia Pulmonary Embolism) Precipitating Events

A

Follows infectious process

Pleuritis pain increases with inspiration, coughing, movement, and supine positioning

Occurs in conjuction with community or HAI’s or VTE

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81
Q

Pulmonary Disorders (Pneumonia Pulmonary Embolism) Alleviating Factors

A

Treatment of underlying cause

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82
Q

Anxiety and Panic Disorders Character

A

Pain described as stabbing to dull ache

Associted with diaphoresis, palpitations, shortness of nbreath, tingling of hands or mouth

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83
Q

Anxiety and Panic Disorders Duration

A

Peaks in 10 minutes

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84
Q

Anxiety and Panic Disorders Precipitating Events

A

Can occur at any time including during sleep

Can be associated with a specific trigger

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85
Q

Anxiety and Panic Disorders Aleviating Factors

A

Removal of stimulus, relaxation, medications to treat anxiety or underlying disorder

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86
Q

Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Character

A

Substernal pain described as sharp, burning, or heavy

OFten mimics angina

Can radiate to neck, arm, or shoulders

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87
Q

Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Duration

A

5-60 minutes

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88
Q

Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Precipitating Events

A

Recumbency, cold liquids, exercise

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89
Q

Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Alleviating Factors

A

Food or actacid

Nitroglycerin

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90
Q

Musculoskeletal Disorders (Costochondritis) Character

A

Sharp or stabbing pain localized in anterior chest

Most often unilateral

Can radiate across chest to epigastrium or back

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91
Q

Musculoskeletal Disorders (Costochondritis) Duration

A

Hours to days

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92
Q

Musculoskeletal Disorders (Costochondritis) Precipitating Events

A

Most often follows respiratory tract infections with sidnificant coughing

Exacerbated by deep inspiration, coughing, sneezing, and movement

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93
Q

Musculoskeletal Disorders (Costochondritis) Alleviating Factors

A

Rest, ice, or heat

Analgesic or anti-inflammatory medications

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94
Q

Nocturia is comon in patients with

A

HF

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95
Q

Because many cardiac medications can cause GI side effects or bleeding, the nurse asks about

A

bloating, diarrhea, constipation, stomach upset, heartburn, loss of appetite, nausea, and vomiting

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96
Q

Screening for bloody urine or stools should be done for patients taking

A

platelet-inhibiting medicatons such as aspirin and clopidogrel

Platelet aggregation inhibitors

Anticoagulants

Oral Anticoagulantns

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97
Q

Activity-induced angina or shortness of breath may indicate

A

CAD.

Occur when myocardialischemia is present, due to an inadequate arterial blood supply

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98
Q

Patients with worsening HF often experience orthopnea, which is

A

a term used to indicate the need to sit upright or stand to avoid feeling short of breath

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99
Q

Patients with orthopne will report that they need to

A

sleep upright in a chair, or add extra pillows to their bed

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100
Q

What is Paroxysmal Noctural Dyspnea is

A

sudden awakening with shortness of breath.

Caused by the reabsorption of fluid from dependent areas of the body back into the circulatory system within hours of lying in bed

This increases preload and places increased demand o the heart of patients with HF causing pulmonary congestion

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101
Q

What is sleep-disordered breathing (SDB)?

A

This is an abnormal respiratory pattern due to intermittent episodes of upper airway obstruction causing apnea and hypopnea

This causes intermittent hypoxemia, sympathetic nervous system activation, and increased intrathoracic pressure

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102
Q

Untreated SDB has been linked to

A

CAD, hypertension, HF and dysrhythmias

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103
Q

SDB is treated by

A

use of continuous positive airway pressure (CPAP) and mandibular advancment devices (MAD).

THey maintain an open airway during sleep, prevent hypoxemia

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104
Q

Patients with CVD are being managed with complex medical regimens and sophisticated technology such as

A

implantable cardioverter defibrillators (ICDs) and left ventricular assist devices

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105
Q

High levels of anxiety are associated with

A

an increased incidience of CAD and in-hospital complication rates after MI

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106
Q

Patients with CAD and HF should be assesed for what mental issue?

A

Depression

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107
Q

Patients who have depresion exhibit common signs and symptoms such as

A

feelings of worthlessness or guilt, problems falling asleep, or staying asleep, having little pleasure, difficulty concentrating, and recent changes in appetite and weight

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108
Q

Stres initiates a variety of responses, such as

A

increased levels of catecholamines and cortisol and has been strongly linked to cardiovascular events

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109
Q

During a physical assessment, the nurse evaluates teh cardiovascular system for any deviations from normal with regard to the following

A

the heart as a pump

Atrial and ventricular filling volumes nad pressures

Cardiac Output

Compensatory mechanisms

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110
Q

With general appearance, patients are observed for what signs

A

Signs of distress, which include pain or discomfort, shortness of breath, or anxiety

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111
Q

For assessment of the skin and extremities, what are the 6 P’s

A

Pain

Pallor
Pulselessness

Paresthesia

Coldness

Paralysis

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112
Q

What sites of the body may be used for catheter insertion?

A

Major blood vessels of the arms and legs

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113
Q

What medicine must be used with catheter insertion?

A

During these procedures, systemic anticoagulation with heparin is necessary

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114
Q

What is peripheral edema?

A

Edema of the feet, ankles, or legs

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115
Q

What is pulse pressure?

A

The diffference between the systolic and the diastolic pressures

A reflection of stroke volume, ejection velocity, and systemic vascular resistance

Normally 30-40 mm Hg, indicated how well the patient maintains cardiac output

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116
Q

Posturual hypotension in patients with CVD is most often due to

A

a significant reduction in preload, which compromises cardiac output.

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117
Q

Reduced preload from postural hypotension is reflective of

A

intravascular volume depletion and is caused by dehydration from overdiuresis, bleeding (due to antiplatelet or anticoagulant medications) or medications that dilate the blood vessels

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118
Q

What is the pulse like in a patient with stenosis of the aortic valve

A

The valve opening is narrowed, reducing amount of blood ejected.

Pulse pressure is narrow, and pulse feels feeble

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119
Q

What is the pulse like in a patient in aortic insufficiency?

A

The aortic valve doe snot close completely, allowing blood to flow back from teh aorta into the left ventricle

120
Q

Right-sided heart function can be estimated by observing the pulsations of the

A

jugular veins of the neck which reflects central venous pressure (CVP).

121
Q

What is central venous pressure?

A

The pressure in the right atria or right ventricle at the end of diastole.

122
Q

Normal heart sounds are referred to as

A

S1 and S2, and produce dby closure of the AV valves and teh semilunar valves.

123
Q

S1 - First heart Sound: What creates this sound?

A

Tricuspid and mitral valve closure creates the first heart sound. Lub is used to repliacte this sound

124
Q

S1 - First heart Sound: Heard loudest in what area?

A

The apical area.

125
Q

S1 - First heart Sound: This serves at the pint of reference for

A

the reminader of the cardiac cycle

126
Q

S1 - First heart Sound: Intensity of S1 increases during

A

tachycardias or with mitral stenosis. AV valves are wide open during ventricular contraction

127
Q

S2 - The Second heart Sound : What creates this sound?

A

Closure of the pulmonic and aortic valves producue this sound, also known as the dub

128
Q

S2 - The Second heart Sound : Aortic component of S2 is heard loudest over

A

the aortic and pulmonic areas

129
Q

Abnormal Heart Sounds: These develop during

A

systole or diastole when structural or functional heart problems are present . These are called S3 or S4 gallops, opening snaps, systolic clicks, or murmurs.

130
Q

Abnormal Heart Sounds: What are S3 and S4 gallop sounds?

A

Heart during diastole. These sounds are created by the vibration of the ventricle and surrounding structures as blood meets resistance during ventricular filling. Gallop evolved from cadence that is produced by the addition of a third or fourth heart sound

131
Q

S3 - Third Heart Sound: Heard when?

A

S3 (Dub) is heard early in diastole during the period of rapid ventricular filling as blood flows from atrium into a noncompliant ventricle.

132
Q

S3 - Third Heart Sound: Why is this important in older adults?

A

Significant finding, and suggests HF.

133
Q

S4 - Fourth Heart Sound: Occurs when?

A

Occurs late in diastole. Heart just before S1 and generated during atrial contraction as blood enters noncompliant ventricle.

134
Q

S4 - Fourth Heart Sound: What causes S4 resistance?

A

Hypertension

CAD

Cardiomyopathies

Aortic Stenosis

135
Q

Opening Snaps and Systolic Clicks: How can abnormal sounds occur here?

A

Diseased valve leaflets create abnormal sounds as they open during diastole or systole

136
Q

Opening Snaps and Systolic Clicks: Mid to late systolic clicks may be heard in patients with

A

mitral or tricuspid valve prolapse as the malfunctioning valve leaflet is displaced into the atrium during ventricular systole. Murmurs expected to be heard following htese sounds

137
Q

Murmurs: What may cause this turbulence?

A

May be a critically narrowed valve, a malfunctioning vcalve that allows regurgitant blood flow, a congenital defect of the ventricular wall, a defect between the aorta, or increased flow of blood

138
Q

Friction Rub: What is this?

A

A harsh, grating sound that can be heard in boths ystole and diastole . Caused by abrasion of the inflamed pericardial surfaces from pericarditis.

139
Q

Lungs: Findings frequently exhibited by patients with cardiac disorders include

A

Hemoptysis (Pink, frothy sputum)

Cough

Crackles

Wheezes

140
Q

Abdomen: A protuberant abdomen with bulging flanks indicates

A

Ascites.

Devlopes in patients with right ventricular or biventricular HF. This impedes the returnr of venous blood. Liver and spleen become engorged with excessive venous blood . As pressure rises, fluid shifts from vascular bed into the abdominal cavity

141
Q

Abdomen: Hepatojugular REflux

A

This test is performed when right ventricular or biventricular HF is suspected. Patient is positoned so that the jugular venous pulse is visible to the lower pat of the neck. When observing, firm pressure applied to right upper quadrant of the abdomen

142
Q

Abdomen: Bladder Distention. Urine output reduction may indicate

A

inadequate renal perfusion or a less serious problem such as one caused by urinary retention

143
Q

What lab tests are performed on someone with cardiovascular conditions?

A

Cardiiac Biomarker Analysis

Blood Chemistry, Hematology, and Coagulation Studies

Lipid Profiles

Brain Natriuretic Peptide

C-Reactive Protein

Homocysteine

144
Q

The diagnosis of MI is made by evaluating

A

the history and physical examination, the 12-lead ECG, and results of lab tests that measure serum cardiac biomarkers.

145
Q

In MI, why would someone analyze serum cardiac biomarkers

A

Myocardial cells that become necrotic from prolonged ischemia or trauma release specific enzymes and proteins. These leak into the intersitital spaces of the myocardium and are carried by the lymphatic system into circulation. This is why it can be detected in blood samples

146
Q

Normal BUN range?

A

10-20

147
Q

What is BUN?

A

BUN and Creatine are end products of protein metabolism

148
Q

What does elevated BUN mean?

A

Reflects reduced renal perfusion from decreased cardiac output or intravasular fluid volume deficit

149
Q

Normal calcium range?

A

8.5-10.5

150
Q

Why is Calcium necessary?

A

Necessary for blood coagulability, neuromuscular activity, and automaticity of the nodal cells

151
Q

What happens in Hypocalcemia?

A

Decreased calcium levels slow nodal function and impair myocardial contractility. Increases risk for HF

152
Q

What happens in Hypercalcemia

A

THis potentiates digitalis toxicity, causes increased myocardial contractility, and increases the risk for varying degrees of heart block and sudden death

153
Q

Normal creatinine range?

A

0.7-1.4

154
Q

What is creatinine used for?

A

Used to assess renal function. Normal creatinine and elevated BUN suggests an intrasvascular fluid volume deficit

155
Q

Magnesium range

A

1.8-3.0

156
Q

What is magnesium used for

A

Necessary for absoprtion of calcium, maintenance of potassium stores, and metabolism of adenosine triphosphate. Playes major role in protein and carbohydrate synthesis

157
Q

What happens in Hypomagnesemia

A

Decrease magnesium levels due to enhanced renal excretion of magneseium from use of diuretic or digitalis therapy. Predisposes patients to atrial or ventricular tachycardias

158
Q

What happens in Hypermagnesemia

A

Increased magnesium levels are commonly cause dby cathartics or antacids.

Depress contreactility and excitability of myocardium, causing heart block and asystole

159
Q

Potassium range

A

3.5-5

160
Q

What does potassium do

A

Major role in cardiac electrophysiologic function

161
Q

What happens in Hypokalemia

A

Due to administration of potassium-excreting diuretics.

Causes many forms of dysrhythmias, includng life-threatening ventricular tachycardia or ventricular fibrilation

162
Q

What happens in Hyperkalemia

A

From increased intake of potassium, decreased K+ excretion.

Heart block, aystole, and life-threatening ventricular dysrhythmias can occur

163
Q

Sodium range

A

135-145

164
Q

What does sodium do?

A

Does not affect cardiac function

165
Q

What happens in Hyponatremia

A

Can indicate fluid excess and can be caused by heart failure or thiazide diuretics

166
Q

What happens in Hypernatremia

A

Indicated fluid deficits and results from decrease water intake or loss of water through sweating or diarrhea.

167
Q

Why are Coagulation Studies done?

A

Occurs when an injury to the vessel occurs. Has two pathways: intrinsic and extrinsic pathways.

Routinely performed before invasive procedures, such as cardiac catheterization, electrophysiology testing, and cardiac surgery

168
Q

Coagulation Studies: Partial Thromboplastin Time (PTT) duration

A

60-70 seconds

169
Q

Coagulation Studies: Partial Thromboplastin Time (PTT) measures what?

A

PTT or aPTT Measures the activity of the intrinsic pathway and is used to assess the effects of unfractioned heparin.

Therapeutic range is 1.5-2.5 times baseline values.

170
Q

Coagulation Studies: What is Activcated Partial Thromboplastin Time (aPTT)

A

Takes 20-39 seconds

171
Q

Coagulation Studies: APTT adjustement doses are

A

Increase of dose for <50s or decrease of dose for >100 seconds

172
Q

Coagulation Studies: What is Prothrombin Time (PT)?

A

Takes 9.5 - 12 seconds.

Measure the extrinsic pathway activity and is used to monitor the level of anticoagulation with warfarin (Coumadin)

173
Q

Coagulation Studies: What is International Normalized Ratio (INR)

A

Provides a standard method for reporting PT levels and eliminates the variation of PT results from different labs.

INR used to monitor the effectiveness of warfarin. Therapeutic range is 2-3.5

174
Q

Hematologic Studies: What does Complete Blood Count identify?

A

Identifies the total number of white and red blood cells and platelets and measures hemoglobin and hematocrit. CBC is carefully monitored in patients with CVD

175
Q

Hematologic Studies: Hematocrit range for males?

A

42-52 %

176
Q

Hematologic Studies: Hematocrit range for females

A

35-47%

177
Q

Hematologic Studies: Hemoglobin range for males

A

13-18

178
Q

Hematologic Studies: Hemoglobin range for females

A

12-16

179
Q

Hematologic Studies: What does hematocrit represent?

A

The percentage of red blood cells found in 100 mL of whole blood.

180
Q

Hematologic Studies: Normal Platelets range?

A

150,000 - 450,000

181
Q

Hematologic Studies: What are platelets?

A

Are the first line of protection against bleeding. They form a thrombus. Several medications inhibit platelet function.

182
Q

Hematologic Studies: Normal WBC Count?

A

4500 - 110,00

183
Q

Hematologic Studies: When are WBC counts monitored?

A

In immunocompromised patients, including patients with heart transplants or when there is concern for infection

184
Q

Laboratory Tests - Lipid Profile: What is measured here and why?

A

Cholesterol, TRiglycerides, and Lipoproteins measured to evaluate a person’s risk of developing CAD

185
Q

Laboratory Tests - Lipid Profile: How are cholesterol and triglycerides transported?

A

In the blood by combining with plasma proteins to form lipoproteins called LDL and HDL

186
Q

Laboratory Tests - Lipid Profile: Blodo specimen for lipid profile should be obtained after what

A

A 12-hour fast

187
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: Cholesterol is a lipid required for

A

hormone synthesis and cell membrane formation. FOund in large quantities in brain and nerve tissue

188
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: Two major sources of cholesterol are

A

diet (animal products) and in the liver.

189
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: Total cholesterol level is calculated by adding

A

the HDL, LDL, and 20% of the triglyceride level

190
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: What does medical management fofcus on?

A

Determining the individuals 10 year risk for atherosclerotic vascular disease to identify those most likely to benefit from taking prescribed statins

191
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: LDL s the primary transporter of

A

cholesterol adn triglycerides into the cell.

192
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: Harmful effect of LDL is

A

the deposition of these substances in the walls of arterial vessels.

193
Q

Laboratory Tests - Lipid Profile and Cholesterol Levels: HDL has a protective action because

A

it transports cholesterol away from the tissuse and cells of the arterial wall to the liver for excretion

194
Q

Laboratory Tests - Lipid Profile and Triglycerides: They arestored where?

A

In adipose tissue and are a source of energy

195
Q

Laboratory Tests - Lipid Profile and Triglycerides: Triglycerides Levels increase after

A

meals and are affected by stress.

Diabetes, alcohol, and obesity can elevate triglyceride levels. These levels have a direct corrlection with LDL and inverse one with HDL

196
Q

Laboratory Tests - Brain (B-Type) Natriuretic Peptide): What is BNP?

A

A neurohormone that helps regulate BP and fluid volume. Primarly secreted from the ventricles in response to increased preload with resulting elevated ventricular pressure

197
Q

Laboratory Tests - Brain (B-Type) Natriuretic Peptide): Level of BNP in blood increases as

A

the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in setting of HF

198
Q

Laboratory Tests - Brain (B-Type) Natriuretic Peptide): BNP levels are useful for prompt diagnosis of

A

HF in settings such as ED

199
Q

Laboratory Tests - Brain (B-Type) Natriuretic Peptide): Elevations of BNP can occur from

A

number of other conditions such as :

Pulmonary embolus

MI
Ventricular Hypertrophy

200
Q

Laboratory Tests - C-Reactive Protein: What is this??

A

A protein produced by the liver in response to systemic inflammation. Inflammation thought to play role in athersclerosis.

201
Q

Laboratory Tests - C-Reactive Protein: High - sensitivity CRP test is used as an adjunct to other tests to predict

A

CVD Risk. People with high hs-CRP levels have be at greatest risk for CVD compared to those with moderate or low

202
Q

Laboratory Tests - Homocysteine: What is this?

A

An amino acid that is linked to the development of athersclerosis because it can damage the endothelial lining of arteries and promote thrombus formation

203
Q

Laboratory Tests - Homocysteine: Elevated blood level of homocystein is thought to indicate

A

high risk for CAD, stroke, and peripheral vascular disease

204
Q

Laboratory Tests - Homocysteine: What is associated with elevated homocysteine levels?

A

Genetic factors and a diet low in

Folate, Vitamin B6 and Vitamin B12.

205
Q

Laboratory Tests - Homocysteine: What is necessary before drawing blood?

A

A 12-hour fast for an accurate serum management.

206
Q

What other tests can be performed for those with cardiovascular dysfunctions?

A

Chest X-Ray and FLuoroscopy

Electrocardiography

Telemetry

LEad Systems

Ambulatory Electriocardiography

Continuous Monitors

Conintuous-REal-Life Monitors

Cardiac Event REcorders

Cardiac Implantable Electronic Devices

207
Q

Cardiovascular Condition Test - Chest X-Ray and FLuroscopy: Chest X-Ray obtained to

A

determine the size, contour, and position of the heart.

Also determine correct placement of pacemakers and pulmonary artery catheters

208
Q

Cardiovascular Condition Test - Chest X-Ray and FLuroscopy: What does Chest X-Ray revel?

A

Cardiac and pericardial calcifications and demonstrates physiologic alterations in the pulmonary circulation

209
Q

Cardiovascular Condition Test - Chest X-Ray and FLuroscopy: Fluroscopy, what is this?

A

An x-ray imaging technique that allows visulation of the heart on a screen. It shows cardiac and vascular pulsations and unusal cardiac contours.

210
Q

Cardiovascular Condition Tests - Chest X-Ray and FLuroscopy: Fluroscopy useful for

A

positioning transvenous pacing electrodes and for guiding the insertion of arterial and venous catheters during cardiac catheterization and other cardiac procedures

211
Q

Cardiovascular Condition Tests - Electorcardiography: What is this?

A

The ECG is a graphic representation of the electrical currents of the heart. Obtained by placing disposable electrobes in standard positions on skin.

212
Q

Cardiovascular Condition Tests - Electorcardiography: Standard ECG composed of

A

12 leads or 12 different views

213
Q

Cardiovascular Condition Tests - Electorcardiography: 12 - lead ECG used to diagnose

A

dysrhythmias, conduction abnormalities, and chamber enlargement, as well as Myocardial Ischemia, injury, or infarction

214
Q

Cardiovascular Condition Tests - Electorcardiography: What is 15-lead ECG used for?

A

Adds three aditional chest leads and used for early diagnosis of right ventricular and left posterior infarction

215
Q

Cardiovascular Condition Tests - Electorcardiography: What is the 18-lead ECG used form?

A

Useful for early detection of myocardial ischemia and injury

216
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring: This is the standard of care for patients who are

A

at high risk for dysrhythmias. Detects abnormalities in heart rate and rhythm.

217
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring: Many systems have capacity to monitor for changes in ST segments, who are used to ifentify the presence of

A

myocardial ischemia or injury

218
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Hardwire Cardiac Monitoring: Why is this used?

A

To continuously observe the heart for dysrhythmias and conduction disorders using 1 or 2 ECG legs.

Displayed on bedside monitor

219
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Telemetry: What is this?

A

ECG can be continuously observed, by using the transmission of radio waves from a battery-operated transmitter to a central bank of monitors

Electrodes placed on the chest with a lead cable that connects to transmitter. Transmitter can be placed in a disposable pouch and worn around neck.

Batteries changed every 24-48 hours.

220
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Telemetry: Benefit of this?

A

System is wireless, which allows patients to ambulate while one or two ECG leads are monitored.

221
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Lead Systems: What does lead system determine?

A

Determines the number of electrodes needed for hardwire cardiac monitoring and telemetry

222
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Lead Systems: Lead II provides teh best visualization of

A

atrial depolarizations (represented by the P wave)

223
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Lead Systems: Lead V1 best records

A

ventricular depolarization and is most helpful when monitoring for certain dysrhythmias

224
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Ambulatory Electrocardiography: What is this?

A

Form of continuous or intermittent ECG home monitoring. Used to identify the etiology of syncope or palpitations caused by dysrhythmias, detect episodes of MI, evaluate effectivenes of treatment of HF and dysrhythmias

And evaluate pacemakers.

225
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Ambulatory Electrocardiography: Where is it placed?

A

Can be worn externally or implanted under the skin. ECG is transmitted ot a centralized monitoring station via telephone

226
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: What are these?

A

Holter Monitors. Small portable recorders that are connected to chest electrodes that record the ECG using several leads onto a digital memory device.

Patient wears recorder for 24-48 hours up to 2 weeks

Do not provide real-time ECG recordings

227
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: Effectiveness is dependent upon

A

Patient’s adherence with keeping a diary and marking events.

228
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: Alternative of Holter monitoring is

A

ECG patch monitoring, uses blueooth. ECG patch placed over left pectoral area. Patient wears patch for 14 days and returns to manufacture for analysis.

229
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: Downside of ECG Patch Monitoring?

A

Capable of monitoring just one ECG lead, which makes it less sensitive to dysrhythmia detection

230
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Real-Time Monitors: What is this?

A

ECG monitored continuously at a remote central monitoring station.

Patient has three electrodes applied to the chest or wears an electrode belt.

When Dysrhythmia detected, system automatically transmit the ECG to a monitoring center

231
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Event Recorders: What are these?

A

Allow patients to record the electrical activity of the heart when they experience symptoms. Recorded ECGS transmitted to doctor by telephone.

232
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Event Recorders: Downside to this?

A

Record and store the ECG during only times when the patient is experiencing symptoms by manually turning it on

233
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Implantble Electronic Device: What are these used for?

A

Used to manage patients with serious cardiac illness.

Uses remote wireless monitoring.

234
Q

Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Event Recorders: What is an implantable loop recorder?

A

Injected under skin. Records ECGS continuously for up to 3 years. Patient doesnt have to wear anything.

Recommended for those who have infrequent symptoms

235
Q

Cardiovascular Condition Tests - Cardiac Stress Tesing: What does this test evaluate?

A

Its a noninvasive way to evaluate the response of the cardiovascular system to stress.

Determines:

  1. Presence of CAD
  2. Cause of chest pain
  3. Functional capacity of heart after MI or surgerye
  4. Effectiveness of antianginal or antiarrhythmic medication
  5. Occurence of dysrhythmias
  6. Specific goals for physical fitness program
236
Q

Cardiovascular Condition Tests - Cardiac Stress Tesing: Contraindications of stress taking include

A

MI within 48 hours

Angina

Uncontrolled Dysrhythmias with hemodynamic compromise

Severe aortic stenosis

Acute myocarditis

Decompensated HF

237
Q

Cardiovascular Condition Tests - Cardiac Stress Tesing: Often combined with

A

echocardiography or radionuclide imaging, techniques used to capture images of the heart

238
Q

Cardiovascular Condition Tests - Exercise Stress Tesing, Procedure: What is the procedure?

A

PT walks on treadmill. Exercise intesnsity progresses.

This is for 10-15 minutes

239
Q

Cardiovascular Condition Tests - Exercise Stress Tesing, Procedure: What is monitored?

A

2 or more ECH leads for heart rate

Rhythm and Ischemic changes

BP

Skin Temperature

Physical Appearance

Perceived Exertion

Symptoms (Chest pain, dyspnea, dizziness, leg cramping)

240
Q

Cardiovascular Condition Tests - Exercise Stress Tesing, Procedure: When is the test terminated?

A

Target heart rate is achieved or experiences signs of MI.

241
Q

Cardiovascular Condition Tests - Exercise Stress Testing, Nursing Interventions: What must be instructed before test?

A

Fast for at least 3 hours before test and avoid stimulants such as tobacco or caffeeine.

242
Q

Cardiovascular Condition Tests - Exercise Stress Testing, Nursing Interventions: What medications might they not take before test

A

Beta-Adrengeric blocking agents before the test

243
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Why would this be used?

A

For those whoa re cognitively impaired and unable to follow directly or physically disabled.

244
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: What is done here?

A

Vasodilating agents such as dipyridamole(Persantine), Adenosine (aDenocard, or regadenoson (Lexiscan) given as IV infusion to mimic effects of exercise by maxilmally dilating coronary arteries

245
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Side effects of these medications?

A

Related to vasodilating action and include

chest pain, headache, flushing, nause, heart block, dyspnea.

246
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Effects of drug can be reversed with

A

Aminophylline.

247
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Vasodilating agents used in conjunction with

A

radionuclide imaging techniques

248
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Why is Dobutamine used?

A

Its a synthetic sympathomimetic agent that increases HR, myocardial contractility and blodo pressure increasing demands of heart. Used when Echocardiography is used because its effecting on altering myocardial wall motion

249
Q

Cardiovascular Condition Tests - Pharmacologic Stress Testing, Nursing Interventions: Preparation for these tests?

A

Patient will not eat or drink anything for at least 3 hours.

Refrain from eaitng any liquids or food that contain chocolate or caffeine for 24 hours.

Stop medications 24-48 hours before test.

250
Q

Cardiovascular Condition Tests - Radionuclide Imaging: What is this?

A

Noninvasive tests that use radioisotopes to evaluate coronary artery perfusion, detect myocardial ischemia, and ifaraction and or asessleft ventricular function

251
Q

Cardiovascular Condition Tests - Radionuclide Imaging: What are radioisotopes

A

Unstable atoms that give off small amounts of energy in the form of gamma rays as they decay.

Injected into the blood strem

252
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: Imaging is performed using what two types of techniques?

A

Single Photon Emission Computed tomography (SPECT)

Positron Emission Tomography (PET).

Commonly performed after an acute MI to determine if arterial perfusion to the heart is comrpomised during activity

253
Q

Nursing Interventions of ECG

A

Assess for allergies to adhesives

Rote sites for electrodes

Ensure electrodes are positioned correctly

Keep leads free form artifact

Two leads should be selected that provide the best tracing for dysrhythmias (LEad II and Chest Lead V)

Avoid placing electrodes over body areas of chest

254
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: These images combined with

A

stress testing to compare images obtained when the heart is resting to images of the heart in a stressed state resulting from exercise.

255
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: An area of the myocardium that shows no perfusion or reduced perfusion is said to have

A

a “defect” present.

A defect that does not change in size before and after stress is called a fixed defect. Theres no perfusion which is the case after an MI

256
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: What is a reversible defect?

A

Defects that appear or that get larger after the stress test. Cardiac Catheterization is recommended after a positive test result to determine the severity of obstructions to blood flow caused by CAD

257
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging:How is the test done?

A

Resting images taken first

IV is inserted to administer radioisotope and electrodes placed on chest to monitor the heart rate and rhyth,.

258
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Single Photon Emission Computed Tomography (SPECT): Why is this used?

A

Used most often because it is more widely available and is technically easier to perform than PET

259
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Single Photon Emission Computed Tomography (SPECT): What is the procedure?

A

Painless, noninvaise. Involves injection of tracer.

Patient positioned supine with arms over their head.

Gamma camera circles around chest area converting singles from teh traces into pictures

260
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Single Photon Emission Computed Tomography (SPECT): What are some Nursing Interventions?

A

Ensure the patient knows that the radiation is the same as any other X-ray

261
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Positron Emission Tomography (PET): Why is this used?

A

Produces better pictures than SPECT, faster, using lower doses of radiation.

Limited because not all facilities have a PET scanner

262
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Positron Emission Tomography (PET): Procedure?

A

TRacers give by injection. One to determine blood flow, another for metabolic function

Provides 3D images.

263
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Positron Emission Tomography (PET): Nursing Interventions include

A

Instruct pt to refrain from alcohol and caffeine for 24 hours before undergoing PET.

For those with diabetes and insulin, dicuss insulin doses and food restrictions.

Insert IV site before hand. Baseline scan takes 30 minutes and scan takes 1-3 hours to complete.

264
Q

Cardiovascular Condition Tests - Radionuclide Imaging, Test of Ventricular Function and Wall Motion: What tests are included here?

A

Equilibrium radionuclide angiocardiography (ERNA) , or MUGA, common noninvasive technique that uses a conventional scintillation camera interfaced with a computer to record images of the heart.

265
Q

Cardiovascular Condition Tests - Computed Tomography: What is this?

A

Form of cardiac imaging that uses x-rays to provide accurate cross-sectional “virtual” slices of specific areas of the heart and surorunding structures. Create a 3D image

266
Q

Cardiovascular Condition Tests - Computed Tomography: What is Coronary CT Angiography?

A

Requires use of an IV contrast agent to enhance the X-Rays and improve visualization of cardiac structures. Evaluates coronary artiers for stenosis. Used in caution in those with renal insufficiency.

267
Q

Cardiovascular Condition Tests - Computed Tomography: What may patient receive before Coronary CT Angiography

A

Beta-Blockers to control heart rate and rhythm and reduce artifact.

268
Q

Cardiovascular Condition Tests - Computed Tomography: What is Electron Beam CT (EBCT)?

A

Used to calculate a coronary artery calcium score that is based on the amount of calcium deposits in teh coronary arteries. Score used to predict likelihood of cardiac aevents.

269
Q

Cardiovascular Condition Tests - Computed Tomography: What is EBCT recommended for?

A

Reasonable test to offer for individuals with low to intermediate risk for future CAD related events

270
Q

Cardiovascular Condition Tests - Computed Tomography: Nursing Interventions

A

Details of procedure for pt.

PT holds breath at certain time during procedure.

271
Q

Cardiovascular Condition Tests - Magnetic Resonance Angiography (MRA): What is this?

A

Is noninvasive, painless technique that is used to examine both the physiologic and anatomic properties of th heart. Uses magnetic field and computer generated picture to picture heart and vessels

272
Q

Cardiovascular Condition Tests - Magnetic Resonance Angiography (MRA): Why is this valueable?

A

Valueable for diagnosing diseases of the aorta, heart muscle, and pericardium, as well as congenital heart lesions

273
Q

Cardiovascular Condition Tests - Magnetic Resonance Angiography (MRA): Nursing Interventions

A

Can’t have pacemaker.

Positioned supine on table and enclosed in tube.

274
Q

Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: What is thisi?

A

Noninvasive ultrasound test that is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures.

Also used to assess for leaking valves

275
Q

Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: Using for diagnosing

A

pericaridal effusions, determining chamber sisze, and etiology of heart murmurs.

276
Q

Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: How does this work?

A

Involves transmission of high-frequency sound waves into heart.

With use of doppler techniques, it can show the direction and velocity of blood flow .

277
Q

Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: Nursing Interventions

A

Gel applied to skin. Takes about 30-45 minutes.

278
Q

What is a DASH Diet?

A

A low fat, low salt diet. high in fiber and no cholic excess. A healthy diet.

279
Q

Cardiovascular Condition Tests - Echocardiography, Transesophageal Echocardiography: Limitation of Transthoracic echocardiography?

A

Poor quality of the images produced. Ultrasound loses its clairty as it passes through tissue, lunch, and bone

280
Q

When is cK-Creatinine Kinase release?

A

Released when there is any muscle damage

281
Q

What is Troponin T?

A

Released when there is heart damage.

282
Q

BNP tells the heart

A

That there is too much fluid in the left ventricle. Anything above 100 suggests HF

283
Q

Triglyceridea range that you want?

A

100-200

284
Q

LDL level that we want?

A

Less than 160

285
Q

FOr HDL, what level do we want?

A

We want it high. For men its 35-80

286
Q

Cardiovascular Condition Tests - Echocardiography, Transesophageal Echocardiography: Why is TEE Transesophageal Echocardiography bbetter?

A

Provies clearer images because ultrasound waves pass through less tissue. Moderate sedation used.

Important first line diagnostic tool for many types of CVD, including HF, valvular heart disease, dysrhythmmias and many other conditions

287
Q

Cardiovascular Condition Tests - Echocardiography, Transesophageal Echocardiography: Nuring Interventions

A

No eat/drinking for 6 hours prior

Insets IV lineAnd stays by the patient for support.

288
Q

Cardiovascular Condition Tests - Cardiac Catheteraization: What is this?

A

Common invasive procedure used to diagnose structural and functional diseases of the heart and great vessels.

289
Q

Cardiovascular Condition Tests - Cardiac Catheteraization: How does this procedure work?

A

Involvves percutaneous insertion of radiopaque catheters into a large vein and artery. Fluroscopy guides to the right and left heart

290
Q

Cardiovascular Condition Tests - Cardiac Catheteraization: How do you prepare for this test?

A

Patients have blood tests performed to evaluate metabolic functioning and renal .

291
Q

Cardiovascular Condition Tests - Cardiac Catheteraization: How is this performed?

A

Patient has one or more IV catheters for administration of fluids. Continuously monitored for chest pain or dyspnea.

292
Q

Cardiovascular Condition Tests - Right Heart Catheterization: Why is this done?

A

Right before left. Performed to assess the function of the right ventricle and tricuspid and pulmonary valves.

293
Q

Cardiovascular Condition Tests - Right Heart Catheterization: How does this work?

A

Passage of catheter from an antecubital or femoral vein into the right atrium, right ventricle. PRessure and O2 sat obtained and recorded. Pressures used to diagnose pulmonary hypertension

294
Q

Cardiovascular Condition Tests - Left Heart Catheterization: Why is this performed?

A

Performed to evaluate the aortic arch and its major branches, patency of the coronary arteries, and the function of the left ventricle and mitral and aortic valves

295
Q

Cardiovascular Condition Tests - Left Heart Catheterization: Nursing interventions

A

Fast 8-12 hours

NRSG 110: Med Surg 2 (29 decks)

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