Exam 2, Week 5: Assessment-Cardiovascular System Flashcards
Myocardial Perfusion begins with which arteries?
a.) Left and right coronary
b.) Left coronary
c.) Right coronary
d.) Neither
a.) Myocardial Perfusion begins in the Left and Right coronary arteries
From what vessel does the blood for Myocardial Perfusion come from?
The Aorta
The Aorta supplies the blood to the left and right coronary arteries so that what action can begin?
What does this action do?
Myocardial Perfusion
Myocardial Perfusion feeds the heart muscle so that it can pump.
Fill in the blanks:
The Left arteries perfuse the “X” side of the heart, while the Right arteries perfuse the “X” side of the heart.
Left arteries perfuse the Left side.
Right arteries perfuse the Right.
Which period gives oxygen to the heart?
-Systole
-Diastole
-Diastole, aka relaxation, provides the heart with oxygen
If a heart rate increases, what happens to the time spent during diastole (relaxation)?
The time spent during relaxation is reduced.
There are 3 layers to the heart. The endocardium, the myocardium and the Epicardium.
Which is the outermost layer?
Which is the middle layer?
Which is the inner layer?
Outer: Epicardium
Middle Myocardium
Inner: Endocardium
Which layer of the heart is responsible for pumping?
Myocardium
The Myocardium contains myocytes. These myocytes work alongside what system to allow for heart muscle contractions?
The electrical system
What is the name of the serous membrane structure that encases the heart?
The Pericardium
The pericardium has 2 layers. An innermost layer, and an outer layer. Which of these is the inner, and which is the outer?
-Visceral Pericardium
-Parietal Pericardium
Visceral is the inner layer
Parietal is the outer layer
Which pericardium layer attaches to the diaphragm, sternum, vertebrae and vessels, and which layer attaches to the endocardium?
-Visceral
-Parietal
Visceral is attached to the endocardium.
Parietal attaches to the diaphragm, sternum, vertebrae, and vessels.
What exists in-between the visceral and parietal pericardium?
20cc’s of serous fluid to fight friction.
The thickness of the arterial and ventricular walls of the heart varies in accordance with what?
Thickness varies according to the workload.
The ventricular walls are thicker than the atrial walls. Why would ventricular walls be thicker?
The Ventricles have a greater workload than the atria. They have to push blood out with great resistance, so they have to work harder. Because of this, they have thicker walls.
The right ventricle is thinner than the left ventricle. What might be the reason for the greater thickness of the left ventricle?
The left ventricle has to work harder by pumping out blood to the body (facing more resistance), while the right ventricle pumps blood to the lungs.
What mechanisms of the heart are responsible for maintaining forward flow of the blood?
The Heart Valves are responsible for maintaining “forward flow” of the blood.
What is the most important section of the heart? Why?
The left ventricle is the most important section of the heart. It pumps out blood to the whole body.
Which heart mechanism prevents backflow?
The heart valves
-Which valves separate the atria and the ventricles?
-During relaxation, are these valves open or closed? What about during contraction?
The Atrioventricular valves: Tricuspid and Mitral separate the atria and the ventricles.
In relaxation, the tricuspid and mitral valves stay open, and during contraction they close
What are the valves that work with the aorta and the pulmonary artery?
During contraction, are they open or closed? What about during relaxation?
The Semilunar Valves: Aortic and Pulmonic work with the Aorta and Pulmonary Artery
The valves are forced open during contraction, but close during relaxation due to backflow.
The Nodal and Purkinje cells of the heart have 3 characteristics: Automaticity, Excitability, and Conductivity. Match the jobs with their corresponding characteristic:
-They respond to electrical impulse
-They have the ability to transmit an electrical impulse
-They initiate the electrical impulse
Automaticity is the initiation of the electrical impulse.
Excitability is the response to an electrical impulse.
Conductivity is the ability to transmit and electrical impulse.
Automaticity, Excitability, and Conductivity are all characteristics of what heart cells?
The Nodal and Purkinje cells of the heart
Which node of the heart is called “The Pacemaker Node?”
How many impulses does it send per minute?
The Sinoatrial node, aka the SA node, is the pacemaker of the heart
It usually fires between 60-100 bpm.
Which node sets the pace for BPM?
SA node. Sinoatrial node
Which node is represented by the “p-wave”, then QRS?
The SA node
What node follows the SA node?
What is this node known as?
The Atrioventricular node, aka the AV node follows the SA node.
The AV node is also known as the “Gatekeeper Node.”
What is the node that is next in line to set the pace of the heart if the SA node fails?
What is the firing rate (BPM) for this node?
If the SA node should fail, the backup node is the AV node.
The AV node firs between 40-60 BPM. No more, no less.
Say that both the SA and AV nodes fail to set the pace of the heart. What is the 3rd and final backup plan for setting the pace of the heart?
What is the firing rate of this final backup plan?
Ventricular cells will kick in as “Ventricular pacing” as the 3rd and final pacemaker.
Ventricular pacing of the cells can only fire at 30-40 BPM.
This pacemaker method will not have a p-wave, and it will not have a regular QRS wave either. It will be messy, and unorganized, starting from the bottom and sporadically charting.
What pacemaker is being used?
Ventricular pacing/cells.
What will Ventricular Pacing represent itself as on an EKG, if it manages to keep its firing at 40BPM?
V-tech, meaning it will represent itself as Ventricular Tachycardia on an EKG. Even though the BPM is so low (Bradycardia)
Depolarization and repolarization of the heart happens due to the shifting of what from outside of a cardiac cell, to the inside (and vice versa)?
Each contraction happens with the shifting of electrolytes from outside the cardiac cell, to the inside (and vice versa)
What are the 3 most important electrolytes for heart health?
Why are they important?
Potassium, Sodium and Calcium
Their shifting allows for depolarization and repolarization.
Within a cardiac cell you have 3 electrolytes. Which 3 are they?
The cardiac cell has the greatest amount of which electrolyte inside of it?
Na+, Ca+, and K+ are the 3 electrolytes.
Out of the 3 electrolytes, K+ has the greatest presence inside the cardiac cell.
All the events that occur in the heart from one beat to the next beat is known as the what?
a.) Atrial Kick
b.) Cardiac Cycle
c.) Cardiac Event
d.) Myocardial Contractility
e.) Stroke Volume
b.) The Cardiac Cycle is all of the events that occur in the heart from one beat to the next beat.
The number of cardiac cycles in one minute is known as what?
Heart rate
There are 3 events that occur during 1 Cardiac Cycle. What are the names of these 3 events?
What is the order of the events?
Diastole, Atrial Systole, Ventricular Systole
Diastole is 1st (Relaxation
Atrial Systole is 2nd (Contraction)
Ventricular Systole is 3rd (Contraction)
The Atria contract, forcing blood into the ventricles, and just before the ventricles contract, the atria add about 15-20% more blood to the ventricles.
What is this event known as?
Atrial Kick
Finish this formula:
Cardiac Output =
Cardiac Output = Stroke Volume x Heart Rate
The amount of blood pumped out in each heartbeat is known as:
a.) Cardiac Output
b.) Flow Rate
c.) Stroke Volume
d.) Heart Rate
c.) Stroke Volume
How much blood that is pumped out of the heart over the course of 1 minute is:
a.) Stroke Volume
b.) Heart Rate
c.) Flow Rate
d.) Cardiac Output
d.) Cardiac Output is how much blood is pumped out of the heart over the course of 1 minute. Written in Liters.
Cardiac Output = Stroke Volume x Heart Rate
How much blood is in your ventricles at the end of diastole is known as:
a.) Preload
b.) Afterload
c.) Atrial Kick
d.) Ejection Fraction
a.) Preload is how much blood is “big-chillin” in your ventricles at the end of diastole (Relaxation) waiting to be pushed out to the body.
The amount of resistance the Left Ventricle has to overcome in order to pump blood is known as:
a.) Filtration
b.) Afterload
c.) Hydrostatic Pressure
d.) Myocardial Contractility
b.) Afterload is the amount of resistance the left ventricle has to overcome in order to pump blood.
The percentage of blood that the Left Ventricle ejects is known as:
a.) Deload
b.) Ejection Fraction
c.) Stroke Volume
d.) Cardiac Output
b.) Ejection Fraction is the percentage of blood that the left ventricle ejects.
What is the average percentage of the left ventricles Ejection Fraction?
55-65%
Stroke volume can be adjusted in several ways, one of which is due to receptors in the Aortic arch, and in the carotid arteries. What are these receptors called?
Baroreceptors
How do Baroreceptors in the Aortic arch, and in the Carotid arteries adjust Stroke Volume?
Baroreceptors, being receptors, receive feedback based on the bodies needs for blood volume, and they will then either trigger vasoconstriction or dilation of the Aorta and Carotid arteries to adjust to these needs.
The Heart Rate is sensitive to SA node changes. What system affects the rhythmic changes in the SA node?
a.) Autonomic NS
b.) Sympathetic NS
c.) Parasympathetic NS
d.) All of the above
e.) None of the above
d.) Sympathetic and Parasympathetic are apart of the Autonomic NS.
What is Myocardium Contractility?
The strength of the Myocardium Contraction
Hypoxemia, acidosis, and medications like beta-blockers can cause weakness to what aspect of the heart?
a.) Myocardial Contractility
b.) Cardiac Output
c.) Stroke Volume
d.) Afterload
a.) Hypoxemia (low blood oxygen, Acidosis (High blood/fluid CO2 levels) and beta-blockers (adrenaline blockers) all cause WEAKNESS in Myocardial Contractility
Cardiac output, stroke volume, and afterload are all consequences of weakened Myocardial Contractility
What are some effects of aging that cause issues in the heart?
-Stiffening and thickening of heart valves, causing more backflow or murmurs.
-Clogging of the arteries
-Less SA & AV nodes, and less Purkinje cells
-Women have higher estrogen levels during their youth that protect them, but lose it as they age, increasing risk of MI’s.
-Weakened myocardium
-Heart hypertrophies
When a nurse is assessing for subjective data on a patient, specifically their health, family, and social history, what are the 1st two things that the nurse should assess for?
Modifiable and non-modifiable risk factors
What are the two most important modifiable risk-factors for a patient’s heart health?
Smoking and drinking are the most important modifiable risk-factors
What are 3 more modifiable risk-factors that can come with assessing heart health?
-Diet
-Exercise
-Medications taken or not taken.
Think of a question you could ask to gain subjective health data from a patient in each of these assessment categories:
-Medications
-Nutrition
-Elimination
-Activity/Excercise
-Sleep & Rest
-Self-Perception
-Role & Relationships
-Sexuality
-Coping & Stress
Examples:
-Meds: Are you taking any meds that lower your Na+, Ca+, K+, blood sugar levels?
-Nutrition: Any changes to your diet that affect Cholesterol levels? Blood pressure?
-Elimination: Are you frequently getting up to urinate at night? Do you have to force bowel excretion?
-Activity: Any changes in exercise tolerance?
Sleep: Shortness of breath while laying?
Self-perception: What do you think caused the illness?
Roles: Who is the caregiver? Do you do the shopping?
Sexuality: Do you have pregnancy plans? Are you on Viagra or Beta blockers?
Coping: Are you having anxiety or high stress levels? Depression?
Which causes impotence in men by lowering blood-pressure?
-Viagra
-Beta-blockers
-Beta-blockers cause impotence by lowering blood pressure
What is intermittent claudication?
Pain while walking that stops when you rest.
Place these in order of objective data collection:
-Vitals
-Inspection
-ABC’s
Auscultation
-Palpation
1st: ABC’s!!!!
2nd: Vitals
3rd: Inspection
4th: Palpation
5th Auscultation
A nurse is collecting objective data on her patient and starts by inspecting for edema’s and jugular distention.
What is incorrect about the nurses assessment?
She must START with the ABC’s, then collect vitals.
If a nurse is inspecting a patient and recognizes that a patient is showing jugular distention, what could this be indicative of?
Heart failure
When inspecting the extremities, it is important to inspect for the 6 P’s. What are the 6 P’s?
Hints:
-Ouch!
-You look like a ghost
-I can’t find it anywhere on you
-Its like a sharp, tingling sensation
-I’m like a lizard, I need a sunlamp
-I can’t move!
-Pain
-Pallor
-Pulselessness
-Paresthesia (Pins N’ Needles)
-Poikilothermia (Can’t regulate your own body temperature; Cold-blooded)
-Paralysis
When palpating a patient’s pulse, what should the arterial pulse be in both extremities?
Rhythmic, Present, and Equal in both
The pulse deficit is the difference between what two things?
A Pulse deficit is the difference between the Heart Rate and the Pulse rate
How would you assess for a pulse deficit?
Hold the stethoscope diaphragm over the patient’s heart for 1 minute, while also checking the radial pulse and comparing the two. rates.
When assessing for heart health, simply checking a patient’s radial pulse is not enough. What kind of premature events can be heard with a stethoscope, but not felt at the radial pulse?
Premature atrial and ventricular contractions
(PAC’s and PVC’s)
When assessing the amplitude of a pulse, what specifically are you documenting?
You are documenting if the pulse is a weak, normal, or bounding heart rate.
Amplitude Score:
0- No pulse
1+ Weak
2+ Normal
3+ Bounding
Auscultating a patient means checking their pulse pressure. What is Pulse Pressure, and what is its usual pressure number?
Pusle Pressure is the difference between the Diastolic number and the Systolic number. The Diastolic or Systolic “number” is its Stroke Volume.
This is represented by something like a Bp reading of: 120/80. The Pulse Pressure would be 40.
The usual difference in the Pulse Pressure number is usually between 30 and 40.
A patient presents with a Bp reading of 160/80. This is his 1st visit to the doctor’s office. What could this difference in pulse pressure be indicative of?
-Exercise before coming
-Anxiety about being at the doctors
More serious:
-Tachycardia
-Hypertension
If a patient has a Pulse Pressure difference of LESS THAN 30, what could this be indicative of?
Decreased cardiac output. Probably needs a follow-up
Changes in “Postural Pressure” can result in what adverse effects?
-Orthostatic Hypotension
-Syncope
-Dizzyness
What are some physical conditions that can cause changes in “Postural Pressure?”
-Dehydration
-Hemorrhaging
If a patient is hacking up pink-tinged sputum, what is this indicative of?
Heart failure
If a patient is experiencing Arterial Stenosis, what is happening?
Stenosis is hardening.
If a patient is experiencing Arterial Stenosis, they are experiencing hardening of their arteries.
In which intercostal space is the apex of the heart located?
5th intercoastal space
How long should you be auscultating the chest wall for rhythm, rate, and valve function?
1 minute
Match these heart sounds with their rhythm: S1 & S2, S3, S4
-1-2…1-2…1-2…1-2…
-1-2-3, 1-2-3, 1-2-3, 1-2-3
-1-2 (3), 1-2 (3), 1-2 (3), 1-2 (3)
Tap them out on the table:
“1-2” is S1 & S2; Lub-dub.
“1-2-3” is S3.
“1-2 (3) is S4
APETM, or as I say it: All People Enjoy Time Magazine, refers to the intercoastal spaces of the heart. In descending order, List the names associated with the Letters: APETM.
Aortic
Pulmonic
Erbs point
Tricuspid
Mitral
Sometimes there is a slight delay in the heart valves closing. This is heard as a “Splitting” noise. This delay in heart valves closing is called paradoxical splitting. Where would you hear Paradoxical splitting best?
The Pulmonic area, in the 2nd intercoastal space
Sometimes S3 and S4 sounds are heard. These heart sounds are referred to as what? (What type of noise do they make? Make the sounds on your desk)
Gallops, like a horse galloping
S3 and S4 heart sounds, often referred to as “Gallops” mean that the blood is going where?
Gallops mean that blood is going somewhere it should not.
The blood is galloping away into the sunset.
When valves are audibly opening when they are supposed to be closed, this causes a sort of sound that gives the event its name. What is that sound/event?
Clicks.
Clicks are when a valve is supposed to be closed but is heard audibly opening.
-Stenosis means “narrowing”.
So, what would Mitral stenosis mean?
Narrowing of the Mitral valve
A rushing sound of fluid going through a narrow space is known as:
a.) Stenosis
b.) Galloping
c.) Clicks
d.) Murmur
e.) Dysrhythmia
d.) A Murmur is a rushing sound of fluid going through a narrow space
What might cause a Pericardial friction rub? Think it through…
What is the Pericardium?
What is around the Pericardium?
What protects against friction?
Inflamed pericardial surfaces rub against each other. Possible reduction in serous fluid
IF you are listening to a patient’s lungs, and you hear a crackling in the bases of their lungs, what might that noise indicate for the patient?
Heart Failure
It is important to include an assessment of the respiratory system in your cardiac assessment.
What feature in the abdomen may also show signs of heart failure in a cardiac assessment?
Abdominal distention.
Pulses in the abdomen and urinary retention can both be signs of what possible cardiac event?
Heart failure
If a nurse wanted to use dye to see a live x-ray of the heart while it was moving, what diagnostic method would they use?
a.) CT-Scan
b.) AP & Lateral CXR
c.) PET (Positron Emission Tomography)
d.) Fluoroscopy
e.) ECG
f.) Stress Test
d.) A Fluoroscopy gives a live x-ray view of the heart while it is moving.
If a nurse wanted to see the size and location of the heart, as well as check for calcification or heart failure, what diagnostic method would they use?
a.) Fluoroscopy
b.) Ct-scan
c.) AP & Lateral CXR
d.) PET (Positron Emission Tomography)
e.) ECG
f.) Stress Test
AP (Anterior/Posterior) & Lateral CXR would be used to see the size and location of the heart.
AP & Lateral CXR can also check for Calcification and Heart Failure
If a nurse wanted to implement a painless test that records the continuous electrical signals made by the heart, what diagnostic method would be used?
a.) Fluoroscopy
b.) Ct-scan
c.) AP & Lateral CXR
d.) PET (Positron Emission Tomography)
e.) ECG
f.) Stress Test
e.) An ECG records the continuous electrical signals released by the heart. This can be used to assess for dysrhythmias, Node function, etc.
If a nurse needed to create a demand on the heart to understand how a patient tolerates activity, what diagnostic method would be used?
a.) Fluoroscopy
b.) Ct-scan
c.) AP & Lateral CXR
d.) PET (Positron Emission Tomography)
e.) ECG
f.) Stress Test
f.) A Stress tests creates a demand on the heart, either through physical activity or chemical induction, that then monitors the hearts’ ability to tolerate activity.
An echocardiogram has the same function as what other type of sound-related diagnostic test?
Ultrasound.
Echocardiogram and ultrasound are basically the same thing.
If a nurse wanted to scan for a future event, and to see the ventricle wall thickness, lesions, masses, and calcium deposits, what diagnostic method would be used?
a.) Fluoroscopy
b.) Ct-scan
c.) AP & Lateral CXR
d.) PET (Positron Emission Tomography)
e.) ECG
f.) Stress Test
b.) CT-scan looks for a future event.
CT-scans also see the thickness of the ventricle walls and assess for masses and lesions.
CT-scans also check for calcium deposits.
AP & Lateral CXR and a CT-scan are similar in that they both can assess for calcium, but AP & Lateral CXR looks for Calcifications, while CT-scans look for Calcium DEPOSITS.
What would you encourage a patient to do during an ECG?
To write down the symptoms that they feel are happening.
If a patient is ordered to have Cardiac Catheterization/Angiography, they will be using a Radiopaque Iodine Dye to visualize their arteries. They will be looking for things like CAD, atherosclerosis, and valve disease. What is the nurse’s role during this procedure? (Select All)
-Check the patients’ allergies
-Raise the HOB to a comfortable position.
-Auscultate the abdomen for abdominal pulse
-Check patients kidney function
-Tell the patient the possibility of heat flashes during the procedure
-Teach the patient that they will have an NPO order for 8-12 hours prior to the procedure
-Check the patients’ allergies
-Check patients kidney function
-Tell the patient about heat flashes as the catheter enters their chest.
-NPO 8-12 hours prior to the procedure
Post-procedure of Cardiac Catheterization/Angiography involves putting pressure over the insertion site.
If the insertion was on the Radial artery, you want to apply pressure on it for “X” hours.
If the insertion was Femoral, you need to apply manual pressure for “X” minutes.
A Gel-patch will be typically applied to an insertion site for “X” minutes but will sometimes be left on for “X” hours.
Radial Artery insertion requires pressure for “2 hours.”
Femoral insertion requires pressure for 30 minutes.
Gel-patch typically stays on for 10 minutes, but will sometimes be left on for 24 hours.
What should a nurse be assessing post-op in a patient that underwent a Cardiac Catheterization/Angiography?
-Check pulses
-Look for swelling and bruising.
(Some bruising is expected, but not excessive amounts.)
If an ECG fails to evaluate AV nodes, or to assess for dysrhythmias, what would be the next diagnostic test used to assess for dysrhythmias, electrical cells firing, and AV node functioning?
a.) Electrophysiology
b.) Electroencephalography
c.) CT-scan
d.) Fluoroscopy
a.) Electrophysiology would be used to evaluate AV node function and to check for dysrhythmias if an ECG failed to do so.
A nurse is educating a patient on proper procedure for an electrophysiology test. One of the roles of the nurse is to ensure the patient understands that there is an NPO order before the test that lasts for:
a.) 1-3 hours
b.) 4-6 hours
c.) 6-8 hours
d.) 12 hours
e.) 24 hours
c.) A patient should follow an NPO order of 6-8 hours before an Electrophysiology test.
Cardiac mapping is a method used in Electrophysiology tests. From what you know about Electrophysiology tests and what they are for, what can you assume “Cardiac Mapping” is used for?
Cardiac mapping is used to locate arrythmias, show electrical cells firing (or not) and finding the AV and SA nodes.
