exam 3 Flashcards
Normal abdominal percussion sound is?
tympanic
where would you not percuss over in a pregnant patient?
uterus
rare kidney cancer in children ages 3-4
wilms’ tumor
pheochromocytoma is a
benign adrenal gland tumor
are benign tumors cancer?
no
signs of appendicitis
RLQ abdominal pain
Migrating abdominal pain
loss of appetite
malaise
nausea/vomiting
diarrhea
what is mcburney’s point?
base of the appendix
what is a positive mcburneys?
severe pain when pressure is released after palpation
causes of stomatitis
flora imbalance
infection
inhaled glucocorticoids
important patient education for stomatitis
brush 4x a day (minimum 2x a day)
erythroplakia is a
red, flat or raised area
thick, white patches on inside of mouth is called?
leukoplakia
types of intestinal obstruction
mechanical
non-mechanical (paralytic ileus)
colorectal cancer S/S
vomiting
changes in bowel habits
rectal bleeding
anemia
pain
incomplete evacuation
the pulse located at the left 5th intercostal space in the mitral area is
the apical pulse
the point of maximal impulse is
the apical pulse
receptors that are stimulated when arterial walls are stretched by increased blood pressure
baroreceptors
swishing sound from unsteady blood flow in narrowed arteries
bruit
bruit can be heard via?
auscultation or doppler
involves passing small catheter into heart & injecting contrast to diagnose heart disease
cardiac catheterization
the most definitive but most invasive test to diagnose heart disease
cardiac catheterization
calculation of cardiac output requirements to account for different body sizes
cardiac index
the volume of blood ejected by the heart each minute
cardiac output
serum lipid that includes high density lipoproteins and low-density lipoproteins
cholesterol
phase of cardiac cycle that consists of relaxation
diastole
amount of pressure against arterial walls during relaxation of cardiac cycle
diastolic blood pressure
use of ultrasound waves to assess cardiac structure and mobility in the heart valves
echocardiography
procedure which causes dysrhythmias to evaluate, diagnose and accurately treat them
electrophysiologic study (EPS)
an EPS is what kind of procedure
invasive
test to assess cardio response to increased workload
stress test (exercise electrocardiography)
number of times ventricles contract each minute
heart rate
part of total cholesterol value that is considered “good” cholesterol
HDL (high-density lipoproteins)
HDL for men should be
higher than 45 mm/dL ( >0.75 mmol/L)
HDL for women should be
more than 55 mg/dL (>0.91 mmol/L)
serum marker of inflammation and component of development of atherosclerosis
hsCRP (highly sensitive C-reactive protein)
buildup of fats, cholesterol and other substances in and on the artery walls
atherosclerosis
amino acid that is produced when proteins break down
homocysteine
elevated homocysteine can be a risk factor for?
cardiovascular disease
Part of total cholesterol that is considered “bad”?
LDL
LDL should be
lower than 130 mg/dL
arterial blood pressure necessary to maintain perfusion of major body organs
MAP (mean arterial pressure)
range of arterial blood pressure necessary to maintain perfusion of major organs
60-70 mm Hg
abnormal heart sound that reflects unsteady blood flow through valves
murmur
use of radionuclide techniques in cardiovascular assessment
MNPI (myocardial nuclear perfusion imaging)
the heart muscle
myocardium
decrease in blood pressure after changing from sitting or lying position to standing position
orthostatic hypotension
exaggerated decrease in systolic pressure by more than 10 mm Hg during inspiratory phase of respiratory cycle
paradoxical blood pressure
abnormal sound from pericardial sac that happens with movements of heart during cardiac cycle
pericardial friction rub
degree of myocardial fiber stretch at end of diastole and just before contraction
preload
difference between systolic and diastolic pressures
pulse pressure
amount of blood ejected by left ventricle during each contraction
stroke volume (SV)
phase of cardiac cycle that consists of contraction and emptying of atria and ventricles
systole
amount of pressure or force generated by left ventricle to distribute blood into the aorta with each heart contraction
systolic blood pressure
form of echocardiography performed through esophagus that examines cardiac structure and function
transesophageal echocardiography (TEE)
serum lipid profile that includes measurement of cholesterol and lipoproteins
triglycerides
myocardial muscle protein released into the bloodstream with injury to the myocardial muscle
troponin
passage of fluid or blood vessels to an organ
perfusion
the cardiovascular system is made up of
the heart and blood vessels
muscular wall that separates the heart into 2 halves
septum
valves that separate the atria from the ventricles
AV valves
valve that separates the right atrium from the right ventricle
tricuspid valve
valve that separates the left atrium from the left ventricle
mitral valve (bicuspid)
when does coronary artery blood flow to the myocardium occur
during diastole
durig diastole the heart is
filling (relaxing)
during systole the heart is
emptying (contracting)
what happens to cardiac muscles when calcium ions are pumped back into the heart
it relaxes
what happens to the heart when calcium ions leave the cardiac muscles
it contracts
the amount of blood pumped from the left ventricle each minute
cardiac output
cardiac output depends on?
heart rate and stroke volume
cardiac output range in adults
3-6 L/min
cardiac index range
2.8-4.2 L/min/m^2
you can find the cardiac index by
cardiac output divided by body surface area
number of time ventricles contract each minute
heart rate
normal resting heart rate
60-100 bpm
nerve that slows the heart rate
vagus nerve
system that slows the heart rate
parasympathetic system
system that increases the heart rate
sympathetic system
epinephrine and norepinephrine do what to the heart
increases heart rate and contractibility
which cardiovascular drugs block the fight or flight pattern by decreasing the heart rate
beta blockers
fight or flight system
sympathetic system
variables that influence the stroke volume and cardiac output
heart rate
preload
afterload
contractibility
myocardial fiber stretch at end of diastole and just before contraction
preload
venous system is on which side of the heart
right side of the heart
which side of the heart is the pulmonary system on?
left side of the heart
pressure that the heart has to overcome to open aortic valve is called
impedance
purposes of vascular system
blood route from heart to get to tissues
carries cell waste to excretory organs
drains tissue fluid back into circulation
returns blood to heart
function of arterial system
deliver oxygen and nutrients to body tissues
anything that increases cardiac output also increases
blood pressure
the 3 mechanisms that regulate blood pressure
autonomic nervous system (ANS)
kidneys
endocrine system
how do the kidneys regulate blood pressure
active renin-angiotensin-aldosterone mechanism when there is a change in blood flow
how does the endocrine system regulate blood pressure
releases hormones to stimulate sympathetic nervous system in the tissues
what hormones does the endocrine system release to stimulate the sympathetic nervous system in tissues
serotonin
histamine
kinins
catecholamine
what are catecholamines
epinephrine
norepinephrine
dopamine
balance of what systems regulate blood pressure
sympathetic and parasympathetic systems
fluid causes blood pressure to do what?
rise
antidiuretic hormone that regulates vascular volume
vasopressin
female gender specific risks of CAD
pregnancy
menopause
obesity is a BMI of over
30
recurrence of these can cause abnormal heart valves
tonsillitis
streptococcal infections
rheumatic fever
rheumatic fever is caused by
poorly treated strep throat or scarlet fever
The nurse is conducting an admission assessment on a male client. Which assessment data does the nurse identify as a risk factor for cardiovascular disease? Select all that apply.
A. BMI of 26
B. BP of 120/66 mm Hg
C. Triglycerides 140 mg/dL
D. Moderate exercise for 20 to 30 minutes weekly E. Exposure to secondhand cigare e smoke
F. History of repeated streptococcal tonsillitis
G. Family history of cardiovascular disease
A. BMI of 26
D. Moderate exercise for 20 to 30 minutes weekly
E. Exposure to secondhand cigaree smoke
G. Family history of cardiovascular disease
nutrition history includes
food and fluid intake over 24 hrs
a bmi over what is considered overweight
25
ischemia is
not enough blood flow to heart
descriptions of chest pain caused by cardiac ischemia
discomfort
heaviness
pressure
indigestion
indigestion is discomfort where?
in upper abdomen
triad of symptoms for women with chest pain
indigestion/abdominal fullness
dyspnea
chronic fatigue
early symptom of heart failure and can be the only symptom felt by women
dyspnea on exertion
orthopnea is a sign of what?
advanced heart disease
a patient with orthopnea would require what to sleep comfortably
several pillows to elevate head and chest
the number of what a patient uses can be used to measure the severity of orthopnea
number of pillows pt uses to sleep
orthopnea can be resolved in minutes by the patient
sitting up or standing
orthopnea is?
dyspnea when a patient lies flat
paroxysmal nocturnal dyspnea occurs
when pt has been lying down for several hours
paroxysmal nocturnal dyspnea is caused by
blood from LE being redistributed to venous system which increases venous return to the heart which causes pulmonary congestion
what will happen to a patient who is experiencing paroxysmal nocturnal dyspnea
they will abruptly wake up w/ suffocating feeling and panic
how is paroxysmal nocturnal dyspnea relieved
by dangling legs over side of bed
how long can the sensation of paroxysmal dyspnea last
20 mins
when is fatigue cased by decreased cardiac output worse
in the evening
most common cause of syncope is
decreased perfusion to the brain
dizziness where you cant maintain an upright position is called
near syncope
conditions that can trigger syncope
cardiac rhythm disturbances
ventricular dysrhythmias
valvular disorders
aortic stenosis
aortic stenosis is
narrowing of valve between left lower heart and aorta
pressure to carotid arteries can result in
syncope
pressure can be applied to carotid arteries by what movements
turning head
shrugging shoulders
performing valsalva maneuver
what is the valsava maneuver haha @sammy
bearing down during defecation
a decrease in what can cause syncope
blood pressure and heart rate
extremity pain related to heart problems can be caused by what 2 conditions
ischemia from atherosclerosis
venous insufficiency of peripheral blood vessels
pts with mod-severe cramping in legs or butt after walking have
intermittent claudication caused by decreased arterial tissue perfusion
claudication is
leg pain during exercise caused by not enough blood flow
The nurse is assessing a client with heart failure. Which assessment data are the best indicator of fluid balance?
a. Blood pressure 144/79 mm Hg
b. Urine output 200 mL in the last 4 hours
c. Weight increase of 9 lb in the past week
d. Generalized edema in the lower extremities
c. Weight increase of 9 lb in the past week
sudden weight gain can be caused by
excess fluid
what is the best indicator of fluid balance
weight
how much weight gain can occur until edema is apparent
10-15 lbs
class I cardiovascular disability is defined by
pt with cardiac disease but no bad effects like fatigue, palpitations, dyspnea or anginal pain
class II cardiovascular disability would be
-cardiac disease w slight limitation w physical activity
- comfortable at rest
- fatigue, palp, dyspnea, anginal pain during activity
class III cardiovascular disabiltiy would be
-cardiac disease w marked limitation of physical activity
-comfortable at rest
- less than ordinary physical activity causes fatigue, palp, dyspnea or anginal pain
class IV cardiovascular disability would be
- cardiac disease resulting in inability to carry out physical activity
- uncomfortable at rest
- increased discomfort with any physical activity
late signs of severe right sided heart failure
ascites
jaundice
anasarca
ascites is
abdominal swelling caused by excess fluid in the abdomen
anasarca is
generalized edema
skin signs of decreased perfusion
cool
pale
moist
cyanosis in dark skinned pts can appear as
graying of skin and mucous membranes
arterial blood pressure is measured by
sphygmonanometry
weak pulse that indicates narrow pulse pressure
hypokinetic pulse
hypokinetic pulses can be found in patients with
hypovolemia
aortic stenosis
decreased cardiac output
large “bounding” pulse caused by increased injection of blood
hyperkinetic pulse
bruits are asessed by
placing stethoscope bell on neck over carotid artery while patient holds their breath
a normal carotid artery with uninterrupted blood flow will have what kind of sound?
no sound
what happens to the sound of a bruit if vessel is blocked 90% or more
bruit cant be heard
the first heart sound is
s1
s1 heart sounds are created by
closure of mitral and tricuspid valves
s1 marks the beginning of what
ventricular systole
on an ECG where does s1 occur
after the QRS complex
decrease in s1 sound intensity is caused by
mitral regurgitation
heart failure
the second heart sound is
s2
s2 heart sound is caused by
closing of aortic and pulmonic valves
paradoxic splitting is caused by
myocardial infarction
left bundle branch block
aortic stenosis
aortic regurgitation
right ventricular pacing
pericardial friction rub can be heard in patients with
pericarditis from an MI, cardiac tamponade or after a thoracotomy
cardiac tamponade is
when fluid/blood fills up in sac around heart causing pressure on the heart
thoractomy is
cut made to see/reach organs in chest or thorax
protein released into blood stream when heart is injured
troponin
which troponins arent found in healthy patients
troponin T and I ( a healthy person wont know TI)
an increase of troponin T and I can indicate
acute MI
cardiac necrosis
