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Medical Surgical Nursing - First Sem > Intro to Cardiovascular System > Flashcards

Intro to Cardiovascular System Flashcards

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1
Q

The cardiovascular system is related to CPO

A

circulation
perfusion
oxygenation

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2
Q

The cardiovascular system delivers blood

Central: to ____
Peripheral: to ____

A

Heart and major blood vessels

Rest of body

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3
Q

(T/F) The heart is a hollow, cone-shaped, muscular pump that is the size of a ___ and weighs __ gms

A

fist

300

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4
Q

(T/F) The heart is in the center of the chest

A

FALSE, it is slightly tilted to the left

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5
Q

The heart is located in the _____

A

mediastinum

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6
Q

Atrium: ____ blood
Ventricle: ____ blood

A

receives

pumps out

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7
Q

Blood flow in the heart is ___ because of the two valves: ____

A

unidirectional
atrioventricular (AV)
semilunar

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8
Q

Name the 2 av valves and 2 semilunar valves

A

AV:
tricuspid valve
Mitral/bicuspid valve

SEMILUNAR:
aortic semilunar valve
pulmonary semilunar valve

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9
Q

S1/Lub is caused by ___ and can be described as ____
while,
S2/Dub is caused by ___ and can be described as ____

A

closure of av valves, short = Systole

closure of sv valves, longer = diastoLe

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10
Q

As an independently functioning organ, the heart requires ____

This follows the principle of ____

A

a constant supply of blood

supply and demand (as supply increases, demand or WORKLOAD decreases)

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11
Q

The arteries supply
Left coronary artery:
Right coronary artery:

A

2/3

1/3

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12
Q

What is known as a widow maker? Why?

A

The LCA

If blocked, more than 2/3 of heart stops working = good as dead

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13
Q

Match the ff diseases to their description:

  1. Atherosclerosis
  2. Myocardial Infarction

A. heart attack
C. build up of plaque

A

1C

2A

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14
Q

(T/F) Atherosclerosis can only happen in end arteries

A

FALSE, it can still happen in any artery (UE, LE, Brain)

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15
Q

A membrane covering the heart to protect it and to prevent the development of friction when it beats

A

pericardial sac

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16
Q

Match the layers of the pericardial sac to its function:

  1. Parietal
  2. Myocardium
  3. Endocardium

A. Keeps interior layers smooth = laminar blood flow
B. Consists of a small space with fluid
C. Involuntary and coordinated muscle

A

1B
2C
3A

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17
Q

Can the heart muscles undergo hypertrophy? When?

Why is the left ventricle wall thicker than the right?

A

Yes, when demand increases

The left ventricle is in charge of pumping blood to the rest of the body = greater resistance = higher AFTERLOAD

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18
Q

Arteries: bring blood __
Veins: bring blood __

A

away from heart (Artery = Away)

to the heart (Vein = Vavalik)

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19
Q

Why do veins need help from muscle contractions during activity?

A

Veins have low pressure compared to arteries = need help for venous return

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20
Q

Veins have _(a)__ to prevent backflow

What is a condition characterized by swelling of the veins caused by incompetent or damaged (a)

A

Valves

Varicosities

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21
Q

Properties of cardiac muscle (AECC)

A

Automaticity: beat on its own

Excitability: produce electrical signal

Conductivity: connected = send signals to each other

Contractility: each single strand is mechanical

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22
Q

(T/F) All heart cells can stand alone = we want them to contract independent of each other

A

FALSE, this would lead to an inefficient pacemaker/cardiac conduction system

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23
Q

The cardiac conduction system is

controlled by:
stimulated by:
inhibited by:

A

autonomic nervous system (ANS)

sympathetic nervous system (SNS)

parasympathetic nervous system (vagus nerve)

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24
Q

Identify the direction of electrical signals in the heart (SABP)

A

SA Node
AV Node
Bundle of His
Purkinje fibers

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25
Q

Identify the capacity of the ff in bpm

SA Node:
AV Node:
Muscle fibers:

A

SA Node: 60-100 bpm

AV Node: 40-60 bpm

Muscle fibers: 20-40 bpm

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26
Q

Match the parameter to its description:

  1. Cardiac Output
  2. Preload
  3. Stroke Volume
  4. Afterload
  5. Heart Rate

A. Blood ejected from the left ventricle (L/min)
B. Blood ejected per heartbeat (ml/beat)
C. Beats per minute
D. Venous return
E. Force needed to push blood into circulation

A 
1A
2D
3B
4E
5C
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27
Q

What is the formula for CO?

A

CO = stroke volume x HR

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28
Q

Identify the false statement:

  1. CO is inversely proportional to HR
  2. HR has a physiological limit no matter how fast
  3. Stroke Volume is measured through 2D-Echo
  4. Preload is controlled by Sterling’s Law
A

1, CO is directly proportional to HR

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29
Q

What is Sterling’s law?

A

the heart is like a rubber band (the more it is stretched, the more potential energy it holds to be transformed into kinetic energy when released

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30
Q

What is cor pulmonale?

A

Right sided heart failure due to pulmonary hypertension (increased resistance = high afterload)

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31
Q

Match the ff blood pressure control mechanisms to its description:

  1. Baroreceptors
  2. Stretch receptors
  3. Antidiuretic Hormone
  4. Aldosterone
  5. RAAS

A. Massaging pressure sensors at carotid artery = vagal reaction = drop in BP
B. Reabsorption of water WITHOUT Na, secreted by anterior pituitary gland
C. Excess fluid triggers receptors in vena cava and right atrium to release Atrial Natriuretic Peptide
D. Renin-Angiotensinogen-Angiotensin I-Angiotensin II = rise in BP
E. Reabsorption of Na only

A 
1A
2C
3B
4E
5D
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32
Q

What does RAAS stand for?

A

Renin-Angiotensin System

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33
Q

What does Atrial Natriuretic Peptide do?

A

It promotes the excretion of Na in kidneys (water will follow)

34
Q

Define the ff subjective s/sx of cardiac problems:

Dyspnea
Chest pain
Weight gain:
Syncope:
Palpitations:
Fatigue:
A

Dyspnea: difficulty breathing

Chest pain: angina

Weight gain: fluid retention r/t poor blood flow

Syncope: fainting spells r/t poor blood flow in brain

Palpitations: hypoxic heart

Fatigue: activity intolerance

35
Q

What is cardiac tamponade?

A

shot = hole = blood leaks out with every heartbeat

36
Q

Define the ff objective s/sx of cardiac problems:

Neck vein distention
Respiration
Peripheral edema
Murmurs

A

Neck vein distention: due to backflow

Respiration: crackles

Peripheral edema: build up of blood in lungs

Murmurs: turbulent blood flow r/t damaged valve

37
Q

Match the ff diagnostic tests to their purpose:

  1. CBC
  2. Cardiac Enzymes
  3. Serum Lipids
  4. Electrolytes
  5. Electrocardiogram (ECG)

A. High levels of LDL = high risk for atherosclerosis
B. Hematological disorders can be linked to MI (anemia, platelet/bleeding, HCT/hemoconc or hemodilute)
C. This leaks out when heart muscles are injured and break apart (Troponin I and T)
D. Monitor electrical activity of heart
E. Can be associated with dysrhythmias

A 
1B
2C
3A
4E
5D
38
Q

What is the difference between sensitivity and specificity?

A

Sensitivity: rule OUT disease

Specificity: rule IN disease, determine presence

39
Q

What is a requirement for serum lipids test?

A

NPO for at least 12 hrs

40
Q

Differentiate between HDL and LDL

A

HDL: good cholesterol, collects excess

LDL: bad cholesterol, deposits excess

41
Q 
Identify the electrolytes associated with:
Dysrhythmias?
Water toxicity/CHF?
Tachycardia/ECG Changes?
Decreased fibrillation/contraction?
A

Potassium
Sodium
Calcium
Magnesium

42
Q

(T/F) An inverted ECG result is abnormal

A

FALSE, as long as waves are complete and the distance between each wave is normal = NORMAL

43
Q

Match the parts of an ECG to their significance:

  1. P wave
  2. PR interval
  3. QRS Complex
  4. ST Segment
  5. T wave
  6. QT interval
  7. U wave
  8. PQRST
  9. last T to first P
A. electrolyte imbalance
B. atrial depolarization
C. ventricular repolarization
D. impulse travel from atria to purkinje fibers
E. ventricular depolarization
F. systole
G. ventricular refractory time
H. plateau, heart relaxes
I. diastole
A 
1B
2D
3E
4H
5C
6G
7A
8F
9I
44
Q

If the interval between P-Q is too far, this can indicate ____

A

Heart block

45
Q

Differentiate the degrees of a heart block

A

First: slightly apart but P and Q waves are identifiable

Second: Some parts may have missing QRST waves

Third: mostly just P waves far apart

46
Q

Where do we position the catheter for Invasive Hemodynamic Monitoring? Aka the zero degree point of the heart

A

At the phlebostatic axis or sternal angle of louis

47
Q

Elevated CVP indicates ___
Low CVP indicates ___
Elevated PAP/PCWP indicates ____

Give the normal values for CVP and PAP/PCWP:

A

Elevated CVP: fluid volume overload
Low CVP: fluid volume deficit
Elevated PAP/PCWP: CHF, fluid overload

Normal values for CVP: 2-6 mmHg or 5-12 cm/H2O
Normal values for PAP/PCWP: 4-12 mmHg

48
Q

What are the steps in CVP (4)

A

Insert catheter at sternal angle up to RIGHT ATRIUM
Fill manometer with NSS
Open one way valve
Observe where it consistently pulsates

49
Q

How is PAP/PCWP performed?

A

The catheter is inserted in the LEFT SIDE OF THE HEART via surgery and is connected to a machine (inflates balloon)

50
Q

Give at least 3 nursing responsibilities for CVP (CAIRC4B)

A

Consent + explain procedure + relax
Arm precaution + infection
Get initial and concurrent reading in same position
Change dressing, IV fluid bag, manometer, tubings Q24h
Remind px to hold breath when catheter is changed

51
Q

Give at least 3 nursing responsibilities for PAP/PCWP (CSDSB)

A

Consent + explain procedure
Position px in supine
Deflate balloon after reading
Assess for swelling and bleeding

52
Q

How is cardiac catheterization both diagnostic (4) and therapeutic (2)? Give specific reasons

A

Diagnostic purposes:
1. Determine blockages (CAD) and shunts (TOF, VSD, Congenital Defects)
2 and 3. Measures O2 concentration in all heart chambers, CO and blood flow
3. Obtain blood sample

Therapeutic purposes

  1. Remove plaque
  2. Insert a stent/balloon
53
Q

How is cardiac catheterization performed? (3)

A

Catheter is threaded into artery/vein through small incision
Using an xray, the catheter is threaded into the heart
Contrast dye is released

54
Q

What type of contrast dye is usually used in cardiac catheterization

A

Iodine based dye

55
Q

(T/F) Cardiac catheterization is not considered a minimally invasive procedure

A

FALSE, it is a minimally invasive procedure because px’s are just sedated

56
Q

Give at least 3 nursing responsibilities for Cardiac Catheterization (pre-procedure, CVSBSN)

A 
Consent + explain procedure
Document baseline VS + height and weight
Assess for allergies to seafood/iodine
Instruct to stop taking blood thinners at least 3 days prior
Remind px to lie still and NPO
57
Q

What should the px expect to feel during cardiac catheterization (2)

A

Warm flushing or fluttery feeling as soon as dye is injected

May feel urge to cough r/t palpitations

58
Q

Give at least 3 nursing responsibilities for Cardiac Catheterization (post-procedure, VA4PBW)

A

VS Q30mins for 2 hrs
Assess for chest pain, dysrhythmias, bleeding, compartment syndrome
Use pressure dressing w/sandbag
Prepare band aid
Remind px incision cannot be wet for 1-2 weeks

59
Q

What are the 5 P’s of Compartment Syndrome?

A 
Pulsations
Paresthesia
Pallor
Pain
Paralysis
60
Q

What are the activity restrictions post-cardiac catheterization

A

CBR (complete bed rest) for 6-12 hrs
Flat on bed (FOB) w/o bathroom privileges with extremities extended for 4-6 hrs
Sit up after 8 hrs
Ambulate after 24-48 hrs w/doctor’s clearance

61
Q

Match the nursing diagnosis to its reason/cause

  1. Decreased Cardiac Output
  2. Impaired Gas Exchange
  3. Pain
  4. Risk for Infection
  5. Anxiety
  6. Altered Family Process

A. Concerned about after effects (work, intimacy, death)
B. Financial burden since it is a chronic condition
C. Poor perfusion, CHF
D. Poor oxygenation = muscle pain which can lead to MI and increased workload as evidence by angina
E. R/t to decreased cardiac output
F. Pulmonary edema

A 
1C
2E
3D
4F
5A
6B
62
Q

Interventions for decreased cardiac output include:

A

CBR, no TV
Plan activities
No smoking
Follow AHA and NYHAF classifications

63
Q

Differentiate the AHA and NYHAF Classifications

A

American Heart Association: patient outcome, the higher the letter = more observable signs

New York Heart Association Functional classification: how bad px condition is + effects on ADL’s

64
Q

Interventions for impaired gas exchange

A

Semi or High Fowlers
Oxygen PRN
Rest

65
Q

Differentiate the 3 cardiac enzyme markers:
CK MB
Troponin I
Myoglobin

A

CK MB: 24-48 hrs, not as sensitive or specific (can elevate with only injury)

Troponin I: 7-10 days, most sensitive and specific (only found in heart muscles)

Myoglobin: earliest, sensitive but not specific

66
Q

What is ESR Test? What is it for?

A

Erythrocyte Sedimentation Rate Test

It is a non-specific test. Any systemic inflammation can elevate the ESR. Can also be linked to rheumatic heart disease

67
Q

When are blood coagulation tests needed?

A

Venous disorders such as DVT or Thrombophlebitis

68
Q

Match the ff coagulation test to its purpose:

  1. Partial Thromboplastin Time (PTT)
  2. Prothrombin Time (PT)
  3. Clotting and Bleeding Time

A. For px taking coumadin
B. For px taking heparin
C. For px taking aspirin

A

1B
2A
3C

69
Q

What is BUN? Why is it needed for CV disorders?

A

Blood Urea Nitrogen

Decrease in CO = poor blood flow to kidneys = decreased GFR = kidney failure

70
Q

Can heart infections occur? How so? What tests are needed to diagnose this? (3)

A

Yes. Injury = change in movement = blood stasis

Blood culture, throat swab, antibody test

71
Q

How many electrodes are used in an ECG? Where are they placed?

A

12 in total, positive and negative

6 on limbs, 6 on chest

72
Q

Is echocardiography invasive?

A

NO, doppler ultrasound is only placed on chest

Limitation: cant see back of heart

73
Q

How is transesophageal 2D Echo performed? Is it an invasive procedure? (ANAG)

A

YES

Px awake and on NPO
Spray anesthetic
NPO until gag reflex returns (aspiration risk)

74
Q

What are the 3 purposes of 2D Echo?

A

Determine if structures are damaged (valve or hypertrophied muscles)

Functioning properly (flow of blood)

Determine ejection fraction

75
Q

What is ejection fraction?

A

Amt of blood the LV pumps (CO)

>40/50% = CHF

76
Q

How is angiogram/arteriography performed?

A

Open blood vessel
Thread catheter via surgery
Inject contrast dye (iodine based)
Visualize in xray

77
Q

How does angiogram differ from arteriography?

A

Angiogram is the general term while arteriography is specific to arteries

78
Q

(T/F) Arteriography is a (1) minimally invasive procedure where the px is sedated and (2) is only diagnostic in nature, not therapeutic

A

1T

2F – it is both diagnostic and therapeutic

79
Q

(T/F) The nursing responsibilities for arteriography and cardiac catheterization are the same

A

TRUE

80
Q

Cerebral angiogram: ____
_____ angiogram: legs
Cardiac angiogram: _____

A

Brain
Femoral
Heart

81
Q

What is CVP for?

A

Indicate pressure in RA/venous return

If poor venous return = poor afterload = poor CO

82
Q

What can cause another obstruction to occur after cardiac catheterization + insertion of a stent? How can we prevent this?

A

Since the stent is a foreign body, this can trigger an inflammatory response = clot = obstruct

Administer blood thinners

Medical Surgical Nursing - First Sem (9 decks)

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