Intro to Cardiovascular System Flashcards
The cardiovascular system is related to CPO
circulation
perfusion
oxygenation
The cardiovascular system delivers blood
Central: to ____
Peripheral: to ____
Heart and major blood vessels
Rest of body
(T/F) The heart is a hollow, cone-shaped, muscular pump that is the size of a ___ and weighs __ gms
fist
300
(T/F) The heart is in the center of the chest
FALSE, it is slightly tilted to the left
The heart is located in the _____
mediastinum
Atrium: ____ blood
Ventricle: ____ blood
receives
pumps out
Blood flow in the heart is ___ because of the two valves: ____
unidirectional
atrioventricular (AV)
semilunar
Name the 2 av valves and 2 semilunar valves
AV:
tricuspid valve
Mitral/bicuspid valve
SEMILUNAR:
aortic semilunar valve
pulmonary semilunar valve
S1/Lub is caused by ___ and can be described as ____
while,
S2/Dub is caused by ___ and can be described as ____
closure of av valves, short = Systole
closure of sv valves, longer = diastoLe
As an independently functioning organ, the heart requires ____
This follows the principle of ____
a constant supply of blood
supply and demand (as supply increases, demand or WORKLOAD decreases)
The arteries supply
Left coronary artery:
Right coronary artery:
2/3
1/3
What is known as a widow maker? Why?
The LCA
If blocked, more than 2/3 of heart stops working = good as dead
Match the ff diseases to their description:
- Atherosclerosis
- Myocardial Infarction
A. heart attack
C. build up of plaque
1C
2A
(T/F) Atherosclerosis can only happen in end arteries
FALSE, it can still happen in any artery (UE, LE, Brain)
A membrane covering the heart to protect it and to prevent the development of friction when it beats
pericardial sac
Match the layers of the pericardial sac to its function:
- Parietal
- Myocardium
- Endocardium
A. Keeps interior layers smooth = laminar blood flow
B. Consists of a small space with fluid
C. Involuntary and coordinated muscle
1B
2C
3A
Can the heart muscles undergo hypertrophy? When?
Why is the left ventricle wall thicker than the right?
Yes, when demand increases
The left ventricle is in charge of pumping blood to the rest of the body = greater resistance = higher AFTERLOAD
Arteries: bring blood __
Veins: bring blood __
away from heart (Artery = Away)
to the heart (Vein = Vavalik)
Why do veins need help from muscle contractions during activity?
Veins have low pressure compared to arteries = need help for venous return
Veins have _(a)__ to prevent backflow
What is a condition characterized by swelling of the veins caused by incompetent or damaged (a)
Valves
Varicosities
Properties of cardiac muscle (AECC)
Automaticity: beat on its own
Excitability: produce electrical signal
Conductivity: connected = send signals to each other
Contractility: each single strand is mechanical
(T/F) All heart cells can stand alone = we want them to contract independent of each other
FALSE, this would lead to an inefficient pacemaker/cardiac conduction system
The cardiac conduction system is
controlled by:
stimulated by:
inhibited by:
autonomic nervous system (ANS)
sympathetic nervous system (SNS)
parasympathetic nervous system (vagus nerve)
Identify the direction of electrical signals in the heart (SABP)
SA Node
AV Node
Bundle of His
Purkinje fibers
Identify the capacity of the ff in bpm
SA Node:
AV Node:
Muscle fibers:
SA Node: 60-100 bpm
AV Node: 40-60 bpm
Muscle fibers: 20-40 bpm
Match the parameter to its description:
- Cardiac Output
- Preload
- Stroke Volume
- Afterload
- 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
1A 2D 3B 4E 5C
What is the formula for CO?
CO = stroke volume x HR
Identify the false statement:
- CO is inversely proportional to HR
- HR has a physiological limit no matter how fast
- Stroke Volume is measured through 2D-Echo
- Preload is controlled by Sterling’s Law
1, CO is directly proportional to HR
What is Sterling’s law?
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
What is cor pulmonale?
Right sided heart failure due to pulmonary hypertension (increased resistance = high afterload)
Match the ff blood pressure control mechanisms to its description:
- Baroreceptors
- Stretch receptors
- Antidiuretic Hormone
- Aldosterone
- 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
1A 2C 3B 4E 5D
What does RAAS stand for?
Renin-Angiotensin System
What does Atrial Natriuretic Peptide do?
It promotes the excretion of Na in kidneys (water will follow)
Define the ff subjective s/sx of cardiac problems:
Dyspnea Chest pain Weight gain: Syncope: Palpitations: Fatigue:
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
What is cardiac tamponade?
shot = hole = blood leaks out with every heartbeat
Define the ff objective s/sx of cardiac problems:
Neck vein distention
Respiration
Peripheral edema
Murmurs
Neck vein distention: due to backflow
Respiration: crackles
Peripheral edema: build up of blood in lungs
Murmurs: turbulent blood flow r/t damaged valve
Match the ff diagnostic tests to their purpose:
- CBC
- Cardiac Enzymes
- Serum Lipids
- Electrolytes
- 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
1B 2C 3A 4E 5D
What is the difference between sensitivity and specificity?
Sensitivity: rule OUT disease
Specificity: rule IN disease, determine presence
What is a requirement for serum lipids test?
NPO for at least 12 hrs
Differentiate between HDL and LDL
HDL: good cholesterol, collects excess
LDL: bad cholesterol, deposits excess
Identify the electrolytes associated with: Dysrhythmias? Water toxicity/CHF? Tachycardia/ECG Changes? Decreased fibrillation/contraction?
Potassium
Sodium
Calcium
Magnesium
(T/F) An inverted ECG result is abnormal
FALSE, as long as waves are complete and the distance between each wave is normal = NORMAL
Match the parts of an ECG to their significance:
- P wave
- PR interval
- QRS Complex
- ST Segment
- T wave
- QT interval
- U wave
- PQRST
- 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
1B 2D 3E 4H 5C 6G 7A 8F 9I
If the interval between P-Q is too far, this can indicate ____
Heart block
Differentiate the degrees of a heart block
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
Where do we position the catheter for Invasive Hemodynamic Monitoring? Aka the zero degree point of the heart
At the phlebostatic axis or sternal angle of louis
Elevated CVP indicates ___
Low CVP indicates ___
Elevated PAP/PCWP indicates ____
Give the normal values for CVP and PAP/PCWP:
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
What are the steps in CVP (4)
Insert catheter at sternal angle up to RIGHT ATRIUM
Fill manometer with NSS
Open one way valve
Observe where it consistently pulsates
How is PAP/PCWP performed?
The catheter is inserted in the LEFT SIDE OF THE HEART via surgery and is connected to a machine (inflates balloon)
Give at least 3 nursing responsibilities for CVP (CAIRC4B)
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
Give at least 3 nursing responsibilities for PAP/PCWP (CSDSB)
Consent + explain procedure
Position px in supine
Deflate balloon after reading
Assess for swelling and bleeding
How is cardiac catheterization both diagnostic (4) and therapeutic (2)? Give specific reasons
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
- Remove plaque
- Insert a stent/balloon
How is cardiac catheterization performed? (3)
Catheter is threaded into artery/vein through small incision
Using an xray, the catheter is threaded into the heart
Contrast dye is released
What type of contrast dye is usually used in cardiac catheterization
Iodine based dye
(T/F) Cardiac catheterization is not considered a minimally invasive procedure
FALSE, it is a minimally invasive procedure because px’s are just sedated
Give at least 3 nursing responsibilities for Cardiac Catheterization (pre-procedure, CVSBSN)
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
What should the px expect to feel during cardiac catheterization (2)
Warm flushing or fluttery feeling as soon as dye is injected
May feel urge to cough r/t palpitations
Give at least 3 nursing responsibilities for Cardiac Catheterization (post-procedure, VA4PBW)
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
What are the 5 P’s of Compartment Syndrome?
Pulsations Paresthesia Pallor Pain Paralysis
What are the activity restrictions post-cardiac catheterization
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
Match the nursing diagnosis to its reason/cause
- Decreased Cardiac Output
- Impaired Gas Exchange
- Pain
- Risk for Infection
- Anxiety
- 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
1C 2E 3D 4F 5A 6B
Interventions for decreased cardiac output include:
CBR, no TV
Plan activities
No smoking
Follow AHA and NYHAF classifications
Differentiate the AHA and NYHAF Classifications
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
Interventions for impaired gas exchange
Semi or High Fowlers
Oxygen PRN
Rest
Differentiate the 3 cardiac enzyme markers:
CK MB
Troponin I
Myoglobin
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
What is ESR Test? What is it for?
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
When are blood coagulation tests needed?
Venous disorders such as DVT or Thrombophlebitis
Match the ff coagulation test to its purpose:
- Partial Thromboplastin Time (PTT)
- Prothrombin Time (PT)
- Clotting and Bleeding Time
A. For px taking coumadin
B. For px taking heparin
C. For px taking aspirin
1B
2A
3C
What is BUN? Why is it needed for CV disorders?
Blood Urea Nitrogen
Decrease in CO = poor blood flow to kidneys = decreased GFR = kidney failure
Can heart infections occur? How so? What tests are needed to diagnose this? (3)
Yes. Injury = change in movement = blood stasis
Blood culture, throat swab, antibody test
How many electrodes are used in an ECG? Where are they placed?
12 in total, positive and negative
6 on limbs, 6 on chest
Is echocardiography invasive?
NO, doppler ultrasound is only placed on chest
Limitation: cant see back of heart
How is transesophageal 2D Echo performed? Is it an invasive procedure? (ANAG)
YES
Px awake and on NPO
Spray anesthetic
NPO until gag reflex returns (aspiration risk)
What are the 3 purposes of 2D Echo?
Determine if structures are damaged (valve or hypertrophied muscles)
Functioning properly (flow of blood)
Determine ejection fraction
What is ejection fraction?
Amt of blood the LV pumps (CO)
>40/50% = CHF
How is angiogram/arteriography performed?
Open blood vessel
Thread catheter via surgery
Inject contrast dye (iodine based)
Visualize in xray
How does angiogram differ from arteriography?
Angiogram is the general term while arteriography is specific to arteries
(T/F) Arteriography is a (1) minimally invasive procedure where the px is sedated and (2) is only diagnostic in nature, not therapeutic
1T
2F – it is both diagnostic and therapeutic
(T/F) The nursing responsibilities for arteriography and cardiac catheterization are the same
TRUE
Cerebral angiogram: ____
_____ angiogram: legs
Cardiac angiogram: _____
Brain
Femoral
Heart
What is CVP for?
Indicate pressure in RA/venous return
If poor venous return = poor afterload = poor CO
What can cause another obstruction to occur after cardiac catheterization + insertion of a stent? How can we prevent this?
Since the stent is a foreign body, this can trigger an inflammatory response = clot = obstruct
Administer blood thinners
