med surg lecture 4 Flashcards
the cardio-vascular system consists of what
-heart
-blood
-vessels
-arteries
-veins
-capillaries
vessels consist of
-arteries
-veins
-capillaries
where is the heart located
central thoracic cavity
Mediastinum
the pericardial sac consists of what
-fibrous pericardium
-parietal pericardium
-visceral pericardium
what is the visceral pericardium also known as
epicardium
what part of the pericardial sac outlines the heart
fibrous pericardium
what part of the pericardial sac is serous membrane and decreases fricton
parietal pericardium
what part of the pericardial sac that is the inner most protective layer
visceral pericardium (epicardium)
what are the cardiac layers
-epicardium
-myocardium
-endocardium
the protective layer of the heart
epicardium
the thick layer of muscle of the heart and aides in contraction
myocardium
the layer of the heart inside the cardiac chambers lining the inside of the heart chambers and valves
endocardium
how the heart is being profused with oxygen is called what
coronary circulation
this artery supplies blood to the right atrium, right ventricle, bottom portion of the left ventricle and back of the septum
right coronary artery
veins that take oxygen-poor deoxygenated blood that has been “used” by muscles of the heart and return it to the right atrium
coronary veins
artery that divides into two branches: the circumflex artery and the left anterior descending artery
left coronary artery
artery that supplies blood to the left atrium and the side and back of the left ventricle
circumflex artery
artery that supplies blood to the front and bottom of the left ventricle and the front of the septum
left anterior descending artery (LAD)
superior chambers of the heart
right atrium
left atrium
inferior chambers of the heart
right ventricle
left ventricle
which part of the heart has the thickest wall
left ventricle
what are the cardiac valves
atrioventricular valves (AV)
semilunar valves
what are the atrioventricular valves
right av valve - tricuspid
left av valve - bicuspid/mitral
coronary blood flow in order
-inferior/superior vena cava
-right atrium
-tricuspid valve
-right ventricle
-pulmonic/pulmonary valve
-pulmonary artery
-lungs (oxygenation occurs)
-pulmonary veins
-left atrium
-mitral/bicuspid valve
-left ventricle
-aortic valve
-aorta
-body tissue/organs
the heart is an _________ driven pump
electrically
the pump is comprised of ______
muscle
the pump requires both ________ and ________ to function
electricity and oxygen
muscle tissue needs _______ to survive
oxygen
electricity is derived from ________
electrolytes
which electrolytes are important for cardiac electrical system
-potassium
-sodium
-calcium
-magnesium
electrical conduction system coordinates both ______ and _______ of the heart chambers
-contraction
-relaxation
pathway of electrical impulses that generates a heartbeat
conduction pathway
electrical impulses causes the heart to _______ and pump _______ to the rest of the body
-contract
-blood
cardiac conduction pathway includes
-sinoatrial (SA) node
-interatrial node/pathway bundle
-atrioventricular (AV) node
-bundle of His
-right and left bundle branches
-purkinje fibers
which node is located in the wall of right atrium
sinoatrial node (SA)
what is also called bachmann’s bundle
interatrial node/pathway/bundle
known as “pacemaker” of the heart
sinoatrial node
this node delays conduction briefly
atrioventricular node
connecting fibers that rapidly send an impulse from the right atrium to the left atrium
interatrial node/pathway/bundle
what starts the heart rate and keeps the heart rate going
sinoatrial node
what gives atria time to contract and pump all blood into the ventricles
atrioventricular node because it delays conduction briefly
conduction passes from av node and travels through
bundle of his
conduction bifurcates into the what and travels through the walls of venticles
right and left bundle branches
fibers spread widely across the ventricles to cause all cells of the ventricles to contract quickly and this is when blood is expelled from ventricles
purkinjie fibers
as atria and ventricles refill with blood the SA and AV node _______ with electrolytes so that they can repeat the electrical conduction cycle again
recharge
cardiac conduction pathway in order
-sinoatrial node
-interatrial node/pathway/bundle (bachmanns bundle)
-atrioventricular node
-bundle of his
-right and left bundle branches
-purkinje fibers
a single cycle of cardiac activity can be divided into what two phases
systole
diastole
contraction of chambers is called what
systole
relaxation of chambers is called what
diastole
atrial systole
atria contracts, blood flows from the atria into ventricals
ventricular diastole
ventricles relax filling with blood sent from atria
amount of blood ejected from the left ventricle in one minute
cardiac output
how do you calculate cardiac output
stroke volume x heart rate
amount of blood pumped per beat
stroke volume
number of heart beats in one minute
heart rate
what is cardiac output measured in
L/min or mL/min
what is the average cardiac output for a healthy adult is about
5L/min
amount of blood the left ventricle pumps out with each contraction
ejection fracture
what value shows how well the heart is functioning
the ejection fraction value
normal range of ejection fraction
55% - 70%
an ejection fraction under 40% may be evidence of _________ or _________
heart failure or cardiomyopathy
what is the most common test performed to determine the ejection fraction
echocardiogram
force of blood against blood vessel walls
blood pressure
what is blood pressure measured in
millimeters of mercury
why is blood pressure greatest in the arteries
there is more force to get to the body
arteries and arterioles are usually slightly _______ to maintain normal blood pressure
constricted
if heart rate and force of contraction increases what happens
blood pressure increases
if heart rate is increased but ventricles are not filing prior to contraction, cardiac output will be decreased and cause blood pressure to what
decrease
the average pressure within the arteries throughout one cardiac cycle (systole and diastole)
mean arterial pressure
what is considered a better indicator of perfusion to vital organs than the blood pressure
The MAP
if the MAP is below __ mmHg for prolonged periods of time, vital organs are not receiving adequate blood flow and oxygen
65
if the MAP is above ___ mmHg for prolonged periods of time the heart workload is increased which leads to various complications
100
what is the MAP equation
systolic blood pressure + 2 times the diastolic blood pressure divided by 3
what does MAP stand for
mean arterial pressure
when calculating the MAP if results are decimals what do you need to do
round to the nearest whole number
hormones made by your adrenal glands
catecholamines
neurotransmitters of the sympathetic nervous system
epinephrine and norepinephrine
what happens when epinephrine and norepinephrine are released
-increased impulse conduction
-increased heart rate
-increase in systolic BP (due to increased cardiac output)
what regulates serum sodium and potassium levels
aldosterone
aldosterone is made by the _________
adrenal cortex
when aldosterone is released kidneys hold onto ______ and releases _______ via urine
sodium
potassium
aldosterone will be released by the body if it needs to ________ blood pressure
raise
increases excretion of sodium by inhibiting secretion of aldosterone
atrial natriuretic peptide
atrial natriuretic peptide inhibits release of _________ when blood pressure is too high
aldosterone
atrial natriuretic peptide is released when we need blood pressure to be _______
lowered
arteries and arterioles carry blood ______ the heart ____ capillaries
from
to
arteries and arterioles are thicker than veins because
it needs more protection
what are the inner layers of arteries and arterioles made up of
simple squamous
capillaries carry blood _____ arterioles ____ venules
from
to
continuation of the lining of arteries and veins
capillaries
capillaries are ____ cell thick to permit exchange of _____, ______, and _______
one
gases
nutrients
waste products
capillaries are ____ and _______
thin
fragile
veins and venules carry blood _____ capillaries ____ heart
from
to
veins dont have as much ______ as arteries
pressure
what happens to the heart as a person ages
-increased atherosclerosis
-resting blood pressure increases
-vein valves more incompetent
-decreased HR
-kyphosis
atherosclerosis
-build up of fats, cholesterol and other substances on artery walls
-reduced/restricted blood flow
-atherosclerosis increases risk for developing cardiovascular disease, increases with age
why does resting blood pressure increase
left ventricle workload increases, increased risk for left sided heart failure
vein valves more incompetent causes
-backflow of blood, varicosities
-dependent edema
dependent edema is caused by
blood not being able to get back up and it starts pooling
what causes decreased heart rate in older adults
-conduction cells less effective
-dysrhythmias common
kyphosis causes what
-changes the shape of chest walls
-hear sounds distant
start cardiovascular assessment with ________ data
subjective
subjective data of a cardiovascular assessment
-health history
-follow up with appropriate questions and assessments based on patients complaints
if there are cardiac related issues upon questioning like dizziness, fatigue, chest tightness/pain, sob or dyspnea do
vital signs
thorough pain assessment by scale
ask more questions about sob and dyspnea
appropriate oxygenation and blood flow to area of skin color
pink
decreased arterial blood flow or decreased oxygen to tissues skin color, possible anemia
pallor
color of skin with gas exchange and/or perfusion issue, tissues are oxygen deficient
cyanosis
decreased arterial blood flow causes what
blood not able to get to the extremeties
what will skin look like with decreased arterial blood flow
-dependent rubor (red)
-shiny, taut, dry skin and decreased hair distribution
venous blood flow problems causes what
blood cant get back to the heart and it is pooling in the extremities
what will skin look like with venous blood flow problems
brown discoloration
purple/blue skin in dependent position
veins in neck are distended/visible when sitting 45-90 degrees and this is caused by increase in venous volume; fluid overload
jugular venous distention
S1 heart sound is heard when
the beginning of ventricular systole
S2 hear sound is heard when
the start of ventricular diastole
this is caused by narrowed valve opening or a valve that doesnt close tightly and prolonged swishing sound due to regurgitation of blood
murmur
what causes heart sounds
valve closure
which valves makes s1 “lubb” sounds
tricuspid and mitral
which valves makes s2 “dubb” sound
aortic and pulmonary
palpation of cardiac assessment
-capillary refill
-edema
-pulses
-temperature
capillary refill of <3 seconds indicates what
and >3 seconds indicates what
-appropriate arterial blood flow
-decrease in arterial blood flow
swelling in dependent extremities is due to
fluid build up/fluid overload
pulses assess what and what do we need to determine with the pulse
arterial blood flow to area and determine rate, volume and strength
if pulse is 0 what is it
absent
if pulse is 1+ what is it
weak/thready
what condition might a person have if their pulse is 1+
hypotension
what does it mean if a person has a 2+ pulse
strong
what does it mean if a person has a 3+ pulse
bounding
what conditions can a person have if pulse is 3+
htn
fluid overload
athletic individuals may have a heart rate between
40-50 bpm
what are the 6 P’s of a neurovascular assessment
-pain
-paresthesia
-pulselessness
-pallor
-poikilothermia
-paralysis
diagnostic studies not heart specific
-chest xray
-ct scan
-cta scan
-mri
-ultrasound of extremities
chest xray of heart shows what
size, position and structures of heart
ct scan of heart shows
calcified plaque in the coronary arteries
cta scan of heart shows
blood flow within coronary arteries
mri of heart can identify
ischemia and heart damage
ultrasounds of extremities
-arterial ultrasound
-venous ultrasound
which ultrasound of the extremities will look for dvts
venous ultrasound
heart specific diagnostic testing
-echocardiogram
-electrocardiogram
-cardiac monitoring
ultrasound test specific for the heart
echocardiogram
what does the machine record when doing an echocardiogram
-the motion of heart structures (valves and chambers)
-heart size, shape, position
-visualize blood flow through heart
-determine ejection fraction of left ventricle
what test shows cardiac electrical activity in a moment of time like a snapshot
electrocardiogram
the ekg or electrocardiogram will reflect abnormalities related to:
-conduction
-heart rate and rhythm
-heart chamber enlargement
-myocardial ischemia and/or infarction
-electrolyte imbalances
cardiac monitoring is also known as
telemetry
how many leads with electrodes are connected to a central cardiac monitor
5 leads
cardiac monitoring may be worn if patient has:
-cardiac complaints
-receiving medications that can change cardiac activity
-during acute illness
-electrolyte imbalances
-iv electrolyte replacement
which lead is colored white
RA
which lead is colored green
RL
which lead is colored black
LA
which lead is colored red
LL
which lead is colored brown
V
labs specific to the cardiovascular system
-troponin
-ck-mb
-bnp
-electrolytes
-lipid panel
-d-dimer
what electrolytes labs are ran for cardiovascular system
-potassium
-calcium
-magnesium
-sodium
this lab is drawn in serial increments every few hours to see if acute cardiac damage is persistent/continuing
troponin
the more cardiac damage present the _______ the troponin value
higher
this lab supports the diagnosis of myocardial injury and will be ordered in conjunction with what other lab
-CK-MB
-will be ordered with troponin
this lab is ordered to diagnose and monitor progression of chronic heart failure
brain naturetic peptide (BNP)
what is the gold standard for heart attack labs
troponin
all therapeutic measures for cardiovascular issues
-improve diet
-promote exercise
-weight loss if needed
-smoking cessation
-ted hose/stocking
-sequential compression devices
-leg elevation
-supplemental oxygen
-medications
what ways would you tell a patient to change their diet if they have cardiovascular disease
-increase fruits and veggies
-decreased saturated fats
how can exercise improve cardiovascular issues
-promotes and improves blood flow
-assists in optimum cardiac function
smoking causes _________ which reduces blood flow
vasoconstriction
ted hose/stockings improve _______ blood flow and _____ blood return
arterial
venous
ted hose/stockings prevent what two things
-clots
-edema
what type of patients are ted hose/stockings used for
-peripheral vascular disease
-bedrest
-after surgery/trauma
what is the most important thing to remember when using a sequential compression devices
make sure it is turned on
leg elevation should be done when there is _______ insufficiency
venous
if a patient has ______ blood flow problems you should not elevate legs
arterial
what type of position would you want your patient in if they are having arterial blood flow problems
dependent
the formation of plaque buildup in the walls of the arteries throughout the body
atherosclerosis
build up of fatty deposits
plaque
plaque causes what
irregular and jagged edges which causes blood cells and other material to stick
atherosclerosis may lead to
ischemia of the organ/tissue
with atherosclerosis arteries ______ and lead to decreased blood flow and oxygen delivery to organs and tissues
narrow
modifiable risk factors for atherosclerosis
-diabetes
-hypertension
-elevated cholesterol
-elevated ldl
-excessive alcohol use
-obesity
-sedentary lifestyle
-tobacco use
non-modifiable risk factors for atherosclerosis
-older age
-african american
-male
-genetics
atherosclerosis lifestyle treatment
-smoking and alcohol cessation
-low fat and low cholesterol diet
-exercise
atherosclerosis medication treatments
-antiplatelet aggregators
-lipid lowering medication
increased activity can raise what lab levels and improve blood flow/circulation
HDL levels
what are the two antiplatelet aggregators
aspirin and clopidogrel
what are the first line drugs to reduce ldl levels in the body by reducing cholesterol synthesis
statins
what are the two things aspirin does
-antiplatelet aggregator
-nsaid
antiplatelet aggregators do what to the platelets
makes them less sticky
what labs will you monitor when taking aspirin
platelets
hemoglobin
hematocrit
what will you need to educate patient on when they are taking aspirin
that they may bleed or bruise easily
if platelets are below _____ you will hold patients antiplatelet aggregator
100
common medications for cholesterol
simvastatin (zocor)
atorvastatin (lipitor)
pravastatin (pravachol)
what do statins do
reduces ldls and total cholesterol levels
may increase hdls
what time of day should statins be taken
in the evening
what should you watch for when a patient is taking statins
muscle pain can cause rhabdomyolysis
narrowing of coronary arteries due to plaque buildup
coronary artery disease
chest pain due to ischemia
angina pectoris
coronary artery disease decreases blood flow which causes what
decreased oxygen delivery to cardiac tissue
stable chest pain qualities
-pain is predictable
-occurs with moderate exertion in familiar pattern
-usually stops with rest or nitroglycerin
unstable chest pain qualities
-pain is unpredictable
-occurs with less exertion, at rest, during sleep
-unrelieved with rest or nitroglycerin
-can lead to myocardial infarction
what does angina feel like
-chest pain
-chest pressure
-squeezing sensation in chest
-indigestion
-pain that spreads to your neck, jaw, arms, back or belly
what is the key drug to fight heart ischemia
nitroglycerin
what does nitroglycerin do in the body
-dilates coronary arteries to increase oxygen
-dilates peripheral vessels to decrease work for the heart
nursing considerations for patients taking nitroglycerin
-monitor bp, hr, and pain level before and after administration
-sublingual
-carry at all times and in original container
-sit down or lay down while taking due to blood pressure changes
what is a common side effect of nitroglycerin
headache
