NUR 118 - Lecture 9/10 - Cardiovascular

Question 1

LECTURE OBJECTIVE

Function of Autonomic Nervous System in cardiovascular function:​

Parasympathetic stimulation

Answer 1

General:
Cardiac Rate
Cardiac Muscle contractility
Vascular Tone (BP)

Parasympathetic:
- Regulates heart via vagus nerve = slows heart rate
- “Rest & Digest”

Question 2

LECTURE OBJECTIVE

Function of Autonomic Nervous System in cardiovascular function:​

Sympathetic Stimulation

Answer 2

General:
Cardiac Rate
Cardiac Muscle contractility
Vascular Tone (BP)

Sympathetic = Fast & Strong Contraction
Parasympathetic = Slow & No impact on contraction

Sympathetic:
- Norepinephrine & Epinephrine: help with constriction of blood vessels
- “Fight or flight”
- Concerned for beta receptors; for drug, atenolol = beta blocker

Question 3

LECTURE OBJECTIVE

Cardiovascular Assessment: Inspection

Answer 3

• Signs of distress
• Skin & mucus membrane color
• General appearance
• Breathing effort
• Jugular neck vein distention (JVD)
  Position Semi Fowler’s
• Edema
• Clubbing of fingers
• Inspect precordium:
  >size, shape, symmetry
  > Apical Impulse/PMI
  > Pulsations, heaves, lifts

Question 4

LECTURE OBJECTIVE

Cardiovascular Assessment: Palpation

Answer 4

• Warm hands

Palpation Locations:
Aortic Area
Pulmonic Area
Erb’s Point
Tricuspid area
Mitral area

• Temperature and moisture
• Discomfort
• Pu;se: Rate, rhythm, quality
  >Rate: Tachycardia/bradychardia
  >Rhythm: Regular/Irregular
  >Quality: 0:absent, 1:thready, 2:weak, 3:strong, 4:bounding
• Edema: Pitting vs dependent

Question 5

LECTURE OBJECTIVE

Cardiovascular Assessment: Auscultation

*ADD MORE LATER IF NECESSARY

Answer 5

• Listen to apical
• Rate, rhythm
• Identify S1 & S2 ( First and second heart sounds)

S1 = Closure of atrioventricular valves: mitral & tricuspid
S2 = Closure of semilunar valves: aortic & pulmonary

APE TO MAN:
Mitral – between left atrium and left ventricle​
Tricuspid – between right atrium and right ventricle​
Aortic – between left ventricle and aorta​
Pulmonic – between right ventricle and pulmonary artery​
Erb’s Point​
Cardiac murmurs caused by aortic insufficiency and mitral stenosis can in particular be heard.​

Question 6

LECTURE OBJECTIVE

Laboratory studies r/t cardiovascular assessment

Answer 6

Cholesterol:
-Total < 200
-HDL >60
-LDL <100

C-Reactive Protein (CRP): < 10; Believe to be value of predicting coronary events

Complete Blood Count (CBC): WBC for infection, hemoglobin for O2 carrying capacity

Electrolyte: Potassium (K+), too much or too little can influence function of heart

PT/PTT: Assess intrinsic system and pathway of clot formation

CK-MB: Elevation indicates cardiac muscle damage (MI); usually rises 3-6 hours after cardiac event

Troponin: Marker for cardiac injury; faster than CK-MB

BNP Natriuretic Peptides: Elevation Identifies patients with Congestive Heart Failure

Question 7

LECTURE OBJECTIVE

Diagnostic tests r/t cardiovascular assessment

Answer 7

Electrocardiogram (EKG): Records the electrical impulses stimulating heart to contract
>Evaluates arrhythmias, conduction defects, myocardial injury

Echocardiogram: Evaluates structure and function of heart & how they move blood through heart
> Detects: heart wall function, mainly left ventricle; disease of heart valves; determines cardiac output

Pulse Oximetry: Measure O2 Saturation

Question 8

LECTURE OBJECTIVES

Nursing Interventions for Cardiovascular diseases

Answer 8

Diet ​
Weight Loss​
Exercise​
Modifiable & Non-modifiable Risk Factors​
Quitting Smoking​
Substance Abuse​
Reduce Stress
Manage Anxiety​

Promote Venous Return​
Promote Peripheral Arterial Circulation​

Clot Prevention
Administer Medications

Question 9

Right-sided heart failure:
Possible etiology
s/s

Answer 9

Etiology:
Right ventricle of heart no longer pumps blood into lungs
Blood builds up in lungs

s/s:
Leads to fluid build-up in legs, and less commonly in genital area, organs or abdomen
Ascites (fluid in abdomen)
Weight gain

Question 10

Left-sided heart failure:
Possible etiology
s/s

Answer 10

Etiology:
Left ventricle of heart no longer pumps blood throughout body
Blood builds up in pulmonary veins

s/s:
Leads to SOB, trouble breathing, coughing
Fluid in alveoli
Impaired gas exchange

Question 11

Peripheral Arterial Disease:
s/s, Nursing interventions

Answer 11

s/s:
Pale/Cyanosis
Weak peripheral pulses
Cool
Loss of hair in lower extremities
Thick toenails
Intermittent Claudication - Pain in legs when walking/exercising

Interventions:
Keep legs down to encourage blood flow
If pt has intermittent claudication, have them sit and rest

Question 12

Peripheral Venous Disease:
s/s, Nursing interventions

Answer 12

s/s:
Edema
Varicose veins
Brownish-red color in lower extremities

Nursing interventions:
Promote venous return
- Encourage ambulation
-Have patient elevate legs
-Don’t cross legs
-Compression stockings

Question 13

Peripheral Vascular Disease (PVD):
5 P’s and a T

Answer 13

Pain
Palor
Pulse
Paresthesia
Paralysis
Temperature

Question 14

Define Ischemia and Infarction

Answer 14

Ischemia - Lack of blood supply to an organ, or body part; ischemia is reversible

Infarction - Necrosis; not reversible

Question 15

APE TO MAN

Answer 15

Apical
Pulmonary
Erb’s Point
Tricuspid
Mitral

Question 16

Risk factors for Coronary Heart Disease

Answer 16

Non Modifiable risks:
Heredity
Age
Gender

Modifiable risks:
Hypertension
Type II Diabetes
Obesity
Elevated serum lipid levels
Smoking

Question 17

What are lab tests to determineif patient had a MI or HF?

Answer 17

CK-MB: Used to diagnose an MI; elevated 3-6 hours after cardiac event
Troponin: Marker for cardiac injury; Elevated 2-3 hours after myocardial injury
BNP Natriuretic Peptdes: Identify patients with congestive heart failure