Overall Study Guide Flashcards
Test 2
What are the three layers of the heart?
Epicardium- outermost layer of the heart
Myocardium- thickest layer of the heart (made up of contractile cardiac muscle cells)
Endocardium-thin layer of endothelial tissue that forms innermost layer of the heart
Draw the heart
Trace Blood Flow As Well
Anatomy of the heart
Four chambers (see other slide) Superior and inferior vena cava Pulmonary artery Pulmonary vein Aorta Two pumps (see other slide) Four valves(see other slide) Two semilunar valves (see other slide)
What are the two pumps of the heart?
The right side pump- pumps blood to lungs for gas exchange (pulmonary circulation)
The left side pump- pumps blood to the body (systemic circulation)
What do the atrioventricular valves do?
Help prevent backflow of blood from the ventricles to the atria. Tricuspid Valve (right atrioventricular valve) Mitral Valve (left atrioventricular valve)
What do the semilunar valves do?
Prevent back-flow of blood from arteries to the ventricles Aortic Valve (left semilunar valve) Pulmonary Valve (right semilunar valve)
Electrical conduction of the heart
Cardiac Cycle Sinoatrial Node A.V. Node A.V Bundle (Bundle of HIS) Perjunkie Fibers (See more in depth on these in the heart study flashcards)
Diastole
Relaxation of the ventricles
Systole
Contraction of the ventricles
Neck Vessels Assessment – JVD Inspect 1st Step
INSPECT!!
Stand on right side of client
Suspine position, torso elevated 30-45 degrees
Client turn head slightly to the left
Jugular Venous Distention (JVD) - May shine a light source onto the neck to increase visualization
Pulsations- Inspect suprasternal notch or the area around clavicles for pulsations of the internal jugular vein.
Note: Not going to assess Jugular Venous Pressure – often omitted and replaced by a medical order for pulmonary artery catheter placement
See page 446 Assesment book
Neck Vessels Assessment – JVD Inspect 2nd Step
AUSCULTATE
Carotid Arteries - Use the bell of the stethoscope, ask the client to hold their breath for a moment, detect if there is a possible Bruit (mumur)
Neck Vessels Assessment – JVD Inspect 3rd Step
PALPATE
Carotid Arteries - Pulse (palpate one side at a time)- Vessel elasticity- thrills (Slight palpable vibration associated with cardiac murmur)
Should you auscultate or palpate first?
Auscultate (examine a patient with a stethoscope) before palpating (examine by touching)
What are heart sounds produced by?
Valve Closure (lubdubb- S1&S2)
Lub Sound and Dub Sound
s1 & s2
S1=?
BEGINNING of systole (Mitral and Tricuspid valve closure) 1st heart sound
S2=?
Indicates the END of ventricular systole (Aortic and Pulmonic valve closure) 2nd heart sound
S3=?
Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. Commonly called heart failure. Heard LLSB (Tricuspid Area) or apex with bell.
S4=?
Ventricular wall damage- Myocardial Infarction (MI - Heart Attack) Heard LLSB (Tricuspid Area) or apex with bell.
Murmurs
Caused by turbulence secondary to increased blood flow, constricted vessels, dilated vessels or a combination (Causing swooshing or blowing sound)
Diminished S1
Sound is decreased in obese/barrel chest clients. Can also be decreased with early heart block.
Split S1
Mitral/Aortic close before tricuspid/pulmonic. Heard in 4th ICS
Accentuated S2
Sound may increase in clients during exercise or with HTN. ( hypertension- High Blood Pressure)
Split S2
During inspiration (inhalation), aortic valve may be heard before pulmonic valve. Heard as “lub”. During expiration (exhalation), valves close as one “Dub”.
What do you do if you detect an irregular rhythm?
Auscultate for a pulse rate deficit - Palpate the radial pulse while you auscultate the apical pulse. Count for a full minute. Radial and apical pulse rates should be identical.
What is a Pulse Deficit
Difference between apical and peripheral/radial pulse.
What can a Pulse Deficit indicate?
May indicate- Atrial Fib, Atrial FLutter, PVC’s (Flutter or Skip a beat heartbeat), and varying degrees of heart block.
What is the precordium?
Anterior chest area (Region in front of the heart)
Where do you locate the angle of Louis?
Anterior angle formed by the junction of the manubrium and the body of the sternum. Felt as prominence on the sternum.
“APE To Man” Where is the Aortic Area Located?
Second ICS at the right sternal border- base of the heart
“APE To Man” Where is the Pulmonic Area Located?
Second or third ICS at the left sternal border- the base of the heart
“APE To Man” Where is the Erb Point Located?
Third ICS at the left sternal border
“APE To Man” Where is the Tricuspid Area Located?
Fourth of fifth ICS at the left lower sternal border
“APE To Man” Where is the Mitral (Apical) Located?
Fifth ICS near the left MCL (Mid-Clavicular Line) - Apex of the heart * Located under assessment guide 21-2
What are the five areas for listening to the heart?
APE To Man - Aortic - Pulmonary - Erb’s Point- Tricuspid - Mitral
What does the S3 heartbeat sound like?
Ventricular Gallop- KEN-TUC-KEY
What does the S4 heartbeat sound like?
Atrial Gallop- TEN-NES-SEE
What does a Heart Murmur sound like?
Turbulent blood flow with a swooshing or blowing sound when doing auscultation.
What are 4 conditions that contribute to Heart Murmurs?
Increased Blood Velocity
Structural Valve Defects
Valve Malfunction
Abnormal Chamber Openings
What does atherosclerosis cause in older clients?
It could possibly cause obstruction, and compression may easily block circulation.
What is atherosclerosis?
Plaque buildup in the artery wall
What is harder to palpate in older clients?
The apical pulse, because of an increased anteroposterior chest diameter.
Overview of coronary heart disease
Accumulation of plaque and lipids-fat around vessels. This can create an inadequate blood supply to heart tissue/muscle and cause an M.I. or Myocardial infarction - heart attack.
Risk factors of coronary heart disease
Family history, increasing age, race, high cholesterol-hyperlipidemia, smoking, hypertension, diabetes, obesity, and physical inactivity.
Risk reduction teaching tips for coronary heart disease
Stop smoking
Choose a diet that emphasizes intake of veggies, fruits, & whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats
Reduce elevated cholesterol
Lower blood pressure
Increase physical activity
Work to achieve or maintain a healthy weight for height.
Manage diabetes if diagnosed.
Limit alcohol intake to an average of one to two drinks per day for men and one drink per day for women
Practice stress reducing techniques
Cultural considerations for coronary heart disease
White middle aged men have the highest incidence of coronary artery disease
- African men have the highest incidence of hypertension
- Women more likely to die after an MI than men
Arteries
Carry oxygenated nutrient-rich blood from the heart to the capillaries
Where are the major arteries of the arm?
Brachial, Radial, Ulnar
Where are the major arteries of the leg? (Peripheral Arteries)
Femoral, Popliteal, Dorsalis Pedis, Posterior Tibial
Veins
Carry deoxygenated, nutrient-depleted, waste-ladden blood from the tissues back to the heart
What are the three types of veins?
Deep veins, Superficial Veins, and Perforator Veins
Other Veins
Femoral, Popliteal, Saphenous Veins
What is the Primary Function of the Lymphatic System?
To drain excess fluid and plasma proteins from bodily tissues and return them to the venous system.
What is the Secondary Function of the Lymphatic System?
To function as a major part of the Immune System and defend the body against microorganisms.
What is the Third Function of the Lymphatic System?
To absorb fats (lipids) from the small intestine into the blood stream.
What does the Lymphatic System consist of?
Lymphatic Capillaries, Lymphatic Vessels, and Lymph Nodes. Small Blood Vessels.
What does the Lymphatic System do in addition to the three functions?
Form the connection between the arterioles and venules.
Arterial Insufficiency Pain
Intermittent claudication to sharp, unrelenting, constant
Arterial Insufficiency Skin
Dependent (down below the level of the heart) rubor (red) ; elevation pallor or foot; dry, shiny skin; cool to cold temperature (clammy)
Arterial Insufficiency Other Effects on the Body
Loss of hair, especially over legs - Nails thickened and rigid.
Venous Insufficiency Pain
Aching Cramping
Venous Insufficiency Pulses
Present, but can be difficult to palpate through edema
Venous Insufficiency Skin
Brown discoloration along ankles and extending up the calf
Skin thickened and rough; may be reddish-blue in color
Frequently associated with eczema
Edema (abnormal amount of fluid accumulating in the body)
Warm Skin
Venous Insufficiency - What to avoid
Prolonged sitting, standing, restrictive clothing, leg crossing
What Can Venous Insufficiency Lead To?
Venous Ulceration
What is Peripheral Artery Disease?
Disorder of the arteries and veins that causes narrowed arteries to reduce blood flow to the limbs. (Chronic condition that deprives lower extremities of oxygen and nutrients)
What is Peripheral Artery Disease also known as and what can it describe?
Peripheral Vascular Disease (if occurs in veins and arteries alike) it can also describe Arterial or Venous diseases.
What is the most common cause of Peripheral Artery Disease?
Atherosclerosis is the most common cause of altered blood flow-blockage
Peripheral Artery Disease Symptoms
Painful cramping in hip, thigh or calf muscles after certain activities such as walking or climbing stairs (claudication)
Leg numbness or weakness
Coldness in lower leg or foot
Sores on toes, feet or legs that won’t heal
A change in the color of legs
Hair loss or slower hair growth on feet and legs
Slower growth of toenails
Shiny skin on legs
No pulse or a weak pulse in legs or feet
Erectile dysfunction in men
Claudication
Pain caused by too little blood flow, usually during exercise
Peripheral Artery Disease Risk Factors
Smoking Diabetes Obesity (BMI over 30) High Blood Pressure High Cholesterol Increasing age ( After 50) Family history of Peripheral Artery Disease High levels of homocysteine (commonly found in meat) African Americans - Twice as likely
Peripheral Venous Disease Symptoms
Heaviness of legs
Aching sensation aggravated by sitting or standing for a long period of time
Leg edema
Varicosities
Risk Factors for Venous Stasis
Long periods of standing, sitting, or lying down
Lack of muscular activity that causes blood to pool in legs which increases pressure in the veins
Varicose (tortuous and dilated) Veins which increase venous pressure. Damage to the vein wall can also contribute to venous stasis.
Deep Vein Thrombosis (DVT) Risk Factors
Reduced Mobility Dehydration Increased viscosity of the blood Venous stasis Leg edema, pain, warm skin, erythema Calf tenderness on palpation USE HOMANS SIGN TO HELP CHECK
Pitting Edema
1+ Sight Pitting
2+ Deeper than 1+
3+ Noticeably deep pit; extremity looks larger
4+ Very deep pit; gross edema in extremity
Phlebitis and Thrombophlebitis Signs, most common cause, and Symptoms
Palpable, firm subcutaneous, cord-like vein, tender, red and warm, may have edema. The common cause is IV therapy.
Phlebitis and Thrombophlebitis Treatment
Immediately remove IV catheter; elevation of extremity to promote venous return, and warm, moist heat to relieve pain and treat inflammation
Inspection for the Peripheral Vascular System Arms
Size, presence of edema, venous return
Antiarrhythmics
Suppress abnormal rhythms of the heart
Antihypertensives
Lower blood pressure - Control blood pressure
Antianginals
Improve blood delivery to the heart
Anticoagulants
Inhibit any step of the coagulation process.
Diuretics
Decrease fluid; lower blood pressure
Types of antihypertensives - Angiotensin
Converting- enzyme inhibitors (ACE Inhibitors). Block the conversion of angiotensin1 to angiotensin 2. Blocks the blood pressure rasing properties of angiotensin.
What are (ACE) inhibitors?
Angiotensin-converting enzyme (ACE) inhibitors help relax your veins and arteries to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder. Angiotensin II also releases hormones that raise your blood pressure.
Types of antihypertensives - What does Angiotensin typically end in?
“-pril”
Types of antihypertensives - Angiotensin 2
Can help raise blood pressure by constricting vessels. Receptor Blockers (ARBs) Selectively binds with angiotensin 2 receptors in vascular smooth muscle & in the adrenal cortex to block vasoconstriction & release of aldosterone.
Types of antihypertensives - What does Angiotensin 2 typically end in?
“-sartan”
Types of antihypertensives - Calcium channel blockers*
Relaxes muscle contraction or other autonomic blockers
Types of antihypertensives - Calcium channel blockers end with?
“-pine”
Types of antihypertensives - Calcium channel blockers interact with?
grapefruit juice
Types of antihypertensives - Blockers (ARB’s)
`Selectively binds with angiotensin 2 receptors in vascular smooth muscle & in the adrenal cortex to block vasoconstriction & release of aldosterone.
Types of antihypertensives - Vasodilators
Dilate vessels in order to lower blood pressure
Vasodilators are reserved for?
Use in severe hypertension
Types of antihypertensives - Beta-blockers
Leads to a decrease in heart rate & strength of contraction as well as vasodilation.
Types of antihypertensives - What do Beta-blockers typically end in?
“-lol”
Types of antihypertensives - Diuretic Agents
Decreases sodium levels and blood volume (lasiks)
Types of antihypertensives - Renin Inhibitor
New class of drugs which directly inhibits renin for treating hypertension. (aliskiren or tekturna)
What is Nutrition and Adequate Nutrition?
Study of food - How it affects the body and influences health, and adequate nutrition is essential to wellness
The study of nutrition studies how living organisms:
Ingest Digest Absorb Transport Metabolize Excrete
What is BMR (Basal Metabolic Rate) ?
Amount of energy required at rest
How do you calculate a BMR for women?
0.9kal/kg/hr. OR healthy weight x 10
How do you calculate a BMR for men?
1kal/kg/hr. OR healthy weight x 11
What are factors influencing BMR? (Basal Metabolic Rate)
Major factor is lean body mass Growth and age Fever / Disease Climate Food Intake Exercise Emotions
What are the Six Classes of Nutrients?
Nutrients that supply energy – Carbohydrates – Proteins – Lipids Nutrients that regulate body processes – Vitamins – Minerals – Water
What are the Nutrients that supply energy?
Carbohydrates
Proteins
Lipids
What are the Nutrients that regulate body processes?
Vitamins
Minerals
Water
What are Carbohydrates?
Sugars and Starches
What is the most abundant and least expensive source of calories in the world?
Carbohydrates
What organic compounds do carbohydrates consist of?
Organic compounds composed of carbon, hydrogen and oxygen.
What do carbohydrates serve as?
They serve as the structural framework of plants; lactose is the only animal source.
What are carbohydrates classified as?
Classified as simple or complex sugars
What percent of Carbohydrate intake is ingested?
90%
What are carbohydrates converted to?
Glucose to provide energy, carbon dioxide, and water
What is needed to prevent Ketosis?
50 to 100g of carbohydrates are needed daily to prevent ketosis
What is Ketosis?
Metabolic process that occurs when the body begins to burn fat for energy.
What are Monosaccharides?
Simple sugars made only of one sugar
Examples of Monosaccharides
Glucose
Fructose
What are Disaccharides?
Two simple sugars are combined
Examples of Disaccharides
sucrose (table sugar) = glucose + fructose
Lactose ( milk sugar): = glucose + galactose
Maltose (malt sugar) = glucose + galactose
Formula for BMI ( rule of thumb method) for Adult Women
100lb (for height of 5ft) + or – 5lbs for each additional inch over 5ft
Formula for BMI ( rule of thumb method) for Adult Males
106 lbs (for height of 5ft) + or – 6lbs for each additional inch over 5ft
Energy Values of Food
4 calories per gram of Carbohydrate
4 calories per gram of Protein
9 calories per gram of fat
Energy in nutrients measured in:
kilocalories - A kilocalorie is the amount of heat required to raise the temperature of 1 kilogram of water to one degree Celsius.
Living organisms
ingest, digest, absorb, transport, metabolize,
excrete.
Why do males have a higher BMR (Basal Metabolic Rate)?
Due to larger muscle mass
What is Basal Metabolic Rate?
Basal Metabolic Rate is the number of calories required to keep your body functioning at rest. BMR is also known as your body’s metabolism.
What are factors that increase BMR?
Growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones
What are factors that decrease BMR?
Aging, prolonged fasting, and sleep.
BMI Formulas
weight (kg) / [height (m)]^2
OR 703 x weight (lbs.) / [height (in)]^2
How many meters in an inch?
39.4
What are polysaccharides?
Many sugars
What are examples of complex carbohydrates?
Starches and Fibers
What form are carbohydrates stored in and where is it stored at?
Glycogen and the Liver and Muscles.
How many grams per day of dietary fiber should one ingest?
Dietary Fiber
25-35 g/day
What is a dietary fiber?
Intact plant components, Complex carbohydrates not used for energy - no usable glucose,
What Is a Soluble Dietary Fiber?
This type of fiber dissolves in water to form a gel-like material. It can help lower blood cholesterol and glucose levels. It can dissolve in water, but cannot be digested by enzymes.
Is soluble fiber fully digested by enzymes?
No, but soluble fiber can help reduce calorie intake as your left feeling fuller longer, and helps to soften stool.
Examples of soluble fiber and what soluble fiber helps do?
Beans, oatmeal, barley, broccoli, and citrus fruits, helps to regulate blood glucose level, Weight loss, and Lowers cholesterol
What Is an insoluble Dietary Fiber?
Cannot be dissolved into water or by enzymes.
What does insoluble fiber help do?
Promote bowel regularity, decreases risk of diverticular diseases, and cancer
What percent of caloric intake is Protein, and what is protein required for?
Protein – 10-35% of caloric intake, and required for the formation of all body structures.
What are complete proteins? (high-quality proteins)
Contain all of the essential amino acids in adequate amounts. Animal proteins are complete. SOY IS ALSO COMPLETE
What are incomplete (low quality) proteins?
Plant proteins are incomplete. WITH THE EXCEPTION OF SOY WHICH IS COMPLETE.
Protein tissues are in a constant state of flux. True or false?
True- Tissues are continuously being broken down (catabolism) and replaced (anabolism).
What is the Protein RDA (Recommended Dietary Allowance) for adults?
0.8 g/kg of body weight.
What are the functions of proteins?
Repair and builds tissue Aids in resisting disease Maintains nitrogen balance Provides energy Maintains osmotic pressure Buffers
What are the types of proteins?
Complete, Incomplete, and Complementary Proteins.
When does a positive nitrogen balance occur?
When nitrogen intake is greater than excretion, and indicates tissue growth—for example, during childhood, pregnancy, lactation, and recovery from illness.
When does a negative nitrogen balance occur?
When nitrogen is excreted than is ingested, and indicates tissue is breaking down faster than it is being replaced. This undesirable state occurs in situations such as starvation and the catabolism that immediately follows surgery, illness, trauma, and stress. This can result in the wasting of muscle tissue as it is converted to glucose for energy.
What are complementary proteins?
Two or more incomplete protein sources that, when eaten in combination (at the same meal or during the same day), compensate for each other’s lack of amino acids.
What is the daily recommended amount of fat per day?
20- 35% total calories,<10% saturated ( less than)
What is the second preferred source of energy?
Fats
Basic units of fats
fatty acids and glycerol (glycerides)
Triglycerides
The predominant form of fat in food and the major storage form of fat in the body.
Phospholipids
Compound lipids in which a lipid is combined with another substance. Regulate certain cellular processes, and possess both stabilizing and dynamic qualities that can aid in drug delivery.
Sterols
Can be used mostly to lower cholesterol. They occur naturally in plants, animals, and fungi, and can be also produced by some bacteria.
Are vegans at an increase for vitamin deficiency?
Yes, b-12
Are fats soluble?
No, they are insoluble in water and blood.
What are fats composed of?
Carbon, hydrogen, and oxygen
What percent of lipids in diet are triglycerides?
95% of lipids in diet are triglycerides.
What does fat contain?
Contain mixtures of saturated (raise cholesterol levels) and unsaturated (lower cholesterol levels) fatty acids
– Most animal fats are saturated.
– Most vegetable fats are unsaturated
What are triglycerides?
glycerol and three fatty acids
Where does digestion largely occur?
Digestion occurs largely in the small intestine.
What is the most concentrated source of energy in the diet?
Fats
What is the key component of lipoproteins?
Fats
What are sterols? ( overall view)
Steroid hormones that are derived from cholesterol and are lipid-soluble molecules
What is a Basic material for brain and nerve tissue?
Sterols
What makes bile?
Sterols
What can be a source of vitamin D?
Sterols
What is a fat-related compound?
Cholesterol
What is produced by the liver?
Cholesterol
What is cholesterol present in?
Present in animal products and lunch meats, egg yolks, fish, shrimp, dairy products.
Do Plant foods contain cholesterol?
NO
What does HDL stand for and do?
high-density lipoproteins; Called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
What does LDL stand for and do?
low-density lipoproteins; Called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries
Energy in nutrients measured in-
Kilocalories
Carbohydrates yield how many calories per gram?
4 calories
Proteins yield how many calories per gram?
4 calories
Fat yield how many calories per gram?
9 calories
What are vitamins, and what form are they most active in?
Organic compounds needed by the body in small
amounts. Most are active in the form of coenzymes.
What are vitamins needed for?
Needed for metabolism of carbohydrates, protein, and fat.
What are vitamins classified as?
Classified as water soluble or fat soluble.
How are vitamins absorbed?
Absorbed through the intestinal wall directly into
bloodstream.
What vitamins are Fat Soluble?
A,D,E,K
What vitamins are Water Soluble?
B,C
