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Exam 3 > Perfusion (Heart) > Flashcards

Perfusion (Heart) Flashcards

1
Q

diastole:

A

period of ventricular relaxation resulting in ventricular filling

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2
Q

myocardium:

A

muscle layer of the heart responsible for the pumping action of the heart

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3
Q

cardiac conduction system:

A

heart cells responsible for generating electrical impulses to the myocardial cells

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4
Q

The four valves in the heart, open and close in response

A

to the movement of blood and pressure changes within the chambers

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5
Q

There are two types of valves:

A

atrioventricular (AV) and semilunar.

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6
Q

the sinoatrial (SA) node

A

(the primary pacemaker of the heart)

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7
Q

atrioventricular (AV) node

A

(the secondary pacemaker of the heart)

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8
Q

The SA node in a normal resting adult heart has an inherent firing rate of

A

60 to 100 impulses per minute

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9
Q

the AV node has the second-highest inherent rate (

A

40 to 60 impulses per minute)

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10
Q

the ventricular pacemaker sites have the lowest inherent rate

A

(30 to 40 impulses per minute)

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11
Q

If the SA node malfunctions,

A

the AV node generally takes over the pacemaker function of the heart at its inherently lower rate.

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12
Q

Should both the SA and the AV nodes fail,

A

a pacemaker site in the ventricle will fire at its inherent bradycardic rate of 30 to 40 impulses per minute

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13
Q

The heart is composed of how many layers

A

three layers

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14
Q

The inner layer, or endocardium,

A

consists of endothelial tissue and lines the inside of the heart and valves.

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15
Q

The middle layer, or myocardium,

A

is made up of muscle fibers and is responsible for the pumping

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16
Q

The exterior layer of the heart is called

A

epicardium

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17
Q

The pumping action of the heart is accomplished by

A

the rhythmic relaxation and contraction of the muscular walls of its two top chambers (atria) and two bottom chambers (ventricles).

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18
Q

During the relaxation phase, called diastole, all four chambers relax simultaneously, which allows

A

the ventricles to fill in preparation for contraction.

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19
Q

delete me

A

delete me

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20
Q

The right side of the heart, is made up of

A

the right atrium and right ventricle,

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21
Q

the right side of the heart distributes venous blood (deoxygenated blood) to

A

the lungs via the pulmonary artery (pulmonary circulation)

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22
Q

The pulmonary artery is the only artery in the body that carries

A

deoxygenated blood.

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23
Q

The left side of the heart, composed of

A

the left atrium and left ventricle

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24
Q

the left side of the heart distributes

A

oxygenated blood to the remainder of the body via the aorta

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25
Q

The left ventricle is two to three times more muscular than the right ventricle because

A

It must overcome high aortic and arterial pressures

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26
Q

patients are at risk for myocardial ischemia (inadequate oxygen supply) during tachycardia (heart rate greater than 100 bpm), especially patients with CAD because

A

there isn’t enough time during diastole to allow perfusion of blood flow

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27
Q

Circle of un-oxygenated blood

A

Vena cavas > right atrium > tricuspid valve > right ventricle > pulmonary valve > pulmonary artery > lungs

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28
Q

Circle of oxygenated blood

A

Lungs > pulmonary veins > left atrium >Bicuspid> left ventricle > aortic valve > aorta > rest of body

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29
Q

Each cardiac cycle has three major sequential events:

A

diastole,
atrial systole, and
ventricular systole

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30
Q

hemodynamic monitoring is

A

measurement of Chamber pressure

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31
Q

Cardiac output refers to

A

the total amount of blood ejected by one of the ventricles in liters per minute

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32
Q

The cardiac output in a resting adult is

A

4 to 6 L/min

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33
Q

Cardiac output is computed by

A

multiplying the stroke volume by the heart rate

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34
Q

Stroke volume is

A

the amount of blood ejected from one of the ventricles per heartbeat

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35
Q

The average resting stroke volume is

A

about 60 to 130 mL

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36
Q

Changes in heart rate are due to

A

inhibition or stimulation of the SA node mediated by the parasympathetic and sympathetic nervous system.

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37
Q

Stroke volume is primarily determined by three factors:

A

preload, afterload, and contractility.

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38
Q

Preload refers to

A

the degree of stretch of the ventricular cardiac muscle at the end of diastole.

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39
Q

Afterload

A

resistance to ejection of blood from the ventricle

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40
Q

Contractility refers to

A

the force generated by the contracting myocardium

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41
Q

Orthopnea

A

is the sensation of breathlessness in the recumbent (flat) position, relieved by sitting or standing.

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42
Q

when assessing chest pain or syncope It is important to identify

A
  1. preceding events
  2. duration of symptoms,
  3. measures that aggravate or relieve the symptoms.
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43
Q

A loss of function of the cells throughout the conduction system leads to

A

a slower heart rate.

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44
Q

in gerontologics The size of the heart

A

increases due to hypertrophy (thickening of the heart walls)

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45
Q

in gerontologics, the valves, due to stiffening, no longer close properly which

A

results in backflow of blood creates heart murmurs, a common finding in older adults

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46
Q

older adults may generally become symptomatic with

A

fatigue, shortness of breath, or palpitations

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47
Q

in gerontologics: Left atria is

A

enlarged causing Irregular heart rhythm

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48
Q

in gerontologics: the valves are

A

thickened, causing elevated BP

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49
Q

in gerontologics: plaque formation (atherosclerosis) leads to increased risk of

A

thrombosis and stroke

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50
Q

in gerontologics: Decreased number of pacemaker cells leads to

A

decreased heart rate

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51
Q

Hypertension is defined as

A

a persistent elevation of the systolic blood pressure at a level of 140 mmHg or higher and a diastolic blood pressure of 90 mmHg or higher

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52
Q

diagnosis of hypertension must be based on

A

an average of two or more accurate readings taken one to 4 weeks apart

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53
Q

the prevalence of hypertension among __________ is among the highest in the world

A

African Americans

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54
Q

normal bp

A

120/80

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55
Q

prehypertension

A

120-139/80-89

56
Q

hypertension stage 1

A

140-159/90-99

57
Q

hypertension stage 2

A

160+/100+

58
Q

hypertensive crisis

A

180+/120+

59
Q

Modifiable Risk Factors for HTN

A 
Obesity
Stress
Diet – sodium consumption, diabetes control
Substance abuse
ETOH consumption
Cigarette smoking
Sedentary lifestyle
Socioeconomics
60
Q

non-modifiable Risk Factors for HTN

A

Family history
Age
Gender
Ethnicity

61
Q

Men have greater HTN risk until

A

64 y of age

62
Q

Women have greater HTN risk at

A

65 y of age and later

63
Q

In prolonged HTN, the walls of arteries

A

stretch excessively and create problems

64
Q

papill-edema (swelling of the optic disc)

A

may be seen In severe hypertension,

65
Q

Primary hypertension (also called essential hypertension)

A

is diagnosed when there is no identifiable cause.

66
Q

Secondary hypertension is defined as

A

high blood pressure from an identifiable underlying cause

67
Q

Blood pressure is the calculated by

A

cardiac output multiplied by peripheral resistance

68
Q

delete me

A

delete me

69
Q

The notable exception to HTN diagnosis is when a patient’s average BP is greater than or equal to 160/100 mm Hg, confirmed by

A

at least two accurate readings on one occasion

70
Q

Effects of Uncontrolled HTN

A 
Increased work of heart
Tissue and organ damage
Vascular weakness
Vascular scarring
 Blood clots
Plaque build-up
71
Q

The goal of hypertension treatment

A

is to prevent complications (i.e., target organ damage) and death by maintaining a blood pressure lower than 130/80 mm

72
Q

HTN Complications (target organ damage)

A 
Myocardial infarction (MI)
Heart failure (HF)
Transient ischemic attack (TIA)
Cerebrovascular accident (CVA)
73
Q

Lifestyle Modifications to Prevent and Manage Hypertension:

A

Weight reduction
Consume a diet rich in fruits, vegetables
Sodium <2 g/day is optimal
Preferred potassium intake is 3500–5000 mg/day.
lower alcohol
Increase activity

74
Q

First-line antihypertensive medications

A

Thiazine diuretics like: chlorthalidone

ACE inhibitors like: benazepril

75
Q

Second-line antihypertensives

A

Loop Diretics like: furosemide

76
Q

Hypertensive emergency

A

180/120 WITH new or worsening target organ damage

77
Q

antihypertensive medications for HTN emergency include

A

intravenous drugs such as nicardipine

78
Q

Taking vital signs every 5 minutes is appropriate if

A

the blood pressure is changing rapidly

79
Q

taking vital signs at 15- or 30-minute intervals is appropriate when

A

the situation is stable

80
Q

CAD (Coronary Artery Disease)

A

is disease of the coronary arteries caused by atherosclerosis

81
Q

atherosclerosis

A

(plaque buildup on the artery walls, causing thickening)
a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls causing thickening.

82
Q

non-modifiable Risk Factors for CAD

A

Age
Family hx/heredity
Gender
Ethnicity

83
Q

modifiable Risk Factors for CAD

A 
HTN
Diabetes Type 2
Excessive ETOH consumption
Metabolic syndrome
Hyperlipidemia
Cigarette smoking
Obesity
Physical inactivity
Stressful lifestyle
84
Q

Heart failure results from

A

impaired ventricular function that prevents the heart from pumping enough blood to meet the demands of the body.

85
Q

HF is not a disease but is associated with

A

cardiovascular diseases – HTN, CAD, MI

86
Q

HF is the most common

A

cause of hospital admission for patients over 65 years old.

87
Q

the primary cause of HF

A

Atherosclerosis of the coronary arteries

88
Q

Patho of HF

A

Myocardial dysfunction, leads to decreased cardiac output, that activates barorecepters to increase BP and HR. As the heart works harder, heart muscles thicken and the ventricles increase in size, then myocardial cells struggle to maintain cardiac output, then die.

89
Q

HF RISK FACTORS

A 
Coronary artery disease (CAD) 
Hypertension
Diabetes
Tobacco use
Obesity
Excessive alcohol
High serum cholesterol
High sodium intake
90
Q

HF has 2 categories of symptoms of failures

A

left-sided failure and right-sided failure

91
Q

Clinical Manifestations of Left-sided Failure

A 
Restless, anxiety, confusion
Basilar crackles (base of lungs)
Cough
Oliguria (little urine)
Faint pulses
tachycardia
92
Q

Clinical Manifestations of Right-sided Failure

A 
Hepato-megaly (liver becomes enlarged)
Spleno-megaly (spleen becomes enlarged)
Ascites (fluid collection in abdomen)
JVD (jugular venous distention)
Anorexia
Anasarca (swelling of body)
edema
93
Q

hepatomegaly

A

(enlargement of the liver)

94
Q

The first step of nursing assessment for the heart

A

patient interview!

95
Q

(skip me) The ejection fraction

A

(skip me) is a measure of ventricular contractility; it is the percentage of the end-diastolic blood volume that is ejected with each heartbeat

96
Q

A normal expected EF (Ejection Fraction) is

A

55% to 65% of the ventricular volume

97
Q

The cornerstone of therapy for HF includes

A

a diuretic, a beta-blocker, and an angiotensin system blocker

98
Q

Cardiac assessment Objective data

A

Physical exam including general appearance, LOC, weight, head, neck, skin and nails, edema, blood pressure, pulse, respirations, heart sounds & lung sounds

Diagnostic data

99
Q

Cardiac assessment Subjective data

A 
Patient history
Dyspnea
Chest pain
Syncope
Palpitations
Fatigue
100
Q

S3 heart sound is an early sign that

A

increased blood volume fills the ventricle with each beat.

101
Q

Clubbing of the fingers and toes indicates

A

chronic hemoglobin desaturation and is associated with congenital heart disease.

102
Q

Prolonged capillary refill time indicates

A

inadequate arterial perfusion to the extremities

103
Q

The difference between the systolic and the diastolic pressures is called

A

pulse pressure

104
Q

Normal heart sounds:

A

S1, S2

105
Q

Abnormal heart sounds:

A

S3, S4

106
Q

S1—First Heart Sound

A

Tricuspid and mitral valve closure creates the first heart sound (S1). The word “lub” is used to replicate its sound

107
Q

S1 is usually heard the loudest at

A

the apical area

108
Q

S2—Second Heart Sound

A

Closure of the pulmonic and aortic valves produces the second heart sound (S2), commonly referred to as the “dub” sound

109
Q

S2 is a softer sound and is heard best

A

over the pulmonic area. Between 2nd and 3rd intercostal spaces left side.

110
Q

Murmurs

A

are created by turbulent flow of blood in the heart.

111
Q

An angiogram

A

is a scan that shows blood flow through arteries or veins, or through the heart, using X-rays

112
Q

Radionuclide imaging

A

is the production of images of internal body parts obtained by cameras that detect the radioactive emissions of an injection

113
Q

Lab diagnostics for the heart

A
  1. Cardiac biomarkers
  2. Lipid profile
  3. Brain B-type
  4. Electrolytes
  5. PT/PTT
114
Q

Cardiac biomarkers are

A

substances that are released into the blood when the heart is damaged or stressed

115
Q

which cardiac biomarker levels are increased during myocardial infarction

A

creatine kinase [CK],
CK isoenzymes (CK-MB),
troponin,
Myoglobin

116
Q

Lipid profile assesses

A

Cholesterol, triglycerides, and lipoproteins are measured to evaluate a person’s risk of developing CAD

117
Q

Brain (B-Type) Natriuretic Peptide (BNP)

A

is a neurohormone that helps regulate BP and fluid volume.

118
Q

The level of BNP in the blood increases as the

A

ventricular walls expand from increased pressure.

119
Q

C-Reactive Protein (CRP)

A

is a protein produced by the liver in response to systemic inflammation.

120
Q

People with high CRP levels of __X mg/L__ may be at greatest risk for CVD

A

(3 mg/L or greater)

121
Q

an elevated blood level of homocysteine is thought to indicate

A

a high risk for CAD

elevated homocysteine = bad

122
Q

high levels of lactic acid reflect

A

inadequate tissue perfusion in HF

123
Q

Cardiac stress testing:

A

are noninvasive ways to evaluate if there is myocardial ischemia and higher myocardial oxygen requirement during these tests.

124
Q

Myocardial perfusion imaging (PET)

A

determines if arterial perfusion to the heart is compromised

125
Q

Echocardiogram

A

is an ultrasound of cardiac structures and used to measure the ejection fraction

126
Q

2 types of echocardiography

A

transthoracic

transesophageal

127
Q

A significant limitation of transthoracic echocardiography is

A

the poor quality of the images produced

128
Q

transesophageal echocardiography (TEE) involves

A

threading a small transducer through the mouth and into the esophagus

129
Q

The high-quality imaging obtained during TEE makes this technique

A

an important first-line diagnostic tool for evaluating patients with many types of CVD, including HF

130
Q

Heart failure Medication Management

A 
Cholesterol lowering drugs 
Vasodilators 
Beta-blockers
Anti-platelets 
Glycoprotein IIB/IIIa receptor agonists 
Calcium channel blockers
131
Q

Cholesterol lowering drugs

A

Statins:

Atorvastatin (Lipitor)

132
Q

Vasodilators example medication

A

nitroglycerin

133
Q

Beta-blockers example and function

A

such as metoprolol

reduce myocardial oxygen consumption

134
Q

Calcium channel blockers

A

decreases the workload of the heart and slowing the HR.

135
Q

Antiplatelet medications

A

are given to prevent platelet aggregation and thrombosis

136
Q

Glycoprotein IIB/IIIa receptor agonists indicated for

A

hospitalized patients with unstable angina

Exam 3 (6 decks)

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