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NSG 2202 > Stressors to Coronary Circulation Part 1/Test 2 > Flashcards

Stressors to Coronary Circulation Part 1/Test 2 Flashcards

1
Q

What is the order of the circulation of the heart?

A 
Venous capillaries
Veins
Heart
Arteries
Arterioles
Arterial capillaries
Venules
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2
Q

Purpose of the heart

A
  • returning oxygen poor blood from body to right heart
  • Pumped into lungs
  • Exchanged for oxygen rich blood returning to Left heart
  • Pumped into systemic circulation
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3
Q

Heart structures

A

-2 pumps
–R-pulmonic circulation
–L- systemic circulation
4 valves
–AV- Mitral & Tricuspid
–SL- Pulmonic & Aortic
3 Layers
–Epicardium
–Myocardium
–Endocardium
Electrical system

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4
Q

Conduction system

A
  • An electrical impulse is initiated by the SA node, which is the hearts pacemaker (intrinsic rate of 60-100 bpm); this causes depolarization of the cells & contraction of the atria
  • It then travels to the AV node (intrinsic rate 40-60 bpm) and moves through the bundle of His & the left right bundle branches
  • The action potential diffuses widely through the walls of both ventricle by means of the Purkinje fibers (intrinsic rate of 20-40 bpm), triggering ventricular contraction
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5
Q

Right and left branch off the aorta

A

Grip the heart and feed from the surface inward. They dilate with exercise

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6
Q

Functioning of circulation depends on

A
  • Pump
  • Electricity
  • Volume
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7
Q

Oxygenation: Decreased cardiac output=

A

Ineffective tissue perfusion which leads to Impaired gas exchange which leads to Activity intolerance= Hypoxia

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8
Q

Cardiac output=

A

Heart rate x Stroke volume

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9
Q

Ejection Fraction

A

Percentage of blood ejected from the heart during systole- 60-80% normal

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10
Q

Preload

A

The degree of fiber stretch at the end of diastole- determined by volume returning to the heart.

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11
Q

Afterload

A

The pressure or resistance the ventricles must overcome to eject blood through the SL valves

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12
Q

PVR or SVR

A

Resistance of the arterial walls. If B/P is increased-PVR is decreased

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13
Q

Neuro Regulation: Sympathetics

A

Stimulate Alpha 1-peripheral

Beta 1- Cardiac

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14
Q

Neuro Regulation: Parasympathetic

A

Inhibits valves

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15
Q

Neuro Regulation: Receptors in aortic and carotid

A

Stretch sensitive, acid and oxygen sensitive. When stretched by volume, B/P is high

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16
Q

Cardiac Regulation

A

The autonomic nervous system consists of the sympathetic nervous system and the parasympathetic nervous system.

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17
Q

Parasympathetics

A

Receptor are muscarinic and are located in smooth muscle; activation (as in vagal stimulation) causes decreased HR ans slower conduction

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18
Q

Sympathetics

A

Increase HR , speed of impulse conduction and the force of contractions a (in heart)- increased contractility a (in smooth muscle)- vasoconstriction. B (in heart)- increased HR, increased conduction, increased contractility. Dopaminergic (located in coronary, renal, mesenteric, and visceral vessels)- increased dilation.

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19
Q

Cardiac regulation/Hormonal response- Angiotensin

A

as CO decreases, kidneys release renin= angiotensinogen which causes vasoconstriction (increased BP) and release of aldosterone

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20
Q

Cardiac regulation/Hormonal response- Aldosterone

A

Causes Na+ retention, which makes body retain water to increase blood volume to increase CO

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21
Q

Cardiac regulation/Hormonal response- Antidiuretic Hormone

A

hold unto urine, so volume increases

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22
Q

Circulation assessment basics:

A 
BP
---normal 120-80
---HTN- >139/89
---Hypotension- <90/60
HR
---normal rate & regularity
---tachycardia
---bradycardia
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23
Q

Sound heard when valves close:

A

S1/S2

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24
Q

S1 lub closure of

A

Mitral and Tricuspid

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25
Q

S2 dub closure of

A

Aortic and Pulmonic

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26
Q

Extra Sounds:

A

Gallops S3 S4

27
Q

S3

A

Early filling phase

28
Q

S4

A

Late filling phase

29
Q

Pericardial rub

A

Inflammation of visceral and pericardial sack

30
Q

Murmurs

A

Incompetent valves- swoosh

31
Q

Murmur: Systolic

A

Closure of aortic and pulmonary

32
Q

Murmur: Dyastolic

A

Closure of mitral and tricuspid

33
Q

Assessment of peripheral arteries

A 
Pulses: Location Head/toe
Quality of grading +1 +2 +3
color
movement
sensation
claudication
presenceof edema
document
34
Q

Assessment and aging

A 
HR
BP
Heart size
Conduction
Vessels
Decreased reserve
35
Q

Assessment/aging

A 
Fatigue
Fluid retention
Irregular heartbeat
Dyspnea
Pain
Calf tenderness 
Syncope
Neuro changes
Leg pain
36
Q

Risk factors: Modifiable

A

Habits- smoking, diet, weight, exercise, coping w/stress
Increased cholesterol
HTN
Increased BG

37
Q

Risk factors: Nonmodifiable

A

Age
Gender
Presence of DM/Disease
Family

38
Q

Diagnostics for coronary circulation

A

Cholesterol
Lipids, LDL, HDL, Triglycerides, CK-MB, Troponin, Echocardiagram, TEE, Stress test, Angiography, Coag panel, INR, EKG 12 lead, BNP, Potassium, Chest xray, ABG’s, CBC

39
Q

Diagnostics: Serum studies-lipid studies

A

LDL’s-bad ones-CAD s- good ones- great if elevated
Total cholesterol- keep 140-200
Triglycerides- keep 40-190

40
Q

Diagnostics: Isoenzyme

A

CKMB >5-6% positive for MI

41
Q

Diagnostics: Troponin

A

2.3 positive for MI

42
Q

Brain Natriuretic Peptide

A

Used with symptoms of CHF
Differentiates cardiac from pulmonary causes of dyspnea
0-100 pg/ml normal
100-400 patient should respond well to treatment
>400 will be more difficult and take longer for positive response

43
Q

Coagulation

A 
Normal values
Pt- 11-13 seconds
PTT- 25-32 seconds 
INR usually <1
Platelets 150-400 thousand
44
Q

PT control

A

1 1/2-2 times Coumadin

45
Q

PTT control

A

1 1/2- 2 1/2 times- Heparin

46
Q

INR

A

2.-3.0 Coumadin If mechanical valve patient then 2.5-3.5

47
Q

Diagnostics Echocardiogram

A

US checks fluid movement through the heart, valve function, ejection fraction

48
Q

TEE

A

Invasive-see posterior wall of heart, can identify and clots that develop with Afib

49
Q

Reversal of coumadin

A

Vit K and aquamafitin

50
Q

With a TEE you can see

A

the posterior wall of the heart and identify any clot formation as well

51
Q

It’s important to check for clots before cardioversion because

A

You don’t want to break the clot loose

52
Q

For cardioversion, pt needs to be

A

NPO for 4-6 hrs before and will remain NPO until gag reflux returns

53
Q

MUGA Scan

A

Stands for multi-unit gated analysis
A gated pool scan that uses radioisotope dye to show how blood pools in your heart during rest, exercise, or both
Also good for EF

54
Q

Stress test

A

Exercise- Thallium

Chemical- Adenosine

55
Q

Vessels should _____to give extra cardiac output needed during exercise

A

Dilate

56
Q

For stress test patient needs to

A 
be NPO or clear fluids
Wear good walking shoes
Baseline VS 
attached to telemetry
should report pain, SOB, dizzyness
staff monitor for changes in heart rhythm, ie PVCs, and other symptoms of decreased CO
57
Q

Cardiac cath post procedure

A

Assess VS, distal pulse, site q15m x 4 then q30 min x2, then qh x 4, or protocol given by MD, keep flat for several hours as ordered , minimum 15-30 degree elevation while eating.

Let finish at least 1 liter of IV fluids to help rid body of dye and its hyperosmotic effect
Report any changes
keep on telemetry
if no problems discharge teaching

58
Q

Complications of Cardiac cath

A

dysrhythmias
hemmorrhage
thrombus formation
infection

59
Q

Angioplasty

A

Cath with inflatable balloon on tip to flatten the plaque

60
Q

Stent insertion

A

do angioplasty

after angioplasty insert the stent to keep the vessel open

post procedure- follow the basic cardio cath protocol

61
Q

Venography

A

Evaluates for DVT’s. Dye injected into the venous side and traced with flouroscopy

62
Q

D= Dimer blood test

A

Assess for increased fragmin = DVT

63
Q

Doppler US

A

detects reflection of increased RBC’s in arteries and veins, produces a wave form or audible sound =DVT

64
Q

CVP

A

(5-11 mm Hg) done with central line in place. Tells you volume without being super invasive

NSG 2202 (22 decks)

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