Unit 3 exam Flashcards
4 determinants of cardiac output
- Heart rate
- Preload
- Afterload
- Contractibility
The number of cardiac contractions per minute. Can be affected by many variables depending on pressure.
Heart rate
increases HR by releasing norepinephrine
Positive chronotropic effect
decreases HR by releasing acetylcholine
Negative chronotropi effect
- Directly related to stroke volume.
- The amount of blood in the ventricles at the end of diastole.
- Also refers to the amount of stretch of the muscle tissue at the end of filling.
Preload
- Inversely correlated to stroke volume.
- The resistance to flow the ventricle must overcome to open the semilunar vlalves and eject its contents.
- This is related to bp, vessel lumen diameter and or vessel compliance.
Afterload
A increased after load causes what?
Decreased stroke volume and decreased cardiac output
A decreased afterload causes what?
Increased stroke volume and increased cardiac output
- The force of the mechanical contraction.
- Contractile force can be increased with sympathetic stimulation or calcium release.
- It can be decreased in the face of hypoxia or acidosis
Contractability
What can cause a decrease in contractability
Hypoxia or acidosis
Formula for calculating cardiac output
Heart rate X Stroke volume = Cardiac output
Normal cardiac output in a healthy adult
4-7 L/min
How does exercise or activity affect cardiac output?
Increases it
How does rest/sleep affect cardiac output
Decreases it
Labs associated with CV disease
- Lipid panel
- CPK
- Troponin
- Myoglobin
- BNP
Age related cardiovascular changes
- Atrophy of left ventricle
- Decreased elasticity of aorta
- Valce rigidity
- Stenosis of heart valances
- Stiffening vessels
- Increase fibrotic changes
- Atheroscopic plaques
- Narrowing vessel walls
1 cause of death in older adults
Heart disease
Altherosclerotic plaques cause what? Which increases the risk for what?
- Narrowing of vessel walls
- Increased risk for clots and CVA
Increased fibrotic changes cause what?
HTN
List things that cause alterations in perfusion
- Early menopause
- Clotting disorders
- Congenital cardiac defects
- CAD
- MI
- Dysrhythmias
- Heart failure
- This causes alterations in perfusion.
- This condition causes the circulation of blood to be slowed d/t shifting hormones
Early menopause
- This condition causes alterations in perfusion
- Perfusion is interuppted when it encounters clots or active bleeding
Clotting disorders
- This condition causes alterations in perfusion
- Causes abnormal blood flow through the heart or obstructs blood in the heart or vessels
confenital cardiac deffects
- This condition causes alterations in perfusion
- plaque builds up causing restricted blood flow
CAD
- This condition causes alterations in perfusion
- A clot or severely obstructed blood flow occurs.
- Tissue becomes ischemic
MI
- This can cause an alteration in perfusion.
- Can be associated with myocardial automaticity, conductivity, or contractability which effects cardiac output.
Dysrhythmias
- This causes alterations in perfusion
- The pumping function of the heart is not working causing a back up of blood in the heart which causes fluid build up in the lungs and legs
Heart failure
Diagnostic tests for CV disease
- CHXR
- ECHOcardiography (ECHO)
- Cardiac stress test
- Cardiac catheterization
- Ejection Fraction
- Coronary angiography
- EKG
Name this type of cardiac testing
- Assess electrical conduction system
- Graphic recording of the hearts electrical activity
- ID’s dysrhythmias, old or new heart damage, electrolyte abnormalities, cardiac hypertrophy
EKG
What type of cardiac testing is this?
Left sided cardiac catheterization with purpose of inspecting the coronary arteries for blockage and determining the necessity of revascularization procedures such as Coronary bypass surgery or percutaneous coronary intervention.
Coronary angoigraphy
- Measurement of how much blood your heart is pumping out with each contraction
- Indicator of heart function
- Described as a percentage
- Healthy level 55-65%
Ejection fraction (EJF)
Normal ejection fraction
55-65%
What type of cardiac testing is this?
- Invasive X-ray procedure
- Evaluates cardiac filling pressure, CO, and valve functions
- Studies can be done on both sides of the heart
Cardiac catheterization
What type of heart cath is this?
- cath can be done through femoral , brachial or subclavian vein
- Catheter advanced to the right heart via the inferior or superior vena cava
Right heart cath
What type of cardiac cath is this?
- cath can be done through femoral , brachial , or radial artery
- Catheter advanced up through the aorta into the left heart.
Left heart cath
What type of cardiac testing is this?
- done to evaluate heart functioning during times of increased workload.
- To evaluate the functional ability of the heart.
- Can also be used as a screening tool for symptoms of CV disease that are only apperent when heart is stressed.
Cardiac stress test
What type of cardiac stress test is this?
on tread mill or bike
Regular stress test
What type of stress test is this?
chemical stress test is done if patient is unable to exercise d/t physical limitations
Isotope (nuclear) stress test
What type of cardiac testing is this?
Uses ultrasound to provide information on the size and pumping function of the heart, blood-volume status, and valve function and integrity. The ultrasound waves are converted to a picture, which can be evaluated
ECHOcardiography or ECHO
What kind of ECHO is this?
Performed by placing a transducer on the patients chest
Transthoracic ECHOcardiography
or
TTE
What type of ECHO is this?
Performed by placing a transducer in the patients esophagus
Transesophogeal ECHOcardiography
or
TEE
What type of cardiac testing is this?
- Provides info about (size , shape and position of heart)
- Cannot diagnose heart disease
- Highlight complications such as cardiac enlargement or pulmonary congestion
Chest X-ray
When body tissues do not receive enough blood and oxygen
ischemia
When cells begin to die when they do not receive enough blood and oxygen to maintain cellular functions
Necrosis/infarct
Possible revascularization procedures
- Percutaneous coronary intervantion
- Coronary Artery Bypass Graft (CABG)
How long should a patient remain on flat bedrest post cardiac cath? and why?
2-6 hrs to prevent stress on insertion site that can cause bleeding.
Post-cardiac cath, what are you observing the insertion site for?
Bleeding or hematoma formation
Post cardiac cath, what should you monitor peripheral pulses for?
Color and temp in affected extremity
The contrast dye used in cardiac catheterization affects the kidneys so what needs to be monitored?
Urine output
The contrast dye used in cardiac catherization affacts the kidneys, so what needs to be done to prevent kidney damage post cardiac cath?
Maintain sufficient oral and/or IV fluid intake to ensure renal clearance of the dye and to maintain adequate hydration status
Pre-procedure teaching for patients undergoing a cardiac cath
- Fasting 6 to 8 hours prior to procedure
- Expected duration of procedure
- Expect IV insertion and sedation
- Tell them to expect “hot flash” as the dye is injected or palpitations if dysrhythmias occur
- Maintaining adequate fluid intake after the procedure
- Avoiding strenuous activity until your provider gives the OK to resume normal activities
- Monitoring cannula insertion site for bleeding
Pre procedure care for a patient undergoing a cardiac cath
- Establish baseline vital signs
- Review blood work focusing on renal studies
- Complete pre-procedure checklist that includes obtaining height and weight and ensuring patient has been NPO
- Administer pre-procedure hydration
- Check glucose levels while NPO
- Anticipate holding diabetic medications
Intraprocedure nursing interventions for a cardiac cath patient
o Psychological support of the patient during the procedure to help ease fears
o Vigilant cardiac monitoring during the procedure to observe for dysrhythmias
o Readiness and ability to respond with advanced cardiac life-support interventions should a lethal dysrhythmia occur
If a patient who just had a cardiac cath dispays weakness, confusion, or slurred speech what could this indicate?
a stroke
- chest pain triggered by some type of exertion i.e. stress, exercise, etc.
- Predictable (each time you work out super hard, you get some chest pain)
- Lasts a short time, 5 min or less
- Resolves itself
Stable angina
sometimes called predictable angina
- Chest pain that may not have a trigger
- Medical emergency
- Unpredictable
- Occurs at rest
- Continues despite resting
Unstable angina
Unstable angina can preced what?
MI
Life’s simple 7 strategies
- No smoking of cigarettes or other tobacco products
- Maintain a normal body weight
- Exercise for at least 150 minutes with moderate-intensity activity, or 75 minutes of vigorous-intensity activity, or a combination of each per week
- Eat a healthy diet that follows the current American Heart Association recommendations.
- Maintain total cholesterol level less than 200 mg/dL
- Keep BP less than 120/79 mm Hg
- Keep fasting blood glucose less than 100 mg/dL
Primary risk factor for dysrhythmias
AGE
