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Nursing 172 > Week 7: Chp 28: Assessment of Cardiovascular Function > Flashcards

Week 7: Chp 28: Assessment of Cardiovascular Function Flashcards

1
Q

Major Risk Factors for Cardiovascular Disease (CVD)

A
  • family history of CVD
  • diabetes mellitus
  • chronic renal disease
  • hypertension
  • hyperlipidemia
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2
Q

Nonmodifiable risk factors for CVD

A

demographic data: age, sex, ethnic background

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3
Q

Modifiable risk factors for CVD

A
  • weight
  • dietary habits (consumption of fats and sodium)
  • alcohol consumption
  • smoking history
  • sedentary lifestyle
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4
Q

Significant complaints pertinent to heart disease

A
  • presence of chest pain
  • difficulty breathing (dyspnea)
  • cough
  • palpitations
  • edema
  • fatigue
  • syncope
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5
Q

Palpitations ae indicative of what?

A

abnormal heart rhythms or dysrhthmias

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6
Q

Syncope is indicative of what?

A

decreased cardiac output resulting from problems with either the mechanical or electrical properties of the heart

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7
Q

Blood Pressure Stages

A 
Normal: SBP <120, DBP <80
Pre-hypertensive: SBP 120-129, DBP <80
Stage 1: SBP 130-139, DBP 80-89
Stage 2: SBP >140, DBP >90
(based on average of two or more readings found two or more times on examination)
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8
Q

Inspection

A

is done to assess color, capillary refill time, edema, presence of absence or jugular vein distension, and clubbing of fingers or toes

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9
Q

Inspection: Cyanosis

A

poor perfusion produces a pale gray or bluish color

  • in dark-skinned people, cyanosis appears gray
  • can be central or peripheral
  • central cyanosis appears as blue coloring in the mucous membranes, lips, and tongue.; usually caused by impaired heart or lung function
  • peripheral cyanosis, or blue discoloration of the extremities, can be caused by heart or lung failure but may also indicate peripheral vasoconstriction or obstruction
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10
Q

Inspection: Capillary refill time

A

a return to color within 3 seconds indicates adequate peripheral circulation
-sluggish return may indicate arterial spasm or insufficiency

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11
Q

Inspection: Edema

A

may be a sign of cardiac or liver issues

  • Bilateral lower extremity edema, if not associated with a local injury, indicates venous insufficiency or heart failure
  • Unilateral extremity edema, if not associated with a local injury, can indicate a venous or lymphatic obstruction
  • identified as pitting or non-pitting; pitting is characterized by an indenting of the skin that remains after pressure has been applied then released
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12
Q

Inspection: Distension of jugular veins

A

may be present in a patient with a constrictive disease such as pericarditis or cardiac tamponade

  • also seen in patients with right ventricular failure, valvular disease, or hypervolemia
  • often associated with poor contractile function of the heart that is present in heart failure
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13
Q

Palpation

A

assessment of skin temperature and pulses

  • adequate cardiac output produces warm skin temperatures
  • cool or cold temperatures may indicate vasoconstriction, heart failure, or shock
  • pulses usually palpated are radial and dorsalis pedis pulse
  • strong, palpable pulses indicate adequate cardiac output and good flow through the peripheral vessels
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14
Q

Auscultation

A

assessment of heart and lung sounds

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15
Q

Heart Sounds

A
  • “lub”, “dub”
  • first heart sound, S1, “Lubb”, is the closing of the AV valves. signifies the beginning of ventricular systole
  • second heart sound S2, “Dubb”, is the closing of the semilunar valves. signifies the beginning of diastole
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16
Q

Systolic Murmur

A

caused by valvular disease such as aortic stenosis

-turbulent flow heard

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17
Q

Diastolic Murmur

A

caused by valvular disease such as aortic or pulmonic regurgitation
-turbulent flow heard

18
Q

Click

A
  • caused by mitral valve stenosis

- high-pitched sound

19
Q

Friction Rub

A
  • caused by pericarditis

- harsh, scratching sound

20
Q

Lung Sounds

A
  • give an indication of both lung and cardiac health

- auscultation of rales, rhonchi, or rubs in the lung fields indicate the presence of fluid

21
Q

Laboratory Markers as Predictors of Heart Disease: Lipid Panel

A

includes:

  • total cholesterol
  • low-density lipoproteins (LDLs)
  • high-density lipoproteins (HDLs)
  • triglycerides
22
Q

Cholesterol

A

lipid necessary for the synthesis of hormones and cell walls

  • available through ingestion of animal products (e.g. meat) and through synthesis in the liver
  • not soluble in blood, so it combines with proteins to form lipoproteins, LDLs and HDLs, to facilitate transport through the vascular system
23
Q

Low-Density Lipoproteins (LDLs)

A

primarily transport cholesterol into the cell but can also deposit it on the walls of the arterial vessels

  • normal values: < 100 mg/dL
  • elevated levels, greater than 100 mg/dL, are associated with an increased risk of heart disease
24
Q

High-Density Lipoproteins (HDLs)

A

protective lipoproteins

  • transport cholesterol away from the cells to the liver for excretion
  • normal: > 40-60 mg/ dL
  • decreased levels, less than 40-60 mg/dL, are a risk factor for heart disease
25
Q

Total Cholesterol

A
  • includes both LDLs and HDLs
  • normal levels: 200 mg/dL or less
  • increased levels at risk for atherosclerotic vessel disease
26
Q

Triglycerides

A
  • lipid
  • store unused ingested calories in fat cells, which may be later released as an energy source between meals
  • normal: less than 150 mg/dL
  • elevated levels, greater than 150 mg/dL, are another risk factor for heart disease
27
Q

Non-specific predictor markers

A
  • glucose
  • homocysteine
  • c-reactive protein
  • coagulation studies
28
Q

Non-specific marker: Glucose

A
  • diabetes and hyperglycemia are major risk factors for CVD

- normal: 65-99 mg/dL

29
Q

Non-specific markers: homocysteine

A

an amino acid

  • increased homocysteine is a risk factor for heart disease
  • can damage the lining of arterial walls, causing clot formation
  • decreased dietary intake of folic acid and B vitamins is associated with increased levels of homocysteine
30
Q

Non-specific markers: homocysteine

A

an amino acid

  • increased homocysteine is a risk factor for heart disease
  • can damage the lining of arterial walls, causing clot formation
  • decreased dietary intake of folic acid and B vitamins is associated with increased levels of homocysteine
  • normal: 4.4-10.8 mm/L
31
Q

Non-specific Markers: C-reactive Protein

A
  • not specific for cardiac disease but used in conjunction with other laboratory tests
  • elevated levels reflect increased production of C-reactive protein in the liver secondary to systemic inflammation; inflammation is implicated in the development of atherosclerosis
  • normal levels: 0 (only present when inflammation is present)
32
Q

Non-Specific Markers: Coagulation studies

A

obtained for screening purposes

  • increased platelet and fibrinogen levels are correlated with an increased risk of atherosclerotic heart disease
  • prothrombin time, partial thromboplastin time, and international normalized ratio are measured in patients with increased clot formation, such as patients with atrial fibrillation
33
Q

Nursing Implications: Lipid Panel Lab Test

A

-lipid panel requires the patient to fast for approximately 8 to 12 hours prior

34
Q

Coagulation Studies

A
  • Platelets: 150,000-400,000 mc/L
  • Fibrinogen Levels: 200-400 mg/dL
  • Partial Thromboplastin Time (PTT): 25-35 seconds
  • Prothrombin Time: 10-13 seconds
  • International Normalized Ratio (INR): <2.0
35
Q

Laboratory Markers of Acute Cardiac Damage or Injury

A

include enzymes or proteins that are elevated in response to cellular injury

  • Creatinine Kinase myocardial bands (CK-MB)
  • Troponin
  • Myoglobin
  • Brain natriuretic peptide (BNP)
36
Q

Creatinine Kinase (CK)

A

general marker of cellular injury

-released from cells in the brain, skeletal muscle, and cardiac tissue after muscle damage has occurred

37
Q

Creatinine Kinase myocardial bands (CK-MB)

A

isoenzyme of CK

  • marker specific to cardiac tissue
  • when myocardial damage occurs, CK-MB is released from the cells
  • increased levels can be seen at 3 hours after myocardial damage and can remain elevated for up to 36 hours before returning to normal
  • normal: 0-3 ng/mL
38
Q

Troponin

A

specific marker of cardiac muscle damage and is the preferred method for diagnosing cardiac injury

  • protein released from damaged tissue and can elevate within 4 hours of injury
  • stay elevated for up to 10 days
  • because it stays elevated longer than CK-MB, it is a valuable marker when attempting to diagnosis injury in the recent past
  • normal: less than 0.4 ng/mL
39
Q

Myoglobin

A
  • protein released and elevated in muscle damage but is not specific for cardiac tissue
  • be used in conjunction with other values
  • normal: 0-85 ng/mL
40
Q

Brain Natriuretic Peptide (BNP)

A

released from overstretched ventricular tissue

  • physiological responses to increased BNP include venous dilation which decreases preload, arterial dilation, which decreased afterload, and diuresis
  • elevations are indicative of heart failure
  • normal: less than 100 pg/mL
41
Q

Nursing Implications for Laboratory Tests

A
  • obtaining CK, CK-MB, and troponin is primarily associated with the timing of the blood draws
  • when a patient is evaluated for acute injury, laboratory tests are obtained at baseline and then at regular intervals (typically 3 to 4 hours) for approximately 12 hours

Nursing 172 (120 decks)

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