26 Flashcards
(134 cards)
1
Q
A
2
Q
what is the weight and size of the heart influenced by?
A
age gender body weight physical exercise heart disease
3
Q
3 layers of the heart
A
endocardium myocardium epicardium
4
Q
Blood flow through the heart
A
superior/inferior vena cave > R atrium > tricuspid valve > R ventricle > pulmonic valve > L pulmonary artery > Lungs > pulmonary veins > L atrium > mitral valve > L ventricle > aortic valve > aorta> Body https://www.khanacademy.org/science/health-and-medicine/human-anatomy-and-physiology/heart-introduction/v/flow-through-the-heart
5
Q
Diastole
A
all chambers relax allowing ventricles to fill in preparation for contraction
6
Q
systole
A
atrial and ventricular contraction
7
Q
oxygenated vs. deoxygenated blood
A
deoxygenated blood from the R side of the heart is distributed to the lungs for oxygenation then oxygenated blood is returned to the L side of the heart
8
Q
the pulsation, known as point of maximal impulse, created during normal ventricular contraction is _______ ________
A
apical impulse
9
Q
_____ ______ is inadequate O2 supply
A
myocardial ischemia
10
Q
_____ _____ ____ generates and transmits electrical impulses that stimulate contraction of the myocardium
A
cardiac conduction system
11
Q
the conduction system stimulates the atria then ventricles. this allow ventricles to fill completely before ejection which maximizes _______ ______
A
cardiac output
12
Q
electrical cells (nodal and purkinje cells) responsible for the electrical impulse of the atria and ventricle work by _________, _________, __________
A
automaticity excitability conductivity
13
Q
_______ is the ability to initiate an electrical impulse
A
automaticity
14
Q
_______ is the ability to respond to an electrical impulse
A
excitability
15
Q
_______ is the ability to transmit an electrical impulse from one cell to another
A
conductivity
16
Q
what is known as the primary pacemaker of the heart?
A
SA node
17
Q
_____ _____ are responsible for supplying arterial blood to the heart
A
coronary arteries
18
Q
electrical activation of a cell caused by influx of Na+ into the cell while K+ exits the cell is known as ___________
A
depolarization
19
Q
____ ____ ___ is a rupture of an atheromatous plaque in a diseased coronary artery
A
acute coronary syndrome
20
Q
return of cell to resting state caused by re-entry of K+ into the cell while Na+ exits is known as ____________
A
repolarization
21
Q
phases of cardiac action potential
A
phase 0- rapid depolarization of atrial and ventricular myocytes, Na+ moves out of cell through fast channels, cells of SA/AV node depolarize when Ca+ enters cell through slow channels phase 1- early repolarization as K+ exit cell phase 2- plateau phase, repolarization slows down, Ca+ enters
22
Q
phases of cardiac action potential
A
phase 3- return of resting state, completion of repolarization phase 4- resting phase before next depolarization
23
Q
_____ ______ is the time which myocardial cells must completely repolarize before they depolarize again
A
refractory period
24
Q
_____ refractory period is when the cell is unresponsive to any stimulus and incapable of depolarizing. related to phase 0 - middle of phase 3
A
effective
25
if a electrical stimulus is stronger than normal than _______ refractory period occurs and the cell may depolarize prematurely.
relative
26
early depolarization of the atrium or ventricular cause premature contractions and place the person at risk for \_\_\_\_\_\_\_\_\_\_\_\_
dysrhythmias
27
\_\_\_\_\_\_ ______ rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the sinus node and travels through the normal conduction pathway
normal sinus (Legaspi said to know this, not sure if it is on test but its located in Ch 27)
28
Characteristics of normal sinus
ventricular/atrial rate: 60-100 ventricular/atrial rhythm: regular QRS shape and duration: normal or regularly abnormal P wave: normal and consistent shape, always in front of QRS PR interval: consistent interval b/w 0.12 and 0.20 seconds P: QRS ratio 1:1
29
\_\_\_\_\_\_ ________ rapid irregular twitching of the muscular wall of the atria. common in ppl with hypertension/diabetes/structural heart disease/sleep apnea etc
atrial fibrillation
30
\_\_\_\_\_\_\_ ________ is disorganized rhythm that causes quivering of the ventricles. commonly caused by CAD and acute MI and there is no atrial activity seen on the ECG
ventricular fibrillation
31
3 or more premature ventricular complexes in a row more than 100 bpm result in a pt being unresponsive and pulseless. this is known as _______ \_\_\_\_\_\_\_\_
ventricular tachycardia
32
if a pt has absent cardiac activity with no heartbeat/pulse/ or respirations. this is known as _________ and can be fatal.
asystole
33
blood flows from an area of high pressure to low pressure and this is known as _______ \_\_\_\_\_\_\_\_\_. pressures responsible for blood flow in the normal circulation are generated during systole and diastole
cardiac hemodynamics
34
pumping action of the heart including systole and diastole is known as the ______ \_\_\_\_\_\_\_\_ and it occurs from one heart beat to the next
cardiac cycle https://www.youtube.com/watch?v=5tUWOF6wEnk
35
\_\_\_\_\_ _____ is the amount of blood pumped by each ventricle during a given period. the average is about 5 L/min in a resting adult
cardiac output
36
what can have an effect on cardiac output?
stroke volume or heart rate
37
cardiac output = stoke volume x heart rate
CO = SV x HR
38
the amount of blood ejected per heart beat is ____ \_\_\_\_\_
stroke volume
39
what is the average resting SV and HR
70 ml and 60-80 bpm
40
changes in HR are affected by reflex controls of the ______ nervous system, ______ nervous system, and ________ activity
central/ autonomic/ baroreceptor
41
\_\_\_\_\_\_\_ impulses slow the HR and _______ impulses increase the HR
parasympathetic/ sympathetic
42
how does the sympathetic nervous system increase the HR
by increased level of catecholamines and excess thyroid hormone which produces a catecholamine like effect
43
\_\_\_\_\_\_\_ specialized nerved cellls located in the aortic arch and in right and left carotid arteries
baroreceptors
44
during _________ baroreceptors increase their rate of discharge and transmit impulses to the medulla. this initiates parasympathetic activity and inhibits sympathetic activitylowering the BP and HR
hypertension
45
\_\_\_\_\_\_\_ results in less baroreceptor activity, decreases in paraysmpathetic activity and increased sympathetic activity resulting in vasoconstriction and increased HR and BP
hypotension
46
what determines stroke volume?
preload afterload contractility
47
\_\_\_\_\_ is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. the colume of blood returning to the heart increases resulting in stronger contraction and greater stroke volume
preload
48
what is preload commonly referred to?
left ventricular end diastolic pressure b/c the volume of blood w/in the ventricle at the end of diastole determines preload and directly affects stroke volume
49
The Frank Starling law (related to preload)
the greater the initial length or stretch of the cardiac muscle cells the greater the degree of shortening that occurs
50
what factors reduce preload?
diuresis nitrates excessive loss of blood dehydration
51
how can you control preload?
IV blood transfusion
52
\_\_\_\_\_\_ is resistance to ejection of blood from the ventricle, also determines stroke volume
afterload
53
systemic vascular resistance?
resistance of systemic BP to left ventricular ejection
54
pulmonary vascular resistance?
resistance of pulmonary BP to right ventricular ejection
55
\_\_\_\_\_ force generated by the contracting myocardium
contractility
56
what enhances contractility?
circulating catecholamines, sympathetic neuronal activity, and meds (digoxin, dopamine?
57
what depresses contractility?
hypoxemia, acidosis, meds (beta blockers)
58
\_\_\_\_\_ ______ is the percent of end diastolic blood volume ejected with each heart beat and is used to measure myocrdial contractility.
ejection fraction
59
ejection fraction less than 40% indicates the patient has _______ left ventricular function and should be treated for heart failure
decreased
60
barriers to seeking cardiovascular care
lack of knowledge about symptoms of heart disease symptoms belonging to a benign source denying symptoms significance embarrassment of symptoms
61
nurse duty during health history for cardiac system
nurse needs to determine if pt. and family are able to recognize symptoms of acute cardiac problems (ACS/HF)
62
common s/s of CVD
CHEST PAIN or discomfort SOB or dyspnea peripheral edema weight gain sbdominal distention palpitations vital fatigue/exhuastion dizziness syncope altered LOC
63
cadiac assessment
health history family/genetic history cultural/social factors risk factors (weight, diet, genes, ethnicity) ABC's and OLDCART
64
prodromal symptoms of ACS
symptoms: fatigue SOB sleep disturbances anxiety chest discomfort
65
what are common restriction of diets for people with cardiac problems?
low sodium, fat, cholesterol, and calories
66
why is noocturia (awake @ night to urinate) common in patients with HF?
fluid collected in the extremities during the day (edema) redistribute into the circulatory system once the pt. is recumbent at night. the increased circulatory volume is excreted by the kidneys resulting in increased urine production.
67
pts. taking meds that affect blood are screened for _____ \_\_\_\_\_ or \_\_\_\_\_\_\_
bloody urine or stools
68
which nonprescription med is commonly taken once a day that improves CAD?
aspirin
69
which sleep and rest patterns indicate worsening HF?
sleeping upright tin chair instead of bed increased number of pillows used awakening w/ SOB at night or awakening w/ angina
70
what are findings to consider in a physical cardiac assessment?
LOC mental status SOB distress size of pt skin color, temp, texture BP
71
common skin findings associated with cardiac disease
pallor peripheral cyanosis central cyanosis ecchymosis xanthelasma thinning of skin arround pacemaker or ICD cold/cool and moist skin
72
\_\_\_\_\_\_\_\_ yellowish spots or plaques along nasal portion or eye lids
xanthelasma
73
\_\_\_\_\_\_\_\_\_ is a bruise on the skin
ecchymosis
74
pulse pressure = systole / diastole
pulse pressure = systole / diastole less than 30 mm Hg needs to be further assessed
75
postural (orthostatic) hypotension
BP decrease when pt goes from sitting to standing
76
normal postural responses
increase HR of 5-20 bpm above the resting rate unchanged systolic pressure or slight decrease of up to 10 mm Hg slight increase of 5 mm Hg in diastolic pressure
77
\_\_\_\_\_\_\_\_\_ _______ is when the pulse rate is increased during inhalation and slow during exhalation
sinus arrhythmia
78
what do you do if the pulse rhythm is irregular?
auscultate apical pulse for a full minute while palpating the radial pulse at the same time
79
pulse deficit
difference between apical and radial pulse
80
when do pulse deficits commonly occur?
A fib Atrial flutter premature ventricular contractions heart block
81
pulse rating scale
0: pulse not palpable or absent 1: weak thready, difficult to palpate, disappear w/ pressure 2: diminished pulse, does not disappear (obliterate) 3: easy to palpate, full pulse, does not obliterate 4: strong bounding pulse, may be abnormal
82
S1 first heart sound
tricuspid and mitral valve closure "lub" heard loudest over apical area
83
S2 second heart sound
closure of pulmonic and aortic valve "dub" loudest over aortic and pulmonic areas
84
when you can distg=inguish between the closure of aortic and pulmonic valves it is known as ____ \_\_\_
split S2
85
S3
early is diastole lub dub DUB normal in children and adults 35-40
86
S4
late in diastole LUB lub dub
87
\_\_\_\_ ____ is when all 4 heart sound occur together resulting in LUb lub dub DUB
summation gallop
88
normally there is no sound when valves open. but diseased valves create a sound call ____ \_\_\_\_ which is abnormal diastolic sounds heard during the opening of the AV valve
opening snaps
89
\_\_\_\_ ____ is the opening of of a rigid and calcified aortic or pulmonic valve during ventricular contraction
systolic click
90
created by turbulent flow of blood _____ are described by their timing in the cardiac cycle, location on chest wall, intensity, pitch, quality, pattern of radiation
murmurs
91
a harsh grating sound that can be heard in systole and diastole is called ____ \_\_\_\_. it is caused by abrasion of the inflammed pericardial surfaces from pericarditis
friction rub
92
which positive test helps confirm the diagnosis of HF
hepatojugular reflux test
93
Lab test for cardiac system
cardiac biomarkers CK, CK-MB myoglobin troponon T and I lipid profile Brain (B type) natriuretic peptide C- creactive protein homocysteine
94
What information does a lipid profile provide?
a persons risk for artherosclerosis or to diagnose a specific lipoprotein abnormality
95
when should the blood specimen for a lip profile be obtained?
after a 12 hour fast
96
what is the normal cholesterol level
less than 200 mg/dl
97
normal levels of LDL
less than 160 mg/dl
98
LDL levels for people with CAD or diabetes
less than 70 mg/dl
99
normal range for HDL
men = 35-70 mg/dl women = 35-85 mg/dl
100
normal range of triglycerides
100-200 mg/dl
101
brain ( b type) natriuretic peptide (BNP) is a neurohormone that helps regulate ___ and ___ \_\_\_\_. it is primarily secreted from the ventricles in response to increase preload and increased ventricular pressure. this test is helpful in diagnosis HF
BP and fluid volume
102
BNP greater than ______ pg/ml suggest HF
100
103
How is homocysteine levels linked to the development of atherosclerosis?
because it can damage the endothelial lining of arteries and promote thrombus formation
104
\_\_\_\_ ____ is used to determine the size, contour, and position of the heart. it reveals cardiac and pericardial calcification, demonstrate physiologic alterations in the pulmonary circulatio, and confirms placement of pacemakers and pulmonary artery catheters
chest x ray
105
\_\_\_\_\_\_\_\_\_ is an x ray technique allowing visualization of heart on a screen and uses a moveable x ray source
flluoroscopy
106
a graphic representation of the electrical currents of the heart is done with a \_\_\_\_\_. disposable electrodes are placed on the skin of the chest wall and extremities
ECG
107
ECG recordings can be obtained by using \_\_\_\_\_. these are specific views of the electrical activity of the heart.
leads
108
\_\_ ____ \_\_\_\_ is used to diagnose dysrhythmias, conduction abnormalities, chamber enlargment, and myocardial ischmia, injury, or infarction.
12 lead ECG
109
\_\_\_ ___ \_\_\_ adds 3 additional chest leads across the right precordium and is used for early diagnosis of right ventricular and left posterior infarction
15 lead ECG
110
\_\_\_ __ \_\_\_ adds 3 posterior leads to the 15 lead and is used for early detection of myocardial ischemia and injury
18 lead ECG
111
pts who are at high risk for dysrhythmias require ____ \_\_\_ ____ which detects abnormalities in the heart rate and rhythm
continuous ECG monitoring
112
2 types of continuous ECG monitoring
hardware cardiac monitoring telemetry
113
does continuous ECG monitoring detect SOB, chest pain, or other ACS symptoms?
no so pts must report new or worsening symptoms immediately
114
what is the benefit of using telemetry ECG monitoring?
the system is wireless so pts can ambulate while one or two ECG leads are monitored
115
3 lead system vs 4 lead system vs 5 lead system
3 lead provides 3 options and 4 lead provides 6 options and 5 lead provides 7 options
116
what two leads are most often selected for continuous ECG monitoring
leads II and V1
117
applying electrodes
clean skin with soap and water clip hair (do not shave) if needed apply benzoin if pt is sweaty but not where the electrode is placed connect electrodes to wire prior to placing them on the chest make sure center of electrode has gell apply electrode with pressure change electrodes ever 24-48 hrs
118
\_\_\_\_\_ electrocardiography is used during outpatient and pt. wears it for 24 hours and keeps a diary noting the time and symptoms occurs
ambulatory
119
\_\_\_\_\_\_ monitoring is ECG monitoring where the pts is home and placesa telephone mouthpiece over the transmitter box
transtelephonic
120
wireless mobile cardiac monitoring can monitor a pt ____ \_\_\_\_ \_\_\_\_\_\_
24 hours 7 days a week
121
\_\_\_\_ ____ \_\_\_ is a non invasive way of evaluating the response of the cardiovascular system to stress
cardiac stress test
122
what does the cardiac stress test help determine?
CAD cause of chest pain functional capacity of heart after MI or heart surgery effectiveness of meds dysrhythmias during exercise goals for physcial fitness program
123
how long should a pt fast before a stress test
4 hours before
124
\_\_\_\_\_\_\_\_\_ is a ultrasound test used to measure ejection fraction and examine the size/shape/motion of the cardiac structures
echocardigraphy
125
\_\_\_\_\_\_\_\_\_\_ echocardiography requires threading a small transducer through the mouth and into the esophagus
transesophageal
126
\_\_\_\_\_\_ __________ is an invasive procedure which catheters are introduced into blood vessels of the heart to measure pressure and O2 sat
cardiac catheterization
127
assessment prior to cardiac catheterization
allergies (specifically to iodine) blood work (hematocrit, HG, BUN, creatinine, INR, PT, aPTT, platelet count, electrolytes)
128
how long do outpatients have to be on bed rest after cardiac catheterization before they can ambulate?
2-6 hours
129
\_\_\_\_\_\_ is a technique which a contrast agent is injected into the vascular system to outline the heart and blood vessels
angiography
130
Assessment for a pt post procedure of cardiac catheter
Circulation Potential for bleeding and dysrhythmias Activity restrictions b/c of bleeding
131
\_\_\_\_\_\_\_\_\_ is a measurement of the pressure in the vena cava or R atrium or preload
Central venous pressure monitoring (CVP)
132
What is the most common problem that cause elevated CVP?
Hypervolemia or R sided HF
133
\_\_\_\_ ____ pressure monitoring is used in critical care for assessing left ventricular function, diagnosing shock and evaluating the pts response to medical interventions
pulmonary artery
134
\_\_\_\_\_\_\_\_\_\_\_ blood pressuring monitoring is used to obtain direct and continuous BP measurements in critcally ill pts who have severe hypertension or hypotension
intra-arterial
