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Medsurg 2.0: Exam 1 > Assessment Of The Cardiovascular System > Flashcards

Assessment Of The Cardiovascular System Flashcards

1
Q

Overview of Anatomy and Physiology

A
  • Three layers: endocardium, myocardium, epicardium
  • Four chambers: Right atrium and ventricle, left atrium andventricle
  • Atrioventricular valves (AV valves): tricuspid (right) and mitral (left)
  • Semilunar valves: aortic and pulmonic
  • Coronary arteries
  • Cardiac conduction system (electrophysiology)
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2
Q

Anatomy of the Heart

A
  • There’s a difference in thickness between atrium and ventricles because atrium doesn’t have to work as hard because blood flows down into ventricles
  • Left ventricle is bigger because it has to push blood to body
  • Right ventricle could be big because of increased pulmonary pressure
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3
Q

Pericardium

A
  • Double-walled sac that encloses the heart. (Two layers)
  • Serves as support and protection
  • Pericardial fluid is found between the layers of the pericardium
  • Minimizes friction of the layers as they rub together with each heartbeat
    — A little fluid is fine but too much can be an issue
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4
Q

Heart Chambers

A

Right atrium
- Receives deoxygenated blood from the body; delivers blood to right ventricle
Right ventricle
- Pumps blood to the lungs for oxygen
Left atrium
- Receives oxygenated blood from the lungs, delivers blood to the left ventricle
Left ventricle
- Pumps blood out to the entire body

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5
Q

Heart Valves

A
  • Open and close based on changes in pressure
  • Open only in the direction of blood flow
  • Closure is responsible for the sounds made by the beating heart.
  • S1: closure of mitral and tricuspid valve (AV valves)
  • S2: closure of the semi-lunar valves (aortic and pulmonic valves)
  • Between S1 and S2 the heart is contracted sending blood to the body (systole)
  • Between S2 and S1 the heart is at rest and filling with blood (diastole)
  • During diastole the coronary arteries are being purfused because they couldn’t perfuse when its contracted
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6
Q

Semilunar valves

A

Pulmonic valve
- Located between right ventricle and pulmonary artery
Aortic valve
- Located between left ventricle and aorta

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7
Q

Atrioventricular (AV) valves

A

Tricuspid valve
- Located between right atrium and ventricle
- Has three cusps
Mitral valve
- Located between left atrium and ventricle
- Has two cusps

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8
Q

Coronary Arteries

A
  • Perfused during diastole when coronary vascular resistance is minimized
  • Mean arterial pressure (MAP): 60 minimum maintains perfusion of organs like the kidneys and the brain
  • Need to Know:
    — Right main coronary
    — Left main coronary
    — Left anterior descending (LAD) coronary artery
    — Circumflex coronary artery
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9
Q

Heart Cells

A

Contractile cells
- Cause the heart to contract
Conduction system cells
- Create and conduct impulses to regulate the cardiac cycle
- Nodal cells and Purkinje cells
— Automaticity: ability to initiate an electrical impulse
— Excitability: ability to respond to and electrical impulse
— Conductivity: ability to transmit an electrical impulse from one cell to another

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10
Q

Cardiac Conduction System: Electrophysiology

A

Photo: the branch connecting to the Left Atrium: Bachmann’s bundle/ branch

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11
Q

Which of the following is the primary pacemaker for
the myocardium?

A

Sinoatrial node

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12
Q

What is known as the gatekeeper of the hearts electroconduction system?

A

The AV node

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13
Q

Cardiac Action Potential

A
  • Depolarization: electrical activation of cell caused by influx of sodium into cell while potassium exits cell
  • Repolarization: return of cell to resting state caused by reentry of potassium into cell while sodium exits
  • Refractory periods:
    — Effective refractory period: phase in which cells are incapable of depolarizing
    — Relative refractory period: phase in which cells require stronger-than-normal stimulus to depolarize
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14
Q

Refractory Periods

A

Absolute
- No stimulus can cause depolarization.
Relative
- Strong stimulus can cause depolarization.
Supernormal period
- Even a weak stimulus can cause depolarization.
- Cardiac cell is “hyper.”

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15
Q

4 stages of the cardiac cycle

A
  • Refers to the events that occur in the heart from the beginning of one heartbeat to the next
  • Number of cycles depends on heart rate
  • Each cycle has three major sequential events:
    — Diastole
    — Atrial systole
    — Ventricular systole
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16
Q

Mechanical Properties of the Heart: heart rate

A
  • Heart rate- number of times the ventricles contract each minute
  • Controlled by Autonomic Nervous System
    — Sympathetic Nervous System
    —- Fight or flight: speeds up HR; digestion slows
    — Parasympathetic Nervous System
    —-Vagus nerve slows the HR; increases digestion
17
Q

Mechanical Properties of the Heart:
Cardiac output (CO)

A
  • Amount of blood pumped from left ventricle per minute determined by Heart rate × Stroke volume.
  • Tells what amount of blood flow goes into systemic circulation.
  • Normal is 4-7 liters per minute
18
Q

Mechanical Properties of the Heart:
Stroke Volume

A
  • the amount of blood ejected by left ventricle during each contraction
  • Average resting stroke volume is 60-130 mL with each contraction
19
Q

Influencing Factors on Cardiac Output

A
  • Control of heart rate
    — Autonomic nervous system, baroreceptors
  • Control of stroke volume
    — Preload: Frank–Starling Law: stroke volume of the heart increases in response to the volume of blood in the ventricles before contraction; due to the increased stretch
    — Afterload: affected by systemic vascular resistance (SVR) (BP), pulmonary vascular resistance
    —- Infection: vasodiated/ low BP
20
Q

Mechanical Properties of the Heart:
Preload

A
  • degree of myocardial fiber stretch at end of diastole just before contraction.
  • determined by the amount of blood returning to the heart from both the venous system (right heart) and the pulmonary system (left heart)
21
Q

Mechanical Properties of the Heart
Afterload

A
  • pressure or resistance ventricles overcome to eject blood through semilunar valves and into peripheral blood vessels.
  • resistance is directly related to arterial blood pressure and the diameter of the blood vessels.
22
Q

Mechanical Properties of the Heart:
Myocardial contractility

A
  • force of cardiac contraction independent of preload
  • increased by sympathetic stimulation, calcium release, and positive inotropic drugs.
  • decreased by hypoxia, acidosis, certain medications such as Beta –adrenergic blocking agents such as Metoprolol
  • Normal pH: 7.35 - 7.45
  • acidosis: <7.35
23
Q

Assessment of the CV System

A
  • Health history
  • Common symptoms
  • Chest pain/discomfort
  • Pain/discomfort in other areas of the upper body
  • SOB/dyspnea
  • Peripheral edema, wt gain, abd distention
  • Palpitations
  • Unusual fatigue, dizziness, syncope, change in LOC
24
Q

Past Health, Family, and Social History

A
  • Medications
  • Nutrition
  • Elimination
  • Activity, exercise
  • Sleep, rest
  • Self-perception/self-concept
  • Roles and relationships
  • Coping and stress
  • Are your parents alive/ have they had any cardiac problem
25
Q

Physical Assessment of CV System

A
  • General appearance
  • Skin and extremities
  • Pulse pressure
  • Blood pressure; orthostatic changes
  • Arterial pulses
  • Jugular venous pulsations
  • Heart inspection, palpation, auscultation
  • Assessment of other systems
26
Q

Risk Factors Non-Modifiable: Can’t change

A
  • Age
  • Gender; males and post menopausal women
  • Race
  • Family history; gene mutations
27
Q

Modifiable Risk Factors: Can change

A
  • Hyperlipidemia: high cholesterol
  • Smoking
  • Hypertension
  • Diabetes
  • Physical Inactivity/Obesity
  • Metabolic Syndrome: 3 or more of the above
28
Q

The nurse understands that which assessment finding is the best indicator of fluid retention?

A

Weight gain

29
Q

Cardiac Laboratory Tests

A
  • Cardiac biomarkers
    — CK-MB: CK isoenzymes
    — *Troponin T & I proteins: marker for heart attack; faster to look at
  • Blood chemistry, hematology, coagulation
  • Lipid profile
  • Brain (B-type) natriuretic peptide: enzyme heart releases during heart failure
  • C-reactive protein: inflammation
  • Homocysteine
30
Q

Electrocardiography

A
  • 12-lead ECG
  • Continuous monitoring
  • Hardwire
  • Telemetry
  • Lead systems
  • Ambulatory monitoring
31
Q

Cardiac Stress Testing

A

Exercise stress test
- Pt walks on treadmill with intensity progressing according to protocols
- ECG, V/S, symptoms monitored
- Terminated when target HR is achieved
Pharmacologic stress testing
- Vasodilating agents given to mimic exercise

32
Q

Heart Diagnostic Tests
Radionuclide imaging:

A
  • Myocardial perfusion imaging
  • Positron emission tomography (PET)
  • Test of ventricular function, wall motion
  • Computed tomography (CT)
  • Magnetic resonance angiography (MRI)
33
Q

Echocardiography

A
  • Noninvasive ultrasound test that is used to:
  • Measure the ejection fraction
  • Examine the size, shape, and motion of cardiac structures
  • Transthoracic
  • Transesophageal: invasive; done with physician present
34
Q

Cardiac Catheterization Most definitive, most invasive

A
  • Involves use of contrast agent Invasive procedure used to diagnose structural and functional diseases of the heart and great vessels
    Right Heart Cath
  • Pulmonary artery pressure and oxygen saturations may be obtained; biopsy of myocardial tissue may be obtained
    Left Heart Cath
  • Involves use of contrast agent
  • Ask about iodine allergy
35
Q

Nursing Interventions-Cardiac Cath

A
  • Observe arterial insertion site for bleeding, hematoma
  • Assess peripheral pulses
  • Evaluate temp, color, and cap refill of affected extremity
  • Screen for dysrhythmias
  • Maintain bed rest 2 to 6 hours
  • Instruct patient to report chest pain, bleeding
  • Monitor for contrast-induced nephropathy:
  • Make sure the pt has good urine output post catheterization
  • Ensure patient safety

Medsurg 2.0: Exam 1 (6 decks)

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