CARDIOVASCULAR ASSESSMENT QUESTIONS

Question 1

The nurse is assessing a 62 year-old woman. She is postmenopausal, diabetic for 10 years, smokes 1 pack of cigarettes for 20 years, walks twice a week for 30 minutes, and describes her lifestyle as sedentary. For her weight and height she has a body mass index of 32 (healthy weight is 18.5 to 24.9). Which risk factors for this patient are controllable for cardiovascular disease? (Select all that apply)
1.Smoking
2.Age
3.Obesity
4.Postmenopausal
5.Sedentary lifestyle

Answer 1

Answer: 1, 3, 5
controllable/modifiable
All risk factors but not all controllable

Question 2

Patient History
Nutrition History
Family and Genetic History
Physical Assessment
Venous and arterial pulses
BP and HR
Precordium (area over heart)
Current Health Concerns/Symptoms
Functional History

Answer 2

Assessment methods

Question 3

Focus on risk factors and symptoms: risk factors - huge for CV disease processes: ask questions about fam history and risk factors; know about modifiable because help change them
Assess non-modifiable risk factors: know have these need do closer monitoring
Assess modifiable risk factors
Assess for chronic diseases

Answer 3

Patient History

Question 4

Age, sex, ethnicity, family history
Ex. men and post menopausal women (lose estrogen) at higher risk for coronary artery disease (CAD)

Answer 4

Assess non-modifiable risk factors: know have these need do closer monitoring

Question 5

Obesity, smoking, inactivity, psychological stress

Answer 5

Assess modifiable risk factors

Question 6

Ex. Diabetic patients at higher risk (high levels of BG viscosity affected and damages blood vessel: microvascular and macrovascular changes that happens with high BG levels - macrovascular put at risk for CV disease)

Answer 6

Assess for chronic diseases

Question 7

Ex. High sodium, fat and cholesterol can increase risk for CV disease - Na and water moves together: limit Na if have HTN; fat and cholesterol: CVD because of atherosclerosis

Answer 7

Nutrition History

Question 8

Screen first degree relative for history of CAD, hypertension, sudden cardiac death
Fam History of CVD/MI before 40; earlier onset higher risk for CVD

Answer 8

Family and Genetic History

Question 9

General appearance
Skin
Extremities

Answer 9

Physical Assessment

Question 10

Assess color and temperature
Assess nail beds, mucous membranes, and conjunctival mucosa
Decreased perfusion can be manifested as cool (indics perfusion), pale (indics perfusion), cyanotic, gray (chronic hypoxia) and/or moist skin

Answer 10

Skin

Question 11

Assess for dehydration – skin turgor - fluid volume
Assess for edema
Vascular changes

Answer 11

Extremities

Question 12

Grade: Location and extent (1+, 2+, 3+, 4+); pitting; tells not circulating blood effectively throughout body

Answer 12

Assess for edema

Question 13

Paresthesia, muscle fatigue, pain, numbness, coolness, loss of hair - not getting oxygenated blood: issues with arterial sys

Answer 13

Vascular changes

Question 14

Venous pulsations in neck assess for jugular venous distention (JVD): pulses check: have fluid overload
Assess all major peripheral pulses
Quality of peripheral pulses (weak or bounding (increased blood volume) pulse): Peripheral pulses: thready or bounding: increased heart volume
Auscultate carotid for bruits – normally there are no sounds if the artery has uninterrupted blood flow: bruits means restricted blood flow/turbulence going on

Answer 14

Venous and arterial pulses

Question 15

Inspection
Auscultation

Answer 15

Precordium (area over heart)

Question 16

S1-Mitral and tricuspid valve closing
S2-Pulmonic and aortic valve closing
Abnormal (splitting of S2; S3, S4, murmurs, pericardial friction rub)
Listen to lung (HF) and heart sounds

Answer 16

Auscultation

Question 17

Chest pain or discomfort
Dyspnea
Fatigue - big
Palpitations - feel PVCs sometimes as these
Edema
Syncope - decreased perfusion
Extremity pain
chest pain, SOB - s/s of decreased perfusion

Answer 17

Current Health Concerns/Symptoms

Question 18

Mobility: ADLs, used hx. to grade HF pats: how much limiting daily life

Answer 18

Functional History

Question 19

What term describes the difference between systolic and diastolic values, which is an indirect measure of cardiac output?
1.Stroke volume
2.Pulse pressure
3.Ankle-brachial index
4.Normal blood pressure

Answer 19

Answer: 2
INDIRECT
Shows force of contraction
SV: amount blood ejected from ventricle with each contraction
Ankle-brachial index: used to assess vascular status of the lower extremities; checking perfusion and comparing that between extremities
CO: SVxHR - amount blood ejected from LV/min; how much heart able push out; IMP VALUE
EF: goes with SV: when LV fills have volume blood in there and then ventricle contracts and then ejects some of the blood; EF is % blood ejected from LV; never 100%; typ 60-70%

Question 20

Blood pressure (BP)
Postural (orthostatic) hypotension
Pulse pressure

Answer 20

Assessment methods

Question 21

Hypertension
BP < 90/60 may not be adequate for providing enough oxygen and sufficient nutrition to body cells

Answer 21

Blood pressure (BP)

Question 22

Systolic blood pressure (SBP) >140 mm Hg
Diastolic blood pressure (DBP) > 90 mm Hg
Considered hypertensive

Answer 22

Hypertension

Question 23

Need MAP (mean arterial pressure) at least 60-70 mmHg to perfusion organs

Answer 23

BP < 90/60 may not be adequate for providing enough oxygen and sufficient nutrition to body cells

Question 24

Decrease of more than 20 mm Hg of the SBP or more than 10 mm Hg of the DBP and 10-20% increase in HR with changes in position; drop BP when changing positions

Answer 24

Postural (orthostatic) hypotension

Question 25

Difference between systolic and diastolic values, used an indirect measure of cardiac output

Answer 25

Pulse pressure

Question 26

True or False A client admitted to the hospital with an elevated HDL requires a cardiac workup to evaluate for cardiovascular disease.

Answer 26

False Cholesterol imp lab values for CAD Elevated levels (cholesterol/tri) increase risk for CAD/atherosclerosis

Question 27

<200 mg/dL

Answer 27

Cholesterol

Question 28

Between 35-160 mg/dL

Answer 28

Triglycerides

Question 29

> 45 mg/dL Considered “good cholesterol”

Answer 29

HDL

Question 30

<130 mg/dL

Answer 30

LDL

Question 31

3:1 ratio Imp: ratio of good cholesterol to blood cholesterol More HDL to LDL

Answer 31

HDL:LDL ratio

Question 32

Cellular injury causes a release of enzymes and those enzyme levels are used to diagnose Acute Coronary Syndrome (ACS) Troponin Creatine kinase (CK) CK-MB Myoglobin

Answer 32

Laboratory assessments: cardiac markers

Question 33

Myocardial muscle protein released when there is injury to myocardial muscle Done more often now Normal=T <0.10 ng/mL and I < 0.03 ng/mL MI/Lack perfusion to heart muscle Classic lab for MI eval Protein release when damage to heart muscle; never detectable; if increased damage to heart muscle Specifically sensitive to heart damage Specifically sensitive to cardiac muscle

Answer 33

Troponin

Question 34

Enzyme specific to cells of the brain, myocardium, and skeletal muscle CK indicates tissue necrosis or injury Elevated if any muscle damage Normal=females 30-135 units/L and males 55-170 units/L

Answer 34

Creatine kinase (CK)

Question 35

Specially found in myocardial muscle Normal =0% of total CK Specific to myocardial muscle; not as sensitive as tropin

Answer 35

CK-MB

Question 36

Protein found in cardiac and skeletal muscle Normal= < 90 mcg/L

Answer 36

Myoglobin

Question 37

Coagulation Studies C-reactive protein (CRP) Brain natriuretic peptide (BNP) Homocysteine Microalbuminuria

Answer 37

Laboratory assessments: miscellaneous

Question 38

Evaluates the ability of blood to clot Monitor when patients on anticoagulants Hypercoagability naturally in body risk for blood clots; PT, INR, PTT, fibrinogen, then platelet count in CBC - causes them stick together to cause occlusion in vascular sys; high: less likely clot Make predisposed for clots; before pre-op, after admin of anticoag meds

Answer 38

Coagulation Studies

Question 39

Any inflammatory process can produce CRP in the blood Inflammatory lab Normal: < 1.0 mg/dL Not seen as much > 3mg/dL indicates high risk for heart disease

Answer 39

C-reactive protein (CRP)

Question 40

Protein released by the heart For HF: when ventricles stretched releases protein; HF and not eject all blood heart muscle stretched more and protein is released >100 abnorm Elevations indicate heart failure

Answer 40

Brain natriuretic peptide (BNP)

Question 41

Not seen as much Amino acid produced when proteins break down Elevated levels indicates increase the risk for cardiac disease Normal: < 14 mmol/dL

Answer 41

Homocysteine

Question 42

Small amounts of protein in the urine Not seen as much Indicates endothelial dysfunction

Answer 42

Microalbuminuria

Question 43

Any abnorm electrolyte put at risk for dysrhythmias: K, Ca, Mg Aggressively treat abnormalities to decrease risk of dysrhythmias, esp K High: slows conduction Low: speeds conduction Messing up electrical conduction

Answer 43

Lab assessments: electrolytes

Question 44

When is B-type natriuretic peptide (BNP) produced and released for a patient with heart failure? 1.When a patient has an enlarged liver 2.When a patient has fluid overload 3.When a patient’s ejection fraction is lower than normal 4.When a patient has ventricular hypertrophy

Answer 44

Answer: 2

Question 45

Studies of the right or left side of the heart and the coronary arteries using fluoroscopy and contrast dye Preparation: Way go in and look at heart and look at coronary arteries that feed heart Post procedure care

Answer 45

Cardiac catheterization - Diagnostic testing

Question 46

A catheter is inserted in the femoral vein for a right sided heart cath A catheter is inserted into the femoral or radial artery for a left sided heart cath and coronary arteriography - most commonly seen Visualize what going on in heart and arteries accessing that heart Might use dye and if have dye allergy but have possible MI will do this to open vessels; need vessels open; premedicate before to prevent rxn - know might have rxn Protect kidneys because lot dye giving: give fluid ahead and give fluids post and flushing dye through kidneys See if vessels occluded and loss circ to heart muscle Check pressures in pulm arteries

Answer 46

Studies of the right or left side of the heart and the coronary arteries using fluoroscopy and contrast dye

Question 47

Renal protection from contrast dye fluids may be given 12-24 hours before the procedure for renal protection Administer acetylcysteine CXR, CBC, Coagulation screen (no risk bleeding), and ECG done NPO after midnight or liquid breakfast if procedure scheduled in the afternoon - for 6 hrs Assess patient for contrast dye allergy (antihistamine or steroid may be given) Sedative

Answer 47

Preparation: - Cardiac catheterization

Question 48

Bed rest and keep insertion site extremity straight: femoral access points From 2-6 hours Radial preferred choice; can do interventions if needed; diagnostic and intervention - get cath lab ASAP to open arteries; femoral better if have lot things do Monitor vital signs Ex. every 15 minutes x 1 hour, 30 minutes x 2hours, then every hour for 4 hours, then q4hrs Assess insertion site for drainage or hematoma: bleeding restart with all checks because common have bleeding and oozing at site Assess peripheral pulses, temperature, and color in affected extremity Monitor I & O/ Maintain hydration Observe for complications

Answer 48

Post procedure care - Cardiac catheterization

Question 49

What is included in post-procedural care of a patient after a cardiac catheterization that has a femoral access? (Select all that apply) 1.Patient remains on bedrest for 12 to 24 hours 2.Patient is placed in a high-Fowler’s position 3.Dressing is assessed for bloody drainage or hematoma 4.Peripheral pulses in the affected extremity, as well as skin temperature and color, are monitored with every vital sign check 5.Adequate oral and IV fluids are provided for hydration 6.Vital signs are monitored every hour for 24 hours

Answer 49

Answer: 3, 4, 5 Typ 4-6 hours bed rest High-fowlers: Concerned about risk for bleeding; break coag going on Skin color and temp tells on perfusion; each VS check need do peripheral vascular check: pulses, cap refill, skin color, movement, sensation Monitored more frequently initially when come out: VS and peripheral vascular checks

Question 50

Which test is the best tool for diagnosing heart failure? 1.transthoracic Echocardiogram 2.Pulmonary artery catheter 3.Electrocardiogram 4.Multigated angiographic (MUGA) scan

Answer 50

Answer: 1 US of heart; on outside of heart; no sedation/prep and on bedside; see structure and func of heart; valves checked and structure and func; EF given from it - looking at it for HF

Question 51

CXR Angiography or arteriography Electrocardiogram (ECG) Echocardiogram (Echo) Exercise electrocardiography (EPS) Transesophageal echocardiography (TEE) Myocardial nuclear perfusion imaging Magnetic resonance imaging (MRI) Thallium - post MI if have damage to func

Answer 51

Diagnostic testing

Question 52

Examine size, silhouette and position of heart Shows heart; HF: heart looks enlarged

Answer 52

CXR

Question 53

Uses contrast dye and fluoroscopy to examine arterial vessels Preparation: Screen for allergy to dye; Sedation required; usually NPO Using Contrast dye to look at arterial vessels

Answer 53

Angiography or arteriography

Question 54

Very common and valuable diagnostic Examines electrical activity of heart: 12-lead: diagnostic: shows electrical activity through diff places of heart; use diagnosis where MI might be Very useful Noninvasive Preparation: None required

Answer 54

Electrocardiogram (ECG)

Question 55

Uses ultrasound to assess cardiac structure and mobility Specifically looks at valves Ejection fraction measured (EF-% of left ventricular volume that is ejected with each contraction) Preparation: None required Regular transthoracic

Answer 55

Echocardiogram (Echo)

Question 56

“Stress test” Looking at Heart rxn to increased workload; typ exerting self: exercise to point where HR elevates where heart under stress; typ outpat Give drugs to simulate exercise Assesses cardiovascular response to an increased workload Patient Preparation

Answer 56

Exercise electrocardiography (EPS)

Question 57

Used to evaluate for asymptomatic CAD, dysrhythmias, or evaluate the effectiveness of antidysrhythmic meds

Answer 57

Assesses cardiovascular response to an increased workload - Exercise electrocardiography (EPS)

Question 58

Encourage rest the night before the procedure Light meal 2 hours before the test (depends on physician order) Avoid smoking (vasoconstriction), alcohol, and caffeine-containing (increases HR) beverages on the day of the test Beta blockers - decrease SNS and falsely keep HR down - and calcium channel blockers usually held To allow heart rate to increase with stress Wear comfortable clothing and rubber-soled supportive shoes

Answer 58

Patient Preparation - Exercise electrocardiography (EPS)

Question 59

Examines cardiac structure and function using ultrasound that is placed behind the heart in the esophagus or stomach Scope in esophagus and then US heart Esophagus behind heart - look back heart and not through bone structures; commonly used for vegetation on heart valves; precardioversion if have afib - not want cardiovert blood clot and it moves so want make sure not there Sedation is required Preparation: similar to upper GI endoscopic exam Numbed: gag there before eat

Answer 59

Transesophageal echocardiography (TEE)

Question 60

Radioactive tracer substances used to view cardiovascular abnormalities Can view myocardial blood flow and left ventricular function Preparation: NPO, no caffeine or cigarettes 4 hours prior

Answer 60

Myocardial nuclear perfusion imaging

Question 61

Magnetic and radio waves used to view cardiac wall thickness, heart chambers, valve and ventricular function, and blood movement Preparation: screen for metallic objects

Answer 61

Magnetic resonance imaging (MRI)