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NRSG 126 #2 > Circulation > Flashcards

Circulation Flashcards

1
Q

how the heart is ageing

A

thickening blood vessel walls

narrowing lumen

less elastic vessles

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2
Q

What is Aneurysm

A

a complication with HTN (hypertension)

unhealthy behaviours that can incerase risks include - HTN, smoking, atherosclerosis - plaques in arteries (fats, cholesterol and other) and high cholesterol

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3
Q

What is Dacron graft?

A

A Dacron graft is a synthetic polyester tube that’s used to repair or replace blood vessels.

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4
Q

where are the coronary sinus and arteries located

A

coronary sinus - in the right atrium and is where de-oxygenated blood enters the rt. Atrium from the myocardium (entering heart)

coronary arteries - in the aorta, feed the myocardium during diastole

in the human heart, two coronary arteries arise from the aorta just beyond the semilunar valves; during diastole, the increased aortic pressure above the valves forces blood into the coronary arteries and thenece into the musculature of the heart

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5
Q

left ventricle

A

the largest and strongest
= pumping into systemic circulation

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6
Q

what is atrial kick

A

the atrial contraction that occurs to help fill the ventricles

ANC influences - pacemakers (electrical) - form an impulse - passes along conduction system - mechanical: myocardial contraction

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7
Q

how does LUB DUB work

A

think of clapping - outside close then inside

LUB or S1
- AV closure
- end of diastole

DUB or S2
- semilunar valve closre
- end of systole

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8
Q

What is atrioventricular valve and semilunar valves

A

Atrioventricular valves:
S1 AKA AV valves
tricuspid and mitral valves

Semilunar valves:
S2
pulmonic and aortic

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9
Q

can valves be repaired or replaced?

A

YES

replaced or repaired with:
mechanical or biological: donor (human), tissue (animal)

mechanical - carbon and metal (20-30years), blood thinners

biological - human donor rare (10-15years), often do not need blood thinner (typically cow tissue around heart or pig valve)

most common - left is larger; bigger and has to pump harder, takes on more workload

Aortic-repair
Mitral-replace

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10
Q

what are the meanings of diastole and systole

A

right - pulmonary
left - systemic

systole/ diastole: 120/80

systole - ventricles contract & empty (pushing the blood)
diastole - ventricles relax & filling

normal: 120-139/ 80-89 with pulse pressure of 30-50 (difference between the systolic and diastolic)

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11
Q

what is Starling’s Law?

A

myocardial stretch directly related to the strength of contraction

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12
Q

what controls blood pressure

A

blood pressure is controlled by **baroreceptors **

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13
Q

Knowing cardiac layers
Endo/ Epi/ Myo/ Cardium

A

endo - within or inner
epi - above or surrounding
myo - muscle
cardium - cardiac

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14
Q

what is the functions of RBCs, WBCs, platelets and the other organs related to cardiac funcitons

A

RBC = carries O2 with hemoglobin (120days)
WBC = fights infections (12-20days)
platelets = clotting (6days)

blood stem cell - an immature cell that can develop types of blood cells, including white blood cells, red blood cells and platelets

kidney - disease can increase fluid retention, and impact EPO (erythropoietin) production which helps our bones to make RBC

plasma - 92% water, proteins (like albumin) and 1% minerals and salts

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15
Q

what are albumin and lymphatic system

A

albumin - produced by the liver. helps to keep fluid in the vascular system
= a major part of the protein in our blood

lymphatic system - also plays an important role in circulation and immune response (where lymphocytes mature)

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16
Q

whatis cardiomegaly?

A

an increase size of heart

erythro - red
thrombo- clotting of blood
leuko - white

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17
Q

what is this: erythropenia, thrombocytopenia, leukopenia

A

erythropenia: less RBC than normal
thrombocytopenia: the platelet counts less than normal
leukopenia: WBC are less than normal counts

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18
Q

what is this erythropoiesis, thrombopoiesis, leukopoiesis

A

erythropoiesis: your body process balancing RBCs numbers in your body
thrombopoiesis: the same but with platelets
leukopoiesis: the same but with WBCs

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19
Q

what is it? Erythrocytosis (polycythemia), Thrombocytosis, leukocytosis

A

erythrocytosis: too many RBCS
thromobodytosis: too many platelets
leukocytosis: too many WBCs

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20
Q

how is the myocardial blood flow

A

return to right to re-oxygenate

lungs to left to life

oxygen-rich blood: enters the herat from the lungs and goes out to the body

oxygen-poor blood: enters the heart from the body and goes out to the lungs

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21
Q

how blood in the heart supply O2 and nutrition to the myocardium

A

Blood in the heart does not directly supply O2 and nutrients to the myocardium

the heart is perfused during diastole (rest) via the coronary artery

You can see that the coronary arteries come off of the aorta - left is larger due to the larger and more muscular left ventricle

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22
Q

HOW does systemic circulation circulate

A

arteries-arterioles-capillaries-Oxygenated to De-oxygenated - capillaries - venule - vein

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23
Q

what is the function of arteries

A

carry blood ways from the heart

all arteries carry oxygenated blood except for the pulmonary arteries

high pressure system

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24
Q

what is the funciton of veins

A

carry blood towards the heart

all veins carry deoxygenated blood except for the pulmonary veins

low pressure system

rely on valves and muscles

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25
what is cardiac output
**how much blood it pushes out** - blood the heart beats in liters per minute = average 4-6 L/ min older adults - CO is affectd by ventricular hypertrophy (due to HTN), increased wall tension
26
heart rate
the number of heart beats/ min
27
stroke volume
amount of blood ejected during each cardiac cycle (heart beat)
28
what is stroke volume preload in cardiac output
ventricular stretch at the end of diastole (rest) ventricle stretch, when relaxed and filling ↑ preload: volume overload or high pressure - Heart failure ↓ preload: low volume or decreased venous return - Hypovolemia- loss of fluids (e.g. blood or water) = low with hypovolemia, increased with heart failure
29
wha tis stroke volume afterload in cardiac output
resistance the heart overcomes to eject (pouring out) blood from the ventricle (s) Vessel diameter, Valves, Viscosity (3 V's) ↑ afterload: increased resistance from left ventricle - HTN or aortic stenosis ↓ afterload: decreased resistance from left ventricle - Distributive shock (vessles got too dilated)- sepsis, anaphylaxis = 3 Vs-vessels, valves and viscosity - any of these will impact the afterload due to increased pressure on which the ventricles must push against
30
what causes distributive shock
due to vasodilation increased afterload- increases wall tension and increases O2 needs example: HTN, increasing need for stronger contraction
31
define stenosis
= hardening/ stiff
32
What is needed for cardiac output assessment
Mean Arterial Pressure, BP, Pulse strength some blood pressure machines will give you the MAP in parentheses. normal is 60 mmHg/ more. is there enough pressure in the arteries to perfuse our organs and body? high - too much/ low - not enough
33
what is Polycythemia
a blood disorder that occurs when the body produces too many red blood cells = increases viscosity
34
what is contractility in cardiac output
ability of the heart to contract and the force at which it contracts ↑ contractility SNS, meds ↓ contractility HF, MI, hypoxemia (lack O2), meds too much contractility = not enough filling time - decreased CO **EF** (ejection fracture): Left ventricle- how much is pumped! Just know normal is 55-70% Hypoxia- low O2 in tissue Hypoxemia- low O2 in blood
35
how does the contractility of old adults' responses different from younger generation
older adult has a rigid/ not flexibility/ stiff and slower resopnse time changing contractility
36
common alterations in cardiac funcitoning
1. disturbances in conduction 2. impaired valvular function 3. myocardial ischemia 4. atherosclerosis (plaques in artries) 5. **HTN** (hypertension) 6. **HF** (heart failure)
37
What is tachycardia
too fast! HR over 100 BPM can cause a decrease in cardiac output * decreased ventricular filling rate (preload) * decreased O2 to heart * **increased myocardial O2 demand** can be benign (exercise) can be serious (ventricular tachycardia) treated is based on the type of rhythm and signs/ symptoms
38
what is the difference between Myocardial ischemia and atherosclerosis
**Myocardial ischemia** occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (**atherosclerosis**)
39
What is bradycardia
TOO slow HR under 60 BPM can cause a decrease in cardiac output * decreased HR = decreased CO can be benign (athletes) treatment is based on the type of rhythm and signs/ symptoms
40
Dysrhythmia
deviation from the normal sinus rhythm = abnormal rhythms * can be: tachy or brady * regular or irregular * classified on where they occur
41
Arrhythmias: **tachy **
especially when irregular the symptoms of a fast HR are worsened (decreased CO) * decreased ventricular filling rate (**preload**) * decreased O2 to heart * **Increased myocardial O2 demand** treated is based on the type of rhythm and signs/ symptoms
42
what are Atrial/ ventricular fibrillation
a-fib = from atria- chaotic signal; multiple pacemaker sites v-fib: impulse comes from ventricles not the SA node. the fiberillation in V.fib means it is irregular potential treatment S/S (symptoms)
43
Arrhythmias: that are brady
can cause an even **more decrease** in cardiac output * decreaed HR = decreased CO treatment is based on the type of rhythm and signs/ symptoms **Sick sinus syndrome** - SA is impacted (dysfunciton or disease) leading to brady; can be caused from hypothyroidism (not making enough thyroid hormones) **Heart block** - aka AV block; something blocking electrical signal
44
alterations in cardiac functionings: valves
stenosis & obstruction degeneration & regurgitation risk factors: age, smoking, birth defect, HTN assessment: murmurs treatments: lifestyle/ intervention or surgery
45
what is myocardial Ischemia
O2 supply/ demand imbalance angina [chest pain] (heart muslces not getting enough O2) ACS [acute coronary syndrome] (muscles suddenly stopped receiving blood) myocardial infarction (MI) treatment: * lifestyle * meds * intervention or surgery
46
what is atherosclerosis
stenosis typically from cholesterol, lipids, and/ or calcium build up plaque buildup- it can rupture can = total or partial occlusion risk factors? LDL treatments: lifestyle/ medications
47
what is CAD
coronary artery disease - does not cause symptoms in the early stages - chest pain, SOB, Fatigue
48
what is PAD
peripheral artery disease - leg pain while walking
49
what is PVD?
periperhal vascular disease - pain, cramping, and changes to the skin (affects blood vessels outside of the heart)
50
2 very common cardiac conditions
Hypertentsion (HTN) Heart failure (HF) including risks, signs and symptoms, diagnostics, treatment (just a basic understanding for now) and health promotion
51
What is PMI
"PMI" = "Point of Maximal Impulse," the location on the chest wall where the heartbeat can **be most strongly felt**, usually found in the **fifth** intercostal space
52
what are the comprehensive information about the patient's condition that nurses can focus on to assess the patient with HF?
1) symptoms and onset 2) shortness of breath 3) swelling (edema) 4) fatigue and activity tolerance 5) weight changes 6) heart-related symptoms 7) cough and respiratory symptoms 8) fluid intake and output 9) lifestyle and medication adherence
53
left sided HF
Left side - Venous return from lungs - failure leads to pulmonary congestions & pressure Left side - supply body organs - failure leads to low organ perfusion and hypoxia * increased pulmonary venous pressure * pulmonary congestions (pulmonary edema) * pulmonary congestion (heavy wet lungs) - most commonly affected organ in LHF 1. dyspnea (feeling short of breath) 2. orthopnea (SOB while lying on bed) 3. paroxysmal nocturnal dyspnea (sudden and severe SOB that wakes someone from a sleep)
54
right-sided heart failure
right side - venous return from body organs (except lungs) - failure leads to venous congestion of body organs right side - pumps blood into lungs - failure happens because of increased pulmonary vascular pressure Azotemia - build up of waste in the blood due to renal failure (creatinine, BUN)
55
what to expect for diagnostics HF
labs: BNP (B-type natriuretic peptide level) - elevated CXR (chest x-ray): looks at cardiac silhouette and lungs - cardiomegaly and pulmonary congestion ECHO: confirms heart failure and decreased EF
56
what to expect for meds
beta blockers: "lol", improving the pump ACE: vasodilator, protect kidneys ARBS: Blocks vasoconstriction * work on the RAAS (renin-angiotensin-aldosterone system) due to HF there is decreased CO and less pressure on kidneys causing constriction increasing the work the heart has to do Diuretic: gets rid of fluid anticoagulants: prevents sticking - warfarin (anticoagulant), Aspirin and plavix - antiplatelet
57
what are the hypertension complications
**MI** **CVA** **Heart Failure** included in metabolic syndrome aneurysm retinopathy kidney disease vascular dementia
58
what is metabolic syndrome
hypertension is also one of a cluster of conditions konwn as **metabolic syndrome, or syndrome X**, along with abdominal obesity, type 2 diabetes, insulin resistance, and high cholesterol and triglyceride levels. this cluster increases risk for heart disease, stroke and T2DM (T2 diabetic)
59
primary and secondary hypertension
Primary hypertension= high blood pressure with no identifiable underlying cause secondary hypertension= high blood pressure that is caused by another medical condition, like kidney disease, adrenal gland issues, or sleep apnea
60
Hypertension risk factors SODA
SODA S= stress, smoking, sedentary (sitting all day) O= obesity, oral contraceptives (birth control) D= diet (Na, Cholesterol), Diseases (diabetes, renal, HF and High cholesterol) A= African american men, age
61
Matching: 1. detects severity of CHF 2. detects MI 3. evaluates valves 4. detects dysrhythmia 5. detexts ejection fraction (CO) 6. done to insert stents echocardiogram/ angiogram/ troponin/ BNP/ ECG
1. BNP 2. Angiogram/ ECG 3. Echocardiogram 4. ECG 5. Echocardiogram 6. angiogram MI- ECG and Trop and Angio
Dysrhythmia- ECG CHF- can also do echo, ecg, stress test, angio Echo- valves and blood flow
Angio- valves, stent
62
what diagnostics focus on for HF & HTN diagnostics
diagnostics often focus on the cause while also looking at organ injury/ damage * urine, renal panel * CBC (RBC and HGB), lytes (ex: potassium, calcium), Choleterol (risk of build-up)
63
Cardiac markers
Troponin: protein found in heart muscle released with damage; new high sensivity trop | chemicals released into the blood when the heart is damaged or stressed
64
inflammatory marker (detects skeletal, cardiac & brain)
CK - detects myocardial cell damage and acute MI. Looks at skeletal muscle, heart and brain injury.
65
Inflammatory marker (looks at tissue injury/ infection)
CRP (total body inflmmation) - there may not be elevated WBC, looked at with sepsis. might be checked with a valve infection or another cardiac it is such as pericarditis, endocarditis etc.
66
heart failure
BNP (ventricle wear and tear) - it is released from the ventricles with the increased stretching that occurs from the HF ## Footnote Cardiac markers: BNP (B-type Natriuretic Peptide) – Helps check for heart failure. High BNP means your heart is struggling to pump.
67
Electrocardiogram
360 degrees of the heart assess: * **STEMI** (ST segment MI) more serious MI - often meaning complete blockage of a coronry artery * **dysrhythmia**
68
Echocardiogram (ECHO)
ultrasound assess valves, blood flow and heart wall motion assess: * contractility * ejection fraction (EF%) TEE (transesophageal exhocardiogram) if valve infection is expected, see how valves work, funciton of heart, find clots. Basically can completely assess the heart
69
Coronary angiogram
AKA heart catheterization assess * heart defects * heart valves * narrowing or blockages * O2 levels Angio- vessel gram - recording with angiogram it uses x-ray to record how the heart is functioning looking at coronary arteries
70
Antigoplasy
the x-ray takes pictures (angiogram) and then specialists can do an angioplasty if needed to remove clots. this uses a device to place a balloon at the narrowed site to open it up, stents can be placed angio - refers to a vessel plasty - repair, restore, replace
71
Chest X-ray (CXR)
rule in/ out conditions affecting the chest airways, bones, cardiac silhouette, diaphragm, lung tissue can help to diagnose fluid (pneumonia/ HF), pneumothorax, fracture
72
Stress test
evaluates exercise tolerance
73
how to do diagnostic tests on hypertension
assessment * **elevated BP * signs and symptoms** look at risk factors consider primary vs. secondary causes taking - ensure patient has rested for at least 5 minutes * multiple elevated BPs not just one
74
75
How to manage HF & HTN
DRESS & DASH diet * lifestyle * medications * pacemaker * ventricular assist devices. * transplant or End of Life care KNOW THEIR CODE STATUS
76
What is DRESS
**D**iet-low Na/cal and chol **R**educe ETOH/ Caffeine **E**xercise - 30min 5x/week **S**top smoking **S**tress- decrease
77
what is DASH diet
= Dietary Approches to Stop Hypertension Diet Reduce alcohol and caffeine exercise stop smoking stress reduction Na+ and water restriction daily weights manage sterss and get sleep don't smoke and decrease ETOH protect organs: kidneys (adrenals release aldosterone for RAAS)
78
what is pacer
single chamber (impuplses to rt vent) or dual (impulses to rt atria and vent or biventricular (to both ventricles - for HF) - kicks in if needed
79
what is VAD
ventricular assist device - waiting for transplant, temp HF, permanent fixture. (it actually bypasses the left side of the heart if it is placed in the left ventricle)
80
what cardiac abnormalitites can nurses detect through auscultation?
rate, arrhythmia, potentially murmur, confirmation postmortem, BP
81
What cardiac abnormalities can nurses detect through palpation?
rate, strength, regularity and edema
82
what cardiac abnormalities can nurses detect through insepction?
pedal edema, cough, colour, respirations
83
what are we assessing for O2 supply and demand
O2 supply/ delivery * O2 available * RBC * Hemoglobin * Cardiac output O2 demand * Stress * Fever * movement * infection
84
How do body organs impact the O2 supply/ demand
Neuro - control; medulla oblongata CVS - supply -perfuse Resp - exchange MSKL - helps with supply, increase/ decreases need, make RBC GI - exchange nutrients GU - erythropoietin
85
How do NANDA describe the nursing diagnosis on cardiac
risk for decreased cardiac output risk for decreased cardiac tissue perfusion ineffective peripheral tissue perfusion activity intolerance
86
87
health promotion for better cardiac health
Exercise Diet Stress Reduction Quit smoking & protect lungs Monitor BP, cholesterol and triglycerides - consider modifiable and non-modifiable options
88
health promotion; health
20-30 min 3-4 x/ week 30-60 min daily (weight loss and lower BP)
89
health promotion; diet
= maintain ideal weight, low fat and low salt, appropriate calories watch those LDLs, triglycerides ensure hydration (but not too much) ensure vitamins, minerals and nutrients remember the importance of Vit B12 and Iron particularly for RBC formation
90
91
health promotion; stress
stress increases O2 demands due to increased metabolism
92
In hospital.... the diet is like
restrict diet and Na, weigh patient for fluid retention (1kg/ litre)
93
what does modifiable and non-modifiable mean?
modifiable = changeable? e.g. lifestyle non-modifiable = non-changeable e.g. genetic

NRSG 126 #2 (3 decks)

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