Week 7: Chp 28: Assessment of Cardiovascular Function

Question 1

Major Risk Factors for Cardiovascular Disease (CVD)

Answer 1

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

Question 2

Nonmodifiable risk factors for CVD

Answer 2

demographic data: age, sex, ethnic background

Question 3

Modifiable risk factors for CVD

Answer 3

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

Question 4

Significant complaints pertinent to heart disease

Answer 4

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

Question 5

Palpitations ae indicative of what?

Answer 5

abnormal heart rhythms or dysrhthmias

Question 6

Syncope is indicative of what?

Answer 6

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

Question 7

Blood Pressure Stages

Answer 7

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)

Question 8

Inspection

Answer 8

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

Question 9

Inspection: Cyanosis

Answer 9

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

Question 10

Inspection: Capillary refill time

Answer 10

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

Question 11

Inspection: Edema

Answer 11

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

Question 12

Inspection: Distension of jugular veins

Answer 12

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

Question 13

Palpation

Answer 13

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

Question 14

Auscultation

Answer 14

assessment of heart and lung sounds

Question 15

Heart Sounds

Answer 15

• “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

Question 16

Systolic Murmur

Answer 16

caused by valvular disease such as aortic stenosis

-turbulent flow heard

Question 17

Diastolic Murmur

Answer 17

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

Question 18

Click

Answer 18

• caused by mitral valve stenosis

- high-pitched sound

Question 19

Friction Rub

Answer 19

• caused by pericarditis

- harsh, scratching sound

Question 20

Lung Sounds

Answer 20

• give an indication of both lung and cardiac health

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

Question 21

Laboratory Markers as Predictors of Heart Disease: Lipid Panel

Answer 21

includes:

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

Question 22

Cholesterol

Answer 22

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

Question 23

Low-Density Lipoproteins (LDLs)

Answer 23

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

Question 24

High-Density Lipoproteins (HDLs)

Answer 24

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

Question 25

Total Cholesterol

Answer 25

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

Question 26

Triglycerides

Answer 26

- 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

Question 27

Non-specific predictor markers

Answer 27

- glucose - homocysteine - c-reactive protein - coagulation studies

Question 28

Non-specific marker: Glucose

Answer 28

- diabetes and hyperglycemia are major risk factors for CVD | - normal: 65-99 mg/dL

Question 29

Non-specific markers: homocysteine

Answer 29

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

Question 30

Non-specific markers: homocysteine

Answer 30

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

Question 31

Non-specific Markers: C-reactive Protein

Answer 31

- 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)

Question 32

Non-Specific Markers: Coagulation studies

Answer 32

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

Question 33

Nursing Implications: Lipid Panel Lab Test

Answer 33

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

Question 34

Coagulation Studies

Answer 34

- 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

Question 35

Laboratory Markers of Acute Cardiac Damage or Injury

Answer 35

include enzymes or proteins that are elevated in response to cellular injury - Creatinine Kinase myocardial bands (CK-MB) - Troponin - Myoglobin - Brain natriuretic peptide (BNP)

Question 36

Creatinine Kinase (CK)

Answer 36

general marker of cellular injury | -released from cells in the brain, skeletal muscle, and cardiac tissue after muscle damage has occurred

Question 37

Creatinine Kinase myocardial bands (CK-MB)

Answer 37

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

Question 38

Troponin

Answer 38

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

Question 39

Myoglobin

Answer 39

- 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

Question 40

Brain Natriuretic Peptide (BNP)

Answer 40

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

Question 41

Nursing Implications for Laboratory Tests

Answer 41

- 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