cardiovascular system dysfunction, NSG 2010 Adult Nsg I Exam #4
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| show | the amount of resistance to ejection of blood from the ventricle
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| show | impulse normally palpated at the 5th intercostal space, left midclavicular line; caused by contraction of the left ventricle
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| show | nerve fibers located in the aortic arch and carotid arteries that are responsible for reflex control of the blood pressure
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| show | specialized heart cells strategically located throughout the heart that are responsible for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells
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| cardiac output | show 🗑
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| show | ability of the cardiac muscle to shorten in response to an electrical impulse
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| depolarization | show 🗑
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| diastole | show 🗑
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| show | percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat
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| hypertension | show 🗑
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| hypotension | show 🗑
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| international normalized ratio (INR) | show 🗑
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| show | sounds created by abnormal, turbulent flow of blood in the heart
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| myocardial ischemia | show 🗑
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| show | muscle layer of the heart responsible for the pumping action of the heart
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| normal heart sounds | show 🗑
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| postural (orthostatic) hypotension | show 🗑
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| preload | show 🗑
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| pulmonary vascular resistance | show 🗑
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| show | return of the cell to resting state, caused by reentry of K+ into the cell while Na exits the cell
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| show | primary pacemaker of the heart, located in the right atrium
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| show | amount of blood ejected from the ventricle per heartbeat; normal stroke volume is 70 mL in the resting heart
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| show | resistance to LEFT ventricle ejection
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| show | period of vascular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta
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| telemetry | show 🗑
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| systole | show 🗑
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| show | relaxation of the heart muscle, when the heart chambers fill with blood in preparation for subsequent ejection
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| show | inner layer of the heart; endothelial tissue that lines the inside of the heart and valves
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| myocardium | show 🗑
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| show | exterior layer of the heart
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| show | distributes venous blood (deoxygentated blood) to the lungs via the pulmonary artery for oxygenation
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| show | receives blood returning from the superior vena cava, inferior vena cava and coronary sinus
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| left side of the heart | show 🗑
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| show | receives oxygenated blood from the pulmonary circulation via the pulmonary veins
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| atrioventricular valves | show 🗑
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| show | separates the right atrium from the right ventricle
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| mitral valve | show 🗑
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| show | the PULMONIC valve and the AORTIC valve
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| pulmonic valve | show 🗑
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| aortic valve | show 🗑
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| show | caused by inadequate O2 supply when the HR accelerates
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| arteries | show 🗑
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| show | carries unoxygenated blood to the lungs
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| show | perfuses the right atria and ventricle
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| show | branches into 1. left anterior descending artery and the 2. circumflex artery
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| show | perfuses the left ventricle and septum
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| If an MI affects your _________ artery, it is called a “widow maker” | show 🗑
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| The most important portion of the heart is the | show 🗑
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| veins | show 🗑
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| right atrium | show 🗑
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| show | pumps blood to the lungs
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| left atrium | show 🗑
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| show | pumps blood to the whole body
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| show | coronary arteries which supply the heart itself
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| Order of the electrical charge is | show 🗑
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| SA node | show 🗑
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| show | collects the impulses from the atria and delays them while the ventricles fill (40-60)
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| The AV node is the “back up” and can beat between | show 🗑
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| Purkinje fibers can still beat _____ bpm when everything else stops working | show 🗑
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| show | the cell is completely unresponsive to any electrical stimulus
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| show | the cells may depolarize too early
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| show | heart has premature contractions
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| Premature contractions can cause | show 🗑
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| show | electrolyte disturbances (hypokalemia, hypomagnesemia), hypoxia, acidosis, MI, HF, hypothermia
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| cardiac output | show 🗑
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| show | preload, afterload, contractility
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| increased contractility results in | show 🗑
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| vasoconstriction causes increases afterload which will | show 🗑
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| What diagnostic test measures contractility? | show 🗑
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| Normal ejection fraction is | show 🗑
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| show | Family Hx of CAD; increasing age; male gender (although POSTmenopausal women have 2 to 3 x the CAD rates of PREmenopausal women of the same age); race (higher incidence in African Americans than Caucasians due to greater risk of HTN)
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| Modifiable Risk Factors | show 🗑
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| Assessment of the Cardiac System | show 🗑
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| Assessment of cardiac system | show 🗑
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| How to assess for neck jugular vein distension | show 🗑
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| show | right atrium
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| show | S1 “lub”; the AV valves (mitral and tricuspid) shutting
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| show | S2 “dub”; the semi lunar valves (aortic and pulmonic) shutting
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| 4 abnormal heart sounds | show 🗑
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| show | 5th intercostal space medial to left midclavicular line
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| S3 gallop | show 🗑
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| S3 gallop best heard how? | show 🗑
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| show | heard when ventricle is resistant to filling. Heard right before S1. Assoc w/ CAD, HTN or stenosis of the aortic valve.
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| show | if heard, usu means stenosis of mitral valve or aortic valve. Could also be from a mechanical valve
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| show | blowing or swooshing sounds made by turbulent blood flow in a large vessel or valve b/c the valve is not shutting fully
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| show | close and seal
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| Friction rub | show 🗑
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| Friction rub best heard how? | show 🗑
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| show | chest pain (#1), dyspnea, peripheral edema and wt gain, fatigue, dizziness, syncope, changes in LOC (disorientation), palpitations
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| Testing to assess cardiac function and dx cardiovascular diseases | show 🗑
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| Brain (B-type) natriuretic peptide | show 🗑
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| C-reactive protein | show 🗑
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| 2 types of cardiac stress testing | show 🗑
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| Chest x-ray done to | show 🗑
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| show | make sure pt has signed consent form; check pt’s allergy to dye or iodine; tell pt the dye may induce a feeling of flushing when injected or in women urinary urgency; tell pt they will be on a hard surface (stainless steel table) for an hour or so; NPO fo
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| Post cardiac catheterization – Nursing interventions | show 🗑
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| Discharge instructions for pt going home after cardiac cath | show 🗑
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| Be sure to tell your pt before an echocardiogram | show 🗑
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| Nursing interventions before pt has a stress test | show 🗑
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| Nursing interventions for pt pre-TEE (transesophageal echocardiography) | show 🗑
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| show | make sure pt continues to fast until fully alert and make sure their gag reflex has returned b/c they numb their throat before procedure
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| Nursing interventions for pt pre-MRI | show 🗑
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| Atherosclerosis | show 🗑
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| In coronary atherosclerosis, blockages and narrowing of the coronary vessels reduce | show 🗑
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| show | cardiovascular disease for men and women of all racial and ethnic groups
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| show | the most prevalent cardiovascular disease in adults
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| Acute coronary syndrome (ACS) | show 🗑
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| show | chest pain brought about by myocardial ischemia
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| show | fibrous cap composed of smooth muscle cells that forms over lipid deposits within arterial vessels and that protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow; also called plaque
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| Creatine kinase (CK) | show 🗑
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| High-density lipoprotein (HDL) | show 🗑
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| Ischemia | show 🗑
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| Low-density lipoprotein (LDL)-a protein-bound lipid that transports cholesterol to tissues in the body; composed of a lower proportion of protein to lipid than high-density lipoprotein; exerts a harmful effect on the arterial wall | show 🗑
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| show | a cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia, and HTN that increase the risk of cardiovascular disease
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| Myocardial infarction (MI) | show 🗑
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| Stent | show 🗑
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| show | immediate cessation of effective heart activity
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| Thrombolytic | show 🗑
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| show | myocardial protein that regulates contractility; measurement is used to assess heart muscle injury
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| show | chest pain, but not always. Some indivs may be asymptomatic or have atypical symptoms such as weakness, dyspnea and nausea.
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| Atypical symptoms of coronary atherosclerosis are more common in | show 🗑
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| show | Yes
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| Is infarcted tissue reversible? | show 🗑
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| show | cold, digestion, stress, HTN, smoking
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| show | tightness, choking, heavy sensation, “elephant sitting on my chest”, retrosternal pain that may radiate to neck, jaw, shoulders, back or arms (usually L arm). Anxiety frequently accompanies the pain. A feeling of impending doom. Other symptoms may occu
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| Stable angina | show 🗑
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| Unstable angina | show 🗑
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| Treatment for angina | show 🗑
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| Priority Nursing concern in treatment of anginal pain | show 🗑
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| Treatment of anginal pain | show 🗑
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| show | they will get a headache
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| Pt teaching with angina | show 🗑
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| Myocardial infarction | show 🗑
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| show | pain (may radiate, crushing), HTN or hypotension, SOB, N/V, cool, clammy, pale skin, anxiety, denial, fear of impending doom. Females may present with atypical symptoms. MD’s often misdiagnose as indigestion. Be aware!
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| show | presenting symptoms, EKG changes (look for ST elevations on an EKG strip), heart enzymes (troponin)
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| CK-MB | show 🗑
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| show | 0-3 ng/ml
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| show | levels starts to rise in 3-4 hrs, and peaks by 24 hrs, and elevated levels can still be seen weeks after the event.
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| Normal troponin level | show 🗑
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| Treatment of Acute MI | show 🗑
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| show | dilating arteries; increases blood supply and therefore O2
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| show | arrhythmias (major cause of death in the first hour), cardiogenic shock (prevented with tx of pain and IV fluid therapy), heart failure (pump failure, pulmonary edema, can be predicted by HBD levels, pulmonary embolism (result of arrhythmias and prolonged
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| Nursing management if your pt has an MI while they are on the floor | show 🗑
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| All of the valves have 3 leaflets except | show 🗑
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| Mitral valve prolapse | show 🗑
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| Medical management of mitral valve prolapse | show 🗑
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| Mitral regurgitation | show 🗑
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| show | obstruction of blood flowing from left atrium into left ventricle. Patho- this causes left atrium to increase more blood volume than it’s used to. Pulmonary circulation becomes backed up or congested. This causes the right ventricle to have to contract
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| show | different s/s are hemoptysis, dry cough and repeated respiratory infections
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| show | flow of blood back into the left ventricle from the aorta. Patho-defect in the aortic valve prevents it form closing all the way, and the aorta pumps blood back into the left ventricle so that the ventricle is getting blood from there and the left atrium
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| show | different s/s are “bobbing head” or visible pulsations at temporal and carotid arteries, widened pulse pressure and Corrigan’s pule (a pulse that disappears)
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| Aortic stenosis | show 🗑
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| show | different s/s: chest pain, vibration upon palpation (best to have pt sit up and lean forward to hear murmur and when palpating)
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| Advantages of mechanical valves | show 🗑
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| show | Xenograft (heterograft): pig or cow valve; homograft (allograft): human valve; autograft: patient’s own valve
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| Important patient teaching with valve disorders | show 🗑
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| show | acquired muscular disorders of the muscles of the heart. Primarily these involve enlargement of the chambers of the heart and put the pt at risk for cardiac decompensation or CHF. Patho: idiopathic, viral infections, metabolic, connective tissue and neu
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| show | early stages there may not be any, dyspnea on exertion and fatigue, coughing on exertion, edema, nausea, chest pain, syncope. Tachycardia, S3 and S4 sounds. May show up on CXR or Echo. Often in younger people the first S/Sx is sudden cardiac death
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| show | inotropic agents (make heart squeeze harder), NTG, diuretics, anticoagulants, treatment of arrhythmias, pacemaker, severe cases may need a heart transplant
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| show | rest (avoidance of poorly tolerated activites and alternating activity with rest, avoid stress, abstain from alcohol, medication compliance esp once home
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| show | occurs most often in school-age children, after group A beta-hemolytic streptococcal pharyngitis. Many cases go undetected, then show up later in life. Spread by direct contact w/ oral or resp. secretions. Malnutrition, overcrowding and lower socioecon
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| show | injury to heart tissue is caused by inflammatory or sensitivity rx to the streptococci (not a true infection). Myocardial and pericardial tissue is also affected by endocarditis results in permanent changes in the valves. Weakens the myocardium and gets
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| Rheumatic endocarditis – S/Sx | show 🗑
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| show | teach about need to promptly recognize and treat strep throat to prevent rheumatic fever. Teach about need to take prophylactic Abx before invasive procedures (including dentist)
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| Infective endocarditis | show 🗑
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| Infective endocarditis – S/Sx | show 🗑
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| show | Abx tx, frequent blood cultures, surgery (debridement, valve replacement)
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| Infective endocarditis – Nursing management | show 🗑
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| show | inflammation of the pericardium (membrane sac surrounding the heart). Can be classified as adhesive or due to what kind of fluid is accumulating in the sac (serum, pus, blood, etc.) Patho – fluid build-up or adhesions increase pressure on the heart, rest
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| show | Most characteristic symptom is chest pain when laying, turning, deep inspirations. May be asymptomatic. Creaky or scratchy sounding friction rub heard upon auscultation – louder at the end of exhalation, best heard when pt is sitting and leaning forward
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| show | Tx of symptoms, find and treat the cause – may require a pericardiocentesis, or window
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| Pericarditis – Nursing Management | show 🗑
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