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Cardiac Unit
Med/Surg - Chapter 25
| Question | Answer |
|---|---|
| What is the relaxation phase of the heart refereed to as? | Diastole |
| What is the contraction phase of the heart refereed to as? | Systole |
| The only artery that carries oxygenated blood. | Pulmonary artery |
| T or F - The right ventricle is two to three times more muscular than the left ventricle. | F - left is thicker because it must overcome high aortic and arterial pressures. |
| Where is the apical impulse or PMI (point of maximal impulse) located? | 5th intercostal space |
| During diastole the mitral and tricuspid valves are ____. | open |
| The ___________- valves are closed during diastole. | semilunar |
| The coronary arteries are perfused during what? How would a faster heart rate effect perfusion? | diastole - with a normal heart rate of 60 to 80 bpm there is a lot of time during diastole for perfusion. Increased heart rate shortens diastole and may lead decrease myocardial perfusion. This puts the patient at risk for myocardial ischemia. |
| _________ is the total amount of blood ejected by one of the ventricles in liters per minute. __________ is the amount of blood ejected from one of the ventricles per heart beat. | Cardiac output, stroke volume |
| What are the three factors that determine stroke volume? | preload, afterload, contractility |
| How do the hearts of men and women differ. | Men generally have bigger hearts and women tend to have more narrow coronary arteries. |
| Women tend to develop CAD 10 year later than men. Why is this? | the hormone estrogen has a cardioprotective effect. |
| The three major effecs of estrogen are? | 1) an increase in high-density lipoprotein (HDL) that transports cholesterol out of arteries (2) a reduction in low-density lipoprotein (LDL) that deposits cholesterol in the artery 3) dilatation of the blood vessels- enhance blood ow to the heart. |
| What are two major negative change of the heart that occur with aging? What are the effects? | 1. loss of function of the cells throughout the conduction system leads to a slower heart rate. 2. Increase heart size -hypertrophy (thickening of the heart walls), which reduces the volume of blood that the chambers can hold. |
| What are four major barriers related to cardiac symptoms that lead to people not seeking prompt medical service. | 1.lack of knowledge about the symptoms of heart disease 2. attributing symptoms to a benign source 3. denying symptom significance 4. feeling embarrassed about having symptoms |
| What are the most common S/S of CVD | - Chest pain or discomfort - Shortness of breath or dyspnea - Peripheral edema, weight gain, abdominal distention due to enlarged spleen and liver or ascites (HF) - Palpitations - Unusual fatigue - Dizziness, syncope, or changes in LOC |
| What is ACS? | Acute Coronary syndrome |
| _______________________________is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death (i.e., MI) if denitive interventions do not occur promptly. | Acute coronary syndrome (ACS) |
| To differentiate among the causes of chest pain, the nurse asks the patient what three things? | 1.to identify the quantity (0 = no pain to 10 = worst pain) 2. location 3. quality of pain. |
| T or F - The location of chest of chest pain is correlated with the cause of the pain. | F - location does not correlate with the cause of chest pain. |
| T or F - The severity or duration of chest pain or discomfort does not predict the seriousness of its cause | T |
| Give an example of when more than one clinical cardiac condition may occur. | During an MI, patients may report chest pain from myocardial ischemia, shortness of breath from Heart Failure, and palpitations from dysrhythmias. Both HF and dysrhythmias can be complications of an acute MI. |
| What are some important points to keep in mind when assessing patents reporting chest pain? | - The location of chest symptoms is not well correlated with the cause of the pain. - The severity or duration of chest pain or discomfort does not predict the seriousness of its cause. -More than 1 clinical cardiac condition may occur simultaneously |
| The __________ provides an opportunity for the nurse to assess patients’ understanding of their personal risk factors for coronary artery, peripheral vascular, and cerebrovascular diseases and any measures that they are taking to modify these risks | health history |
| Some non modifiable risk factors related to cardiac issues include age. male sex and race. List 6 modifiable risk factors. | 1. smoking 2. Hypertention (drugs can be taken to lower this) 3. High cholesterol 4. Diabetes 5. Obesity 6. Physical inactivity These can all be modified by lifestyle changes or medications. |
| What are some questions a nurse can ask a patient to determine perceived health status? Example: - What do you do to stay healthy and take care of your heart? Or -What health concerns do you have? | -How is your health? Have you noticed any changes from last year? 5 years ago? -Do you have a cardiologist or primary provider? How often do you go for checkups? -Do you have a family hx of genetic disorders that place you at risk for CVD. |
| Characteristics of what? Uncomfortable pressure, squeezing or fullness in substernal chest. Can radiate across chest to the medial aspect of 1 or both arms, jaw, shoulders, upper back, or epigastrium. Radiation to arms & hands - (numbness or aching.) | Angina |
| What is the duration of Angina? What are the precipitating events and aggravating factors? | 5 to 15 minutes - physical exertion, emotional upset, eating large meals or expose to extremes in temperature |
| Characteristics of what? Same S/S of Angina Pectoris. Pain or Discomfort ranges from mild to sever. Associated with shortness of breath, diaphoresis, palpitations, unusual fatigue, and N/V | ACS |
| What is the duration of ACS? What are the precipitating events and aggravating factors? | Greater than 15 minutes - Emotional upset or unusual physical exertion occurring withing 24 hours of symptom onset. Can occur at rest or while sleeping. |
| Alleviating factors for Angina (list 3) | Rest, nitroglycerin, oxygen |
| Alleviating factors for ACS (list 2) | 1. morphine 2. reperfusion of coronary artery with thrombolytic (fibrinolytic) agents or percutaneous coronary intervetion |
| Why is Nocturia common with pts that have HF? | Fluid collected in gravity-dependent tissues (extremities) during the day (edema) redistributes into the circulatory system once the patient is recumbent at night. The increased circulatory volume is excreted by the kidneys (increased urine production). |
| What condition? Sharp, sever substernal or epigastric pain. Can radiate to neck, arms and back. Associated symptoms include fever, Malaise, dyspnea, cough, nausea, diziness and palpitations. | Pericarditis |
| What is the duration of pericarditis? What are the precipitating events and aggravating factors? | intermittent - sudden onset. Pain increase with inspiration, swallowing, coughing and rotation of trunk. |
| What are some alleviating factors of pericarditis? | Sitting upright, analgesia, anti-inflammatory medications |
| What is the term for Suddenly awakening with shortness of breath ? What is this a symptom of? | Paroxysmal Nocturnal dyspnea - This is a symptom of worsening heart failure. |
| What causes Paroxymal nocturnal dyspnea? | Reabsorption of fluid from dependent areas of the body (arms & legs) back into the circulatory system within hours of lying in bed. Shift increases preload & places increased demand on the heart of patients with HF, causing sudden pulmonary congestion. |
| Patients with worsening HF often experience________, a term used to indicate the need to sit upright or stand to avoid feeling short of breath. What will patients experiencing report? | orthopnea - Patients experiencing orthopnea will report that they need to sleep upright in a chair or add extra pillows to their bed. |
| Clues to worsening cardiac disease, especially HF, can be revealed by____________ events. | sleep-related |
| There is mounting evidence of cardiac consequences associated with what? | Sleep disorder breathing (SDB) often called Obstructive Sleep Apnea. |
| What is SBD? | Sleep disorder breathing - abnormal respiratory pattern due to intermittent episodes of upper airway obstruction caused by causing apnea and hypopnea (shallow respirations) during sleep |
| Why is untreated Sleep disorder breathing (SBD) an issue? | it cause intermittent hypoxemia, sympathetic nervous system activation and increase intrathoracic pressure that puts mechanical stress on the heart and large artery walls. Untreated SBD has been linked to CAD, hypertension, HF and dysrhythmias. |
| What are the Cardinal signs of SBD? What are two important risk factors to know? | 1. Loud disruptive snoring and apnea lasting more than 10 seconds 2. Obesity and large neck circumference |
| How can a nurse make patient fell more comfortable about resuming sexual activity after a heart incident? | Education - sexual activity is equivalent to 3 to 5 minutes of mid to moderate activity. |
| Patients with CAD or HF should be assessed for __________. | depression |
| Patients who have depression exhibit common signs and symptoms. What are they? (6) | 1.feelings of worthlessness or guilt 2. problems falling asleep or staying asleep 3. little interest or pleasure in doing things they usually enjoy 4.having difficulty concentrating 5. restlessness 6. recent changes in appetite or weight. |
| Signs and symptoms of acute obstruction of arterial blood flow in the extremities. What are the 6 P's | 1.pain, 2. pallor 3. pulselessness 4. paresthesia (abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) 5. poikilothermia (coldness) 6. paralysis |
| Prolonged ________ refill time indicates compromised arterial perfusion, a problem associated with cardiogenic shock and HF. | capillary |
| __________ of the fingers and toes indicates chronic hemoglobin desaturation and is associated with congenital heart disease. | Clubbing |
| Hair loss, brittle nails, dry or scaling skin, atrophy of the skin, skin color changes, and ulcerations are indicative of chronically reduced oxygen and nutrient supply to the skin observed in patients with what? | arterial or venous insufficiency |
| A normal BP in adults is considered a systolic BP less than ____mm Hg over a diastolic BP less than __ mm Hg. Hypertension, is defined by having a systolic BP that is consistently greater than ___ mm Hg or a diastolic BP greater than __ mm Hg. | - 120/80 - 140/ 90 |
| The difference between the systolic and the diastolic pressures is called the ________ ___________. | pulse pressure |
| Pulse pressure is normally s 30 to 40 mm Hg. What does this mean. | It is a reflection of stroke volume, ejection velocity, and systemic vascular resistance. Indicates how well the patient maintains cardiac output. |
| A pulse pressure of less than _____ mm Hg signifies a serious reduction in cardiac output and requires further cardiovascular assessment. | 30 |
| _______ _________ is a sustained decrease of at least 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP within 3 minutes of moving from a lying or sitting to a standing position. What is usually accompanied with this? | Postural (orthostatic) hypotension - It is usually accompanied by dizziness, lightheadedness, or syncope |
| Postural hypotension in patients with CVD is most often due to a significant reduction in _________, which compromises cardiac output. What causes this? | preload --- caused by dehydration from overdiuresis, bleeding (due to antiplatelet or anticoagulant medications or post intravascular procedures), or medications that dilate the blood vessels |
| What is a pulse deficit? | When there is a difference between apical and radial pulse rates |
| Rhythmic changes are heard as blood cells ow through patent arteries, whereas obstruction to blood ow is evidenced by what? | no changes in sound |
| ______sided heart function can be estimated by observing the pulsations of the jugular veins of the neck, which refects central venous pressure. What is CVP? | Right- CVP is the pressure in the right atria or the right ventricle at the end of diastole |
| Obvious distention of the jugular veins with the patient’s head elevated 45 to 90 degrees indicates an abnormal increase in CVP. This abnormality is observed in patients with right-sided HF due to what? | -hypervolemia, pulmonary hypertension, and pulmonary stenosis; less commonly with obstruction of blood flow in the superior vena cava; and rarely with acute massive pulmonary embolism. |
| 1 __ 3rd intercostal space. left of sternum 2.___2nd intercostal space. right of sternum. 3. ___4th & 5th intercostal spaces. left of sternum 4___2nd intercostal space. left of sternum 5.____left 5th intercostal space- midclavicular | 1. Erb’s point 2. Aortic area 3. Tricuspid area 4. Pulmonic area 5. Mitral (apical) area |
| Normally, the apical impulse is palpable in only one intercostal space; palpability in two or more adjacent intercostal spaces indicates ______________ _____________ _______. | left ventricular enlargement. |
| An apical impulse below the fth intercostal space or lateral to the midclavicular line usually denotes what? | left ventricular enlargement from left ventricular failure |
| If the apical impulse can be palpated in two distinctly separate areas and the pulsation movements are paradoxical (not simultaneous), a ventricular ___________ may be suspected. | aneurysm |
| With a heart inspection a vibration or purring sensation may be felt over areas where abnormal, turbulent blood ow is present. What is this called and what does it indicate? | This vibration is called a thrill and is associated with a loud murmur. |
| The period between S1 and S2 corresponds with ventricular ___________ . When the heart rate is within the normal range, _______is much shorter than the period between S2 and S1 which is ________. | systole, systole, diastole |
| as the heart rate ________, diastole shortens. | increases |
| What sound make up the first heart beat (S1)? | tricuspid and mitral valves closure |
| What sound make up the 2nd heart beat (S2)? | closure of the pulmonic and aoritc valves |
| S3 and S4 gallop sounds are heard during diastole. These sounds are created by what? | the vibration of the ventricle and surrounding structures as blood meets resistance during ventricular filling. |
| Can an S3 sound be a normal finding? explain. | It represents a normal finding in children and adults up to 35 or 40 years of age. In these cases, it is referred to as a physiologic S3 In older adults, an S3 is a significant finding, suggesting HF. |
| When is an S3 sound heard? | immediately after S2. Lub- Dub- Dub |
| When is an S4 sound heard? | Just before S1 is generated during atrial contraction as blood forcefully enters the noncompliant ventricle . lub -lub - dub |
| What is it called when you hear all 4 heart sounds? | summation gallop - lub-lub- dub - dub |
| What are opening snaps? | Opening snaps are abnormal diastolic sounds heard during opening of an AV valve. |
| What are systolic clicks? | stenosis of one of the semilunar valves creates a short, highpitched sound in early systole, immediately after S1. This sound resulting of the opening of a rigid and calcified aortic or pulmonic valve during ventricular contraction. |
| mitral stenosis can cause an __________ ______ , which is an unusually high-pitched sound very early in diastole. This sound is caused by high pressure in the left atrium that abruptly displaces or “snaps” open a rigid valve leaet. | opening snap |
| ____________ are created by turbulent ow of blood in the heart. | Murmurs |
| Heart murmurs are described in terms of what six things? What do these thing provide? | 1. location, 2. timing, 3. intensity 4.pitch, 5 quality 6. radiation These characteristics provide information needed to determine the cause of the murmur and its clinical significance. |
| A harsh, grating sound that can be heard in both systole and diastole | friction rub |
| What causes friction rub? | abrasion of the inflamed pericardial surfaces from pericarditis. |
| What are three frequent finding in the lungs associated with cardiac disorders? | Hemoptysis cough crackles wheezing |
| Pink, frothy sputum is indicative of acute pulmonary edema. | Hemoptysis |
| T or F - A dry, hacking cough is not a common fining with cardiac disorders? explain why or why not? | A dry, hacking cough from irritation of small airways is common in patients with pulmonary congestion from HF. |
| Wheezes: Compression of the small airways by interstitial pulmonary edema may cause wheezing. What drug can cause this? | Beta-adrenergic blocking agents (beta-blockers), such as propranolol, may cause airway narrowing, especially in patients with underlying pulmonary disease. |
| What abdominal finds are relevant to cardiovascular disorders? | Abdominal distention hepatojugular reflux bladder distetion |
| Why is abdominal distention (Ascites) a finding with some cardiovascular disorders? | failing RH = abnormally high chamber pressures impede the return of venous blood. The liver & spleen become engorged w/ venous blood (hepatosplenomegaly). As pressure in the portal system rises, fluid shifts from the vascular bed to the abd cavity. |
| ________ is a neurohormone that helps regulate BP and uid volume | BNP - Brain Natriuretic peptide |
| This increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. This is useful for prompt diagnosis of HF in settings such as the ED. | BNP levels - can be obtain quickly |
| A BNP level greater than ________ pg/mL is suggestive of HF. | 100 |
| This is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis. Testing this helps to predict CVD risk. | CRP |
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