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assess cardiac fxn
assess cardiac fxn - ch26 - p684-707
| Question | Answer |
|---|---|
| when do all 4 heart chambers relax simultaneosly? | DIASTOLE = ALL 4 CHAMBERS RELAX |
| Why are the atrial and ventricular contractions syncronized and not simultaneous? | allows for complete ventricular filling |
| Venous blood = | deoxygenated blood |
| the right atrium receives blood from what 3 sources | superior vena cava inferior vena cava coronary sinus |
| the left atrium receives oxygenated blood from what source | 4 pulmonary veins |
| the left ventricle is how much more muscular than the right? | 2 1/2 times |
| during DIASTOLE the AV Valves (tricuspid/mitral) are... | DIASTOLE = OPEN AV VALVES tricuspid / (BI)mitral (for ventricular filling) |
| The heart extracts what % of O2 from coronary artery circulation? | the heart's high metabolic requirements extract 70-80% O2, (where as other organs extract @25%) |
| Pts (especially w. CVD) are at risk for ___ during tachycardias due to ___. | Pts (especially w. CVD) are at risk for MYOCARDIAL ISCHEMIA during tachycardias due to INADEQUATE TIME FOR MYOCARDIAL PERFUSION. |
| the heart BASE is located at the __ and the APEX is located at the ___ | heart base = top heart apex = bottom |
| what is the normal/resting firing rate of the SA node? impulses per minute? | SA node = 60-100 impulses per min |
| what is the normal/resting firing rate of the AV node? impulses per minute? | AV node = 40-60 impulses per min |
| what is the normal/resting firing rate of the ventricular pacemaker sites? impulses per minute? | ventricular pacemaker sites = 30-40 impulses per min |
| Atrial Kick = | atrial kick = atrial systole adds 15-25% to ventricular filling |
| cardiac regurgitation = | regurgitation = cardiac backflow.. blood flow opposite from the correct direction(i.e. ventricle to atrium) |
| resting cardiac output (CO) = (average adult) | resting cardiac output (CO) = 5 L/min (average adult) |
| resting stroke volume (SV)= (average adult) | resting stroke volume (SV)= @70mL (average adult) |
| how do you calculate cardiac output (CO)? | CO = (SV) X (HR) cardiac output = stroke volume X heart rate |
| changes in stroke volume and or heart rate can change what? | changes in stroke volume and or heart rate can change cardiac output |
| parasympathetic cardiac stimulation from the __ nerve, __ the heart rate. | parasympathetic cardiac stimulation from the VAGUS nerve, SLOW the heart rate. |
| CATECHOLAMINES (adrenal gland secretions) AND EXCESS THRYROID HORMONE have what affect on the heart? | CATECHOLAMINES (adrenal gland secretions) AND EXCESS THRYROID HORMONE ... SYMPATHETICALLY INCREASE HEART RATE |
| STROKE VOLUME IS DETERMINED BY... | PRELOAD AFTERLOAD CONTRACTILITY |
| PRELOAD = LVEDP = | LEFT VENTRICULAR END DIASTOLIC PRESSURE |
| WHAT CONDITIONS REDUCE PRELOAD? | DIURESIS VENODILATING AGENTS (i.e. nitrites) EXCESS BLOOD LOSS DEHYDRATION (vomiting, diarrhea, diaphoresis) |
| What things would increase PRELOAD? | -blood xfusions -IV fluids (controlling loss of blood/fluids, replacing fluids) |
| Increased contractility = Increased stroke volume.. What increases contractility? | -sympathetic response / reflex -Rx: Digoxin, dopamine/Intropin, dobutamine, Dobutrex |
| Depressed contractility = decreased stroke volume.. What depresses contractility? | -hypoxemia -acidosis -Rx: beta adrenergic blockers - atenolol/Tenormin |
| The EJECTION FRACTION is used to measure.. ? | The EJECTION FRACTION is used to measure MYOCARDIAL CONTRACTILITY |
| normal left ventricular ejection fraction = | normal left ventricular ejection fraction = 55-65% |
| ejection fraction < 40% incidates..? | ejection fraction < 40% incidates DECREASED LEFT VENTRICULAR FXN most likely requires treatment for HF |
| age related cardiac changes.. | -decreased contractility -increased lft vent ejection time(prolonged systole) -delayed conduction (inadequate rate increase and longer returns to normal resting rate) |
| how are WOMEN'S hearts different from men's? | Women's hearts and coronary arteries are smaller than mens |
| major barriers to seeking prompt cardiac treatment... | -lack of heart disease knowledge -denying symptom signifigance -embarrassment -mistaking symptom for benign cause |
| most common S/S CVD = | -CP (chest pain)/discomfort -SOB / dyspnea -peripheral edema, weight gain, abdominal distention -palpitations -vital fatigue (unusually tired, irritable) -dizziness / syncope |
| if pt. complains of CP, the nurse should... (assessment) | ask questions to differentiate among sources of chest pains symptoms... (see chart p 692-693) |
| prodromal symptoms of ACS = (ACUTE CORONARY SYNDROME) | -fatigue -SOB -sleep disturbances -anxiety -fleeting chest pain/ache/pressure that comes and goes **NURSES SHOULD ASK ABOUT THESE WHEN ASSESSING/HISTORY** |
| 50% of ACS sensations/pains are experienced in the (location). 50% are felt in what other locations? | -50% ACS pains/ senstions in the CHEST -50% upper back, shoulder, arm, neck, epigastic burning or SOB |
| SILENT ISCHEMIA = | -ASYMPTOMATIC ACS |
| 3 MAJOR CARDIOVASCULAR RISK FACTORS | 1. HYPERLIPIDEMIA 2. HYPERTENSION 3. DIABETES MELLITUS |
| NOCTURIA | waking in the night to urinate (common in pts with HF) |
| cardiac medications cause what common side effect? patients on cardiac Rx are screened for? | cardiac Rx common SE = GI upset / bleeding Screen pts on cardiac Rx for bloody urine bloody stools (melena) |
| ASSESSMENT OF CARDIOVASCULAR SYSTEM / PT HISTORY INCLUDES: | -health history / risk factors -Rx / OTC / Herbal info -Nutritional/Elimination assessment -Activity-Exercise/ Rest-Sleep info -health perception -stress? - Preventions? - |
| PULSE PRESSURE = | DIFFERENCE BETWEEN SYSTOLE & DIASTOLE (i.e. 120-80=40) |
| normal pulse pressure | 30-40 mmHg |
| elevated >40 pulse pressure may result from: | -anxiety/exercise/bradycardia -fever -atherosclerosis -aging / hypertension |
| decreased pulse pressure may result from: | -shock -HF -hypovolemia -mitral regurgitation -mitral or aortic stenosis |
| pulse pressure <30 = | **erious cardiac output reduction** focused assessment required/indicated |
| pulse deficit = | difference between apical and radial pulse.. often result from dysrhythmias |
| pulse quality = | 0 = absent +1 = weak +2 = diminished +3 = full +4 = bounding (document location, quality and scale / left radial +3/+4) |
| Split S2 = | delayed pulmonic valve closure heard best over pulmonic area during inspiration = ok constant = ABNORMAL |
| CVD - CAD LABS / TESTS? | -cardiac biomarker analysis -Lipid profile(LDL, HDL, TRIGLYC) -BNP (reg's BP and fluid volume) -CRP (systemic inflammation marker) -homocysteine (atherosclerosis) -chest x-ray / ECG |
Created by:
rtcdavis
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