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assess cardiac fxn

assess cardiac fxn - ch26 - p684-707

QuestionAnswer
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