assess cardiac fxn - ch26 - p684-707
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| when do all 4 heart chambers relax simultaneosly? | DIASTOLE = ALL 4 CHAMBERS RELAX
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| Why are the atrial and ventricular contractions syncronized and not simultaneous? | allows for complete ventricular filling
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| Venous blood = | deoxygenated blood
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| the right atrium receives blood from what 3 sources | superior vena cava
inferior vena cava
coronary sinus
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| the left atrium receives oxygenated blood from what source | 4 pulmonary veins
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| the left ventricle is how much more muscular than the right? | 2 1/2 times
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| during DIASTOLE the AV Valves (tricuspid/mitral) are... | DIASTOLE = OPEN AV VALVES
tricuspid / (BI)mitral
(for ventricular filling)
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| 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%)
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| 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.
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| the heart BASE is located at the __ and the APEX is located at the ___ | heart base = top
heart apex = bottom
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| what is the normal/resting firing rate of the SA node? impulses per minute? | SA node = 60-100 impulses per min
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| what is the normal/resting firing rate of the AV node? impulses per minute? | AV node = 40-60 impulses per min
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| what is the normal/resting firing rate of the ventricular pacemaker sites? impulses per minute? | ventricular pacemaker sites =
30-40 impulses per min
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| Atrial Kick = | atrial kick = atrial systole
adds 15-25% to ventricular filling
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| cardiac regurgitation = | regurgitation = cardiac backflow..
blood flow opposite from the correct direction(i.e. ventricle to atrium)
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| resting cardiac output (CO) = (average adult) | resting cardiac output (CO) = 5 L/min
(average adult)
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| resting stroke volume (SV)= (average adult) | resting stroke volume (SV)= @70mL
(average adult)
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| how do you calculate cardiac output (CO)? | CO = (SV) X (HR)
cardiac output =
stroke volume X heart rate
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| changes in stroke volume and or heart rate can change what? | changes in stroke volume and or heart rate can change cardiac output
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| parasympathetic cardiac stimulation from the __ nerve, __ the heart rate. | parasympathetic cardiac stimulation from the VAGUS nerve, SLOW the heart rate.
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| 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
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| STROKE VOLUME IS DETERMINED BY... | PRELOAD
AFTERLOAD
CONTRACTILITY
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| PRELOAD = LVEDP = | LEFT
VENTRICULAR
END
DIASTOLIC
PRESSURE
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| WHAT CONDITIONS REDUCE PRELOAD? | DIURESIS
VENODILATING AGENTS (i.e. nitrites)
EXCESS BLOOD LOSS
DEHYDRATION (vomiting, diarrhea, diaphoresis)
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| What things would increase PRELOAD? | -blood xfusions
-IV fluids
(controlling loss of blood/fluids, replacing fluids)
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| Increased contractility = Increased stroke volume.. What increases contractility? | -sympathetic response / reflex
-Rx: Digoxin, dopamine/Intropin, dobutamine, Dobutrex
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| Depressed contractility = decreased stroke volume.. What depresses contractility? | -hypoxemia
-acidosis
-Rx: beta adrenergic blockers - atenolol/Tenormin
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| The EJECTION FRACTION is used to measure.. ? | The EJECTION FRACTION is used to measure MYOCARDIAL CONTRACTILITY
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| normal left ventricular ejection fraction = | normal left ventricular
ejection fraction = 55-65%
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| ejection fraction < 40% incidates..? | ejection fraction < 40% incidates
DECREASED LEFT VENTRICULAR FXN
most likely requires treatment for HF
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| 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)
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| how are WOMEN'S hearts different from men's? | Women's hearts and coronary arteries are smaller than mens
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| major barriers to seeking prompt cardiac treatment... | -lack of heart disease knowledge
-denying symptom signifigance
-embarrassment
-mistaking symptom for benign cause
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| 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
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| if pt. complains of CP, the nurse should... (assessment) | ask questions to differentiate among sources of chest pains symptoms...
(see chart p 692-693)
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| 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**
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| 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
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| SILENT ISCHEMIA = | -ASYMPTOMATIC ACS
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| 3 MAJOR CARDIOVASCULAR RISK FACTORS | 1. HYPERLIPIDEMIA
2. HYPERTENSION
3. DIABETES MELLITUS
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| NOCTURIA | waking in the night to urinate
(common in pts with HF)
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| 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)
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| 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?
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| PULSE PRESSURE = | DIFFERENCE BETWEEN
SYSTOLE & DIASTOLE
(i.e. 120-80=40)
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| normal pulse pressure | 30-40 mmHg
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| elevated >40 pulse pressure may result from: | -anxiety/exercise/bradycardia
-fever
-atherosclerosis
-aging / hypertension
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| decreased pulse pressure may result from: | -shock -HF
-hypovolemia
-mitral regurgitation
-mitral or aortic stenosis
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| pulse pressure <30 = | **erious cardiac output reduction**
focused assessment required/indicated
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| pulse deficit = | difference between apical and radial pulse.. often result from dysrhythmias
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| pulse quality = | 0 = absent
+1 = weak
+2 = diminished
+3 = full
+4 = bounding
(document location, quality and scale / left radial +3/+4)
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| Split S2 = | delayed pulmonic valve closure
heard best over pulmonic area
during inspiration = ok
constant = ABNORMAL
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| 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
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