-
What is contained in the blood that is pumped out of the left ventricle?
A full supply of oxygen
- In what pattern does the heart contract?
- Both atria, then both ventricles
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Together, what are the interior lining of the heart, the valves and the large vessels of the heart called?
endocardium
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Valve flaps prevent the backflow of blood from the pulmonary artery into what?
Right ventricle
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What is the name of the normal period in the heart cycle during which the muscle fibers lengthen, the heart dilates, and the cavities fill with blood (roughly the period of relaxation)?
Diastole
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Where does the right atrium receive blood from?
Superior and inferior venae cavae and coronary sinus
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What does a nurse observe in a patient receiving heparin therapy?
Emesis, urine and stools for blood
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In HF, what does an increase in abdominal girth, increase in total body weight, and pitting edema indicate?
Fluid retention
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What should a nurse include in the teaching to a patient diagnosed with hypertension?
Education on continuing to take antihypertensive meds as prescribed.
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Why should IVs of older patients be monitored carefully?
They may get a fluid overload of the circulatory system
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What are the nursing interventions of a patient diagnose with acute infective endocarditis?
Restricted activity for several weeks.
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What should a patient do to decrease the pain from angina pectoris?
Take nitroglycerin sublingually at the first sign of chest discomfort.
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What would patient teaching for arterial occlusive disorder include?
The importance of avoiding exposure to cold and chilling
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What should a postmyocardial patient being prepared for discharge be instructed to do?
Begin a cardiac rehab program
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What are dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein and abdominal distention signs and symptoms of?
Right-sided heart failure
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What is the primary function of patient teaching following a myocardial infarction?
To assist the patient to develop a healthy lifestyle
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What is an important nursing intervention when caring for a patient with remote telemetry?
Never remove telemetry and allow patient to shower unless physician has written the order to allow a shower
-
What are the signs and symptoms of cardiogenic shock?
Decreasing blood pressure and weak, rapid pulse
-
What are some modifiable risk factors for coronary artery disease?
High cholesterol, obesity
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What is the name of the neurohormone released from the left ventricle in response to volume expansion and pressure overload that has emerged as the blood marker for the identification of individuals with CHF?
B-type natriuretic peptide (BNP)
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What is the normal range for B-type natriuretic peptide (BNP)?
0 to 100 pg/ml
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What is a myocardial muscle protein released into circulation after myocardial injury and is useful in diagnosing a myocardial infarction?
Tropin l
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What typical vital signs will display in a patient presenting with a myocardial infarction?
Hypertension, tachycardia, weakened pulse, temperature elevation
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What are the signs and symptoms of angina?
Syncope, fatigue and dyspnea with exertion
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What is the impulse pattern of the cardiac conduction system?
SA node, AV node, Bundle of His, Right and left bundle branches, Purkinje fibers
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What is the diagnostic test that allows observation of real time movement via radiography?
Fluoroscopy
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What cardiac markers is specific to the heart, not influenced by skeletal muscle trauma or renal failure, and rises 3 hours following a myocardial infarction?
Troponin I
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How does an older cardiac patient is different from the younger cardiac patient?
Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity.
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What is a modifiable risk factor in a patient at risk for cardiovascular disease?
Hyperlipidemia
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What is the most serious type of dysrhythmia?
Ventricular fibrillation
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What would a nurse do when caring for a patient with a new pacemaker?
Monitor the heart rate and rhythm by apical pulse and ECG patterns
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What nursing care is followed for a patient with myocardial infarction?
Bedrest with commode privileges for 24 to 48 hours.
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What should the nurse plan to do to enable a patient to best tolerate ambulation following cardiac surgery?
Premedicate the patient with an analgesic before ambulating
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What should the nurse first check if there is no electrocardiographic complexes in a patient wearing a continuous cardiac monitor?
Check the client status and lead placement
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Why would a physician perform carotid massage on a patient with a diagnosis of rapid rate atrial fibrillation?
The procedure may stimulate the vagus nerve to slow the heart rate.
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What observation would be of highest priority to the nurse of a patient following cardioversion?
Status of airway
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How should the nurse ensure she does not dislodge the pacing catheter in a patient immediately after insertion of a pacemaker into the right subclavian vein?
Limit movement and abduction of the right arm
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What would the nurse check for in a patient with complaints of claudication and superficial thrombophlebitis of the lower leg?
Smoking history
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What breath sounds would a nurse expect to hear in a patient with myocardial infarction who suddenly becomes tachycardic and shows signs of air hunger?
Crackles
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What characteristics would a nurse note on a client with a diagnosis of right-sided heart failure?
Dependent edema
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What observation would indicate that a pericardiocentisis was unsuccessful?
Distant and muffled heart sounds
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A family member who has a cardiovascular problem before what age places the patient at a greater risk for developing cardiovascular disease?
Before 50 years of age
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What sex is at a greater risk of developing cardiovascular disease?
Men
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What culture has a higher risk of developing cardiovascular disease?
African-American males
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What are modifiable risk factors associated with cardiovascular disease?
Smoking, hyperlipidemia, hypertension, diabetes, obesity, sedentary lifestyle, stress, oral contraceptives, psychosocial factors.
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What is arteriosclerosis?
Thickening, loss of elasticity and calcification of arterial walls resulting in a decreased blood supply
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What is heart failure?
When the heart doesn't pump enough blood
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What is atherosclerosis?
Yellowish plaques of cholesterol, lipids and cellular debris in the inner layers of the walls of large and medium-sized arteries
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What hormones of the sympathetic nervous system produce negative effects on the failing heart?
Epinephrine and norepinephrine
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Where does heart failure usually begin?
In the left ventricle
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What are signs and symptoms of left ventricular failure?
Weakness and shortness of breath because the lungs are filling up with fluid; cough, frothy blood-tinged sputum
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What is pleural effusion?
An abnormal accumulation of fluid in the thoracic cavity between the visceral and parietal pleurae
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What are the signs and symptoms of right ventricular failure?
Distended jugular veins, liver enlargement, edema in feet
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What is orthopnea?
A condition in which a person must sit or stand to breathe deeply or comfortably
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What is Buerger�s disease?
A vascular condition in which the small and medium-sized arteries become inflamed and thrombotic.
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Which patients are more at risk for Buerger�s disease?
Those who smoke
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What is the most common symptom of Buerger�s disease?
Instep claudication
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What is congestive heart failure?
Heart failure in which patients suffer pulmonary or systemic congestion
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What is endocarditis?
An infection of inflammation of the inner membranous lining of the heart, valves
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What are the signs and symptoms of endocarditis?
Flu-like symptoms, undue fatigue, chest pain, headaches, petechia, oral mucosa
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What can be diagnosed from an angiogram?
Vessel occlusion, congenital anomalies, pooling in heart chambers
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What can be seen in an aortogram?
Abdominal aorta and the major leg arteries by use of a dye
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What is the purpose of a cardiac cath?
Measure pressure within the heart and blood-volume relationship
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How is a patient placed after a cardiac cath?
Supine with a sandbag over the pressure dressing at the insertion site
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What is an electrocardiogram?
A graphic study of the electrical activities of the myocardium
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What does an electrocardiogram determine?
Transmission of cardiac impulses
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What is telemetry?
The monitoring of a patient's heart rhythms from a distant location via a transmitter
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When is a telemetry unit removed from a patient?
NEVER without a Doc's order (even for a shower!)
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What is Thallium Scanning?
An x-ray injection of a radioisotope that is not absorbed by an infarcted cell
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What does a CBC determine?
The number of red and white blood cells, platelets, hemoglobin and hematocrit
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When is ESR used?
To monitor or rule out inflammatory conditions of the heart
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What are serum cardiac markers?
Proteins that are released into the blood in large quantities only when cardiac muscle is damaged.
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What is homocysteine?
And amino acid produced during protein digestion
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When is myoglobin released into circulation?
A few hours after an MI
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What does increased troponin levels indicate?
If a patient has had a heart attack and how much cardiac muscle was damaged
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Why is the aorta prone to aneurysm?
Because it is continuously exposed to high pressures
-
What is an arterial aneurysm?
An enlarged, dilated portion of an artery
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What is the first priority of care for a patient with an aneurysm?
Control of hypertension
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What is angina pectoris?
A spasmodic, cramplike, choking feeling of the myocardium; believed to be a temporary lack of oxygen and blood supply to the heart
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What is the most common cause of angina?
Atherosclerosis of the coronary arteries
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When does angina typically occur?
With an increased cardiac workload
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Which medications are used to treat angina?
Aspirin, vasodilators, nitroglycerin
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What is the nation�s number one killer?
Coronary artery disease
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What is a percutaneous transluminal coronary angioplasty?
A technique that uses a balloon to widen the narrowing in a coronary artery without open heart surgery; used on pt's with CAHD
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What are the signs and symptoms of angina?
Tightness of the chest, a pressure or a squeezing sensation but not a sharp pain
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What is a myocardial infarction?
An occlusion of a major coronary artery
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What is collateral circulation?
Development of new vessels within the heart to compensate for the loss of circulation from the occluded artery (the heart re-routes itself to work around a blockage)
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What are the signs and symptoms of an MI?
crushing, viselike sensation of the chest and heart region with pain that radiates down the left arm and to the neck, jaws, teeth and epigastric area
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What is reperfusion?
Reinstitution of blood flow to an area that was ischemic
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To be effective, when must reperfusion be attained?
Within 3-5 hours following the onset of MI symptoms and is most affective in the first 30 min to an hour
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How long does it take myocardial cells to die?
4-6 hours
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What is a coronary artery bypass graft?
Used to bypass occluded arteries, usually taken from saphenous veins in the legs
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What is cardiomyopathy?
A term used to describe a group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium
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What are the primary forms of cardiomyopathy?
Dilated (ventricular), hypertrophic (increased heart size), and restrictive (ventricular walls are rigid)
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What are the secondary forms of cardiomyopathy?
Infective, metabolic, nutritional, alcohol, peripartum, drugs, lupus, rheumatoid arthritis, �crack� heart
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What are the most common signs and symptoms of cardiomyopathy?
Angina, syncope, fatigue, and dyspnea on exertion
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What is a dysrhythmia?
Any cardiac rhythm that deviates from normal sinus rhythm
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How is tachycardia characterized?
Heartbeat of 100-150 or more per minute
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How is bradycardia characterized?
By a pulse rate of fewer than 60 beats per minute
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What is supraventricular tachycardia?
The sudden onset of a rapid heartbeat characterized by a pulse rate of 150-250 beats per minute.
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What is atrial fibrillation?
A very rapid production of atrial impulses characterized by an atrial rate of 350 to 600 beats per minute (atria fibrillates or quivers rather than contracts)
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What are premature ventricular contractions?
Abnormal heart beats that arise from the right or left ventricle
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What is ventricular tachycardia?
Occurs when three or more successive PVCs occur;.ventricular rate is 140-240
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What is ventricular fibrillation?
Occurs when the ventricular musculature of the heart is quivering
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What is thrombophlebitis?
An inflammation of a vein in conjunction with the formation of a thrombus
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What is referred to as a positive Homans� sign?
Active dorsiflexion of the foot that results in calf pain
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How is thrombohlebitis treated?
Bed rest, moist heat and elevation of the legs
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What is a major risk during the acute phase of a DVT?
Dislodging of the thrombus which can migrate to the lungs
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What is a Greenfield filter?
A device inserted into a vein that permits filtration of clots without interruption
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What is Raynaud's disease?
Intermittent attacks of ischemia of the body caused by exposure to cold or emotional stimuli
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What medical management is utilized for patients with Raynaud�s?
avoid temperature extremes and caffeiene
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What is cardiogenic shock?
Pump failure; Complication of MI and heart failure
-
What are the clinical manifestations of cardiogenic shcok?
Decreased cardiac output, myocardial ischemia, cerebral hypoxia
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What are the signs and symptoms of cardiogenic shock?
Dysthrymias, chest pain, anxiety, agitation, diminished or absent urinary output, decreased BP, cyanosis
-
What drugs are used to treat cardiogenic shock?
vasopressors, digoxin, dopamine
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What is pulmonary edema?
Accumulation of extravascular fluid in lung tissues and alveoli, caused by severe left ventricular dysfunction
-
What are the signs and symptoms of pulmonary edema?
Severe respiratory distress, frothy sputum, coughing, choking
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Where is the Greenfield filter inserted?
Percutaneously through superficial femoral or internal jugular veins
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What is venous insufficiency?
Abnormal circulatory condition characterized by decreased return of venous blood flow from the legs to the trunk of the body
-
What is the first sign of venous insufficiency?
Edema
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What are varicose veins?
A dilated vein with incompetent valves
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What is a venous stasis ulcer?
Ulcers that occur when tissue is congested and dies and blood can�t leave that spot
-
What is coronary artery disease?
A term used to describe a variety of conditions that obstruct blood flow in the coronary arteries
-
What is atherosclerosis?
An arterial disorder characterized by plaques in the inner layers of the walls of large and medium arteries
-
What is hypertension?
High blood pressure greater than 140/90 on two or more occasions
-
What is orthopnea?
An abnormal condition in which a person must sit or stand to breathe deeply or comfortably
-
Why is hypertension known as the silent killer?
Because there are usually no symptoms in the early stages
-
What are some signs and symptoms of hypertension?
Awakening with a headache, blurred vision, and nosebleeds
-
What is claudification?
Process of activity, then eschemia, then pain in an affected area that subsides with rest
-
What drug is given to a patient with a suspected MI?
Lidocaine
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Why was the term �congestive heart failure� changed to just �heart failure�?
Because not every patient suffering from heart failure has pulmonary congestion
-
How is nitroglycerin administered?
PO, 1 tablet every 5 minutes times 3.
-
What is the first step to determine why a patient isn�t compliant with their meds?
Ask them why they aren't taking their meds
-
What symptoms are seen in angina pectoris?
Chest pain that radiates down the left arm, dypsnea, anxiety, apprehension, diaphoresis and nausea
-
What would you expect to see in a patient with suspected cocaine use?
An enlarged heart
-
What should be assessed in a patient before they are sent to the cardiac cath lab?
Any allergies
-
What labs should be constantly checked in a patient who is on lasix?
Potassium
-
When is the hormone b-type natriuretic peptide (BNP) released?
It's secreted by the heart in response to pressure overload as in a heart failure
-
What type of medication is nitroglycerin?
A vasodilator; it will lower BP
-
What types of foods should patients on lasix consume?
Oranges, bananas, etc
-
What is the function of the cardiovascular system?
It delivers oxygen and nutrients to the cells and transports cell waste to the appropriate organs.
-
What is the outer layer of the heart?
Pericardium
-
Where is the heart located?
In the mediastinum
-
What layer of the heart is the pump?
Myocardium
-
What is the inner most layer of the heart?
Endocardium
-
What are arteries?
Vessels that carry blood away from the heart
-
What are veins?
Vessels that carry blood to the heart
-
What is an echocardiogram?
An ultrasound of the heart.
-
What is a PET used for?
To examine the metabolic activity of the various body structures
-
What are the serum cardiac markers?
CK-MB, myoglobin, troponin l
-
What labs will increase in a patient during an MI?
SGOT, AST, CK-MB, LDH, Troponin l
-
What is a CK-MB lab?
Creatine phosphokinase-it will rise 2-3 hours after the beginning of an MI
-
What is troponin l?
a muscle protein released after an MI
-
50% of all MI�s occur in people over what age?
65
-
When are women at risk for an MI?
after menopause
-
What causes a v-fib?
Myocardial ischemia or infarction
-
What type of rhythm is sinus tachycardia?
Rapid, regular rhythm originating in the SA
-
What are the causes of sinus tachycardia?
Exercise, anxiety, fever, shock, meds
-
What type of rhythm is sinus bradycardia?
Slow rhythm
-
What causes sinus bradycardia?
Sleep, vomiting, MI, intracranial tumors, vagal stimulation
-
What is supraventricular tachycardia?
The sudden onset of a rapid heartbeat
-
What causes supraventricular tachycardia?
Drugs, alcohol, mitral valve prolapse; emotional stress, smoking
-
What happens during atrial fibrillation?
The atria quivers instead of contracts
-
What causes a-fib?
Hypertension, pulmonary embolism, atherosclerosis, mitral valve disease, HF, COPD
-
What is the function of a cardioglycoside?
It increases cardiac force and slows the heart rate
-
What is the function of an antidysrhythmic?
It suppresses the impulse that triggers dysrhythmias
-
What is the function of beta-blockers?
The decrease heart rate and workload of the heart
-
What I the function of calcium channel blockers?
They dilate the coronary arteries
-
What is the function of an inotropic agent?
They increase blood pressure; used in severe CHF with pulmonary edema
-
What is the drug of choice in treating angina?
Low doses (81 mg) of aspirin
-
What is the function of an ace inhibitor?
It acts as a hypertensive and reduces peripheral arterial resistance and improves cardiac output
-
What are the signs and symptoms of left-sided heart failure?
Crackles, SOB, pink-frothy sputum, orthopnea, pulmonary edema
-
What are the signs of hypoxia?
Increased heart rate, decreased BP, low pulse, cyanosis
-
Which drug is a respiratory depressant?
Morphine
-
What levels are checked in an ABG lab?
pH, O2, & CO2 levels
-
What is the function of a vasodilator?
It decreases the workload of the heart
-
What happens during valvular heart disease?
Cardiac output is increased because the valves aren't opening & closing properly
-
Why is digoxin given to a patient?
It strengthens the force of the contraction and helps the heart beat faster
-
What is the most important pulse to check in Valvular HD and why?
The pedal pulse because it ensures total body circulation
-
What labs are checked in valvular HD?
PTINR
-
What are the signs and symptoms of right-sided heart failure?
Edema in legs, jugular vein distention, liver enlargement, ascites
-
What do you assess with PATCHES?
Pulse, Appearance, Temp, Color, Edema, Sensation
-
What is the number one dysrhythmia that occurs with an arterial embolism?
A-fibb
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