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Decreased pumping action and decrease in the volume of blood ejected rom the ventricles (SV) has the potential to cause these two disease states?
Coronary artery disease (CAD) and Cardiomyopathy (enlarged heart)
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The normal cardiac output in a healthy 150lb adult at rest is what?
4 to gL/min
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When manipulating the amount of circulating blood volume you change the preload or afterload?
Change the preload and subsequent SV
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What is preload?
The end diastolic volume in the ventricles. The ventricles stretch when filling with blood; the more stretch on the ventricular muscle, the greater the contraction and the greater the SV.
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During the systolic phase what vale opens?
The semilunar valave opens (aortic and pulmonic) pushing blood from ventricles into the aorta and the pulmonary artery. Closure of the valves = S2 sound
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If a person is experiencing dysrhythmias a nurse may suspect what of the SA and AV nodes?
Suspect that the AV node is trying to take over as the packmaker of the heart
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Define systemic circulation?
Arteries and veins of systemic circulation deliver nutrients and oxygen to and remove waste from the tissues.The veins form larger veins which carry deoxygenated blood to the right side of the heart where it then returns to the pulmonary circulation.
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What provides most of the blood to the heart (define coronary artery circulation)?
The left coronary artery does most of the heart's work. The coronary artery provides the myocardium with oxygen and nutrients and removes waste
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If a client has backflow/regurgitation of blood through an incompetent valve or valvular disease, what might this cause (something the nurse will discover) on assessment of client?
A murmur
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During the systloic phase what valves open? What direction does blood move?
What sound does this make in the heart?
The semilunar valves (aortic and pulmonic) pushing blood from the ventricles to the aorta and pulmonary artery. Closure of the valves = S2 sound
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During ventricular diastole what valves open? And what direction does blood flow? What sound of the heart does this make?
The atrioventricular (mitral and tricuspid valves open) pushing blood from area of higher-pressure (atria) to lower/relaxed ventricles. Closure of the valves = S1 sound
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Hypertension does what to the afterload and CO?
Afterload increases, CO increases
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1. When a patient presents with a hemorrage, what happens to the fluid volume, the SV and the CO as fluid is replaced?
2. What happens if volume is not replaced?
1. The fluid volume increasesto increase circulating volume and increases preload, SV and CO
2. Preload volume and CO decrease
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What is afterload?
The resistance to left ventricular ejection.
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What physiological factors can affect oxygenation?
Anemia or inhalation of a toxic substance: decrease O2 carrying capacity
COPD, pneumonthorax: Upper/lower respiratory obstruction
Shock, severe dehydration, increased CO: Hypovolemia
Fever, exercise, anything that increases metabolic rate
Conditions that affect chest wall movement: fractures, pregnancy, musculoskeletal abnormalities, trauma, neuromuscular (MS, MD) or CNS alterations (OD on heroin and opidate drug use)
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What is Osmosis?
Movement of a fluide from low concentration to high concentration across a semi-perm membrane. E.g., allbumin sucks fluid across membrane.
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What is diffusion?
Exchange of respiratory gases in the alveloi and capillaries. Diffusion is movement of particles from high concentration to low concentration; happens to electrolytes.
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What is inspiration and expiration?
An active process stimulated by chemical receptors in the aorta and a passive process for expiration
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What is oxygen transport?
The lungs and cardiovascular system make up oxygen transport. This is the flow of oxygen and CO2 through the systemic and pulmonic systems through the heart. So know blood flow and where deoxygenated and oxygenated blood come from and go to.
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What is pulmonary circulation?
Process that moves blood to and from the alveolar capillary membranes for gas exchange
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What is ventilation?
Process of moving gases into and out of the lungs
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What is the difference between angina and myocardial infarction?
Angina is the imbalance between oxygen supply and demand. A transient imblance occurs meaning pain will come, go away, come, go away...etc.
Myocardial infarction means a sudden decrease in coronary blood flow usually due to ischemia (restriction of blood supply). Pain is persistant and usually lasts 30 minutes
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What sound might you hear on initial assessment if a potential mitral regurgitation or mitral vavle does not close completely?
Whooping or wheezing sound
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When stenosis occurs in the smilunar valves (aortic and pulmonic) what happens to adjacent ventricles? Overtime stenosis can lead to what?
Ventricles have to work harder to move the ventricular blood volume beyond the stenotic valve. Over time can lead to left or right-sided heart failure due to ventricle hypertrophy (enlarge ventricles) which cause blood flow to be obstructed
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What is stenosis?
What is regurgitation?
Stenosis = flow of blood through the vales is obstructed
Regurgitation = backflow of blood into adjacent chamber
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What assessment findings might a nurse observe on a client presenting with right-sided heart failure? If continues to fail this will cause?
- Means there is impaired functioning of the right ventricle. Commonly results from pulmonary disease or result of long-term left-side heart failure. As failure continues blood "backs-up" in the systemic circulation. Pulmonary vascular resistance increases.
- Assessment: nurse will see a client present with weight gain, distended neck veins, hepatomegaly, splenomegaly and dependent peripheral edema
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What does left-sided heart failure mean?
Does CO increase or decrease?
What assessment findings might a nurse observe on a client presenting with left-sided heart failure? If continues to fail this will cause?
Means there is decreased functioning of of the amount of blood ejected from the left ventricle to the aorta causing CO to decrease.
Assessment: fatigue, breathlessness, dizziness, confusion (due to hypoxia) from diminished CO). If continues to fail the client will present with crackles on auscultaion, hypoxia, SOB on exertion often at rest, cough, and paroxysmal nocturnal dyspnea due to blood pooling in pulmonary circulation causing pumonary congestion.
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How to you treat bundle blocks when it is:
1) a conduction system disease
2) client has dilated cardiomyopathy
3) Syncope (a client is unconscious)
Typically a pacemaker (either temporary or permanent) are needed to electrically realign the heart to work in simultaneously rhythm (right and left together) vs. sequential rhythm (right first then left or vice-versa)
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What disease states can lead to a left bundle block?
May indicate an underlying cardiac pathology: dilated cardiomyopathy, hypertrophic cardiomyopathy, hypertension, aortic valve disease, coronary artery disease, and potentially other cardiac conditions.
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What disease states can cause a right bundle block to occur?
Blood clots to the lung (pulmonary embolus), chronic lung disease, cardiomyopathy, and atrial and bentricular septal defects.
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What occurs if the right or left bundle branch is blocked?
Electrical impulse no longer happens simultaneously it occurs sequentially causing dysrhythmias to occure
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What is a bundle branch block?
Bundle branches (bundle of His and and right/left bundle branches) are the cardiac electrical system that coordinates muscular contraction to assure that the heart works efficiently as a pump.
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