Cardiovascular System – Flashcards
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blood pressure
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the force of blood exerted against the vessel walls.
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blood pressure is regulated by:
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-ANS -Renal System -endocrine system -external
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venous system structure
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a series of veins located adjacent to the arterial system
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venous system function
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completes the circulation of blood by returning blood from the capillaries to the right side of the heart
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CV changes in older adult
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•Change only evident when the person is active or under stress •Valve rigidity = murmurs maybe heard •Pacemaker cells decrease in # (prone to atrial dysrhythmias. A-fib is common) •Size of left Ventricle increases = decrease in compliance leads to CHF ( S3 & S4) •Aorta thickens & gets stiff (more resistance; systolic BP increases) •PVR increases, increase afterload leading to hypertension •Baroreceptors less sensitive causing orthostatic changes and syncope
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assessment techniques
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•History •Demographic data •Family history and genetic risk •Personal history •Diet history •Socioeconomic status
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non-modifiable risk factors
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age, gender, ethnicity
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modifiable risk factors
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cigarette smoking, physical inactivity, obesity, psychological factors, chronic disease
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Signs & Symptoms of Cardiac Disease
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•Fatigue •Fluid Retention ( wgt gain, edema) •Chest Pain (classic symptom) •Irregular HR •Palpitations •Dyspnea (DOE/orthopnea) •Calf Pain
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physical assessment
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•General appearance •Integumentary system •Skin color •Skin temperature •Extremities •Blood pressure •Venous and arterial pulses: central and jugular venous pressures, and jugular venous distention
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increase in troponin
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classic marker for cardiac event:
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serum markers of myocardial damage
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•Troponin •Creatine kinase (Isoenzyme CK-MB more specific for an MI) •Myoglobin •Serum lipids •Blood coagulation tests PT, PTT •Arterial Blood Gases •Electrolytes
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angiography
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•Detection of coronary artery obstruction •Catheter inserted into arm or groin→heart •Cardiac vessels are injected with contrast media •Rapid succession of X-rays (fluoroscopy) to assess blood flow
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pre-procedure nursing implications
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-Consent -Warm sensation when dye injected -Allergies
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post-procedure nursing implications
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-BR 4-6 hours -Supine, extremity flat -Pressure dressing/sand bag -Assess for hematoma -Assess distal pulses and skin temperature
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possible complications with cardiac catheterization:
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myocardial infarction, stroke, thromboembolism, arterial bleeding, lethal dysrhythmias, and death
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follow-up care with cardiac catheterization:
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-Restricted bedrest, insertion site extremity kept straight -Monitor vital signs -Assess for complications
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other diagnostic tests
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•Electrocardiography ECG •Electrophysiologic study •Exercise electrocardiography Stress Test •Echocardiography •Pharmacologic stress •Transesophageal •Imaging
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transesophageal echocardiogram
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•Same as endoscopic procedure •Examines cardiac structure & function •Tube passed down esophagus
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Hemodynamic Monitoring
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-Invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion -swan ganz catheter
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central venous pressure
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•Measures pressures from the right atrium -7 to 12 cm H20 normal -Elevated in right ventricular failure -Low in hypovolemia
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swans ganz catheter
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-Right Atrial Pressure RA -Pulmonary Artery Pressure PAP -Pulmonary Artery Wedge Pressure PAWP
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cardiac conduction system
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SA node, AV junctional area, bundle branch system
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Sinoatrial node
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pacemaker of heart. Electrical impulses at 60-100 beats/min
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Atrioventricular junctional area
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Electrical impulses at 40-60 beats/min
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bundle branch system
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Electrical impulses at 20-40 beats/min
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Electrocardiographic Rhythm Analysis
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-Determine the heart rate. -Determine the heart rhythm. -Analyze the P waves. -Measure the PR interval. -Measure the QRS duration.
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cardioversion
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Synchronized countershock that may be used for emergent hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias (A-fib) resistant to medical therapies
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Dysrhythmias
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any disorder of heartbeat
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Dysrhythmias causes:
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-Disturbances between the electrical conductivity and myocardium response -Disturbance in impulse formation (ectopic foci) -Disturbance in impulse conduction ( heart blocks)
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pacemaker
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intervention that provides a timed electrical stimulation
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synchronous and asynchronous
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types of pacemaker:
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home teaching of pacemaker:
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-Check pulse -Know type and settings -watch for infection -keep cellular equipment at least 6" away -No MRIs -Avoid sources with strong electromagnetic fields
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defibrillation
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•Delivers an asynchronous electric shock that stuns the heart momentarily; stopping all activity. •Gives the heart a chance to restart normal electrical activity via the SA node and resume beating effectively •Automatic External Defibrillator (AED)
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vagal maneuvers
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decreases heart rate; treatment for tachydysrhthmias (carotid sinus massage and valsalva maneuvers)
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carotid sinus massage
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•Decreases SA node and AV node conduction •Performed by trained individual
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heart failure
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•Also called pump failure, general term for the inadequacy of the heart to pump blood throughout the body; causes insufficient perfusion of body tissue with vital nutrients and oxygen •Most common cause is MI
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types of heart failure
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left-sided and right-sided
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compensatory mechanisms
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Initially effective in increasing CO, however over time are deleterious. -SNS stimulation -renin-angiotensin system activation -myocardial hypertrophy
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left-sided heart failure manifestations:
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-Weakness -Fatigue -Dizziness -Confusion -Pulmonary congestion→pulmonary edema -Shortness of breath -Organ failure, especially renal failure -Oliguria -Death
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left-sided heart failure symptoms:
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•Orthostatic hypotension •Disorientation/confusion •Weak pulses, cool extremities •Irregular heart rhythm, tachycardia, palpitations, angina •Tachypnea •Hacking cough, crackles/wheezes •Frothy, pink-tinged sputum •S3 & S4 (s/s of heart failure) •Oliguria or a decrease in urine output
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right-sided heart failure manifestations:
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-Distended neck veins, increased abdominal girth -Hepatomegaly (liver engorgement) -Hepatojugular reflux -Ascites -Dependent edema -Weight: the most reliable indicator of fluid gain or loss
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weight
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most reliable indicator of fluid gain:
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right-sided heart failure symptoms:
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•Fluid retention •JVD •Enlarged liver and spleen •Anorexia and nausea •Distended abdomen •Polyuria at night •Increased B/P from excess or decrease B/P from failure
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treatment
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•Diuretics •Oxygen •Digitalis •Nitroglycerin •Foley •Lung sounds
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mitral stenosis
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rheumatic fever, valves thicken and calcify
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mitral regurgitation (insufficiency)
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Fibrosis and calcification prevent valves from closing, allows backflow into the left atrium
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aortic stenosis
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Narrows and obstructs left ventricular outflow
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aortic regurgitation
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Valves don't close during diastole -Backflow of blood into left ventricle from aorta -Left ventricular hypertrophy compensatory
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non-surgical management
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•Drug therapy, including diuretics, beta blockers, digoxin, oxygen, and sometimes nitrates •Prophylactic antibiotic •Management of atrial fibrillation, cardioversion •Anticoagulant •Rest with limited activity
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surgical management
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balloon valvuloplasty and replacement procedures
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replacement procedures
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•Prosthetic or biologic •OR procedure similar to a CABG •Prosthetic of synthetic valves require anticoagulant therapy
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infective endocarditis
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•CV Manifestations -Heart failure -Murmurs •Embolus complicate 50% of patients •Petechiae, splinter hemorrhages
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pericarditis assessment:
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•Sternal precordial pain-radiates to left neck, shoulder or back •Chronic associated with right sided Heart failure •Pericardial friction rub •Elevated WBC •ECG changes •Pericardial effusion seen on echocardiogram
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Cardiac Tamponade
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accumulation of fluid in pericardium. emergency situation
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Cardiac Tamponade treatment
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-Pericardiocentesis -Pericardial window -Pericardiectomy
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pericarditis treatment:
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-Antibiotic-acute -Chemo/radiation-chronic -Pericardiectomy
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cardiomyopathy
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disease of cardiac muscle
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dilated, hypertrophic, restrictive
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cardiomyopathy types:
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lab test for arteriosclerosis
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Cholesterol Levels -Total >200 mg/dL -HDL 100 mg/dL Triglyceride <200
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high risk for arteriosclerosis
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-Diabetes -Smoker -No exercise -Obese -High levels of lipids -Genetics
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hypertension intervention
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•Na Restriction •Weight Reduction •Moderate alcohol intake •Exercise •No Smoking •Drug Therapy
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hypertension types
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-primary/essential -secondary
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hypertension
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Systolic > 140 mmHg Diastolic > 90 mmHg
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peripheral arterial disease (PAD)
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•Atherosclerosis is the most common cause •Arterial occlusion deprives the lower extremities of O2
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peripheral arterial disease (PAD) assessment:
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•Pain •Loss of hair on lower calf, ankles and foot •Dry, scaly, dusky, pale or mottled skin •Thickened toenails •Severe pallor or gray-blue and rubor noted
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compartment syndrome
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•Leads to tissue damage and tissue death •Medical emergency •Caused by tissue pressure within confined space •Very painful •Assess extremity; remove or loosen dressings • Place extremity at level of heart •May have to perform fasciotomy
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aneurysm
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•Permanent localized dilation of an artery •Forms when the inner layer of an artery is weak •Atherosclerosis most common cause; hypertension and smoking contributing factors •Rupture leads to massive hemorrhage
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types of aneurysm
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abdominal, thoracic, and dissecting
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Raynaud's phenomenon
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•Vasospasm of arterioles and arteries of upper and •Lower extremities, usually unilateral •Usually occurs in older than 30 years •Common in both sexes
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Raynaud's disease
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•Disease occurs bilaterally •More common in ages 17 to 50 years •More common in women •Symptoms blanching then cyanosis, numb and cold extremities •Aggravated by cold and stress
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venous insufficiency
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•Result of prolonged venous hypertension which stretches veins and damages •Leads to edema •Occurs in those who stand or sit for long time such as teachers and office personnel as well as those who are pregnant or obese
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venous insufficiency treatment
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-Wear elastic or compression stockings -Elevate legs at least 4xD for 20 minutes -Elevate legs above heart at night
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treatment for DVT
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-BR and elevate extremity -Evaluate for PE -Drug therapy-Heparin -Thrombectomy -Inferior Vena Caval Filter
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shock
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•Can occur when any part of the cardiovascular system does not function properly for any reason •Begins with abnormal cellular metabolism that occurs when too little oxygen is delivered to tissues (anaerobic metabolism)
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processes of shock
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-Initial stage (early shock) -Nonprogressive stage (compensatory stage) -Progressive stage (intermediate stage) -Refractory stage (irreversible stage)
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types of shock
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•Hypovolemic •Cardiogenic •Distributive •Obstructive
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Notify the health care provider if the client does not experience a rapid improvement and diuresis.
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Harvey is now exhibiting signs of pulmonary edema as a result of his CHF. Which nursing intervention demonstrates best practice in the care of this client?
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Position the client to alleviate dyspnea.
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Karen is caring for a CHF client in the coronary care unit (CCU) who is now exhibiting signs of air hunger and anxiety. Which nursing intervention should Karen perform first for this client?
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Fatigue, weakness, and palpitations
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Mrs. Clark is an 83-year-old woman admitted with symptoms of heart failure. Her nurse, after performing the assessment, tries to decipher between right- and left-sided heart failure. Which symptoms below are consistent with left-sided heart failure?
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Assist respiratory therapy in applying BiPAP to the client.
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Which of the following tasks would be appropriate to delegate to the LPN working with you on a client who has pulmonary edema?
