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52 Cards in this Set
- Front
- Back
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THE HEART
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Divided into 2 sides- which receive and send blood to different parts of the body
– Left- receives blood from the lungs and sends blood to the body – Right- receives blood from the body and sends it to the lungs |
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Septum
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A thick wall separates the right side of the heart from the left side
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Heart Chambers
The heart has 4 chambers |
Upper chambers
– Right and left ATRIA Receiving chambers for blood Lower chambers – Right and left ventricle Pumping chambers for blood |
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The right atrium receives
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deoxygenated blood from the venous system and sends it to the right ventricle
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The right ventricle
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pumps that blood to the lungs to be oxygenated
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The left atrium receives
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oxygenated blood from the lungs and sends it to the left ventricle
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The left ventricle
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pumps all the blood to all the cells and tissues in the body
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Endocardium
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lines the inside of cardiac chamber, made of thin endothelial cells
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Myocardium
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middle layer, made of muscle fibers and responsible for pumping
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Epicardium
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made of fibrous and loose connective tissue, also known as visceral pericardium (sac that surrounds and protects the heart)
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tricuspid valve
mitral valve, also called bicuspid |
- separates the RA and RV
-separates the LA and LV |
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pulmonary valve
aortic valve |
-separates the right ventricle and the pulmonary artery
-separates the left ventricle from the aorta |
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RCA
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branches off to supply the nerve tissue of the conduction system
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LCA
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branches off into the LAD and circumflex artery
supplies blood to LA, LV, and septum |
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The term cardiac cycle refers to what?
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cardiac cycle refers to the contraction (systole) and relaxation (diastole) of both the atria and ventricles
The chambers fill with blood, contract and relax |
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Polarization
Depolarization repolarization |
-negative state inside myocardial cell
-positive state inside myocardial cell -Once contraction occurs the charges inside the cells returns to normal until the next stimulus is sent. This process |
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CARDIAC OUTPUT
Amount of blood pumped out of the left ventricle in one minute 4-8L/min Cardiac output can be increased by: |
increasing heart rate
– increasing stroke volume Volume of blood ejected with each ventricular contraction – normal 65-70 ml Cardiac Output = HR X stroke volume |
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Factors That Affect Stroke Volume Preload
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Preload
– amount of blood that is in the ventricles during the filling stage u increase preload=increase SV= increase CO |
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Factors That Affect Stroke Volume Contractility
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ability of muscle fibers to produce contraction
u factors that have (+) inotropic effects increase and those with (-) inotropic effects decrease |
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Factors That Affect Stroke Volume Afterload
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amount of pressure ventricles must overcome to eject the blood volume it holds
- increases with vasoconstriction - decreases with vasodilation |
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NURSING ASSESSMENT OF CARDIAC FUNCTION
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Begin with chief complaint and history of present illness
Medical history Family history Review of Systems – head to toe assessment |
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Lung Sounds
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should not hear any “noises”
if lungs are “wet” sign of Lt. sided heart failure or fluid overload |
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Sputum
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may have productive or none productive coughs
– frothy sputum can indicate CHF |
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Blood Pressure
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– check in both arms
– Orthostatic BP – as BP decreases the HR should increase |
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Skin
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– inspect for intactness, cap. refill, temperature, turgor, and color
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Heart Sounds
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– the valves closing produces the “lub dub” sound
- “lub” is S1(atrioventricular valves closing) - “dub” S2 (semilunar valves closing) |
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Abnormal Heart Sounds
– Murmurs – Rubs |
-sound produced by turbulent blood flow across valves
-heard when pericardium is inflamed can be pericardial or pleural |
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Peripheral Edema
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– sign of fluid overload and the inability of the heart to compensate for imbalance
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Areas for Edema
Extremities |
the fluid is “backing up” into the tissues
sign of Rt sided heart failure |
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Areas for Edema
Lungs |
– the fluid is “backing up” into the lungs
sign of Lt. sided failure |
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Mental Status
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may be decreased R/T:
decrease level of O2 to brain electrolyte imbalance SOB or Chest Pain can cause anxiety |
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Jugular Vein
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– if Rt side of heart backs up, the blood can’t drain from jugulars, causing distention
– sit patient up 45 degrees and assess for distention |
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Weight
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weight upon admission and then daily
– increase > 2 lbs in 24-48 hrs is a weight gain of 1 liter of fluid – ***best indicator of fluid balance*** |
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Different Enzymes to diagnose cardiac disease
Troponin |
protein involved in contractility of muscles
– Troponin I is specific to the heart u released after myocardial infarction and increases in 4-6 hrs from onset of s/s u peaks in 14 to 18 hrs will return to normal in 7 days |
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Different Enzymes to diagnose cardiac disease
Creatinine Kinase (CK) |
indicative of muscle damage
Found in 3 tissues: – Brain – Skeletal muscle – **Heart (CKMB)** elevates in 4-12 hrs after damage, peaks in 24 hrs, and returns to normal in 3-4 days |
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Different Enzymes to diagnose cardiac disease
Lipid Profile |
cholesterol, triglycerides, phospholipids
Triglycerides – major contributor to CAD – produced in the liver – usually elevated with the LDL – normal 40-150 |
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Cholesterol
Lipid Profile |
– produced by the liver, used to form bile salts for digestion of fats and for production of adrenal, ovarian and testicular hormones
– if > 200 mg/dl at risk for CAD, HTN, MI |
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Forms of cholesterol
– a. high density (HDL |
promote excretion of LDL’s and VLDL’s
risk for CAD is decreased if HDL’s are elevated normal 30-70 |
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Forms of cholesterol
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b. low density (LDL)
if elevated, risk for CAD normal60 -160 – c. very low density (VLDL) |
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CARDIAC CATHETERIZATION
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A diagnostic test performed in an operative setting
– Done for a variety of purposes A catheter is advanced into the vascular system and dye is injected into the heart’s veins, arteries, and vessels to check for damage or blockages A catheter is advanced into the vascular system and dye is injected into the heart’s veins, arteries, and vessels to check for damage or blockages |
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GUIDELINES FOR CARDIAC CATHETERIZATION
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NPO after MN
Assess for allergies to iodine, radiographic dye, and latex IVF’s Consent for procedure Sedation Post care instructions keep sand bag in place for bleeding check pedal pulses keep leg straight @ least 6 hrs. |
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Systolic Blood Pressure
Determined by: |
– the force and volume of blood that the left ventricle ejects during systole
– The ability of the arterial system to distend at the time of ventricular contraction Narrowing of the arterioles increases peripheral resistance – Which increases BP |
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Diastolic Blood Pressure
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Reflects arterial pressure during ventricular relaxation
If arterioles are resistant, blood is under greater pressure |
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Prehypertension
Stage 1 hypertension Stage 2 hypertension |
– 120/80 to 139/89
– 140/90 to 159/99 – >160/100 |
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Hypertension
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Causes the heart to work harder to pump against the increases resistance
Size of heart muscle increases When the heart can no longer pump adequately to meet the body’s metabolic needs, heart failure occurs The extra work and greater mass increase the heart’s need for oxygen If the myocardium does not receive sufficient oxygenated blood, myocardial ischemia occurs Can result in a myocardial infarction |
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ACE Inhibitors
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Prevents Angiotensin I from converting to Angiotensin II
Promote fluid and sodium loss and decrease peripheral vascular resistance |
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Angiotensin Receptor Blockers
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Angiotensin II receptor antagonist
Blocks effects of angiotensin II Relax vascular smooth muscle Increase salt and water excretion |
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Calcium Channel Blockers
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Block calcium ions through specific channels of the cell membrane in the blood vessels
Dilate coronary and peripheral arteries |
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Diuretics
Thiazide Lasix |
Inhibit reabsorption of sodium in distal convoluted tubules
Promote sodium and water excretion, thus reducing circulating blood volume |
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Accelerated and Malignant Hypertension
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-Markedly elevated BP, accompanied by hemorrhages and exudates in the eyes
– Dangerously elevated BP accompanied by papilledema |
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Accelerated and Malignant Hypertension S/S
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Onset of sudden severe back pain with hypotension **
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Nursing Management of
Accelerated and Malignant Hypertension |
Lower BP within 1-2 hours
Report a systolic BP of 160 or diastolic of 115 or higher |
