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118 Cards in this Set
- Front
- Back
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What does the Cardiovascular System of
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the heart and blood vessels
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What are the two major divisions of the cardiovascular system
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Pulmonary circulation, Systemic circulation
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What is the function of pulmonary circulation
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carries blood through the lungs where carbon dioxide is excreted and oxygenis absorbed
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What is the function of systemic circulation
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transports oxygen and nutrients to all body tissues
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The three layers of the heart
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endocardium, myocardium, epicardium
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Endocardium
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The inner layer that lines the heart
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Myocardium
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thick muscular middle layer
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Epicardium
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thin outer layer or sac, which surrounds the heart and attaches the heart to the diaphragm and sternal wall of the thorax
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What are the four chambers of the heart
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Right and left atria, right and left ventricles
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Name of the thick muscular wall that divide the chambers of the heart
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Spectum
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Where does the right side of the heart pump blood to
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pumps blood to lungs for oxygenation
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Why is the muscles of the left side of ther heart thicker than the right
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Higher pressure is required to pump blood systematically
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Purpose of the four valves of the heart
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Allow one way blood flow through the chambers of the heart
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What are the four valves of the heart
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Tricuspide, mitral (bicuspid), pulmonic, aortic
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Atrioventricular valves
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Tricuspid (between the right atria and right ventricle)
Mitral or Bicuspid (between the left atria and left ventricle) |
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Semilunar valves
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Pulmonic (between the right ventricle and pulmonary artery)
Aortic (between the left ventricle and the aorta) |
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what are the three types of blood vessels
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Arteries, Capillaries, Veins
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Arteries
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thick walled, carry oxygenated blood from heart to tissues. The LARGEST artery in the body is the AORTA
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Capillaries
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connect arteries and veins: thin walled to allow oxygen to leave the blood and enter tisues and waste products to enter the blood
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Veins
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carry deoxygenated blood to the right side of heart. the LARGEST vein is the VENA CAVA
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What is the cardiac cycle
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the rhythmic movement of blood through the heart
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Two Phases of Cardiac Cycle
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Diastole : ventricles relax and fill with blood. 2/3 of cardiac cycle
Systole: Heart's contraction. Blood pumped from the ventricles and fills the pulmonary and systemic arteries |
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What is cardiac function based on
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The adequacy of CO
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What is Cardiac Ouput
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The amount of blood pumped from the left ventricle per minute
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How is cardiac output calculated
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CO = SV * HR
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What is stoke volume (SV)
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The amount of blood ejected from one ventricle with one heart beat
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Preload
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amount of blood entering the heart
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Factors affecting Cardiac Output (CO)
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* amount of blood entering heart determines how much pumped out
*stroke volume depends on strenth of heart muscle or contractility *stoke vlume depends on restistant to blood flow in circulatory system(afterload) |
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Afterload
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resistance of blood flow in circulatory system.
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Sytole
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Period of ventricular contraction
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what happens during sytole
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aortic valve open, allows ejection of blood from left ventricle into aorta
*MITRAL valve Closed, preventing regurgitation back into left atrium |
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Diatole
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Perioad of ventricular relaxation
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What happens during diastole
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Aortic valve closed, preveint regurgitation of blood from aorta to left ventricle
*MITRAL valve opens, allowing blood flow from left atrium into left ventricle |
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Frank Starling Principle
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the heart will stretch to accomodate an increase in volume
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S1 sound
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Lub sound - closure of AV vales; signals Beginning of systole (first heart sound)
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S2 sound
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Dub sound - closure of semi lunar valves; signals END of sytole
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Conduction (Automaticity)
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heart can contract by itselrf; independent of signals or stilumation from body; contracts in responxe to electrical current by conductive system
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AV Node
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secondary pacemaker; slow than regular heart rate
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In the conduction sytem, where does impulses start
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In the SA Node (sinoatrial); implulse cause atria to contract
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Which node is considered the pacemaker of the heart
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SA Node
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Cycle of conduction system
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Impulse in SA none ( causes atria to contract)--> Impulse move to AV node (pause occurs, atria empty blood into ventricles)-->Impulse to bundles of his, bundle branches, punkinje fibers (ventricles contract)
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Cardiac conduction pathways
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SA Node, AV Node, Bundle of His, Bundle Branches, Purkinje fibers
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Tissue Perfusion
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flow of blood through the body tissue; vital organs requires continuous perfusion for optimal function;
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Which arteries supply the cardiac muscles with Oxygen and nutrients
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coronary arteries
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What does adequate perfusion depend on
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adequate heart rate and blood pressure
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Factors affecting Cardiovaascular function (High BP)
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-most common manifestation of altered blood blow
-most common risk factor for cardiovascular disease -may be caused by increased level of circulating vasoactive substance or increased sympathetic nervous system activity -changes in sodium excretion in kidney or changes in arterial smooth muscles contractility caused by changes in calcium absoption may also elevate BP |
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High BP most often occur when:
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positive family hist., male, urban dweller, african americans, obesity elderly, excess use of sodium or alcohol, oral contraceptives
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Factors affecting cardiovascular function
(Smoking) |
increases HR & BP,
-constricts arterioles, -enhances process of atherosclerosis, -limits O2 carrying capacity of blood by displacing O2 with carbon monoxide -the most modifiable risk factor of heart disease |
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Factors affecting cardiovascular function
(Nutrition) |
-high diet in fat, especially saturated fat strong associate with heat disease
-cholesterol, (primary component of plaque) occuludes arteries -high levels low density cholesterol lead to peripheral vascular disease and hypertension -increase salt intake can increase blood bloum and aggravate BP and CHF |
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Factors affecting cardiovascular function
(Body Size and Fat) |
increase weight increases the body demands for O2, increase metabolic rate which increeases demands on heart
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Factors affecting cardiovascular function
(Exercise) |
resting HR in person who exercises regularly is slower that person who does not
-strenghten cardiac muscle -promotes wieght reduction and helps raise high density cholesterol and reduces triglycerides |
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Factors affecting cardiovascular function
(Medical and family history) |
genetics may play role in certain cardiac disorders
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Factors affecting cardiovascular function
(Stress) |
-elevates serum lipids, increases blood coagulation and incresease BP in people with pre-existing disease
-type A personality have high incidence MI |
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Factors affecting cardiovascular function
(Medication and drug use) |
-Asthma and cold meds. increase HR and BP
-diuretics decrease circulating blood volume -oral contraceptives increase BP -caffeine increases HR and BP -alcohol increases BP -cocaine is assoicated with sudden cardiac death |
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Factors affecting cardiovascular function
(Aging) |
diabetes, kidney disease and peripheral vascular disease
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Manifestations of altered Cardiovascular Function
(Changes in Vital signs) |
-BP: fluctuates w/ changes in CO and fluid volume
-Orthostatic hypotension: when blood pressure drops more than 15mm Hg systolic, or 10mm Hg diastolic afte a person assumes upright position -low BP is indication of diminished oxygenation and is a serious sighn of decreased CO -HR: increase in response to increased oxygen demand -HR increases greater than 20 beats during mild activity may indicate decreased CO is contributing to activity intolerance -HR that does not increase w/ exercise indicate the heart is unable o adjust to changes in oxygenation **HR should return to base w/in 3 min. after exercise -Respiratory Rate: increases in person w/ cardiovascular dysfunction -cough productive of frothy sputum is common manifestation of heart failure -Pulse character: diminished or absent pulses may indicate inadequate blood flow to area |
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Manifestations of altered Cardiovascular Function
(Changes in Skin) |
-skin temp rises w/ increased blood lfow to area
-flushing -cyanosis -chronic poor persusion will cause hair loss, thickened nails, shiny and dry skin |
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Manifestations of altered Cardiovascular Function
(Decreased CO) |
-muscle damage: decreased blood lfow thru coronarary arteries cuase muscle hyposia and myocardia infarction
-Inflammatory diseases of heart can cause muscle weakness --muscle damage may occur when heart overworked -valve dysfunction -conduction problems (arrhythmias) |
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Manifestations of altered Cardiovascular Function
(Altered Blood Flow) |
-alteration in blood:anemia, increased blood volume, decreased blood volume (shock), polycythemia, changes in sodium or potassium level
-Arterial dysfunction: atherosclerosis causing arterial occlusion -Capillary dysfunction: leaking of fluid causing edema -Venous dysfunction: inflammation (phlebitis) |
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Manifestations of altered Cardiovascular Function
(Decreased tissue perfusion) |
symptoms depend on organ with decreased persusion: kidney failure, cognitive dysfunction, pain, angina
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Assessment
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Involves careful, systematic evaluation of pt. medical, family, social, cultural, psychological, and occupation history and exim of the hear & vascular system
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How should assessment be conducted
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Conducted in organized manner. Being w/ overall eval. of pt, asess skin, nails, extremities for general signs of circulatory compromise. Then more direct evaluation of cardiovascular integrity, consisting palpating pulses, eval. of major arteries & veins, measur BP, assess heat by palpation and auscultation
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Assessment:Subjective Data
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chest pain, angina, when started? how frequently? How treated? How effetive is treatment?
-Dyspnea: what brings it on? How long does it last? What relieves it? -Cough: sputum production? -Fatigue: when does it occur? Skin changes -Edema -Nocutia - Past medical history -Family history -Life Style habits: smoking, alcohol, exercise -Nurtition -Medication use |
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Assessment: Objective Data
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-Skin color
-nail bed color, clubbing -peripheral edema -cheast: note apical impulse (fourth or fith intercostals space at midclavicular line) -Jugular vein distention -level of consciousness |
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Inspection
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Skin - evaluate for color, turgor, temp, moisture
*Color : normal pin to deep or light brown; darker skin more difficult so eval. conjunctiva, tongue, buccal mucosa, palms |
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Inspection: Turgor
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Reflects elasticity & water content of skin & subcutaneous tissue. It is assesed by lifting a fold of skin & observing how quickly it returns to normal position
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Inspection: Temperature & Moisture
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Skin should be warm & dry, unless environmental temperature are extreme. Extremity that is cooler & drier than other body surfaces suggest arterial insuffieciency
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Inspection: Skin
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check for PALLOR whcih means decreased oxyhemoglobin concentration
-CYANOSIS: blest observed at nail beds, lips & inside mouth; caused by increased amt. of deoxygenated hemoglobin |
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Inspection: nails
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should be assess for color, shape, thickness, symmetry, nail adherence
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Peripheral Vascular disease
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Can produce nail depression, pitting, longitudinal striations
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Koilonychias
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spoon shaped nail isassociated with several conditions including Raynaud's disease
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Clubbing
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accompanies lonstanding cyanosis & is associated with decreased oxygen. Distal tips of fingers become bulbous. The nails are thickened, hard & curved at tip & nail bed feels boggy when squeezed. Separation from nail bed produces white, yelloisyh, greenish color on non adherent portion of nail
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Inspection of Extremities
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Upper & lower extremities should be evaluated for S/S of acute & chronic changes due to arterial or venous disorders
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Chronic arterial insufficiency
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Can over time lead to changes such as uneven hair distribution or hair loss & atrophy of skin, which becomes smooth, shiny & think
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Severe ischemia of lower extremity
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Results in varying degrees of tissu loss, including ulceration or gangrene
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Gangrene
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indicates complete occlusion of arterial circulation to portion of extremity that has been ongoing for several days. Skin is black, dry & hard. Pre-gangrene sighns are deep cyanois or purple balc color that is not affecte by pressur or changes in position
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Venous Incompetence
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can lead to a number od chronic problem. Varicose veing apprear dilated, oftern tortuous veins when legs are in dependent position
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Thrombophlebitis
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Redness, thickening, tenderness along superficial vein
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Dee vein thrombosis- DVT
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can't be confirmed by physical exam alone. should be suspected if swelling, paink, tenderness appear over vein
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What can bilateral edema suggest
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Can be sign of heart failure or veenous insufficiency
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Assessment: Palpation
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Pulses: radial, brachial, femoral, popliteal, posterior tibia, dorsalis pedis (normal rate,rhythm, equal force)
-Note skin temp. and rugor (clammy, cold) -Capillary refil: should be less than 2 seconds -Edema: 1+ mild, 2+ moderate, 3+ deep, 4+ very deep pitting) |
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Exam of Arterial Pulses
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Provide info abour cardiovasculary system, function of ventricles, quality of arterial blood vessels, condition of arotic valve
**NEVER palpate both carotid arteries; to avoid reduction in cerebral blood flow or vagal bradycardia -excessive pressure could result in slowing of hear rate & hypotension |
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Exam of Jugular veins
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-exam provides inro on volume & pressure in right side of heart
-external jugular vein is visible above clavicle. Palpation obliterates pulse, visual inspection only. not visible when pt. in upright position. Pt. must recline 30-45 degree angle |
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Assessment: Ausculatation
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Assess BP, note sytole & diastolic & pulse pressure (diff. bet. systole & diastole)
-Assess Apical putlse _use diaphragm of stethoscope for high pitched sounds -use bell for low pitched sounds |
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Auscultation Location of heart
APE TO MAN |
-second intercostal space, right sternal border = aortic valve are
-second intercostal space, left sternal border = pulmonic valve area -fifth intercostal space, left sternal boarder = tricuspid valve -fifth intercostal space, midclavicular line, mitral valve area (apical area) |
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Ausculation Sounds
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S1 (lub sound) loudest at apex (tricupide and mitral area) and coincides w/ carotid pulsse
S2 (dub sound) is loudes at the base (pulmonic and aortic area) Note rate & rhythm -tachycardia: beats above 100 -bradycardia: beats below 60 -sinus arrhtymia: irregular rhythm (slows w/ expiration)normal in children & young adults |
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Lab Test
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-CBC
-RBC count is decreased in rheumatic fever and infective endocarditis -RBC count is increased in heart disease characterized by inadequate tissue oxygenation -HCT (packed cell volume) - increased in obstructive lung diseases & vascular volume depletion in hemoconcentration (i.e hypovolemic shock & excessive diuresis). Decreased in Hct & Hbg indicate anemia - reduction RBC mass & O2 carrying capacity can eventually result in angina, aggravate CHF & produce heart murmurs. -WBC - increase infectious & inflammatory heart diseases; & following MI (large amounts necessary to dispose of necrotic tissue from infarction -HDL category : optimal -Triglycerides Catergory: optimal, borderline high |
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Serum Electrolytes: Hyperkalemia
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Increased levels usually associated with kidney & endocrine disorders.
-Signs & Symptoms: weakness, nausea, diarrhea, bradycardia |
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Serum Electrolytes: Hypokalemia
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Decreased levels can result from diuretic therapy, persisten vomiting, diarrhea, alkalosis, cardiac effects such as increased electrical irritability, ventricular dyshythmia and increased risk of digitalis toxicity, EKG changes show flattening or inversion of T wave and sagging of ST segment. Other signs & symptoms: mental confusion, decreased reflexes, rapid weak irregular pulse
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Serum Electrolytes
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CV disorders can impact on fluid & electrolyte regualtion. Certain meds alter electrolite balance
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Serum Electrolytes: Potassium
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-major intracellur cation; Helps regulate muscle activity, essential n maintaing electrical conduction w/in cardiac & skeletal muscles
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Serum Electrolytes: Sodium
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major extracellular cation. affects water distribution; levels reflects water balnace & may decrease (indicating water excess) in CHF, stress, excessive IV infursion of hypotonic fluids, vomiting & extensive use of diuretics (nroma NA level 135-145 mEq)
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Serum Electrolytes: Chloride
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extracellular anion, interacts w/ NA to maintain osmotic pressure of blood, therefore helps regulate blood volume & arterial pressure.
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Serum Electrolytes: Calcium
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extracellular cation in R/T neuromuscular irritability & in initiation of muscular contractility. Changes in Ca levlels lead to cardiac manifestations. Low Ca - ventricular dysrhythmia, EKS changes, carica arrest.
High Ca - EKG changes, tachycardia, bradycardia, digitalis hypersensitivity, cardiac arrest |
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Lab Tests done to determine CV function & disease:
BUN |
(blood, nitrogen,urea) test of renal function -ability to excrete urea & protein. Increased level BUN in kidney disease, during H2O & Na depletion, in heart conditions that adversely affect renal perfusion. ie. CHF, cardiogenic shock (BUN 10-20mg/dl)
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Lab Tests done to determine CV function & disease:
Blood Glucose |
routinely assesed in pt w/ CV disorders ind DM is major risk factor in dev. of artherosclerosis. Aslo stress of cardiac event can greatly increse blood sugar. (80-120 mg norm)
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Lab Tests done to determine CV function & disease:
Digoxin Level |
to determine plasman levels to evvaluate therapeutic effect of a digoxin & to establish dx of digoxin toxicity. Digoxin is a cardiotonic glycoside used to imporve myocardial contractility (positive inotropic effect), inrease CO in CHF & to mange atrial arrhythmias
Therapeutic leve 0.5-2.0 mg/ml -If above 2, pt is toxic. S/s anorexia, N/V, yellow or green vision, slow irregular pulse. Slow pt. HR, must take apical pulse 1 min. if below 60 hold meds. |
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Lab Tests done to determine CV function & disease:
Blood Culture |
normally, blood is sterile.
-if bacteria enters blood, cause severe infections -BACTEREMIA - bacteria in bloodstream -SEPTICEMIA - systemic disease caused by bacteria & their toxins in blood -blood culture commonly done for pt. w/ unexplained fever, high risk for spsis, appearance of septic shock |
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Laboratory Studies
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-ECG: produces graphic recording of heat's electrical activity
-Holter monitoring: produces continuous ECG tracing over specified period, ususally 12-24 hrs. -Exercise stress test: evaluates the cardiac response to physical stress -Echocardiography -Cardiac catherization |
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Cardiac Catherization
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Coronary angiography, Angiocardiography, Ventriculography
-catheter placed in the CB System to study the anatomy & function of the heart -measure pressures in the cardiac chambers -analysis of waveform confirguration -sampling of oxygen content -view cardiac chambers & coronary arteries w/ conrast material -determine cardiac output -confirm dx of heart disease. determine effect on structure & functionof heart -determine congenital abnormalites -obtain clear picture of anatomy prior to surgery -obtain pressure w/in chambers and great vessels -measure blood oxygen concentration, tension, saturation w/in chamber -perform angiography for better coronary artery visualization -obtain endocardial biopsies -allow infursion of fibrinolytic agents directly into an occuled artery (check for allergies to dyes, and shellfish & assess for pulse -dorsalis, popliteal, posterial tibial) |
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Diagnostics: TEE
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Transeophageal Enchocardiography: invasive procedure, gives higher quality picture of heat; allows clear visualiztio of heart & structures than regular echocardiography. most useful in dx of cardiac masses, prosthetic valve function, aneurysm, posterior effusions
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Diagnostics: Angiography
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involves IV injection of a contrast material into the heart during cardiac catherization & a series of film is taken. Open an occuled artery
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Diagnostics: PTCA
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Percutaneous Transluminal Coronary Angioplasty; performed to reduce frequencey and severity of chest discomfort for pt. with angina by restoring blood supply. Used to open occluded artery but does not always open complex lesions.
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Nursing Diagnosis: Decreased Cardia Output
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-describes person experiencing or at high risk to experience inadequate blood supply for tissue needs because of insuffiecient blood pumping of heart
RELATED FACTORS: increased BP, obesity, increased cardiac work load, increased fluid volume DEFINING CHARACERISTICS: variation in BP readings, dysrhythmias, jugular vein distention, color changes, oliguria(no urine output), decreased pulses, cold clammy skin, dyspnea |
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Nursing Diagnoses: altered tissue perfusion (renal, cerebral, GI peripheral, cardiopulmonary)
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-state in which aperson experiences or is at risk of experiencing decreased in nutrition and respiration at the cellular level because of a decrease in capillary blood supply
RELATED FACTORS: immobility, trauma, tobacco use, increased blood viscosity DEFINING CHARACTERISTICS: chest pain, absent pulses, cyanosis, prolonged capillary refill, decreased BP |
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Nursing Diagnosis: Activity Intolerance
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reduction in one's physiologic capacity to endure activites to the degree desired or required
RELATED FACTORS: history of heart or blood vessel disease, hx of lung disease, sedentary lifestryle, obesity, immobility, decreased muscle strength DEFINING CHARACTERISTICS: increased pulse or respiratory rate, shortness of breath, failure of pulse to retun to base after three minutes |
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Planning
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Goals and outcomes are aimed at:
-increasing tissue perfusion -increasing endurance -maintaining adequate cardiac output -maintaining fluid balance |
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Implementation
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Modifying risk factors:
-health promotion: reducing cholesterol in diet, increasing exercise, losing weight, quitting smoking -Preventing venous stasis: leg exercises: alternately contract and relax muscles of lower extremities, promoting blood flow back to the heart -antiembolism stockings: they exert external pressure, decreasing venous blood from pooling in the extremities and promoting blood flow back to the heart. -inspect that circulation is not impeded |
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Implementation: Edema reduction
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-elevation of limbs: gravity assists venous return
-fluid restrick: monitor I & O -low sodium diet Positioning: body position effects the wrok of the heart -lying flat promotes venous return, thereby causing the heat to work harder -semi-fowlers avoided in shock |
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Implementation: Pain management
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Chest pain: always consider chest pain the the cardiac patient a sign of cardiac hypoxia until proven otherwise
-administer O2 -Nitroglycerin while client is lying down (vasodialator) -Claudication and peripheral ischemic pain: *intermitten claudication- a reproducable pain |
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Implementation: Increasing Activity
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activity begins slowly and progresses graudally
-perform range of motion exercises to maintain muscle tone and joint movement -allow to sit in the shower -space activity to avoid fatigue *Education for patient and family - how to handle emergency |
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Evaluation
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compare cleint behaviors with those described in the goads and outcomes
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Medications: Cardiac Glycosides
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Common Drug: Lanoxin (Digoxin)
Action: increase myocardial contraction secondary to the inhibition of the sodium pump. Decrease the rate of electrical conduction. slows and strengthens the heart beat Adverse Effects: bradycardia, anorexia, nausea, malaise, , halo vision, headache Nursing Implications for administration: monitor pulse prior to administration (usually hold if HR is less than 60). Double check dosing. Drugh has very narrow therapeutic dosage range Conditions pre-disposing a patient to toxicity: hypokalemia, hyper calcemia, hypothyroidism, elderly age |
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Medications: Antihypetension
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B- adrenergic blockers - Inderal, calcium channel blockers- Nifedipine, Vasodialorts - Apresoline
ACE inhibitiors -Captopril Action: decrease blood pressure Side effects: Low blood pressure, dizziness |
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Medications: Vasopressor
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Norepinephring
Action: Increases blood pressure Side Effects: High blood pressure |
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Medication: Antiarrhythmic
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Quinindine Sulfate
Action: regulates heart rate Side Effects: h;ypotension, dizziness |
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Medication: Nitrates
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Nitroglycerin
Action: relieves angina by vasodialtion Side Effects: hypotension, headache |
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Medication: Diuretics
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Lasix
Action: reduces edema and fluid volume by increasing urine output Side effects: electrolyte imbalance, volume depletion |
