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118 Cards in this Set

  • Front
  • Back
What does the Cardiovascular System of
the heart and blood vessels
What are the two major divisions of the cardiovascular system
Pulmonary circulation, Systemic circulation
What is the function of pulmonary circulation
carries blood through the lungs where carbon dioxide is excreted and oxygenis absorbed
What is the function of systemic circulation
transports oxygen and nutrients to all body tissues
The three layers of the heart
endocardium, myocardium, epicardium
The inner layer that lines the heart
thick muscular middle layer
thin outer layer or sac, which surrounds the heart and attaches the heart to the diaphragm and sternal wall of the thorax
What are the four chambers of the heart
Right and left atria, right and left ventricles
Name of the thick muscular wall that divide the chambers of the heart
Where does the right side of the heart pump blood to
pumps blood to lungs for oxygenation
Why is the muscles of the left side of ther heart thicker than the right
Higher pressure is required to pump blood systematically
Purpose of the four valves of the heart
Allow one way blood flow through the chambers of the heart
What are the four valves of the heart
Tricuspide, mitral (bicuspid), pulmonic, aortic
Atrioventricular valves
Tricuspid (between the right atria and right ventricle)

Mitral or Bicuspid (between the left atria and left ventricle)
Semilunar valves
Pulmonic (between the right ventricle and pulmonary artery)

Aortic (between the left ventricle and the aorta)
what are the three types of blood vessels
Arteries, Capillaries, Veins
thick walled, carry oxygenated blood from heart to tissues. The LARGEST artery in the body is the AORTA
connect arteries and veins: thin walled to allow oxygen to leave the blood and enter tisues and waste products to enter the blood
carry deoxygenated blood to the right side of heart. the LARGEST vein is the VENA CAVA
What is the cardiac cycle
the rhythmic movement of blood through the heart
Two Phases of Cardiac Cycle
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
What is cardiac function based on
The adequacy of CO
What is Cardiac Ouput
The amount of blood pumped from the left ventricle per minute
How is cardiac output calculated
CO = SV * HR
What is stoke volume (SV)
The amount of blood ejected from one ventricle with one heart beat
amount of blood entering the heart
Factors affecting Cardiac Output (CO)
* 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)
resistance of blood flow in circulatory system.
Period of ventricular contraction
what happens during sytole
aortic valve open, allows ejection of blood from left ventricle into aorta
*MITRAL valve Closed, preventing regurgitation back into left atrium
Perioad of ventricular relaxation
What happens during diastole
Aortic valve closed, preveint regurgitation of blood from aorta to left ventricle
*MITRAL valve opens, allowing blood flow from left atrium into left ventricle
Frank Starling Principle
the heart will stretch to accomodate an increase in volume
S1 sound
Lub sound - closure of AV vales; signals Beginning of systole (first heart sound)
S2 sound
Dub sound - closure of semi lunar valves; signals END of sytole
Conduction (Automaticity)
heart can contract by itselrf; independent of signals or stilumation from body; contracts in responxe to electrical current by conductive system
AV Node
secondary pacemaker; slow than regular heart rate
In the conduction sytem, where does impulses start
In the SA Node (sinoatrial); implulse cause atria to contract
Which node is considered the pacemaker of the heart
SA Node
Cycle of conduction system
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)
Cardiac conduction pathways
SA Node, AV Node, Bundle of His, Bundle Branches, Purkinje fibers
Tissue Perfusion
flow of blood through the body tissue; vital organs requires continuous perfusion for optimal function;
Which arteries supply the cardiac muscles with Oxygen and nutrients
coronary arteries
What does adequate perfusion depend on
adequate heart rate and blood pressure
Factors affecting Cardiovaascular function (High BP)
-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
High BP most often occur when:
positive family hist., male, urban dweller, african americans, obesity elderly, excess use of sodium or alcohol, oral contraceptives
Factors affecting cardiovascular function

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
Factors affecting cardiovascular function

-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
Factors affecting cardiovascular function

(Body Size and Fat)
increase weight increases the body demands for O2, increase metabolic rate which increeases demands on heart
Factors affecting cardiovascular function

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
Factors affecting cardiovascular function

(Medical and family history)
genetics may play role in certain cardiac disorders
Factors affecting cardiovascular function

-elevates serum lipids, increases blood coagulation and incresease BP in people with pre-existing disease
-type A personality have high incidence MI
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
Factors affecting cardiovascular function

diabetes, kidney disease and peripheral vascular disease
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
Manifestations of altered Cardiovascular Function

(Changes in Skin)
-skin temp rises w/ increased blood lfow to area
-chronic poor persusion will cause hair loss, thickened nails, shiny and dry skin
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)
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)
Manifestations of altered Cardiovascular Function

(Decreased tissue perfusion)
symptoms depend on organ with decreased persusion: kidney failure, cognitive dysfunction, pain, angina
Involves careful, systematic evaluation of pt. medical, family, social, cultural, psychological, and occupation history and exim of the hear & vascular system
How should assessment be conducted
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
Assessment:Subjective Data
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
- Past medical history
-Family history
-Life Style habits: smoking, alcohol, exercise
-Medication use
Assessment: Objective Data
-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
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
Inspection: Turgor
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
Inspection: Temperature & Moisture
Skin should be warm & dry, unless environmental temperature are extreme. Extremity that is cooler & drier than other body surfaces suggest arterial insuffieciency
Inspection: Skin
check for PALLOR whcih means decreased oxyhemoglobin concentration
-CYANOSIS: blest observed at nail beds, lips & inside mouth; caused by increased amt. of deoxygenated hemoglobin
Inspection: nails
should be assess for color, shape, thickness, symmetry, nail adherence
Peripheral Vascular disease
Can produce nail depression, pitting, longitudinal striations
spoon shaped nail isassociated with several conditions including Raynaud's disease
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
Inspection of Extremities
Upper & lower extremities should be evaluated for S/S of acute & chronic changes due to arterial or venous disorders
Chronic arterial insufficiency
Can over time lead to changes such as uneven hair distribution or hair loss & atrophy of skin, which becomes smooth, shiny & think
Severe ischemia of lower extremity
Results in varying degrees of tissu loss, including ulceration or gangrene
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
Venous Incompetence
can lead to a number od chronic problem. Varicose veing apprear dilated, oftern tortuous veins when legs are in dependent position
Redness, thickening, tenderness along superficial vein
Dee vein thrombosis- DVT
can't be confirmed by physical exam alone. should be suspected if swelling, paink, tenderness appear over vein
What can bilateral edema suggest
Can be sign of heart failure or veenous insufficiency
Assessment: Palpation
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)
Exam of Arterial Pulses
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
Exam of Jugular veins
-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
Assessment: Ausculatation
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
Auscultation Location of heart

-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)
Ausculation Sounds
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
Lab Test
-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
Serum Electrolytes: Hyperkalemia
Increased levels usually associated with kidney & endocrine disorders.
-Signs & Symptoms: weakness, nausea, diarrhea, bradycardia
Serum Electrolytes: Hypokalemia
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
Serum Electrolytes
CV disorders can impact on fluid & electrolyte regualtion. Certain meds alter electrolite balance
Serum Electrolytes: Potassium
-major intracellur cation; Helps regulate muscle activity, essential n maintaing electrical conduction w/in cardiac & skeletal muscles
Serum Electrolytes: Sodium
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)
Serum Electrolytes: Chloride
extracellular anion, interacts w/ NA to maintain osmotic pressure of blood, therefore helps regulate blood volume & arterial pressure.
Serum Electrolytes: Calcium
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
Lab Tests done to determine CV function & disease:

(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)
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)
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.
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
Laboratory Studies
-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
-Cardiac catherization
Cardiac Catherization
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)
Diagnostics: TEE
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
Diagnostics: Angiography
involves IV injection of a contrast material into the heart during cardiac catherization & a series of film is taken. Open an occuled artery
Diagnostics: PTCA
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.
Nursing Diagnosis: Decreased Cardia Output
-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
Nursing Diagnoses: altered tissue perfusion (renal, cerebral, GI peripheral, cardiopulmonary)
-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
Nursing Diagnosis: Activity Intolerance
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
Goals and outcomes are aimed at:
-increasing tissue perfusion
-increasing endurance
-maintaining adequate cardiac output
-maintaining fluid balance
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
Implementation: Edema reduction
-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
Implementation: Pain management
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
Implementation: Increasing Activity
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
compare cleint behaviors with those described in the goads and outcomes
Medications: Cardiac Glycosides
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
Medications: Antihypetension
B- adrenergic blockers - Inderal, calcium channel blockers- Nifedipine, Vasodialorts - Apresoline
ACE inhibitiors -Captopril
Action: decrease blood pressure
Side effects: Low blood pressure, dizziness
Medications: Vasopressor
Action: Increases blood pressure
Side Effects: High blood pressure
Medication: Antiarrhythmic
Quinindine Sulfate
Action: regulates heart rate
Side Effects: h;ypotension, dizziness
Medication: Nitrates
Action: relieves angina by vasodialtion
Side Effects: hypotension, headache
Medication: Diuretics
Action: reduces edema and fluid volume by increasing urine output
Side effects: electrolyte imbalance, volume depletion