Chapter 32: Nursing Assessment Cardiovascular System

Front 1

Pericardium

Back 1

Fiborous sac that surrounds the heart. Consists of two layers. The visceral and the pericardium.

Front 2

What is the visceral layer of the pericardium?

Back 2

Inside

Front 3

What is the pericardium layer of the pericardium?

Back 3

Outer

Front 4

How much fluid lubricates the space between the visceral and pericardium layer? What does it prevent?

Back 4

10-15 mL : Prevents friction

Front 5

Three Layers of the Heart

Back 5

Endocardium, Myocardium, and Epidcardium

Front 6

Endocardium

Back 6

Inner layer

Front 7

Myocardium

Back 7

Middle layer

Front 8

Epicardium

Back 8

Outer layer

Front 9

The heart is divided by a ________

Back 9

Septum

Front 10

The septum includes what two parts?

Back 10

Interarterial septum and interventricular septum

Front 11

What does the interatrial septum partition?

Back 11

Right and left atria, thinner then ventricles

Front 12

What does the interventricular septum partition?

Back 12

The right and left ventricles, L ventricle 2-3x thicker then R ventricle

Front 13

Blood Flow through the heart mnemonics: RAT

Back 13

Right Atrium Tricuspid

Front 14

Blood flow through the heart mnemonics: LAMB

Back 14

Left atrium mitral (also known as bicuspid)

Front 15

Where does blood flow begin in the heart?

Back 15

Right atrium: Receives venous blood from inferior and super venae cavae and coronary sinus.

Front 16

What does blood in right atrium pass through?

Back 16

Tricuspid valve

Front 17

Where does the tricuspid valve bring blood?

Back 17

Into the right ventricle.

Front 18

With each _________ the right ventricle pumps blood through which valve?

Back 18

Contraction; Pulmonic valve

Front 19

Where does the pulmonic valve bring blood?

Back 19

Into pulmonic artery

Front 20

Where does the pulmonic artery bring blood?

Back 20

Into the lungs: Oxygenated blood will flow out of the lungs

Front 21

What takes __________ blood out of the lungs?

Back 21

Oxygenated: Pulmonic veins

Front 22

Where does pulmonic veins take the blood?

Back 22

To the left atrium

Front 23

What valve does blood go through from the left atrium?

Back 23

Mitral valve

Front 24

From the mitral valve where does the oxygenated blood go?

Back 24

Into the left ventricle

Front 25

Blood is ejected from the left ventricle where?

Back 25

Aortic valve

Front 26

Where does the aortic valve take the blood?

Back 26

Aorta

Front 27

Where does the aorta bring blood?

Back 27

Into high pressure systemic circulation.

Front 28

Four valves that keep blood flowing?

Back 28

APE TO MAN: Aortic, Pulmonic, Tricuspid and Mitral.

Front 29

Cusp

Back 29

One of the leaflike divisions or parts of the valves of the heart

Front 30

Chordae Tendinae

Back 30

Anchored in the papillary muscles of the ventricles. Prevents back flow

Front 31

What attaches the tricuspid and mitral valves

Back 31

Chordae tendinae

Front 32

What do the pulmonic and aortic valves prevent?

Back 32

Prevent blood from regurgitating into the ventricles.

Front 33

The myocardium does not have it's own blood supply: T or F

Back 33

False. It's called coronary circulation.

Front 34

Blood flows into the two major coronary arteries occurs primarily during diastole. T or F

Back 34

True

Front 35

The left coronary artery arises from the _________ and divides into ________ main branches

Back 35

Aorta, two.

Front 36

What are the two main branches the divide the left coronary artery called?

Back 36

Left anterior descending artery and left circumflex artery.

Front 37

What does the left anterior descending artery and the left circumflex artery supply blood to?

Back 37

Left atrium, left ventricle, and the interventricular septum and a portion of the right ventricle

Front 38

Where does the right coronary artery arise from?

Back 38

The aorta

Front 39

What does the right coronary artery branches supply blood to?

Back 39

Right atrium, right ventricle, portion of the posterior wall of the left ventricle, and in 90% of people the AV node and bundle of HIS, part of cardiac conduction system, receive blood from right coronary artery. For this reason obstruction of this artery often causes serious defects in cardiac conduction.

Front 40

Depolarization

Back 40

Electrical activity

Front 41

What does depolarization trigger?

Back 41

Mechanical activity including systole, diastole, and CO

Front 42

What happens to valves, myocardium, and ventricles during diastole?

Back 42

Tricuspid and mitral valves are opened, myocardium is relaxed, which allows for ventricles to fill

Front 43

What happens to valves, myocardium, and ventricles during systole?

Back 43

Tricuspid and mitral valves are closed, myocardium contracts, and ejection of blood from ventricles.

Front 44

Cardiac Output

Back 44

Total volume of blood pumped by each ventricle in 1 minute, controlled primarily by ANS.

Front 45

Factors that affect CO

Back 45

HR, stroke volume, contractility, preload, afterload.

Front 46

CO formula

Back 46

CO=HR x SV

Front 47

What is HR primarily regulated by?

Back 47

ANS (Parasymapthetic and sympathetic)

Front 48

Stroke Volume

Back 48

Amount of blood ejected from the ventricles w/ each heartbeat, affected by preload, afterload and contractility.

Front 49

Preload

Back 49

Amount of blood in the ventricles at end of diastole before next contraction

Front 50

What can increase preload?

Back 50

MI, aortic stenosis and hypervolemia

Front 51

Contractility

Back 51

Rpresents the intrinsic ability of the heart and myoocardium to contract

Front 52

What can increase contractility

Back 52

Epinephrine and norepinephrine released by the SNS. Raises SV by increasing ventricular emptying

Front 53

Afterload

Back 53

Peripheral resistance against which the left ventricle must pump

Front 54

What affects afterload?

Back 54

Size of ventricle, wall tension and arterial BP

Front 55

If arterial BP is elevated then the ventricles meet increased or decreased resistance by ejection of blood

Back 55

Increased, increases work load of heart.

Front 56

What can elevated arterial BP result in?

Back 56

Ventricular hypertrophy

Front 57

Does a decrease or increase in O2 demand happen when increases in preload contractility and afterload?

Back 57

Increase.

Front 58

Three major types of blood vessels

Back 58

Arteries, veins and capillaries

Front 59

Arteries carry oxygenated blood ____________ from heart

Back 59

Away

Front 60

Arterioles

Back 60

Relatively little elastic tissue and more smooth muscle, major control of BP and blood distribution, respond readily to changes in O2 and CO2 by dilating and constricting.

Front 61

Endothelium of arteries

Back 61

Innermost lining of artery, serves to maintain homeostasis, promote blood flow and under normal conditions inhibit blood coagulation

Front 62

Capillaries

Back 62

Made up of endothelial w/ no elastic or muscle tissue. Exchange of cellular nutrients and metabolic end products take places through these, thin-walled vessels. Connect arterioles and venules.

Front 63

Veins

Back 63

Large diameter, thin walled that return blood to the right atrium. Carry deoxygenated blood to the heart.

Front 64

What are the largest veins?

Back 64

Superior venae cavae and inferior venae cavae

Front 65

Superior venae cavae

Back 65

Returns blood to the heart from the head, neck, and arms.

Front 66

Inferior venae cavae

Back 66

Returns blood to the heart from the lower part of the body

Front 67

What can elevated right atrial pressure cause?

Back 67

Distended neck veins or liver engorgement

Front 68

Autonomic Nervous System consists of what two systems?

Back 68

Sympathetic and parasympathetic

Front 69

Sympathetic Nervous System

Back 69

Stress. Fight or flight. Increases HR, increases speed of impulse conduction. Mediated by bedta adrenergic receptors that receive neurotransmitters norepinephrine and epinephrine. Stimulation of alpha adrenergic receptors can cause vasoconstriction, decreased stimulation caused vasodialation.

Front 70

Parasympathetic Nervous System

Back 70

Peace. Rest and Digest. Decrease in HR, by slowing the SA node, rate and conduction through the AV node. Selective distribution in blood vessels does not affect skeletal muscles.

Front 71

Baroreceptors

Back 71

Located in the aortic arch and carotid sinus. Play an important role in maintenance of BP stability.

Front 72

What happens when baroreceptors are stimulated by an increase in BP?

Back 72

Inhibit impulses to the sympathetic vasomotor center in the brainstem. Results in decrease in HR, decrease force of contraction and vasodialation in peripheral arterioles.

Front 73

What happens when baroreceptors are stimulated by an decrease in BP?

Back 73

Activation of SNS. Results in increased HR, increased contractility of heart.

Front 74

Chemoreceptors

Back 74

Located in the aortic arch and carotid body. Capable of initiating a chance in HR and arterial pressure w/ decreased arterial oxygen pressure, increased CO2 pressure (hypercapnia) and decreased plasma pH, the result in increased BP.

Front 75

Blood Pressure

Back 75

Measure of the pressure exerted by blood against the walls of arterial system

Front 76

Systolic BP

Back 76

Peak pressure exerted against the arteries when the heart contracts, tricuspid and mitral valves are closed, aortic and pulmonic valves are opened

Front 77

Diastolic BP

Back 77

Residual pressure on the arterial system during ventricular relaxation (filling), tricuspid and mitral are open, aortic and pulmonic valves are closed

Front 78

Two main factors affecting BP

Back 78

CO and SVR

Front 79

BP equation

Back 79

BP=CO x SVR

Front 80

CO

Back 80

Indicates the total blood flow through the systemic or pulmonary circulation per minute

Front 81

SVR

Back 81

Force opposing the movement of blood within the blood vessels. Radius of the small arteries and arterioles is the principal factor determines SVR.

Front 82

Korotkoff Sounds

Back 82

Heard during BP reading.

Front 83

Phase 1 of BP is what?

Back 83

SBP, caused by spurt of blood into constricted artery w/ cuff deflation

Front 84

Phase 5 of BP is what?

Back 84

DBP, when sound disappears

Front 85

Ausculatory gap

Back 85

Loss of sound between SBP and DBP

Front 86

Doppler ultrasonic flowmeter

Back 86

Handheld transducer over the artery

Front 87

Pulse pressure

Back 87

Difference between the SBP and DBP. Normally pulse pressure is about 1/3 of SBP.

Front 88

Increase pulse pressure reasons

Back 88

Exercise or atherosclerosis (increased BP)

Front 89

Decrease pulse pressure reasons

Back 89

Cardiac failure or hypovolemia

Front 90

Mean arterial pressure (MAP)

Back 90

Average pressure within the arterial system that is felt by organs in the body.

Front 91

MAP formula

Back 91

MAP = (SBP + 2 DBP)

-----------------------------

3

Front 92

What is a persons MAP if their BP is 120/60?

Back 92

80

Front 93

MAP must be __________ then _______ to sustain vital organs

Back 93

Greater, 60.

Front 94

What happens to cardiac valves in elderly?

Back 94

Cardiac valves become thicker, and stiffer from lipid accumulation, degeneration of collagen and fiborsis

Front 95

PMH to ask pt r/t cardiovascular

Back 95

Hx of SOB, cx pain, fatigue, alcohol, tobacco use, anemia, rheumatic fever, streptococcal throat infections, congenital heart disease, stroke, palpitations, and htn

Front 96

Meds to ask pt about r/t cardiovascular

Back 96

OTC, herbs, prescription. Aspiring can prolong blood clotting time, NSAIDs can increase BP and corticosteroids can cause hypotension, edema, and K+ depletion.

Front 97

Nutrional/Metabolic to ask pt about r/t cardiovascular

Back 97

Underweight/overweight. Diet: amount of salt use and sat fat

Front 98

Health perception assessments r/t cardiovascular

Back 98

Hx of family members, elevated lipids, htn, tobacco (pack years), sedentary lifestyle, obestiy, stress, diabetes, ETOH (amount, frequency), use of habit forming drugs, allergies (shellfish, iodine), and noncardiac conditions such as asthma, renal disease, liver disease, obesity can affect cardio.

Front 99

GI/GU patterns r/t cardiovascular to ask pt

Back 99

GU: use of diuretics, nocturia. GI: Straining during BM (Valsalva)

Front 100

Valsalva maneuver

Back 100

Forced expiratory effort against a closed airway such as when a person holds the breath and tightens muscles (IE coughing, straining during BM, lifting a heavy weight) causes intrathoracic pressure and impedes venous blood to the heart.

Front 101

Activity/ Exercise assessment r/t cardiovascular

Back 101

Sustained aerobic exercise. Note symptoms like light headedness, cx pain, SOB, claudication, and palpitations.

Front 102

Sleep/Rest Patterns r/t cardiovascular

Back 102

Often interrupt sleep, Cheyne Stokes, Orthopnea, and Paroxysmal noctural dysnpea

Front 103

Cheyne Stokes

Back 103

Abnormal pattern of respiration characterized by alternating periods of apnea and deep rapid breathing

Front 104

What is Cheyne Stokes associated w/?

Back 104

HF

Front 105

Orthopnea

Back 105

Need to sleep upright, abnormal condition in which as perons must sit/stand to breathe deeply/comfortably

Front 106

What is orthopnea r/t?

Back 106

Cardiac and resp disorders

Front 107

Paroxysmal nocturnal dyspnea

Back 107

Disorder characterized by sudden attacks of resp distress that awaken the person

Front 108

What is paroxysmal nocturnal dyspnea associated w/?

Back 108

HF

Front 109

Sexuality/Reproductive r/t Cardio

Back 109

Pts may have a fear of sudden death during sex. Fatigue, cx pain and SOB may limit sex. Erectile dysfunction may be a symptom of PVD and/or side effect of meds (BB). Known risk of blood clots for women who take oral contraceptives and smoke.

Front 110

Measuring Accurate VS (BP)

Back 110

Sit in chair w/ feet flat. Measure orthostatis BP and HR while pt is supine, sitting with legs dangling or standing. Take baseline may vary from 5-15 mm hg. Reduction of up to 20 mm hg in SBP from supine to standing. HR should not increase more then 20 BPM from supine to standing. Use arm w/ highest BP for subsequent measurements.

Front 111

Inspection for cardiovascular

Back 111

Color, hair. Extremeties for edema, dependant rubor, clubbing of nail beds, varicosities, and lesions.

Front 112

Dependent rubor

Back 112

Reddish-blue discoloration

Front 113

Distended neck veins

Back 113

Large veins in the neck (internal/external jugular) should be inspected while the pts in supine position w/ HOB elevated 30-45 degrees.

Front 114

Etiology of distended neck veins

Back 114

Right atrial pressure elevation

Front 115

Central cyanosis

Back 115

Bluish/purplish tinge of central areas such as tongue, conjunctivae, and inner surface of lips

Front 116

Etiology of central cyanosis

Back 116

Inadequate oxygen sat of arterial blood due to pulmonary or cardiac disorders

Front 117

Peripheral Cyanosis

Back 117

Bluish or purplish tinge in extremeties or in nose and ears from reduced blood flow because of HF, vasoconstriction or cold enviornment

Front 118

Splinter hemorrhages

Back 118

Small red to black streaks under fingernails caused by infective endocarditis

Front 119

Clubbing of nails beds

Back 119

Obliteration of normal angle between base of nail and skin

Front 120

Etiology of clubbing of nail beds

Back 120

Endocarditis, congenital defects, prolonged O2 deficiency.

Front 121

Color changes in extremities w/ postural changes

Back 121

Pallor, cyanosis, mottling of skin after limb elevation, dependent rubor, and glossy skin

Front 122

Color changes in extremities w/ postural changes etiology

Back 122

Chrnoic decreased arterial perfusion

Front 123

Ulcer (Chronic venous insufficiency)

Back 123

Venous: Necrotic crater like lesion usually found in lower leg at medial malleolus characterized by slow wound healing

Front 124

Etiology for ulcer (venous)

Back 124

Poor venous return varicose veins, incompetent venous valves, and arteriosclerosis ,diabetes

Front 125

Ulcer (Chronic arterial insufficiency)

Back 125

Absence of hair on lower limb is an indication of arterial insufficiency. Reduction of perfusion of hair follicle results in a reduction of nutrients to the area.

Front 126

Ulcer (arterial) etiology

Back 126

Redness caused by inflammation replaces pallor in a dependent foot

Front 127

You can palpate both carotid pulses simutaneously T or F

Back 127

False

Front 128

Arterial pulse pressure scale what do the numbers 0-3 indicate

Back 128

0: absent 1: weak 2: normal 3: full/bounding

Front 129

Bounding pulse

Back 129

Sharp, brisk, +3. Caused by hyperkinetic states (anxiety, fever) anemia, and hyperthyroidism

Front 130

Thready pulse

Back 130

Weak, slow rising, easily obliterated +1. caused by blood loss, decreased CO, aortic valve disease, peripheral arterial disease.

Front 131

Irregular pulse

Back 131

Reguarly irregualr/ irregularly irregular, skips beats. Caused by cardiac dysrhythmias.

Front 132

Pulsus alternans

Back 132

Regular rhythm but strength of pulse varies w/ each beat. Caused by HF or cardiac tamponade.

Front 133

Absent pulse

Back 133

+0. Caused by artherosclerosis, trauma, embolism.

Front 134

Thrill

Back 134

Palpated. Vibration of vessel or chest wall. Caused by aneurysm, aortic regurgitation, and arteriovenous fistula.

Front 135

Rigidity

Back 135

Stiffness or inflexibility of vessel wall caused by atherosclerosis

Front 136

>100 BPM.

Back 136

Tachycardia. Caused by exercise, anxiety, trauma, shock, increased CO, and hyperthyroidism

Front 137

<60 BPM

Back 137

Bradycardia. Rest/sleeping, SA/AV node damage, athletes, drug side effect (BB) and hypothyroidism

Front 138

Displaced point of maximal impulse

Back 138

Point of maximal impulse is palpated below the fifth ICS and to the left of the MCI caused by cardiac enlargement as a result of CAD, HF or cardiomyopathy

Front 139

Palpation Unusually warm

Back 139

Hands/feet warmer then normal. Possibly from thyrotoxicosis

Front 140

Cold extremeties upon palpation

Back 140

Hands and/or feet cold to touch. external coverings needed. caused by intermittent claudication, peripheral arterial obstruction, low CO, and severe anemia.

Front 141

Pitting edema of lower extremeties or sacral areas

Back 141

Visible finger indentation after application of firm pressure. Wgt gain, tight clothes, and/or shoes, and indentations from constricting garments. Caused by possible reduced arterial cap perfusion and anemia.

Front 142

Asymmetry in limb circumference

Back 142

Measurable swelling of involved limb caused by venous thromboembolism, varicose veins or lymphedema.

Front 143

Abornal cap refill

Back 143

Blanching of nail bed for 2 sec or more after release of pressure caused by possible reduced arterial cap perfusion or nemia

Front 144

Palpable pulsations or thrills? Etiology?

Back 144

Pulse-rhythmic beating or vibrating movement. Caused by either it being normal for thin chest wall or valvular disorder

Front 145

Pulsations in the epigastric area

Back 145

Pulse-rhythmic beating or vibrating movemetn. May be normal if pt has thin chest wall, may indicate abdominal aortic aneurysm.

Front 146

Heaves at precordium located over heart

Back 146

Sustainable lifts of chest wall in the precordial area tha can be seen or palpated can indicate left ventricular hypertrophy.

Front 147

Palpable point of maximal impulse

Back 147

Reflects the pulsation of the apex of heart. Heart may be enlarged

Front 148

Abnormal Cardiac Borders

Back 148

Left border of cardiac dullness extends beyond MCL in fifth ICS, right border of cardiac dullness extends beyond sternal border. Etiology is cardiac enlargement due to CHD, HF or cardiomyopathy.

Front 149

What happens during S1?

Back 149

"Lub". Closure of tricuspid valve and mitral valve. Beginning of systole, ventricular contraction. High pitched sound, heard best w/ stethoscope diaphragm.

Front 150

What happens during S2?

Back 150

Associated w/ closure of the aortic and pulmonic valves, beginning of diastolic, ventricular relaxation, heard best w/ pt leaning forward.

Front 151

Pulse deficit

Back 151

Apical HR exceeds the peripheral pulse rate. Etiology is cardiac dysrhythmias most common being a fib/ a flutter or PVCs

Front 152

Arterial bruit

Back 152

Turbulent flow sound in the peripheral artery. Caused by arterial obstruction or aneurysm.

Front 153

S3

Back 153

May be normal in young adults. Extra heart sound low pitched heard in early diastole, sound of a gallop. Caused by left ventricular failure, volume overload, mitral, aortic or tricuspid regurgitation.

Front 154

S4

Back 154

Extra heart sound, low pitched, heard in late diastole. Simliar to gallop. Caused by forceful arterial contraction from resistance to ventricular filling.

Front 155

Cardiac Murmurs

Back 155

Turbulent sounds occuring between normal heart sounds. They are char by loudness, pitch, shape, quality, duration and timing. Caused by cardiac valve disorders, and abnormal blood flow patterns.

Front 156

How are cardiac murmurs graded?

Back 156

On a six point scale. I- VI: Indicates a murmur barely audible. VI murmur that can be heard w/ stethoscope lifted just off the chest

Front 157

Pericardial Friction Rub

Back 157

High pitched scratchy sound heard during S1 and/or S2 at the apex. Heard best w/ pt leaning forward at the end of expiration. Caused by pericarditis

Front 158

Troponin

Back 158

Biomarker of choice for MIs. Myocardial muscle protein released into circulation after injury. Detectable within hours (4-6 avg) peak 10-24 hrs and up to 10-14 days. Two subtypes Troponin 1 (cTn1) and Troponin T (cTnT)

Front 159

Nursing Care for Tropnin test

Back 159

Rapid point of care test available. Purpose of serial sampling explain in conjunction w/ CK-MB and serial ECGs

Front 160

Troponin I how much is negative, suspicious and positive for myocardial injury

Back 160

<0.5 mcg/L-negative. 0.5-2.3 suspicious for injury, >2.3-positive for injury

Front 161

CK-MB

Back 161

Creatine kinase enzyme specific to myocardial injury. Released into circulation after myocardial injury and necrosis. Begin to rise 3-6 hrs after symptoms, peak at 12-24 hours and return 12-48 hours.

Front 162

What % CK-MB highly indicative of MI?

Back 162

4-6%

Front 163

Myoglobin

Back 163

Heme protein found in cardiac and skeletal muscle. Elevation is sensitive indicator of very early myocardial injury but lack specificity for MI. Usefulness limited.

Front 164

C-reactive protein (CRP)

Back 164

Protein produced by the liver during periods of active inflammation. Increased levels of CRP independent risk factor for CAD. May also predict future cardiac events intps w/ unstable angina or MI, conflicting results in studies.

Front 165

Homocystiene

Back 165

Amino acid produced during protein catabolism (breakdown) that has been identified as a risk factor for cardiovascular disease

Front 166

Hyperhomocystiene Causes

Back 166

Dietary defiency treated w/ folic acid, B6 and B12

Front 167

BNP (B type natriuretic peptide)

Back 167

Peptides tha cause natriuresis. Indicates presence of HF and may help distinguish cardiac vs resp cause of dyspnpea.

Front 168

BNP >100 pg/mL indicates what?

Back 168

HF

Front 169

ANP (Atrial natiuretic peptide)

Back 169

Originates in atrium

Front 170

Cholesterol

Back 170

Blood lipid. Elevated is risk factor for CAD

Front 171

Normal Cholesterol

Back 171

<200 mg/dl

Front 172

Triglycerides

Back 172

Mixture of fatty acids. Elevations associated w/ cardiovascular disease and diabetes

Front 173

Normal Triglycerides

Back 173

<150 mg/dl

Front 174

LDL

Back 174

Contains more cholesterol than any other lipoprotein and have an affinity for arterial walls. Lousy, low density lipoprotein.

Front 175

Recommended LDL

Back 175

LDL <100 mg/dl. near optimal: 100-129 mg/dl, moderate risk for CAD: 130-159 mg/dl, high risk for CAD: >160 mg/dl

Front 176

HDL

Back 176

Carry lipids away from arteries to the liver for metabolism. A high HDL desirable. Healthy lipoprotein.

Front 177

Recommended HDL

Back 177

Men >40 mg/dl

women >50 mg/dl

low risk CAD >60 mg/dl

high risk CAD <40 mg/dl

Front 178

Nursing Responsibilty for Lipid Panel

Back 178

Must obtained in fasting state for at least 12 hours, and no ETOH intake for 24 hours before tests.

Front 179

Risk for cardiac disease calculation w/ cholesterol levels and HDL

Back 179

Divide total cholesterol level by HDL. Low risk: ratio less then 3 avg risk: 3-5 increased risk=>5

Front 180

Lipoprotein

Back 180

Increased levels associated w/ risk of premature CAD and stroke, can be obtained in non fasting state

Front 181

Lipoprotein interval

Back 181

<30 mg/dl

Front 182

Basic Metabolic Panel

Back 182

Serum glucose, Na, K, Chloride, CO2, BUN and creatinine. Glucose: Diabetes, K: Detects increased aldosternoism, BUN/Creatinine: renal involvement

Front 183

Chest Xray for Cardio

Back 183

Pt placed in upright position examine lung fields and size of heart. Ask pt about frequency and possibility pregnancy. Remove any jewelry or metal objects.

Front 184

ECG

Back 184

Electrodes placed on chest and extremeties, record electrical activity, can detect rhythm, pacemaker activity, conduction abnormalities, position of heart, size of atria/ventricles, presence of injury, hx of MI.

Front 185

Nursing resp for ECG

Back 185

Skin prep, apply electrodes and leads. No discomfort. Avoid moving to decrease artifact

Front 186

Ambulatory ECG

Back 186

Holter monitor. Recording of ECG rhythm for 28-48 hours and then correlating rhythm changes w/ s/s recorded in diary.

Front 187

Nursing resp for ambulatory ECG

Back 187

Prep skin and apply electrodes/leads. No discomfort, lessen moving to decrease artifact

Front 188

Exercise/Stress Test

Back 188

3 minute stages at set speeds/elevations on treadmill belt. Pt exercises to peak hr (subtracting age from 220) or peak exercise tolerance. Terminated for cx discomfort, sig changes in VS and cardiac ischemia.

Front 189

Nursing Resp for Stress Test

Back 189

Comfortable shoes/clothes, Monitor VS, ECG before exercise, BB held 24 hours, Caffeine containing foods/drinks held. Refrain from smoking/exercise 3 hours within test

Front 190

Echo

Back 190

Transducer that emits and receives ultrasound waves is placed in four positions on the chest above the heart. Records direction and flow of blood. Can see valve abnormalities, congenital cardiac defects, wall motion, ejection fraction.

Front 191

Echo Nursing Resp

Back 191

Place pt in left side lying position facing equipment. Instruct pt about procedure and sensations.

Front 192

Ejection Fraction

Back 192

Percentage of end diastolic blood volume that is ejected during systole.

Front 193

Transesophageal Echocardiogram

Back 193

Probe w/ ultrasound transducer at tip is swallowed while physician controls angle/depth. Sends back clear images of heart size, wall motion, valvular abnormalities, endocarditis, vegetation, thrombi. Constrast may be injected iV for blood flow

Front 194

TEE Nursing Respo

Back 194

NPO 6 hrs post op. Remove dentures. IV sedation. DD if outpt. VS and O2 sat.

Front 195

Pharmacological Echo.

Back 195

Substitute for exercise stress test if individual unable to exercise. IV dobutamine or dipyradamole is infused and dosage increased at 5 min intervals

Front 196

NUCLEAR Cardiology

Back 196

IV injection of radioactive isotope. Radioactive uptake is counted over the heart by camera. Supplies info about contractility, perfusion and acute cell injury.

Front 197

Nursing Resp NUCLEAR Cardiology

Back 197

Explain procedure. Establish IV line for injection of isotopes. Explain radioactive isotope will lose most of its radioactivity within hrs. Tell pt they will be lying still on back w/ arms extended over head for 20 mins. Repeated scans performed within a few mins to hrs after injection.

Front 198

NUCLEAR Muga Scan

Back 198

Small amt of pts blood is removed mixed w/ a radioactive isotope. Using ECG for timing images are acquired during cardiac cycle. Indicated for pts w/ MI, HF, or valvular heart disease.

Front 199

Nursing resp for NUCLEAR muga scan

Back 199

Explain procedure. Est IV line for removal of blood and reinjection of isotope. Est ECG monitor.

Front 200

NUCLEAR Exercise Imaging

Back 200

Nuclear images are takne at rest and after exercise. Injection given at maximal HR on a bike or treadmill. Pt is required to continue to exercise for 1 minute to circulate the radioactive isotope. Scanning is done 15-60 mins after exercise. Testing scan id one 60-90 mins after initial infusion or 24 hours alter

Front 201

Nursing resp NUCLEAR exercise imaging

Back 201

Explain procedure. Certain meds held. no caffeine within 12 hours.

Front 202

NUCLEAR positron emission tomography (PET) scan

Back 202

Highly sensitive in distinguishing viable/nonviable myocardial tissue. Uses two radionuclides 1: perfusion 2: metabolic function. In normal heart both will match, in damaged they will not.

Front 203

PET scan nursing resp

Back 203

Explain to pt they will be scanned by a machine and will need to stay still for a period of time. Glucose levels must be between 60-140 mg/dl. Pt needs to be NPO for exercise and refrain from tobacco and caffeine 24 hours preop.

Front 204

MRI

Back 204

Noninvasive imaging techniqure obtains info about cardiac tissue, intergrity, aneurysms, ejection fractions, CO and patency of proximal coronary arteries.

Front 205

MRI nursing resp

Back 205

Contraindicated in pt w/ implanted metallic devices or metal.

Front 206

Magnetic Resonance Angiography (MRA)

Back 206

Used for imaging of valvular occlusive disease and abdominal aortic aneurysms. Same as MRI but w/ contrast. (Contraindicated in shellfish allergy/implanted metal)

Front 207

Cardiac Tomography (CT)

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Heart specific CT imaging w/ angiography or w/out IV contrast used to visualize heart anatomy, coronary circulation and blood vessels.

Front 208

Cardiac Cath

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Insertion of cath into heart to obtain info about O2 levels and pressure readings within heart chamber. Contrast is injected to assist examining struutre/motion. Done by insertion of cath into vein and/or artery

Front 209

Coronary Angiography

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During cath contrast medium injected into coronary arteries, evaluates patency of conary arteries and collateral circulation

Front 210

Intracoronary Ultrasound

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During cath. small ultrasound probe is introduced into coronary arteries used to assess size, and consitency of plaque, arterial walls and effectiveness of intracoronary artery treatment

Front 211

Fractional Flow resrve

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Special wire is inserted into coronary arteries to measure pressure and flow info is used to determine need for angioplasty or stenting a significant blockage

Front 212

Cardiac Cath. nursing resp

Back 212

Check for iodine sensitivity. NPO 6-18 hours. Sedative or other drugs. Educate pt on anesthesia, cather, feeling of warmth when dye is injected. After procedure assess circulation to extremity used for cath. Check peripheral pulses, color and sensation Q15min-Q1H. Observe site for hematoma and bleeding Place compressin device over arterial site if indiacted. VS

Front 213

Electrophysiology Study

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Invasive study used to record intracardiac electrical activity using catheters inserted via the femoral and jugular veins into right side of the heart. Electrodes record electrical activity in diff cardiac strucutres. Dysrhythmias can be induced/terminated.

Front 214

Nursing resp for electrophysiology study

Back 214

Antidysrhythmics meds may be discontinued several days before study. NPO 6-8 hours prepop. Sedation often used.

Front 215

Peripheral Arteriography and Venography

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Injection of radiopaque contrast medium into either arteries or veins. Serial xrays taken to detect/visualize any atherosclerotic plaques, occlusions, aneurysms, or traumatic injury

Front 216

Nursing resp for peripheral arteriography and venography

Back 216

Check for iodine allergy. Check extremity w/ puncture site for pulsation, warmth, color or motion postop. inspect insertion site for bleeding/swelling.