Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
117 Cards in this Set
- Front
- Back
|
Where is the anatomical position to listen to apical pulse?
|
midclavicular line, 5th intercostal space (mitral valve)
|
|
|
Where is the mitral valve located?
|
between the left atrium and left ventricle
|
|
|
Where is the pulmonic valve located?
|
between the right ventricle and pulmonary artery
|
|
|
Where is the aortic valve located?
|
between the left ventricle and aorta
|
|
|
Where is the tricuspid valve located?
|
between the right atrium and right ventricle
|
|
|
Where is the anatomical position to listen to aortic valve?
|
Right Upper Sternal Border, 2nd/3rd intercostal space
|
|
|
Where is the anatomical position to listen to pulmonic valve?
|
Left Upper Sternal Border, 2nd/3rd intercostal space
|
|
|
Where is the anatomical position to listen to mitral valve?
|
Mid-clavicular line, 5th/6th intercostal space (apical pulse)
|
|
|
Where is the anatomical position to listen to tricuspid valve?
|
Left Lower Sternal Border, 3rd/4th/5th/6th intercostal space
|
|
|
Name pathway of conduction system of the heart
|
SA NODE (pacemaker) to INTERNODAL PATHWAYS to AV NODE to BUNDLE OF HIS to RIGHT BUNDLE BRANCHES to LEFT BUNDLE BRANCHES to PURKINJIE FIBERS to VENTRICULAR MYOCARDIUM
|
|
|
Why is the SA node the pacemaker of the heart?
|
it is the fastest, beating 60-100 BPM
|
|
|
How fast is the intrinsic rate of junction? (AV Node)
|
40-60 BPM
|
|
|
How fast is the purkinjie fibers?
|
20-40 BPM
|
|
|
What is the best evidence that your cardiac client can get out of bed?
|
the HEART RATE is stable
|
|
|
what is the difference between systolic and diastolic called?
|
pulse pressure
|
|
|
what is the difference between the apical and radial pulse called?
|
pulse deficit
|
|
|
How do you determine a pulse deficit?
|
take both apical and radial pulses at the same time for a full minute (can be performed by 2 individuals)
|
|
|
If you are looking at a rhythm strip, how do you calculate the heart rate if the pulse is irregular?
|
number of R waves x 10
|
|
|
If you are looking at a rhythm strip, how do you calculate the heart rate if the pulse is regular?
|
300 / number of boxes between each R wave
|
|
|
Where is the carotid pulse located?
|
neck
|
|
|
Where is the popliteal pulse located?
|
behind the knee
|
|
|
Where is the pedal pulse located?
|
on top of the foot between the toes
|
|
|
What assessment finding best supports that the client's stroke volume has decreased?
|
dizziness and fainting with activity
|
|
|
How long do you place a holter monitor on a client?
|
24 hours
|
|
|
Client with angina is going for an exercise stress test. How do you explain what is going to happen?
|
Testing is non invasive. It will assess cardiovascular function and conduction
|
|
|
Patient is going for femoral arteriogram, prior to procedure, what should you check?
|
check for distal pulse before and after, and for bleeding after procedure
|
|
|
What lab test would you expect the physician to order to confirm MI?
|
TROPONIN 1 (most important), EKG's, CKMB, AST, ALT, LDH
|
|
|
Risk factors for Coronary Artery Disease (CAD) - MODIFIABLE
|
obesity, smoking, stress
|
|
|
Risk factors for coronary artery disease (CAD) - NON-MODIFIABLE
|
gender, family history, age, sex
|
|
|
How would you describe atrial fibrillation
|
irregularly irregular rhythm
|
|
|
How would you describe atrial flutter?
|
regularly irregular rhythm
|
|
|
Which client would need to be seen first?
- sinus bradycardia - sinus tact - atrial flutter - ventricular fibrillation |
ventricular fibrillation
|
|
|
Where do you usually place a permanent pacemaker?
|
under the skin below the right clavical (near SA node - aortic valve)
|
|
|
What is the clinical sign of a pacemaker malfunction?
|
dizziness
|
|
|
How would you know if cardiversion is successful?
|
The patient will have a normal sinus rhythm
|
|
|
Prior to performing a cardioversion, what medication should you hold?
|
digoxin
|
|
|
What safety measures do you do before defibrillating someone?
|
visual clearance, verbal - call "ALL CLEAR"
|
|
|
What is the reason why cholesterol levels should be controlled?
|
Cholesterol thickens the lining of the arterial walls, narrowing the lumen of the blood vessels
|
|
|
What is the lipoprotein that is bad for cardiac patients?
|
LDL (low density lipoprotein) = margarine, coconut oil, whole milk, cheese, shortening
|
|
|
What is the lipoprotein that is good for cardiac patients?
|
HDL (high density lipoprotein) = corn oil, sapphire oil, peanut oil. Stops liver from producing cholesterol.
|
|
|
Where is the SA Node located?
|
just below superior vena cava
|
|
|
What would a narrow pulse pressure mean?
|
shock
|
|
|
What would a widened pulse pressure mean?
|
increase in ICP (intercranial pressure)
|
|
|
Where would you palpate for a femoral pulse?
|
inguinal area (groin)
|
|
|
What is the definition of stroke volume?
|
volume of blood ejected uring contraction (heart beat) = 60-80mL
|
|
|
How do you calculate cardiac output?
|
stroke volume x HR = cardiac output
|
|
|
What does the holter monitor report?
|
electrical activity of the heart, NOT mechanical action. RECORDS TRACINGS OF ABNORMAL RHYTHMS DURING ADLS.
|
|
|
What would you suspect if a patient had severe chest pain for more than 15 minutes?
|
MI
|
|
|
What is premature ventricular contractions?
|
skip of a beat. unifocal = one.
|
|
|
What would an atrial flutter look like on an rhythm strip?
|
sawtooth
|
|
|
what is the only treatment for a ventricular fibrillation?
|
defibrillation
|
|
|
What is the common complication of MI?
|
1. dysrhythmias. take vital signs and POX. 2. heart failure du to contraction vailure, 3. cardiogenic shock, 4. weakened walls-rupture
|
|
|
What medications are taken for cardioversion?
|
valium and ativan
|
|
|
what do you put on the pads for a conduction?
|
add gel or saline
|
|
|
What is the difference between Angina Pectoris and MI?
|
Angina Pectoris: chest pain that stops when you rest and pain goes away within 15 minutes.
MI: chest pain stays for more than 15 minutes. need medication |
|
|
Describe pain of angina
|
substernal pain radiation to shoulder, arms, jaw
|
|
|
Patient is diagnosed with angina, complains of chest pain. What is the first thing to do?
|
monitor vital signs Q15minutes, especially BP. hook up to ECG, GIVE OXYGEN, nitro, aspirin, betablocker. assess PQRST
|
|
|
What is the reasoning for chest pain?
|
lack of oxygen (ischemia) to myocardial. blood vessels constrict
|
|
|
What is a percutanious transluminal coronary angioplasty?
|
catheter to femoral or brachial artery - goes to Right atrium, Left ventricle. Breaks up any clots. CHECK DISTAL PULSES
|
|
|
why do we put patients on a cardiac monitor that have chest pain?
|
monitor rhythm of the heart because dysrhythmia is common complication of MI
|
|
|
After coronary angioplasty, patient complains of chest pain. what do you do?
|
take vitals, notify physician
|
|
|
after coronary angioplasty, what position do you put patient?
|
legs extended, not flexed. lay flat
|
|
|
What happens if patient has right sided heart failure?
|
jugular vein distention, liver enlargement, dependent edema
|
|
|
what happens if patient has left sided heart failure?
|
pulmonary edema, shortness of breath, crackles in lungs
|
|
|
What do you assess on daily basis after heart failure?
|
daily weight (fluid retention), vitals, lung sounds (should have no crackles)
|
|
|
What is the most common vein used during CABG?
|
saphenous vein (in leg) or mammary
|
|
|
How should patient feel after CABG?
|
warm, non-tender, non-edematous
|
|
|
What do you asses for after CABG?
|
distal pulse, evidence of collateral circulation, capillary refill, CMST
|
|
|
what position should client be in during left sided heart failure?
|
sit up position, high fowlers (due to pulmonary edema)
|
|
|
What are the enzymes affected in heart failure?
|
ELEVATED BNP, ast, alt, ldh
|
|
|
What are the symptoms of pulmonary edema? (left sided heart failure)
|
ROWLS, crackles in lungs, hypoxia, confusion, tachypnea, PINK FROTHY SPUTUM, hemoptysis (coughing blood)
|
|
|
What drug does patient need for pulmonary edema?
|
OXYGEN
|
|
|
What test is elevated and most indicative of rhuematic fever?
|
elevated ASO test caused by strep
|
|
|
What does rheumatic fever lead to?
|
Rhuematic Heart Disease, mitral valve backflow (drops cardiac output, incompetent valve leads to regurgitation
|
|
|
What is a typical sign of pericarditis?
|
muffled heart sounds (pericardial friction rub)
|
|
|
What is pericardial?
|
sound when holding breath
|
|
|
What is pleural?
|
no sound when holding breath
|
|
|
what are the s/s of acute bacterial endocarditis?
|
chest pain, fever
|
|
|
What is acute bacterial endocarditis?
|
infection of endocardium
|
|
|
What is the cause for acute bacterial endocarditis and how is it treated?
|
caused by IV drug abuse. Treated with antibiotics, rest, analgesics, and Oxygen
|
|
|
How does a child get secondary bacterial endocarditis?
|
fever was untreated strep. Child will look flushed, have chest pain, malaise
|
|
|
Problem with bacterial endocarditis can lead to what?
|
pulmonary embolis
|
|
|
What is the prognosis of mycarditis?
|
inflammation of the heart (viral). can recover without any treatment
|
|
|
What is cardiac tamponade?
|
fluid and pus surrounding the heart. Takes away negative pressure.
|
|
|
What are s/s of cardiac tamponade and how can it be treated?
|
s/s: beck's triad, elevated CVP with JVD. treated with pericardiocentesis or pericardectomy
|
|
|
What should be most concerned for african americans?
|
essential hypertension
|
|
|
s/s of hypertension
|
headache, unexplained nose bleeds (slient killer)
|
|
|
what is malignant hypertension?
|
diastolic is over 120
|
|
|
what is the definition of hypertension?
|
sustained BP of 140/90
|
|
|
How can a patient lower their blood pressure?
|
reduce sodium intake, weight loss, reduce stress, reduce smoking, reduce alcohol use, take diurectics
|
|
|
What would the urinalysis results of hypertension be?
|
elevated BUN & CRT, elevated potassium and protein
|
|
|
if there is protein in urinalysis, what does that mean?
|
kidneys may not be working properly
|
|
|
What is Reynaud's disease?
|
vasospastic disorder causing discoloration of fingers and toes triggered by EMOTIONAL STRESS, and COLD. This is arterial insufficiency and mainly with females, causing vasoconstriction. DO NOT ELEVATE, USE SOCKS AND GLOVES
|
|
|
What is Buerger's disease?
|
affects men, venous insufficiency. Problem in getting venous return. can cause ulcers. RAISE EXTREMITIES.
|
|
|
What causes periferal vascular disease?
|
smoking - causes vasoconstriction
|
|
|
s/s of vericose veins?
|
swelling, itching, TORTUROUS itching, dilated, painful. caused by pregnancy or obesity.
|
|
|
Danger of arterial insufficiency
|
ulcers
|
|
|
risk factors for thrombophlebitis
|
surgeries, prolonged bed rest, obesity, pregnancy, contraceptives
|
|
|
How do you prevent Deep Vein Thrombosis (thrombophlebitis)?
|
elevate, leg exercises, stocking, ambulation
|
|
|
What does thrombophlebitis lead to?
|
embolis - can go to the lungs. HOMAN'S SIGN (DVT)
|
|
|
What is intermittent claudication?
|
When patient is walking and suddenly experiences leg cramps, patient can rest and then ambulate again
|
|
|
if you are checking your patient's distal pulses and notice that one of them is better than the other, what can you conclude?
|
artery is blocked
|
|
|
When patient has an abdominal aortic aneurysm, what is the most important VS to check?
|
BLOOD PRESSURE
|
|
|
What do you assess for with an aortic aneurysm?
|
pulsating abdominal mass (do not palpate)
|
|
|
How is the PQRST of a dissecting aneurysm?
|
Provoke: none; Quality: ripping, tearing; Radiates: flank; Severity: 10/10; Time: constant
|
|
|
What is the normal urinary output?
|
30mL/hr
|
|
|
What are the s/s of shock?
|
altered level of consciousness, cool, clammy skin, tachypnea, urinary output of 20mL/hr
|
|
|
What is the underlying cause of venous insufficiency?
|
poor blood return to the heart. should not stand for too long. prolonged venous hypertension
|
|
|
What should you assess for with right arterial occlusion? (artery is blocked)
|
pulses distal to obstruction, capillary refill CMST both sides
|
|
|
if blood pressure is elevated, what groups of meds should you take?
|
anti hypertensive medication
|
|
|
what data best supports diagnosis of disecting aortic aneurysm?
|
- flank bruising bilaterally YES
- diminished or absent pulses YES - pale cold clammy skin (shock) YES - hourly output of 50mL/hr NO |
|
|
after cardiac surgey, patient has an output of 20mL/hr. what does this indicate?
|
drop of cardiac output, insufficient, oliguric
|
|
|
in Post Anesthesia Care Unit (PACU), patient is given general anasthestic. Systolic BP was 130 and now is at 190. what do you do?
|
put patient in supine position with feet elevated. (modified trendelenberg) NOTIFY MD
|
|
|
Client lost 15-20% blood volume. What vital signs will change first?
|
PULSE
|
|
|
What is the definition of shock?
|
inadequate tissue perfusion
|
|
|
What are the types of shock?
|
1. cardiogenic: failure of heart to act as a good pump.
2. hypovolemic 3. distributed 4. obstructive |
|
|
Patients BP is 120/70 and P is 70. Now, patient's BP is 90/50 and P is 100. what is the first thing to do?
|
elevate legs. modified trendelenberg position
|
