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42 Cards in this Set
- Front
- Back
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Briefly describe cardiac contraction
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(very simplified)
1. electrical impulse initatied 2. na moves into the cell and k moves out 3. negatively charged cell now positively charged or "depolarized" 4. ca moves in causing myofibrils to contract (hint hint!! if CA2+ levels are too high could that be a problem?! remember a&p!!) 5. cell returns to resting electrical state and "repolarizes" |
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What is the SA (sinoatrial) node?
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1. primary pacemaker of the heart
2. intrinsic firing rate of 60-100 impulses/min 3. internodal pathways in atria conduct impulses |
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What is the AV (atrioventricular) node?
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1. pathway for conducting impulses to ventricles
2. delays impulses to allow for emptying of atria-atrial kick |
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A little a&p review..
What are the two phases of heat contraction? |
1. systole
2. diastolic |
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Systole
contraction of relaxation of myocardium? |
contraction
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Diastolic
Relaxation or contraction of myocardium? |
Relaxation
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What is cardiac output?
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the volume of blood ejected per minute
4-8 L/min |
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How is CO calculated?
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CO=stroke volume X HR
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How is stroke volume determined?
(3 factors) |
1. preload
2. afterload 3. contractility |
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What is preload defined as?
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degree of stretch of myocardial fibers determined by the volume of blood in LV at the end of diastole
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Increased blood volume will increase preload which will do what to CO?
(hint hint fluid & balances!) |
increase it!
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Decreased blood volume will decrease preload which will do what to CO?
(hint hint fluid & balances!) |
decrease it!
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Name 3 factors that increase preload
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1. iv fluids
2. blood (volume) 3. vasoconstriction |
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Name 4 factors that decrease preload
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1. diuretics
2. dehydration 3. hemorrhage 4. vasodilation |
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What is afterload defined as?
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resistance or pressure the ventricles must overcome to pump blood out
-LV affected by systemic vascular resistance (SVR) -RV affected by pulmonary vascular resistance (PVR) |
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what is cardiac "contractility" defined as?
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force generated by the myocardium when it contracts - inotropic property
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What is Ejection Fraction "EF"?
What percentage is it normally? |
% of LV end-diastolic volume that is ejected with each contraction
normally approx 50-55% |
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Describe the ANS (autonomic NS) regulation of the CV system
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-Heart rate
-contractility -conduction velocity at AV node -afterload: vascular resistence - arterial vasoconstriction & dilation -preload: venous constriction & dilation |
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Which side of the heart pumps deoxygenated blood to the lungs?
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right side
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Which side of the heart pumps oxygenated blood to the systemic circulation?
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left side
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do arteries only carry oxygenated blood?
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NO! artery just means "away from heart"
remember, the pulmonary artery carries deoxygenated blood from the heart to the lungs & then the pulmonary vein carries oxygenated blood back to the heart |
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What are some examples of subjective data needed during a pt health history, related to CV system?
(recall subj vs obj data in basics!) |
past health history
past & current medications surgery & other treatments |
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Assessing the CV system
What are functional health patterns requiring assessment? |
health perception - health management pattern
nutritional - metabolic pattern elimination pattern activity - exercise pattern sleep - rest pattern cognitive - perceptual pattern |
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Provide examples of common CV disease symptoms
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chest pain/discomfort
palpitations syncope fatigue dyspnea cough, hemoptyosis weight gain edema nocturia |
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Chest discomfort/pain
-Is this one of the most important manifestations of cardiac ischemia? -what are other causes? -is their big or little correlation btwn severity of pain & gravity of situation? |
-YES!
-pulmonary embolus, GB disease, GERD, esophageal spasm -assume chest discomfort is related to ischemia unless proven otherwise, especially if risk factors & history of CAD/CV disease. -little correlation |
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Palpitations
"dysrhythmias or arrhythmias" What can cause? |
stress, caffeine, drugs, myocardial ischemia, mitral valve disease, electrolyte imbalances, ventricular aneurysm
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What can cause syncope?
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stroke, hypovolemia, orthostatic hypotension, seizures, dysrhythmias, hypoglycemia.
Be sure to ask pt about associated symptoms. |
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Is fatigability with mild exertion/activity common with CV disease?
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YES
other causes can be anemia, depression, chronic diseases, thyroid diseases |
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How is dyspnea related to CV disease?
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-often assoc with myocardial ischemia
-primary symptom of pulmonary congestion from LV failure |
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What are different forms of dyspnea?
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-exertional dyspnea (DOE)
-orthopnea -paroxysmal nocturnal dyspnea (PND) |
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Coughing & hemoptysis
CV causes are...? |
heart failure
pulmonary edema ACE inhibitors - ask about frequency & quality - if hemoptysis is present, ask if streaks of blood, pink tinged or frank blood |
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Weight gain and dependent edema
How does it relate to CV disease? |
- as heart fails, fluid accumulates
- increase of 3lbs or more in 24hr or 5lbs in 1 week - inquire about weight gain, fitting of shoes, tightening of clothing around waist |
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How does nocturia relate to CV disease?
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kidneys inadequately perfused by weak heart and receive increased blood flow during night -> output increases
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What should you inquire about regarding family history and CV?
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-diabetes
-kidney disease -stroke -heart disease -hypertension (HTN) -parents and siblings |
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Optimal BP:
Systolic >? & Diastolic >? Normal BP: Systolic <? & Diastolic <? High BP: Systolic <? & Diastolic <? (american heart assoc 18 years age+) |
Optimal BP:
Systolic <120 & Diastolic <80 Normal BP: Systolic <130 & Diastolic <85 High BP: Systolic >140 & Diastolic >90 |
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When inspecting the peripheral vascular system what should you note/look at?
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skin color
hair distribution venous patterns neck veins |
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CV system palpation, what should you note/look at?
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temperature
moisture pulses edema skin integrity |
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What are 4 concerns related to palpation of pulses?
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-symmetry
-rate -rhythm -intensity |
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List common sites for palpating arteries
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-carotid
-brachial -radial -ulnar -femoral -popliteal -posterior tibial -dorsalis pedis |
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What is the pulse scale?
Absent = Weak = Normal = Increased = Bounding = |
Absent = 0
Weak = +1 Normal = +2 Increased = +3 Bounding = +4 |
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What is a pulse deficit?
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radial pulse not equal to cardiac apical pulse. rapid rate prevents sufficient ventricular filling.
when irregular pulse is noted, nurse should always compare apical and radial pulses |
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What are the 2 types of edema and what is the scale?
slight = noticeable = deep = remarkable = |
pitting and non-pitting
slight = +1 noticeable = +2 deep = +3 remarkable = +4 |
