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;
73 Cards in this Set
- Front
- Back
|
Cardiology Heart review
• Divided by a __ thick _______ in middle |
• Divided by a v. v. thick septum in middle
|
|
|
Cardiology Heart review
• LV __ x thicker size & muscle mass than _____ pumps against much ______pressure. |
• LV 3 x thicker size & muscle mass than RV b/c pumps against much higher pressure.
|
|
|
Cardiology Heart review
• L _____ is mostly seen on a _________ |
• L vent is mostly seen on a normal X-ray
|
|
|
4 Valves
____ valves separate atria & ____ – inlet valves |
AV valves separate atria & ventricle – inlet valves
|
|
|
4 Valves
R side - t______ L side - m______ |
R side - tricuspid
L side - mitral |
|
|
4 Valves
Semilunar valves – shape diff than _______ – outlet valves |
Semilunar valves – shape diff than AV valves – outlet valves
|
|
|
4 Valves
Semilunar valves R side - _____ L side - _______ |
R side - pulmonic
L side - aortic |
|
|
4 Valves
Chordae tendonae attach to _______ (mitral & tricuspid) & ________(look at the diff in shapes). |
Chordae tendonae attach to AV valves (mitral & tricuspid) & semilunar valves (look at the diff in shapes).
|
|
|
4 Valves
w/ MI, cn _______ muscle _____ or __________ rupture & ________ valve will b altered (often see regurgitation smtms mitral valve regurgitation) from potential damage to _________ or ________ |
w/ MI, cn hv papillary muscle ischemia or papillary muscle rupture & bld vlow thru valve will b altered (often see regurgitation smtms mitral valve regurgitation) from potential damage to papillary muscles or chordae tendonae
|
|
|
4 Valves
If valve doesn’t work, u get _________. The valve won’t be able to close properly – the ventricle will _______, but it will go back up into the _______. See in pts w/ infarct. |
If valve doesn’t work, u get regurgitation. The valve won’t be able to close properly – the ventricle will contract, but it will go back up into the left atrium. See in pts w/ infarct.
|
|
|
Aortic Valve
C________ come off of (3 ________ cusps around) the ________. |
Coronaries come off of (3 coronoary cusps around) the aortic valve.
|
|
|
Aortic Valve
Normally a _______ valve - __% of pop hv bicuspid valve, need valve _________. Accounts for about ___% of the valve _______ surgeries. |
Normally a tricuspid valve - 2% of pop hv bicuspid valve, need valve replacement. Accounts for about 50% of the valve replacement surgeries.
|
|
|
Aortic Valve
__% of coronary filling takes place during _______, and that’s very important. The blood flow going to the coronary arteries takes place during ________. |
80% of coronary filling takes place during diastole, and that’s very important. The blood flow going to the coronary arteries takes place during diastole.
|
|
|
Aortic Valve
One of our goals when we’re taking care of patients with MIs – we monitor their _______. |
One of our goals when we’re taking care of patients with MIs – we monitor their heart heart rate.
|
|
|
Aortic Valve
When your heartrate ________, what happens to the period of diastole? It _______. What happens to coronary filling? It ______. |
When your heartrate increases, what happens to the period of diastole? It shortens. What happens to coronary filling? It shortens.
|
|
|
Representation of Heart
• Base of heart sits at _____ & ______ intercostals space. |
• Base of heart sits at second & third intercostals space.
|
|
|
Representation of Heart
• Apex of heart sits at ______intercostal space almost to _________ line |
• Apex of heart sits at fifth intercostal space almost to midclavicular line
|
|
|
Representation of Heart
MCL) – PMI (_____ of _____ ________) – ______ here & try to feel ____ on patient |
MCL) – PMI (Point of Maximal Impulse) – palpate here & try to feel PMI on patient
|
|
|
Representation of Heart
• You have to know what _____ is no matter what – you must understand what ________ findings are |
• You have to know what normal is no matter what – you must understand what normal findings are
|
|
|
Representation of Heart
Sometimes you can see PMI pulsating through chest wall on a _______ patient – it’s not usual or normal. |
Sometimes you can see PMI pulsating through chest wall on a very thin patient – it’s not usual or normal.
|
|
|
Representation of Heart
Pt w/ L _______ failure, over time the heart muscle mass will become _______ to compensate. PMI will shift – sometimes _______ and __________. You will see that with left _______ h_____. Sometimes it will shift to the left. |
Pt w/ L ventricular failure, over time the heart muscle mass will become bigger & bigger & bigger to compensate. PMI will shift – sometimes laterally and downward. You will see that with left ventricular hypertrophy. Sometimes it will shift to the left.
|
|
|
Things to Understand in Cardiac
Electrical Anatomy (Electrical Aspects) • ______ – impulse starts from _____, travels down to the _______ |
• SA Node – impulse starts from SA node, travels down to the AV node
|
|
|
Things to Understand in Cardiac
Electrical Anatomy (Electrical Aspects) • AV Node – impulse travels from AV node to: • B___ _____ • B___ ______ • P___ ______ |
• AV Node – impulse travels from AV node to:
• Bundle of His • Bundle Branches • Purkinje fibers |
|
|
Alterations of Blood Flow
due to ____ deficiencies, secondary complication to ___, ventricular _____ defects. May see ______ in heart. |
due to valve deficiencies, secondary complication to MI, ventricular septal defects. May see holes in heart.
|
|
|
Review of Normal blood flow
• Blood flow from _______ • Blood from _________ cava into _____ atria |
• Blood flow from body returns to right side of heart
• Blood from superior vena cava into right atria |
|
|
Review of Normal blood flow
• crosses _____ (tricuspid) valve into _____ • crosses ______ (pulmonic) valve into ______ artery to lungs • returns from ______ through ______ veins into ______ atria • crosses ____ (mitral) valve into ____ ventricle • crosses _______ (aortic valve) into ______ out to body |
• crosses AV (tricuspid) valve into right ventricle
• crosses semilunar (pulmonic) valve into pulmonary artery to lungs • returns from lungs through pulmonary veins into left atria • crosses AV (mitral) valve into left ventricle • crosses semilunar (aortic valve) into aorta out to body |
|
|
Main Arteries in the Heart
• R______ • L______ – divides |
• Right Coronary Artery
• Left Coronary Artery – divides |
|
|
Main Arteries in the Heart
• Left Coronary Artery – divides • Left _______Coronary Artery – blood flows to anterior wall • CX- __________ |
• Left Coronary Artery – divides
• Left Anterior Descending Coronary Artery – blood flows to anterior wall • CX- Circumflex Artery |
|
|
Main Arteries in the Heart
**Important to know what ______ is _______ in MI. Anterior or inferior? Will tell us about______ to that ____ of the heart. |
**Important to know what artery is blocked in MI. Anterior or inferior? Will tell us about blood flow to that particular area of the heart.
|
|
|
CardioVascular
• Arteries - carry oxygenated blood away from heart. ____ is the biggest artery. Undergoes stretch, have thick walls of elastic tissue because they have to undergo a lot of stretch. Propels the blood forward. • Veins - carries _________ blood (but still has ______ in it) relies on valves in veins • Capillaries - exchange ______, nutrients, wastes. Connect arterial & venous circulation |
CardioVascular
• Arteries - carry oxygenated blood away from heart. Aorta is the biggest artery. Undergoes stretch, have thick walls of elastic tissue because they have to undergo a lot of stretch. Propels the blood forward. • Veins - carries deoxygenated blood (but still has oxygen in it) relies on valves in veins • Capillaries - exchange gases, nutrients, wastes. Connect arterial & venous circulation |
|
|
Important health information
• _________ • _________ • _________ • __________ |
• Past health history – What kind of questions are you going to ask the patient? smoking, family history, drugs (especially in a young patient), what were you doing before, history of diabetes/congenital/renal disease
• Risk factors – should be explored in detail • Medications – What are they taking, what are they for, over-the-counter drugs, aspirin, vitamins, history of hypertension • Surgery or other treatments - All surgeries whether it is related to cardiac or not |
|
|
Presence of Risk Factors
• Unmodifiable Risk Factors a. ____ b. ______ (men > women until 60 yrs) c. _________ d. _________(______ > African Americans) |
a. age – the older you are, more likely to have cardiac disease. Increase cases due to living longer. Because we are living longer, we’re seeing more and more heart disease.
b. gender (men > women until 60 yrs) – Women MIs tend to be more fatal, hormones and age have influence of when it occurs c. genetic predisposition – family history d. ethnicity (whites > African Americans) |
|
|
• Modifiable Risk Factors – Major
a. e____________ – b. h_________ – a huge major factor for heart disease c.c____________ d. o_________ e. p_________ |
a. elevated serum lipids – history of high cholesterol, many pts don’t know what their levels are
b. HTN – a huge major factor for heart disease c. cigarette smoking – 2 – 6 X increased risk in smokers vs. nonsmokers, proportional to number of cigarettes, how much have they smoked, how long have been smoking, how many cigarettes do they smoke per day. Risk dramatically drops after 1 year when smoking is stopped d. obesity e. physical inactivity– included in discharge instructions. Give the patients guidelines. Try to get patients to do a minimum of exercise 20-30 minutes 3 times a week – simple as walking. Get off the couch. |
|
|
• Modifiable Risk Factors - Contributing
a. __________ – b. __________ |
a. Diabetes – is it diet controlled, taking insulin?
b. Stressful lifestyle |
|
|
Cardiovascular Assessment Objective Data
Vital Signs - Ask patient what the normal B/P is. a. _______ b. _______ • __________- taking B/P while patient is lying down, sitting (look for possible drop), standing (possibly see increase in heart rate). • If B/P drops more than _____mm - systolic drop of ______mm or more, diastolic drop of 10mm or more, that would be significant. • If patient feels dizzy or lightheaded when standing up, that would be significant. See in patients with volume depletion. • Most common cause of orthostatic hypertension is: __________. |
a. cuff size
b. affect on position • orthostatics- taking B/P while patient is lying down, sitting (look for possible drop), standing (possibly see increase in heart rate). • If B/P drops more than 20mm - systolic drop of 20mm or more, diastolic drop of 10mm or more, that would be significant. • If patient feels dizzy or lightheaded when standing up, that would be significant. See in patients with volume depletion. • Most common cause of orthostatic hypertension is: volume depletion. |
|
|
Cardiovascular Assessment Objective Data
vital signs c. which arm? normal variance of ____ – 15mm • B/P taken in both arms d. _________ vs. ________ • BP taken in _________ if you cannot take on arm • BP tends to be higher in lower extremities e. ___________ – crude measurement of patient’s stroke volume • difference between ________ and _________ blood pressure • (narrow vs wide pulse pressure) • in certain conditions we see it narrow and in certain conditions we see it widen |
c. which arm? normal variance of 5 – 15mm
• B/P taken in both arms d. lower extremities vs. upper • BP taken in lower extremity if you cannot take on arm • BP tends to be higher in lower extremities e. Pulse pressure – crude measurement of patient’s stroke volume • difference between systolic and diastolic blood pressure • (narrow vs wide pulse pressure) • in certain conditions we see it narrow and in certain conditions we see it widen |
|
|
Look at patient!
• I__________ • A________________ • A__________________ • P__________________ • P__________________ • A__________________ • A________________ |
Look at patient!
• Inspection: skin color, capillary refill < 3 sec; skin temp, hair distribution, and venous blood flow • Assess for edema, thrombophlebitis, varicose veins, stasis ulcers • Assess for jugular venous distention (JVD) • Palpation: assessment of peripheral pulses • Palpate point of maximal impulse (PMI) located at the fifth intercostal space at the midclavicular line **Turn patient to left lateral decubitus position to best assess PMI. • Auscultation: assess major arteries for bruits • Feel for thrill, hear for bruit. Thrill feels like rushing sensation, vibrates. Document this - Dialysis graft will have a HUGE bruit. Bruit means turbulence (not good but can be normal). • Check for thrill in carotid areas with patients who have come from cath lab • Auscultation: assess for normal heart sounds. Proper position |
|
|
Cardiovascular Assessment Objective Data
• Palpation: assessment of peripheral pulses a. e____________ b. A____________ c. a___________ |
a. examination of cardiac rate & rhythm
b. Assess characteristic of pulse as a reflection of cardiac contraction • assessing carotic artery is important – bounding pulses suggest an increase in the stroke volume. Do one, then the other, then both • listen, feel for thready, weak pulses c. assessment of the adequacy of the arterial conduit. • checking pulses on grading scale 1-4. 0= no pulse, 1= very, very faint, 2= normal, 4=bounding • may not find a pulse easily in some patients with cardiovascular disease. If you don’t find a pulse, always helpful to mark with an X after you find it so you don’t have to search for it again. Listen with a Doppler. • ** Palpate all major arteries - radial, brachial, carotid, • for peripheral vascular disease, check femoral bilaterally, popliteal, posterior tibular, pedal pulses, etc • ** Ascultate for one minute if you feel irregular pulse • ** Call physician if change occurs, or cant feel/hear pulse with doppler |
|
|
Your heart sounds are produced by what? ___________
|
Your heart sounds are produced by what? Closure of the valves
|
|
|
a. S1 signals the beginning of _____
• Contraction of _________ (most important). Want blood to go to right place or go up through to ______ atrium. • When we hear closure of our ________, semilunars remain closed, that signifies S1 – the ventricle can now squeeze to push blood out. • Put stethoscope in mitral area. Best heard when patient on left side |
a. S1 signals the beginning of systole
• Contraction of ventricles (most important). Want blood to go to right place or go up through to left atrium. • When we hear closure of our AV valves, semilunars remain closed, that signifies S1 – the ventricle can now squeeze to push blood out. • Put stethoscope in mitral area. Best heard when patient on left side |
|
|
b. S2 signals the beginning of ________
• Closure of _______ valves with blood flowing into the ventricle. • ________ stop below pulmonic area, best to hear S2 – listen all over *assess for normal S2 split during inspiration • “____________” that you hear on inspiration. Semilunar valves don’t close exactly at the same time, present in _____% pts. You may not always hear a split. |
b. S2 signals the beginning of diastole
• Closure of aortic/pulmonary valves with blood flowing into the ventricle. • Erbs stop below pulmonic area, best to hear S2 – listen all over *assess for normal S2 split during inspiration • “physiological split” that you hear on inspiration. Semilunar valves don’t close exactly at the same time, present in 50% pts. You may not always hear a split. |
|
|
Listen at the _____ basic locations – use diaphragm of stethoscope on chest wall
• Make sure that you have patient in _______ position to listen in mitral area. • Aortic/pulmonic area is in ___ -____ intercostal space. • Also listen to ______ and mitral area |
Listen at the four basic locations – use diaphragm of stethoscope on chest wall
• Make sure that you have patient in left lateral position to listen in mitral area. • Aortic/pulmonic area is in 2nd - 3rd intercostal space. • Also listen to triscupid and mitral area |
|
|
Age related changes
a. ________ – HR is slower to rise with exercise and slower to return to normal b. ____________- affects the aortic and mitral valve the most c. ___________ – elderly have 10% of the normal # of _________. Sinus node dysfunction leading to sinus bradycardia Decrease heart rate, have syncope episodes d. blood vessels thicken and become less elastic – development of _____ – see elevations in both systolic and diastolic blood pressure |
Age related changes
a. decreased CV response to increased workload – HR is slower to rise with exercise and slower to return to normal b. valves can become thicker and stiffer - affects the aortic and mitral valve the most c. the number of pacemaker cells decrease with age – elderly have 10% of the normal # of pacemaker cells. Sinus node dysfunction leading to sinus bradycardia Decrease heart rate, have syncope episodes d. blood vessels thicken and become less elastic – development of HTN – see elevations in both systolic and diastolic blood pressure |
|
|
Cardiovascular Assessment Abnormal Findings
a. P_______ b. d_______ c. l_______ d. i________ e. f______ |
a. Pain and Dyspnea
• ask about quality, how long have it, rate it b. dizzyness or lightheadedness • ask for history of cardiac problems, pacemaker • what were you doing when it happened c. leg pain • looking for DVT, ask is pain occurs during walking and if it stops when sit down (sign of claudication) d. irregular heartbeat • feel palpitations, feel pulses, or that heart is skipping. • Do you feel lightheaded, diaphoretic (sweating) e. fluid retention • shortness of breath • ask about any trouble with sleeping/# of pillows needed to prop oneself up • look for edema |
|
|
Cardiovascular Assessment Ausculatory Abnormalities
• ________: sounds produced by turbulent blood flow through the heart. • Can sometimes hear it/feel it • Can be ______ |
• Murmurs: sounds produced by turbulent blood flow through the heart.
• Can sometimes hear it/feel it • Can be asymptomatic |
|
|
Cardiovascular Assessment Ausculatory Abnormalities
• Documentation: a. I_______ I – VI b. timing – _____ vs _____ c. l______ d. p______ e. q_________ |
• Documentation:
a. Intensity Graded I – VI • (1-6. 1= extremely faint, 6= rare, very loud) • Valve is fixed depending on symptoms (SOB) not grade b. timing – systolic vs diastole – is murmur in systole or is it in diastole? c. location –where you hear the murmur the loudest d. pitch – high pitch, rumbling e. quality – rubbing, harsh, soft |
|
|
Cardiovascular Assessment Ausculatory Abnormalities
• ____: Low intensity extra heart sound • Occurs with rapid filling of the___ ventricular – Any condition causing ____ ventricular dilatation • Possible etiologies include: a. l____ b. m____ c. v_____ d. n_____ |
• S3: Low intensity extra heart sound
• Occurs with rapid filling of the left ventricular – Any condition causing left ventricular dilatation • Possible etiologies include: a. left ventricular failure b. mitral valve regurgitation c. volume overload – especially in elderly patients d. normal pregnancy |
|
|
Cardiovascular Assessment Ausculatory Abnormalities
• ___: low pitch vibration caused by atrial contraction – very difficult to hear • Timing: occurs in late diastole preceding __ • Also known as an _____ • Possible etiologies: a. left ventricular hypertropy b. p_________ c. aortic stenosis |
Cardiovascular Assessment Ausculatory Abnormalities
|
|
|
Regulation of the Cardiovascular System
• Autonomic Nervous System -_________ – fight or flight response -____________ |
Regulation of the Cardiovascular System
• Autonomic Nervous System – basic pathophysiology Sympathetic – fight or flight response increase heart rate, how hard is that heart squeezing? heart pumps harder, alpha-andrenergic receptors in the smooth muscles to produce vasoconstriction to get that blood pressure up, Parasympathetic mediation of the vagus nerve, decreased heart rate • Baroreceptors – in aortic part of heart and carotid sinus, respond to stretch, can tell when hypertensive • Chemoreceptors – tells if chemical change occurring, found in carotid/aortic arch, decrease in arterial oxygen pressure and arterial CO2 |
|
|
Blood Pressure
• BP = ___ x ____ • CO: ___ x___ • In normal patients, __ -110 average amount ejected from heart when heart muscle is contracted • ____: force opposing the movement of blood - systemic vascular resistance –how tight vessels are • P________ • MAP: ____ + 2 (DBP)/3 |
Blood Pressure
• BP = CO x SVR - (Cardiac output x systemic vascular resistance) • CO: SV x HR - (Stroke volume x heart rate) • In normal patients, 60 -110 average amount ejected from heart when heart muscle is contracted • SVR: force opposing the movement of blood - systemic vascular resistance –how tight vessels are • Pulse pressure – we already know what that means • MAP: SBP + 2 (DBP) 3 |
|
|
Hemodynamic Terminology
• ________: volume of blood pumped by the heart in 1 minute • __________: measurement of CO adjusted for patient’s body size • _________: amount of blood pumped in with each beat (doesn’t pump out all of it – if it takes in ___cc, it pumps out less. not the same as what comes in) • ____________: measurement of SV adjusted for body size • ____________: the opposition to flow by the vessels. • P_________ |
Hemodynamic Terminology
• CO: Cardiac output: volume of blood pumped by the heart in 1 minute • CI: Cardiac index: measurement of CO adjusted for patient’s body size • SV: Stroke volume: amount of blood pumped in with each beat (doesn’t pump out all of it – if it takes in 100cc, it pumps out less. not the same as what comes in) • SVI: Stroke volume index: measurement of SV adjusted for body size • SVR: Systemic Vascular Resistance: the opposition to flow by the vessels. • (how much resistance we have in vessels. A rough estimate of resistance - systolic BP as a very rough estimation. The higher the blood pressure, the more resistance) • PVR: Pulmonary Vascular Resistance. • imagine a blood pressure cuff on a pulmonary artery. If you have pulmonary blood pressures that are high, it’s the resistance. Reflection of the right side of the heart whereas systolic blood is a rough estímate of SVR which is a reflection of the left side of the heart. |
|
|
Preload
• volume __________ • (can not measure volume) Volume is a reflection of the ________ at the end of diastole • estimate the stretch by how much balloon stretches using a ____________ • how much balloon stretches is how much preload there is • _________:Where catheter sits. Normal range 2-8. Normal range in LAP 6-12. • If elevated too much volume, is low need more volume |
Preload
• volume within a cardiac chamber at the end of diastole • an estimate of volume using pressure • (can not measure volume) Volume is a reflection of the measured pressure at the end of diastole • estimate the stretch by how much balloon stretches using a pulmonary artery catheter • how much balloon stretches is how much preload there is • RAP: Right atrial pressure or CVP (central venous pressure). • Where catheter sits. Normal range 2-8. Normal range in LAP 6-12. • If elevated too much volume, is low need more volume |
|
|
Starling’s Law
• The more a _________ is stretched during filling, the more it shortens during systole and the greater the force of the contraction. • Effects of preload on ____, CO, and _____ consumption The more the volume, the better the stretch, the better the contractions, increase _____, increase RAP, more O2 (but only up to a certain point) Ex. The more you stretch a rubber band, the farther it goes |
Starling’s Law
• The more a myocardial fiber is stretched during filling, the more it shortens during systole and the greater the force of the contraction. • Effects of preload on SV, CO, and O2 consumption The more the volume, the better the stretch, the better the contractions, increase BP, increase RAP, more O2 (but only up to a certain point) Ex. The more you stretch a rubber band, the farther it goes |
|
|
Starling’s Law
We can figure out where patient’s volume should be by looking at how his ________ and ____________ are responding to the ________ that they are giving. |
We can figure out where patient’s volume should be by looking at how his cardiac output and blood pressure are responding to the volume that they are giving.
|
|
|
_______________: balloon floats up the pulmonary artery – it’s indirectly a pressure of the left side of the heart. It allows us to take a peek at the left side of the heart by monitoring pulmonary capillary wedge pressures.
|
Pulmonary artery wedge pressure: balloon floats up the pulmonary artery – it’s indirectly a pressure of the left side of the heart. It allows us to take a peek at the left side of the heart by monitoring pulmonary capillary wedge pressures.
|
|
|
Know that your _______ pressures are lower than your ________ pressures.
|
Know that your right atrial pressures are lower than your left atrial pressures.
|
|
|
LVEDP – ________
PAWP or LAP – ____________ PADP – _______________ |
LVEDP – Left ventricular end diastolic pressure – closest thing we have to left side of heart
PAWP or LAP – pulmonary artery wedge pressure or left atrial pressure PADP – pulmonary diastolic pressure |
|
|
Normal ranges pressure ranges:
RAP/CVP: ____ LAP: _______ PADP: _______ |
Normal ranges:
RAP/CVP: 2 – 8 LAP: 6 – 12 PADP: 4 – 12 |
|
|
Factors Affecting Preload
• _________ • _________ • _________ |
• Positioning
• patients who are short of breath, lying flat in bed – raise head of bed. Decreases preload • sitting at the side of the bed, raise the patient up. Decreases preload. • Anything that causes venous pooling will decrease preload • Medications • Give morphine to patients with congestive heart failure – affects preload by causing venous pooling, decreases blood return back to the heart which decreases preload • Fluid status • If patient is hypovolemic, put in a Swan-Ganz catheter and then it looks like their right atrial pressure – their central venous pressures are low, so we give them volume and see cardiac output go up. |
|
|
Afterload
• The forces opposing _______ ejection • Indices for afterload are ________ and ________ • SVR: ______________ = (MAP – CVP) x ______ CO • PVR and PAP indices for RV afterload |
Afterload
• The forces opposing ventricular ejection • Indices for afterload are systemic blood pressure and SVR • SVR: systemic vascular resistance = (MAP – CVP) x 80 CO • PVR and PAP indices for RV afterload |
|
|
Other Hemodynamic Parameters
• Stroke Volume (SV) = _______ 60 – _______ ml/beat • CO = __________ – important formula – tells you what affects ___________, which is stroke volume and heart rate • Ejection Fraction: the % of the ________ ventricular end-diastolic volume ejected during each ___________. |
Other Hemodynamic Parameters
• Stroke Volume (SV) = CO / HR 60 – 150 ml/beat • CO = SV x HR – important formula – tells you what affects cardiac output, which is stroke volume and heart rate • Ejection Fraction: the % of the left ventricular end-diastolic volume ejected during each cardiac cycle. |
|
|
Review Questions:
Upon physical exam, a 56 year old man is palpated and it is noted that his PMI is in the 6th intercostal space lateral to the midclavicular line. The most appropriate mention of the findings by the nurse would be a. PMI is in normal location b. patient may have left ventricular hypertrophy c. patient should be observed for MI |
Review Questions:
Upon physical exam, a 56 year old man is palpated and it is noted that his PMI is in the 6th intercostal space lateral to the midclavicular line. The most appropriate mention of the findings by the nurse would be a. PMI is in normal location b. patient may have left ventricular hypertrophy Answer c. patient should be observed for MI |
|
|
The beginning of systole is accompanied by which heart sound?
|
S1
|
|
|
In reference to the second heart sound, S2, which is false?
a. it’s produced when the aortic and pulmonic valves close. (true) b. occurs at the end of ventricular systole c. may be heard best with the diaphragm of the stethoscope d. used when the mitral and tricuspid valve closes |
In reference to the second heart sound, S2, which is false?
a. it’s produced when the aortic and pulmonic valves close. (true) b. occurs at the end of ventricular systole (true) c. may be heard best with the diaphragm of the stethoscope d. used when the mitral and tricuspid valve closes. False |
|
|
To ausculate for extra heart sounds in the mitral area, the nurse listens with the
a. bell of the stethoscope with the patient in the left lateral position b. the diaphragm c. the diaphragm d. bell of the stethoscope with the patient sitting |
To ausculate for extra heart sounds in the mitral area, the nurse listens with the
a. bell of the stethoscope with the patient in the left lateral position Answer b. the diaphragm c. the diaphragm d. bell of the stethoscope with the patient sitting |
|
|
A 75 year old man is admitted with acute CHF. To promote more efficient ventricular emptying by decreasing preload, the nurse should
a. administer oxygen b. encourage active leg exercises to encourage venous return c. administer sedative to decrease myocardial oxygen demand d. position the patient in the High Fowler’s position |
A 75 year old man is admitted with acute CHF. To promote more efficient ventricular emptying by decreasing preload, the nurse should
a. administer oxygen b. encourage active leg exercises to encourage venous return c. administer sedative to decrease myocardial oxygen demand d. position the patient in the High Fowler’s position Answer |
|
|
Flotation of pulmonary catheter into wedge pressure increases risk of
a. dysrhythmias b. pulmonary infarction c. pneumothorax d. infection |
b. pulmonary infarction Answer (balloon becomes inclusive
|
|
|
In which area of the heart would the pulmonary artery most likely cause dysrhythmia?
|
right ventricle
|
|
|
Preload may be best described as:
a. stretch produced by myocardium at the end of diastole b. volume in ventricles during systole c. the back up of pressure in the systemic circulation d. the amount of blood returning to the heart |
a. stretch produced by myocardium at the end of diastole
|
|
|
A patient has a blood pressure of 142/84 – calculate mean arterial pressure (know the formula).
|
just know the formula.
|
|
|
A patient is receiving a drug that decreases peripheral arterial resistance. The nurse anticipates the effects of this drug on the patient’s cardiac function will result in
a. an increase in preload b. a decrease in afterload c. a decrease in contractility d. a decrease in stroke volume |
b. a decrease in afterload
|
|
|
Afterload is indicated best by the measurement of
a. pulmonary capillary wedge pressure (PCWP) b. stroke volume c. systemic vascular resistance d. ejection fraction |
c. systemic vascular resistance
|
|
|
Afterload may best be described as
a. measurement of left ventricular end-diastolic pressure b. amount of force of ventricular contraction c. impedance to ejection of blood from left ventricle d. amount of blood remaining in left ventricle after systole |
c. impedance to ejection of blood from left ventricle
|
