Nursing 3

Front 1

While each cell in the cardiac muscle is _______, it is not healthy for each cell to contract individually.

Back 1

automatistic

Front 2

There is a network of specialized cells and pathways called the _____ conduction system that normally has control over the way the heart beats.

Back 2

cardiac

Front 3

Stroke volume x heart rate= ?

Back 3

cardiac output/minute

Front 4

What is the amount of blood ejected from the heart with each beat?

Back 4

stroke volume

Front 5

What is the number of beats per minute?

Back 5

heart rate

Front 6

What is the ability of the heart muscle fibers to contract or shorten?

Back 6

contractility

Front 7

What is the degree to which the muscle fibers in the ventricle are stretched when full and ready to eject blood; the more these fibers are stretched, the stronger the contraction (Frank-Starling Law of the Heart)?

Back 7

preload

Front 8

With preload, if these fibers are overstretched, the capacity to increase contraction strength may decrease, thereby decreasing what?

Back 8

carbon dioxide

Front 9

What is the resistance against which the heart must pump to eject blood into the circulation? This is impacted by systemic (or peripheral) vascular resistance or systemic(or peripheral) vascular dilation?

Back 9

afterload

Front 10

The afterload resistance is determined by what three things?

Back 10

viscosity or thickness of the blood
blood vessel lenth and
blood vessel diameter

Front 11

What is the primary reason we have a circulatory system?

Back 11

Transport oxygen, nutrients and hormones to the cells of the body and to transport metabolic wastes from the cells for elimination.

Front 12

What nonmodifiable factor retrieved during assessment is a positive family history of CAD in a first degree relative is a major risk factor?

Back 12

heredity

Front 13

Age is nonmodifiable risk. Incidence of CAD and valvular disease increases with age. Post menopausal women are 2-3 times more likely to have CAD than __________ women. Women are often underdiagnosed, usually thought to have gallbladder pain

Back 13

premenopausal

Front 14

What modifiable risk factor according to the department of health and human services, is directly responsible for 21 % of all deaths from CAD.

Back 14

cigarette smoking

Front 15

What three modifiable factors that are presence of chronic diseases that are not diagnosed or in which the patient does not follow a treatment plan for control?

Back 15

diabetes, serum lipid levels and hypertension

Front 16

Obesity is a modifiable risk factor. A particular problem especially when the obesity is abdominal and measurement greater than ______ measurement.

Back 16

hip

Front 17

Less than ___ minutes of activity a day is a modifiable risk factor concerning CAD

Back 17

30

Front 18

Extreme exposure to heat or cold increases the ____ on the heart, maybe enough to stress a marginally well heart into pathology.

Back 18

workload

Front 19

The normally healthy body ahs built-in mechanisms to compensate for temporary decreases in oxygenation of the cells and tissues. For example, Increased heart rate, increased depth of respirations

In the unhealthy heart, these compensatory mechanisms can eith fail all together or can make the patient's condition worse.

Back 19

no answer

Front 20

While some stress may be tolerated without problem, there is an increased ___?___ workload on the heart.
The amount of "tolerable" stress will depend upon the underlying physical condition of the patient. There is also research into the way in which the patient deals with stress and the influence that has on the patient's health. The concept of hardiness comes into play with this research

Back 20

workload

Front 21

Diet: the well knownn connections are with high fat diets (leading to the modifiable risk factor of elevation of ______ ______ levels), increased salt intake (leading to or making worse a tendency to hypertension).

Also consider potassium and calcium levels as these electrolytes play a big part in the electrical conduction of the heart.

Back 21

serum lipid

Front 22

How many oz. of alcohol per day may be protective of the heart?

Greater amounts may cause such problems as decreased oxygenation, malnutrition, hypertension, as well as poor impulse control and decision making.

Back 22

1-2 oz

Front 23

What is an amino acid that research has shown to often be elevated in people with atherosclerosis. Since atherosclerosis is the precursor to plaque development and occlusion of the coronary arteries (thereby MI), elevatin of this may indicate an increased risk of MI.

Back 23

homocysteine

Front 24

Current health problem or chief complaint
Pain or discomfort: physiologically can be from ischemia, pericarditis, aortic dissection.
Be sure to use alternative words for pain such as discomfort, heaviness, pressure, indigestion.

Back 24

no answer

Front 25

What can occur as a result of both cardiac and pulmonary disease?

Back 25

Dyspnea

Front 26

What is dyspnea that occurs when a patient lies flat?

Back 26

orthopena

Front 27

What dypsnea occurs after the patient has been lying down for several hours. the blood from the lower extremeties redistributes to the venous system and increases venous return to the heart. this overloads the heart, causing pulmonary congestion. The patient awakes abruptly, with a feeling of SOB, panic and suffocation. Must sit up to relieve the feeling.

Back 27

Paroxysmal nocturnal dyspnea (PND)

Front 28

What is a feeling of fluttering in the chest and awareness of the heartbeat, which may be irregular; may be caused from ischemia to the hearts conductions system or muscle?

Back 28

palpitations

Front 29

What is transient loss of consciousness (fainting), the result of poor perfusion to the brain, can be caused by decreased cardiac output or problems with venous flow to the brain?

Back 29

Syncope

Front 30

Near _____ is dizziness with an inability to remain in an upright position without loss of consciousness.

Back 30

syncope

Front 31

What is the term for severe cramping sensation in the legs or buttocks associated with an activity such as walking? it is relieved by rest

Back 31

intermittent claudication

Front 32

What is a myocardial muscle protein released into the bloodstream with injury to the myocardial muscle?

This is not found in healthy individuals, so any rise is significant for myocardial damage. Peak levels are in 12 hours, but there is a high specificity as quickly as 3-6 hours post symptoms.

Back 32

troponin

Front 33

What is an enzyme specific to cells of the brain, myocardium, and skeletal muscle, the MB band is specific to the myocardium (peak rise is 24 hours post injury)

Back 33

Creatine kinase

Front 34

This are predominantly cholesterol and high levels are positively correlated with CAD.

Back 34

LDL's low-density lipoproteins

Front 35

This are mainly protein with 20% cholesterol; high levels are negatively correlated with CAD and appear to be a protective factor?

Back 35

HDL- high-density lipoproteins

Front 36

These are the main storage form of lipids? High levels are linked to the progression of CAD

Back 36

triglycerides

Front 37

What levels may be decreased by a diet rich in B complex vitamins, especially folic acid?

These may be a greater significance in women

Back 37

Homocysteine

Front 38

______ is a critical component in the development of atherothrombosis.

Back 38

inflamation

Front 39

Highly sensitive ______ protein is the most studied marker of inflammation and a level over 3 mg/dL places the patient at high risk for heart disease. These can be elevated by hypertension, infection, and smoking.

Back 39

C-reactive

Front 40

These help to determine heart size, presence of pulmonary congestion, and presence of cardiac calcifications.

Back 40

chest xray

Front 41

This is a test that includes placement of a catheter that infuses radiopaque dye into the coronary arteries. The flow of the dye is observed radiiographically and the degree of occlusion present in the coronary arteries is determined.

Back 41

cardiac catheterization

Front 42

This is a simple rhythm strip analysis?

Back 42

Cardiac monitoring

Front 43

This is a routine part of every cardiac evaluation this test records the electrical activity of the heart. Variance from normal electrical activity indicates variance from healthy heart function.

Back 43

Electrocardiogram

Front 44

Basic ____ also termed EKG is a noninvasive test done by connecting the patient to a ECG machine in a prescribed manner with 5 skin electrodes. The placement of these "leads" allows the health care provider to view myocardial electrical conduction from different positions, which helps to identify sections of the heart that have abnormal electrical conduction.

Back 44

ECG

Front 45

This is a form of continuous ECG that allows recording of cardiac activity during an extended period of time (often 24-48 hours) while the patient goes about their regular daily activities.
Useful to assess the impact of these activities on the CV system
Patient records any health events (like dizziness, palpitations, etc) along with time
After the testing period is completed, the ECG reading is compared to events and the amount of abnormal ECG activity is assessed.

Back 45

Holter Monitoring

Front 46

In this test the patient is connected to ECG monitoring and is exercised on a treadmill or stationary bicycle. The ECG and B/P are monitored during the exercise period for changes

Back 46

Exercise stress testing

Front 47

This uses ultrasound waves to assess cardiac structure and mobility. Helps to assess and diagnose cardiomyopathy, valvular disorders, pericardial effusion, left ventricular function, ventricular aneurysms, and cardiac tumors. This is a noninvasive, risk free test

Back 47

Echocardiography

Front 48

This nursing diagnosis is "decrease in oxygen resulting in the failure to nourish the tissues at the capillary level".
- altered b/p, oliguria, altered mental status, restlessness, chest pain, dyspnea, sense of impeding doom, capillary refill > 3 seconds, claudication, skin temp or color changes, edema and delayed healing.

Back 48

Ineffective tissue perfusion

Front 49

This nursing diagnosis is "Inadequate blood pumped by the heart to meet the metabolic demands of the body"
May be related to altered rate/rhythm (arrhythmias), altered preload (JVD, edema, weight gain), altered afterload (cold, clammy kin, anuria), altered contractility (crackles, cough, S3 and S4 heartsounds)

Back 49

Decreased Cardiac output

Front 50

This nursing diagnosis is "Insufficient physiologic or psychological energy to endure or complete required or desired daily activities"
Pt. report of fatigue or weakness, exertional discomfort or dyspnea, abnormal heart rate or B/P responses to activity, ECG changes to activity

Back 50

Activity Intolerance

Front 51

The broad goals for these patients include:
Maintaining or improving tissue perfusion
Absence of pain, improvement in color
Maintaining or restoring adequate cardiac output
Demonstrating understanding o CV risk factors
Describing a specific plan for risk factor modification

Back 51

no answer

Front 52

Implementation
Encourage frequent postition changes, ambulation, and exercise
_____ is very detrimental to CV function

Back 52

Immobility

Front 53

The best position for a cardiac patient is ____?_____ as this position decrease preload and pulmonary congestion and helps to improve cardiac function.

Back 53

high Fowler's

Front 54

Patients with poor venous return may benefit from being postitioned with legs _____ to promote venous return
This can be very helpful for a patient who needs increased cerebral blood flow (someone who has become light headed, hypotensive, or fainted)
BUT, this is a bad position for a cardiac pt. with a laboring heart

Back 54

elevated

Front 55

Avoidance of venous ____ , which puts the patient at risk for development of varicose veins, hypercoagulability, and formation of clots (venous thrombosis) which can dislodge and become emboli.
Avoid use of pillow under the knees or more than 15 degress of knee flexion in bed as this promotes venous _____
Closely monitor patients whose daily activities include lots of sitting.

Back 55

Status

Front 56

Use of _________ and or TED hose may also help prevent venous status

Back 56

SCD, sequential compresison devices

Front 57

Patient with _____ claudication often benefit from a mild exercise program

Back 57

intermittent

Front 58

If the patient is confined to bed encourage ___ exercises (alternate flexion and extension of the feet and/or contraction and relaxation of calf muscles).

Encourage ambulation as quickly as possible
Encourage or provide frequent postition changes.

Back 58

leg

Front 59

Medications can be used to help reduce vasoconstriction, thereby reducing the workload on the heart
Nitrates: _____
Calcium channel blockers: nifedipine (Procardia)
Ace inhibitors: captopril (Capoten)

Back 59

nitroglycerin

Front 60

Medications can be used to prevent or treat arrhythmias: Procainamide (Procan), Lidocaine, flecaninide (Tamocor), ______ (inderal), amiodarone (Cordarone)

Back 60

propranolol

Front 61

What medication can be used to increase contractile strength of the heart?

Back 61

digitalis (Lanoxin)

Front 62

What two medications can be used to block sympathetic nervous system action to reduce myocardial oxygen consumption?

Back 62

metoprolol (Lopressor) or propranolol (Inderol)

Front 63

The ____ atrium basically serves as a reserve.

Back 63

right

Front 64

________ walls are more muscular because it must pump the blood everywhere else.

Back 64

ventricular

Front 65

Blood oxygen exchange takes place at the ______ level.

Back 65

alveolar

Front 66

After the blood goes to the lungs it goes back to the _______ and then into the left ventricle.

Back 66

left atrium

Front 67

The body must have a certain amount of vascular tone, if you don't have that your body will go into ______.

Back 67

shock

Front 68

What can cause the blood to get thicker?

Back 68

dehydration

Front 69

The _____ ______ is in control of all the cells, this electricity produced by this travels everywhere else in the heart.

Back 69

SA node

Front 70

What is an oversized heart?

Back 70

cardio myopathy

Front 71

______ MI's are common in diabetics and women. These people never know about until an EKG reveals it.

Back 71

Silent

Front 72

What is the term used for not enough blood flow to the tissues?

Back 72

ischemia

Front 73

What kind of echocardiogram is invassive, it is when they put a scope down your esophagus?

Back 73

transesophageal electrocardiogram