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73 Cards in this Set

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While each cell in the cardiac muscle is _______, it is not healthy for each cell to contract individually.
automatistic
There is a network of specialized cells and pathways called the _____ conduction system that normally has control over the way the heart beats.
cardiac
Stroke volume x heart rate= ?
cardiac output/minute
What is the amount of blood ejected from the heart with each beat?
stroke volume
What is the number of beats per minute?
heart rate
What is the ability of the heart muscle fibers to contract or shorten?
contractility
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)?
preload
With preload, if these fibers are overstretched, the capacity to increase contraction strength may decrease, thereby decreasing what?
carbon dioxide
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?
afterload
The afterload resistance is determined by what three things?
viscosity or thickness of the blood
blood vessel lenth and
blood vessel diameter
What is the primary reason we have a circulatory system?
Transport oxygen, nutrients and hormones to the cells of the body and to transport metabolic wastes from the cells for elimination.
What nonmodifiable factor retrieved during assessment is a positive family history of CAD in a first degree relative is a major risk factor?
heredity
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
premenopausal
What modifiable risk factor according to the department of health and human services, is directly responsible for 21 % of all deaths from CAD.
cigarette smoking
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?
diabetes, serum lipid levels and hypertension
Obesity is a modifiable risk factor. A particular problem especially when the obesity is abdominal and measurement greater than ______ measurement.
hip
Less than ___ minutes of activity a day is a modifiable risk factor concerning CAD
30
Extreme exposure to heat or cold increases the ____ on the heart, maybe enough to stress a marginally well heart into pathology.
workload
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.
no answer
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
workload
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.
serum lipid
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.
1-2 oz
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.
homocysteine
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.
no answer
What can occur as a result of both cardiac and pulmonary disease?
Dyspnea
What is dyspnea that occurs when a patient lies flat?
orthopena
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.
Paroxysmal nocturnal dyspnea (PND)
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?
palpitations
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?
Syncope
Near _____ is dizziness with an inability to remain in an upright position without loss of consciousness.
syncope
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
intermittent claudication
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.
troponin
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)
Creatine kinase
This are predominantly cholesterol and high levels are positively correlated with CAD.
LDL's low-density lipoproteins
This are mainly protein with 20% cholesterol; high levels are negatively correlated with CAD and appear to be a protective factor?
HDL- high-density lipoproteins
These are the main storage form of lipids? High levels are linked to the progression of CAD
triglycerides
What levels may be decreased by a diet rich in B complex vitamins, especially folic acid?

These may be a greater significance in women
Homocysteine
______ is a critical component in the development of atherothrombosis.
inflamation
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.
C-reactive
These help to determine heart size, presence of pulmonary congestion, and presence of cardiac calcifications.
chest xray
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.
cardiac catheterization
This is a simple rhythm strip analysis?
Cardiac monitoring
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.
Electrocardiogram
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.
ECG
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.
Holter Monitoring
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
Exercise stress testing
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
Echocardiography
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.
Ineffective tissue perfusion
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)
Decreased Cardiac output
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
Activity Intolerance
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
no answer
Implementation
Encourage frequent postition changes, ambulation, and exercise
_____ is very detrimental to CV function
Immobility
The best position for a cardiac patient is ____?_____ as this position decrease preload and pulmonary congestion and helps to improve cardiac function.
high Fowler's
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
elevated
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.
Status
Use of _________ and or TED hose may also help prevent venous status
SCD, sequential compresison devices
Patient with _____ claudication often benefit from a mild exercise program
intermittent
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.
leg
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)
nitroglycerin
Medications can be used to prevent or treat arrhythmias: Procainamide (Procan), Lidocaine, flecaninide (Tamocor), ______ (inderal), amiodarone (Cordarone)
propranolol
What medication can be used to increase contractile strength of the heart?
digitalis (Lanoxin)
What two medications can be used to block sympathetic nervous system action to reduce myocardial oxygen consumption?
metoprolol (Lopressor) or propranolol (Inderol)
The ____ atrium basically serves as a reserve.
right
________ walls are more muscular because it must pump the blood everywhere else.
ventricular
Blood oxygen exchange takes place at the ______ level.
alveolar
After the blood goes to the lungs it goes back to the _______ and then into the left ventricle.
left atrium
The body must have a certain amount of vascular tone, if you don't have that your body will go into ______.
shock
What can cause the blood to get thicker?
dehydration
The _____ ______ is in control of all the cells, this electricity produced by this travels everywhere else in the heart.
SA node
What is an oversized heart?
cardio myopathy
______ MI's are common in diabetics and women. These people never know about until an EKG reveals it.
Silent
What is the term used for not enough blood flow to the tissues?
ischemia
What kind of echocardiogram is invassive, it is when they put a scope down your esophagus?
transesophageal electrocardiogram