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90 Cards in this Set

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While each cell in the cardiac muscle is automatistic, it is not healthy for each cell to?

contract individually.
While each cell in the cardiac muscle is automatistic, it is not healthy for each cell to?
The cardiac conduction system is a network of specialized cells & pathways that normally has control over?

The way the heart beats
The cardiac conduction system is a network of specialized cells & pathways that normally has control over?
Stroke volume is?

the amount of blood ejected from the heart with each beat
The amount of blood ejected from the heart with each beat is called?
Heart rate is?

number of beats per minute
The number of heart beats per minute is called?
Contractility of the heart is?

ability of the heart muscle fibers to contract or shorten
the ability of the heart muscle fibers to contract or shorten is called?
Terms to remember:

Cardiac output (CO)
=
stroke volume X heart rate (SV X HR)
stroke volume X heart rate (SV X HR)

equals ?
Preload 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)
The degree to which the muscle fibers in the ventricle are stretched when full and ready to eject blood is calld?
The Frank-Starling Law of the Heart states?

The more the fibers in the ventricles are stretched, the stronger the contraction
The more the fibers in the ventricles are stretched, the stronger the contraction is called the?

Frank-Starling Law of the Heart
If ventricle fibers are overstretched?

the capacity to increase contraction strength may decrease, thereby decreasing CO.
The capacity to increase contraction strength may decrease, thereby decreasing CO if the?
Afterload is?

The resistance against which the heart must pump to eject blood into the circulation
The resistance against which the heart must pump to eject blood into the circulation is called?
Afterload is impacted by?


systemic (or peripheral) vascular resistance or systemic (or peripheral) vascular dilation
Systemic (or peripheral) vascular resistance or systemic (or peripheral) vascular dilation impacts?
The resistance in Afterload is determined by?


Viscosity or thickness of the blood

Blood vessel length

Blood vessel diameter
Viscosity or thickness of the blood, Blood vessel length, & Blood vessel diameter determines the resistance in?
The primary reason we have a circulatory system is to?

Transport oxygen, nutrients and hormones to the cells of the body

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

Transporting oxygen, nutrients & hormones to the cells of the body & transporting metabolic wastes from the cells for elimination is the primary purpose of?
Assessment for CAD includes?

Thorough history including modifiable & nonmodifiable risk factors for the development of CAD.

Personal habits, socioeconomic status & presence of chronic diseases
Assessment for CAD includes?
Factors that Affect CV Function?

risk factors for development of CV disease include modifiable & nonmodifiable factors

RNs often teach & counsel about either in individual sessions or in community or group sessions
Factors that Affect CV Function?
Modifiable factors of CAD are?

Cigarette smoking: (responsible for 21% of all deaths from CAD)

Presence of chronic diseases not diagnosed or in which the pt does not follow a treatment plan for control

Diabetes

Serum lipid levels

Hypertension

Obesity:
especially when obesity is abdominal (waist measurement greater than hip measurement)

Sedentary lifestyle:
less than 30 minutes of activity a day
Modifiable factors of CAD are?
Other factors to ask the patient in assessing CAD are?

Is the patient exposed to extremes of heat and cold

exposure to heat or cold increases workload on heart
(maybe enough to stress a marginally well heart into pathology)
Other factors to ask the patient in assessing CAD are?
The healthy body has built-in mechanisms to?

“compensate” for temporary decreases in oxygenation of the cells and tissues.
The healthy body has built-in mechanisms to?
Increased heart rate, increased depth of respirations are healthy mechanisms that?

“compensate” for temporary decreases in oxygenation of the cells and tissues
Increased heart rate, increased depth of respirations are healthy mechanisms that?
In an unhealthy heart, these compensatory mechanisms that can either fail all together or can make the patient’s condition worse are?

Increased heart rate

Increased depth of respirations
In an unhealthy heart, these compensatory mechanisms that can either fail all together or can make the patient’s condition worse are?
While some stress may be tolerated without a problem, there is ... ?

an increased workload on the heart
While some stress may be tolerated without a problem, there is ... ?
"Tolerable” stress will depend upon the?

underlying physical condition of the patient.
"Tolerable” stress will depend upon the?
The well known connections with diet are?

high fat diets (leading to the modifiable risk factor of elevation of serum lipid levels)

increased salt intake (leading to or making worse a tendency to hypertension)
The well known connections with diet are?
High fat diets lead to the modifiable risk factor of?

Elevation of serum lipid levels
High fat diets lead to the modifiable risk factor of?
Increased salt intake leads to or making worse a?


tendency for hypertension
The tendency for hypertension is increased with?
Moderate alcohol intake may be"

protective of the heart
(11-2 oz per day)
Moderate alcohol intake may be"
Alcohol intake greater than 1-2 oz perday may cause problems such as?

Decreased oxygenation Malnutrition
Hypertension
Poor impulse control
Poor decision making
Alcohol intake greater than 1-2 oz perday may cause problems such as?
Elevation of homocysteine level is often shown in people with?

atherosclerosis
Elevation of homocysteine level is often shown in people with?

atherosclerosis
An amino acid that research has shown to often be elevated in people with atherosclerosis is called?

Homocysteine
Homocysteine is ?
Since atherosclerosis is the precursor to plaque development & occlusion of the coronary arteries (thereby MI), elevation of homocysteine levels may indicate an increased risk of?

MI
Elevation of homocysteine levels may indicate an increased risk of?

MI
Current health problem or chief complaint for CAD?

Pain or discomfort: physiologically can be from ischemia, pericarditis, aortic dissection

***Use alternative words for pain such as discomfort, heaviness, pressure, indigestion
(many patients (esp. women or those with DM) will experience nontypical pain and may not realize the feeling as pain, but may identify with one of the other descriptors
Current health problem or chief complaint for CAD?
Pain or discomfort from CAD can be from?

Ischemia
Pericarditis
Aortic dissection
Pain or discomfort from CAD can be from?
Avoid using the word "pain"

Use alternative words for pain such as discomfort, heaviness, pressure, indigestion

(many patients (esp. women or those with DM) will experience nontypical pain and may not realize the feeling as pain, but may identify with one of the other descriptors
Avoid using the word "pain"

Use alternative words for pain such as discomfort, heaviness, pressure, indigestion

(many patients (esp. women or those with DM) will experience nontypical pain and may not realize the feeling as pain, but may identify with one of the other descriptors
Dyspnea can occur as a result of?

cardiac and pulmonary disease
Cardiac and Pulmonary disease
can cause?

Dyspnea
Dyspnea can occur as a result of both cardiac & pulmonary disease. Questions to ask?

Is the dyspnea exertional?
Is the patient dypsneic at rest?
Does the patient have orthopena (dyspnea that occurs when he or she lies flat)?
Does the patient require use of several pillows at night to avoid being SOB?
Dyspnea can occur as a result of both cardiac & pulmonary disease. Questions to ask?
Dyspnea that occurs after the patient has been lying down for several hours is called?


Paroxysmal nocturnal dyspnea (PND)
Dyspnea that occurs after the patient has been lying down for several hours is called?
What causes Paroxysmal nocturnal dyspnea (PND)?

The blood from the lower extremities redistributes to the venous system increasing venous return to the heart.
The heart becomes overloaded causing pulmonary congestion

The patient awakes abruptly with a feeling of SOB, panic and suffocation.

Must sit up to relieve the feeling.
When the blood from the lower extremities redistributes to the venous system increasing venous return to the heart, then
the heart becomes overloaded causing pulmonary congestion describes?
What relieves symptoms of Paroxysmal nocturnal dyspnea (PND)?

Must sit up to relieve the feeling.
What relieves symptoms of Paroxysmal nocturnal dyspnea (PND)?
The blood from the lower extremities redistributes to the venous system increasing venous return to the heart is called?


Paroxysmal nocturnal dyspnea (PND):
Paroxysmal nocturnal dyspnea (PND) occurs when?
Fatigue associated with CAD is often worse in the evening so the patient may need to?

patient may self limit activity to avoid fatigue
Fatigue associated with CAD is often worse in the evening so the patient may need to?
Palpitations are?

a feeling of fluttering in the chest and awareness of the heartbeat, which may be irregular
May be caused from ischemia to the hearts conduction system or muscle
A feeling of fluttering in the chest and awareness of the heartbeat, which may be irregular which may be caused from ischemia to the hearts conduction system or muscle is called?
Palpitations may be caused by?

ischemia to the hearts conduction system or muscle
Ischemia to the hearts conduction system or muscle may cause?
Edema from poor cardiac function may result in?


weight gain & edema

Ask about tightness of shoes, indentations from socks, tightness of rings
Edema from poor cardiac function may result in?
Syncope 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
Transient loss of consciousness (fainting)
as the result of poor perfusion to the brain is called?
The result of poor perfusion to the brain, can be caused by decreased cardiac output or problems with venous flow to the brain is called?

syncope
Syncope is?
Pain in the extremities can be caused from?

ischemia from atherosclerosis or by venous insufficiency

Severe cramping sensation in the legs or buttocks associated with an activity such as walking is termed intermittent claudication

Relieved by rest
Ischemia from atherosclerosis or by venous insufficiency can cause symptoms such as?
Intermittent claudication is ?

Severe cramping sensation in the legs or buttocks associated with an activity such as walking
Severe cramping sensation in the legs or buttocks associated with an activity such as walking is called?
Ischemia from atherosclerosis or by venous insufficiency can cause these symptoms?

Severe cramping sensation in the legs or buttocks associated with an activity such as walking is termed intermittent claudication

Relieved by rest
Ischemia from atherosclerosis or by venous insufficiency can cause these symptoms?
Troponin is?

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

Troponin
Troponin is?
In diagnostic testing this protein is not usually found in healthy individuals?


Troponin
In diagnostic testing this protein is not usually found in healthy individuals?
CK-MB is?


creatine kinase

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
An enzyme specific to cells of the brain, myocardium, and skeletal muscle is?
An enzyme specific to cells of the brain, myocardium, and skeletal muscle is?


CK-MB (creatine kinase)
CK-MB (creatine kinase)
Serum lipids are?


Cholesterol (LDL and HDL)

Triglycerides
Cholesterol (LDL and HDL) &
Triglycerides are called?
LDL is?


low-density lipoproteins that are predominantly cholesterol
High LDL levels are positively correlated with CAD
Low-density lipoproteins that are predominantly cholesterol are called?
Low-density lipoproteins that are predominantly cholesterol are?


"LDL"
(low-density lipoproteins)
Low-density lipoproteins are called?
HDL are?


high-density lipoproteins (mainly protein with 20% cholesterol)

Higher HDL levels are negatively correlated with CAD and appear to be a protective factor
These levels are negatively correlated with CAD and appear to be a protective factor and called?

HDL
Triglycerides are?


the main storage form of lipids

High triglyceride levels are linked to the progression of CAD
The main storage form of lipids are?
Homocysteine levels may be decreased by a diet?

rich in B complex vitamins, especially folic acid
A diet rich in B complex vitamins, especially folic acid may decrease levels of?

Homocysteine
C-Reactive Protein is?

inflammation is a critical component in the development of atherothrombosis
C-Reactive Protein is?
Radiographic examinations include?


Chest xray

Cardiac catheterization
Chest xray's & Cardiac catheterization is ?
A test that includes placement of a catheter that infuses radiopaque dye into the coronary arteries. The flow of the dye is observed radiographically and the degree of occlusion present in the coronary arteries is determined is called a?

Cardiac catheterization
Cardiac catheterization is?
A diagnostic test producing a simple rhythm strip analysis is called?

Cardiac monitoring
Cardiac monitoring is?
A routine part of every cardiac evaluation that records the electrical activity of the heart is a?


Electrocardiogram (ECG)
Electrocardiogram (ECG)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 is called?


Holter monitoring
Holter monitoring is?
A diagnostic tool in assessing the cardiovascular response to an increased workload is ?


Exercise Stress Testing
A diagnostic tool in assessing the cardiovascular response to an increased workload is ?
A diagnostic test where the patient is connected to ECG monitoring and is exercised on a treadmill or stationery bicycle is called ?


Exercise Stress Testing
Exercise Stress Testing is?
A diagnostic test that uses ultrasound waves to assess cardiac structure and mobility is called?

Echocardiography
Echocardiography is?
A a noninvasive, risk-free test that helps to assess and diagnose cardiomyopathy, valvular disorders, pericardial effusion, left ventricular function, ventricular aneurysms, and cardiac tumors is called?


Echocardiography
Echocardiography is?
NANDA includes three NDX problem statements that are specific to circulatory problems. They are?


Ineffective tissue perfusion (Cardiopulmonary)

Decreased cardiac output

Activity intolerance
NANDA includes three NDX problem statements that are specific to circulatory problems. They are?
A decrease in oxygen resulting in the failure to nourish the tissues at the capillary level” is caused from?

Ineffective tissue perfusion
A decrease in oxygen resulting in the failure to nourish the tissues at the capillary level” is caused from?
Altered B/P, oliguria, altered mental status, restlessness, chest pain, dyspnea, sense of impending doom, capillary refill > 3 seconds, claudication, skin temp or color changes, edema, delayed healing are all signs of?


Ineffective tissue perfusion:
A decrease in oxygen resulting in the failure to nourish the tissues at the capillary level
Ineffective tissue perfusion is?

A decrease in oxygen resulting in the failure to nourish the tissues at the capillary level
Decreased cardiac output is?

Inadequate blood pumped by the heart to meet the metabolic demands of the body”
The inadequate blood pumped by the heart to meet the metabolic demands of the body”
An altered rate/rhythm (arrhythmias), altered preload (JVD, edema, weight gain), altered afterload (cold, clammy skin, anuria), altered contractility (crackles, cough, S3 and S4 heart sounds)my be the result of?

Decreased cardiac output?
Decreased cardiac output may cause?
Activity Intolerance is?


Insufficient physiologic or psychological energy to endure or complete required or desired daily activities
Insufficient physiologic or psychological energy to endure or complete required or desired daily activities is due to?
Activity Intolerance is indicated when?


Patient report of fatigue or weakness, exertional discomfort or dyspnea, abnormal heart rate or B/P responses to activity, ECG changes to activity
Activity Intolerance is indicated when?
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 of CV risk factors

Describing a specific plan for risk factor modification
The broad goals for these patients include?
Implementation should be?

Encourage frequent position changes, ambulation, and exercise

Immobility is very detrimental to CV function
Implementation should be?
The best position for a cardiac patient is?


high Fowler’s
this position decreases preload and pulmonary congestion and helps to improve cardiac function.
The best position for a cardiac patient is?
Patients with poor venous return may benefit from being positioned with?


legs elevated 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 patient with a laboring heart.
Patients with poor venous return may benefit from being positioned with?
Avoidance of venous status which puts the patient at risk for development of?


varicose veins
hypercoagulability
formation of clots (venous thrombosis)

can dislodge & become emboli

Avoid use of pillows under the knees or more than 15 degrees of knee flexion in bed as this promotes venous status

Closely monitor patients whose daily activities include lots of sitting.
Avoidance of venous status which puts the patient at risk for development of?
To help in the prevention of venous status the use of?

sequential compression devices and/or TED hose may also help prevent venous status
To help in the prevention of venous status the use of?
Encourage healthy patients to include exercise in daily routines such as?

At least a 30 minute walk
Encourage healthy patients to include exercise in daily routines such as?
Patients with cardiac disease also benefit from exercise, but may need?

a thorough cardiac assessment before beginning an exercise regimen
Patients with cardiac disease also benefit from exercise, but may need?
Patients with intermittent claudication often benefit from a?

mild exercise program
Patients with intermittent claudication often benefit from a?
When a patient is confined to bed encourage?

leg 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 position changes
When a patient is confined to bed encourage?
Medications that can be used to help reduce vasoconstriction, thereby reducing the workload on the heart are?

Nitrates: Nitroglycerin

Calcium channel blockers: nifedipine (Procardia)

ACE inhibitors: captopril (Capoten)
ACE inhibitors: captopril (Capoten) is used to?
Medications that can be used to prevent or treat arrhythmias are?

procainamide (Procan)

Lidocaine

Flecaninide
(Tambocor)

Propranolol (Inderal)

Amiodarone (Cordarone
Procainamide (Procan), Lidocaine, Flecaninide
(Tambocor), Propranolol (Inderal), and Amiodarone (Cordarone) are prescribed for?
Medications used to increase contractile strength of the heart are?

digitalis (Lanoxin)
Digitalis (Lanoxin) is prescribed for?
Medications used to block sympathetic nervous system action to reduce myocardial oxygen consumption are?

Metoprolol (Lopressor)

Propranolol (Inderal)
Metoprolol (Lopressor) or Propranolol (Inderal) are prescribed for?