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99 Cards in this Set
- Front
- Back
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What is the "lubb" sound of the cardiac cycle?
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S1
systole |
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What are you hearing during the first, lubb sound?
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Mitral and tricuspid valves
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What is the "dubb" sound of the cardiac cycle?
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S2
diastole |
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What are you hearing during the second, dubb sound?
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Aortic valve and the pulmonic valve
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Cells in ___ of the heart have the ability to stimulate themselves
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atrium
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Cardiac output
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How much blood is leaving the heart
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Heart rate
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How many times a minute the heart is pumping
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Stroke volume
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amount of blood is coming out of the Left ventricle with each contraction
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Preload
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Volume of blood in the ventricles at the end of diastole
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Myocardial contractility
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how well the heart muscle can contract
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How to calculate cardiac output?
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HR X Stroke volume
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Normal resting HR
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60-100
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Heart rate is controlled by the...
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Autonomic nervous system
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What happens when the vagus nerve in the PSNS is stimulated?
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It makes the heart go slower
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What can cause the vagal nerve to be stimulated?
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valsalva maneuver (bearing down)
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What will catecholamines, epinephrine, and norepinephrine do to the heart?
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Increase HR and increase contractility
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Preload ___ with hypervolemia
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increases (lots of H2O and IV fluid can increase preload)
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Starlings Law
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the more stretch in our heart muscle, the more preload we can have, and the more blood to shoot out
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What will hypovolemia do to preload amount?
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decrease the preload amount
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What will a pt with low preload look like?
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dehydrated
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What is the hearts conduction pathway?
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SA node --> AV node --> Bundle of HIS --> Purkinje Fibers
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What is the hearts natural pacemaker?
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SA node
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what rate does SA node tell heart to beat?
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60-100
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What electrolyte do we worry about losing too much of when on diuretic therapy?
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Potassium
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What happens to myocardial contractility during hypoxia?
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decreases
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What happens to myocadial contractility during acidosis?
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decreases
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What respiratory conditions can cause hypoxia?
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hyperventilation, COPD, pneumonia
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What are baroreceptors?
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receptors that sense if there is low blood volume, they respond to stretch
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Where are baroreceptors located?
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in carotid arteries and arch of the aorta
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What happens if the baroreceptors sense that there is low blood volume?
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Will increase the Heart rate
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What type of patients may have problems with baroreceptors not working?
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Pts with arteriosclerosis
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How does our body help itself if we have low BP?
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Baroreceptors
Renin angiotensin system/ADH made by pituitary to retain water and increase blood volume. |
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What does ADH do for low BP?
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It causes the body to decrease the amount of urine produced, leaving more water in the body, and thereby increasing blood pressure
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What to chemoreceptors do?
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Respond to CO2 levels, if there is too much CO2 the receptors tell the arteries to vasoconstrict so that more O2 can get around.
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What effect do chemoreceptors have on the Cardiac and vascular system?
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Because it causes vasoconstriction, it increases BP to increase, but it also causes HR to go up to try to get rid of the CO2 faster
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What does aldosterone do to our fluid level?
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Helps us retain fluid
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Diet for cardiac pts
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low sodium
low fat avoid excessive fluids |
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How much sodium/day should cardiac diets contain?
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2 gm
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How much fat/day should cardiac diets contain?
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triglycerides about 150
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How much fluid/day should cardiac diets contain?
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about 2 Liters/day
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Teaching tip on how to reduce water intake?
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consume ice instead of water
2 glasses of ice= 1 glass of water |
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how to calculate lifetime smoker amt?
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packs per day times years smoked
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Where in the body is BP the highest?
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Aortic arch
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Where in the body is BP the lowest?
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peripheral capillaries
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Blood Pressure is the...
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force exerted against the vessel walls
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orthopnea
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hard to breathe laying down, need to sit up to breathe
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How to assess cardiovascular system?
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general appearance
skin extremities blood pressure heart sounds cap refill |
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What BP is considered prehypertension?
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120-139
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What BP is considered HTN?
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140/90- even if it's controlled
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Any BP over 135/85 makes the ____ ventricle work harder and causes the muscle to ______
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left
harden |
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Serum Markers of Myocardial Damage (6)
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Troponin—Troponin T and troponin I
Creatine kinase (CK) Myoglobin Serum lipids Highly sensitive C-reactive protein |
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Serum lipids should be what number?
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less than 70
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Serum triglycerides should be what number?
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<250
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Serum HDL should be what number?
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>40
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Serum LDL should be what number?
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<130
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Other diagnostic tests for myocardial damage?
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catheterization
ECG EPS stress test Echo Myocardial nuclear perfusion imaging |
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Heart failure AKA
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Pump failure
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What is heart failure?
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the inability of the heart to work effectively as a pump
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What types of heart failure are there? (3)
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Left-sided heart failure
Right-sided heart failure |
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Left sided heart failure aka
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congestive heart failure
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What are 3 typical causes of left sided heart failure?
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hypertensive
coronary artery valvular disease |
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Two types of left-sided heart failure:
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Systolic heart failure
Diastolic heart failure |
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What is Right-Sided Heart Failure
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Right ventricle not able to empty completely
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Typical causes of Right-Sided Heart Failure
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Typical causes—left ventricular failure, right ventricular MI, pulmonary hypertension
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What does Right-Sided Heart Failure cause?
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Increased volume and pressure in the venous system and peripheral edema
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Left-Sided Heart Failure Manifestations
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Weakness
Fatigue Dizziness Confusion Pulmonary congestion Breathlessness Oliuria Death |
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Right-Sided Heart Failure Manifestations
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Distended neck veins, increased abdominal girth
Hepatomegaly (liver engorgement) Hepatojugular reflux Ascites Dependent edema Weight—the most reliable indicator of fluid gain or loss |
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Ascites
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accumulation of fluid in the peritoneal cavity.
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Impaired Gas Exchange interventions
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Ventilation assistance
Position Oxygen |
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Decreased Cardiac Output Nursing interventions
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Safety (fall precautions)
Balance activities with rest Medications Medication teaching (Digoxin adm/ toxicity) |
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What is afterload?
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pressure or resistance the heart has to overcome to eject blood.
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Interventions That Reduce Preload
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Nutrition therapy
Drug therapy—diuretics and venous vasodilators Drugs that enhance contractility—digoxin, other inotropic drugs, beta-adrenergic blockers |
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Nutritional interventions for heart failure
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reduce sodium intake
monitor/restrict fluid intake lower cholesterol and saturated fats |
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1 liter of fluid retention is equal to ___ kg
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2.2
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Drug therapy for heart failure with fluid overload
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Diuretics- (Loop, Thiazide, Potassium sparing)
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What are some loop diuretics?
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Lasix, Bumex
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What to monitor for with loop diuretics
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Blood Pressure and K+
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What are some examplex of venous dilators
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nitrites
notroglycerin or isosorbide |
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What is a side effect of venous dilators?
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headache, low bp
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Example of drugs that enhance contractility (inotropic drugs)
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digoxin
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What to monitor with digoxin
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Apical pulse (decreases HR so may hold at 60)
toxicity- blurred vision, Mental status changes, fatigue monitor serum dig levels and K levels for toxicity |
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Important to monitor with metoprolol
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Take blood pressure immediately prior to adm Hold if SBP <100
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Troponin T & I
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These troponins are protein components of striated muscle, and are only found in the heart muscle. Elevation of cTnT or TnI is absolutely indicative of cardiac damage,
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CK- creatinine Kinase
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CKMB= cardiac tissue
If the value of CK-MB is elevated and the ratio of CK–MB to total CK (relative index) is more than 2.5–3, it is likely that the heart was damaged. |
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Myoglobin- marker for MI
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Myoglobin is a protein found in muscle, it holds oxygen inside heart muscle. When muscle is damaged, as in a heart attack, larger amounts of myoglobin are released and blood levels rise rapidly.
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S/S heart failure?
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SOB, increased RR, High BP, orthopnea, crackles at bases of lungs
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What is tissue perfusion like with heart failure?
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Inadequate tissue perfusion, heart is not working
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What is the most common heart failure?
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Left
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Reasons for left HF?
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HTN, Coronary artery disease, valvular disease
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systolic failure
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problem contracting
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diastolic failure
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problem relaxing
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If left HF backs up enough...
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can cause R sided HF
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2 reasons for Right sided HF?
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R or L MI or Left HF
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What does R HF look like?
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increased volume and pressure in venous system... peripheral edema
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What is important to know when admin sublingual nitro??
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Protect from sunlight! also s/e lightheadedness and dizziness
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What foods are high in k?
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green, leafy, vegetables - kale, collards, spinach, and turnip greens are the highest.
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Nursing care for HF
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labs, I & Os, assess daily wt, edema, O2 sat, EKG, lung sounds, heart sounds, maintain upright airway, DVT precaution
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pt teaching for hf
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diet (low sodium, low fat)
stay as active as possible |
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What is the point of maximal impulse?
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Apical pulse-
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