363 notecards = 91 pages (4 cards per page)
the cardiovascular system delivers oxygenated blood to
the cardiovascular system delivers deoxygenated blood to
when are some times that cardiac output will increase?
what makes up the vascular system?
what are the functions of the vascular system?
arteries carry oxygenated blood, except the
veins carry deoxygenated blood, except the
workhorse of the vascular system?
the amount of blood ejected from the left heart
cardiac output (CO)
what is delivered to the tissues and what is removed in the capillary bed?
what is the blood flow through a capillary bed?
artery to arteriole to metarteriole into the capillary
what controls the blood flow through the capillary bed?
what are the layers of the heart?
the thin outer layer of the heart that is continuous with the inner layer of the pericardial sac
thick middle layer of the heart that is the muscular layer responsible for the mechanical, contractile function of the heart
thin inner layer of the heart that is continuous with the inner layer, or endothelium, of the blood vessels
what are the chambers of the heart?
which side of the heart has deoxygenated blood?
which side of the heart has oxygenated blood?
the heart needs valves to facilitate:
there are ______________ between the atria and ventricles on the right and left
atrioventricular (AV) valves
the AV valve between the R atrium and ventricle
the AV valve between the L atrium and ventricle
bicuspid, or mitral valve
during diastole, the AV valves are
open: allowing blood to flow into the ventricles
valves present between the ventricles and their respective arteries
semilunar valves: pulmonary and aortic
the pulmonary valve is located between the
R ventricle and pulmonary artery
the aortic valve is located between the
L ventricle and aorta
What is the composition of the heart?
A. Four chambers with four valves that control flow through the heart and lungs through changes in pressure
B. Four chambers and four valves that control flow through the heart and lungs through changes in oxygen levels
C. Two chambers on the right receiving blood from the high-pressure venous system and two chambers on the left sending blood into the low-pressure arterial system
D. Two chambers on the right receiving oxygenated blood from the venous system and two chambers on the left receiving deoxygenated blood from the pulmonary circuit
what is the blood flow through the heart?
what are the major vessels that supply blood to the heart?
left and right coronary arteries
if the left coronary artery (LCA) is clogged, it is called
if the right coronary artery is clogged, you will have problems with?
the normal pacemaker that has an inherent rate of 60 to 100 beats per minute
sinoatrial (SA) node
in the absence of an impulse from the SA node, the ____________ can generate impulses at rates of 40 to 60 bpm
atrioventricular (AV) node
the cells of the cardiac electrical conduction system that generate and conduct the action potential follow this pathway:
what happens with the impulse at the Purkinje fibers?
fibers extend the impulse into the ventricular tissue, facilitating ventricular contraction
if the SA and AV nodes fail, _____________ can generate impulses at a rate of 20 to 40 bpm
process in which the membrane potential changes or goes up and down in a consistent pattern
cardiac action potential
difference in charge between the interior and exterior of the cell
movement of ions preceding and facilitating cardiac mechanical contraction
movement of ions back to the resting state to allow for the initiation of another action potential
occurs during and immediately following depolarization; during this time, the cell is unresponsive to any stimulus
absolute refractory period
immediately following the absolute refractory period is the
relative refractory period
represents a time when a greater-than-normal stimulus may initiate an impulse
relative refractory period
steps of the action potential?
waveforms can be amplified and viewed on a paper tracing called
what are the parts of an ECG?
the P wave corresponds to
the PR interval is from the beginning of the _________ to the beginning of the ______
from the beginning of the p wave to the beginning of the QRS complex (size measurement)
what does the PR interval reflect?
time required for atrial depolarization and the delay of the impulse at the AV node (time measurement)
the PR segment is the time immediately following _______ to beginning of ______
immediately following P wave to beginning of QRS
the QRS complex corresponds to
ventricular contraction occurs after the ______ in the ________
occurs after the QRS complex in the ST segment
the QRS interval reflects the time required for
the T wave corresponds to
the QT interval reflects time required for _______ and ______
ventricular depolarization and repolarization
Which is true of the electrical conduction system of the heart?
A. It is primarily controlled by the movement of uncharged ions
B. It has a positive resting membrane potential
C. It is reflected in the waveforms on the electrocardiogram
D. It requires cells that respond only to a stimulus from the autonomic nervous system
ventricular relaxation (filling of ventricles is first 2/3 of cycle)
ventricular contraction (ejection of blood from the ventricles, last 1/3 of cycle)
reflection of the pressure generated during the cardiac cycle; represent the force exerted against the vessel wall by blood flow
how is cardiac output calculated?
heart rate X stroke volume
amount of blood ejected with each ventricular contraction
stroke volume is affected by what 3 variables?
amount of blood in the ventricles at the end of diastole; also refers to the amount of stretch of the muscle tissue at the end of filling
resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents
refers to the force of the mechanical contraction
contractility decreases in the face of
A patient with hypertension has which physical symptom?
A. Decreased resistance, which may increase CO
B. Increased resistance, which may decrease CO
C. Increased resistance, which may increase CO
Decreased resistance, which may decrease CO
what are some risk factors for cardiovascular disease (CVD)?
closing of the AV valves; signifies the beginning of the ventricular systole
closing of the semilunar valves; signifies the beginning of diastole
what is the cause of the S1 heart sound?
closure of AV valves
what is the description of the S1 heart sound?
what is the cause of the S2 heart sound?
closure of semilunar valaves
what is the description of the S2 heart sound?
what is the cause of a systolic murmur?
valvular dz such as aortic stenosis
what is the description of the systolic murmur sound?
turbulent flow heart
when do we hear the systolic murmur?
systole between S1 and S2
what is the cause of a diastolic murmur?
valvular dz such as aortic or pulmonic regurgitation
what is the description of a diastolic murmur?
turbulent flow heard
when do we hear a diastolic murmur?
diastole after S2
what is the cause of a friction rub?
what is the description of friction rub?
harsh, scratching sound
when do we hear a friction rub sound?
anywhere during the cardiac cycle
where is the aortic point?
R 2nd ICS
where is the pulmonic point?
L 2nd ICS
where is Erb's point?
L 3rd ICS
where is the tricuspid point?
L 4th ICS
where is the mitral point?
L 5th ICS/midclavicular line
A nurse is providing care for a patient newly diagnosed with heart disease. Which dietary, activity, or lifestyle modification(s) should be included in the plan of care? (Select all that apply).
A. Stopping smoking
B. Drinking lots of water
C. Limiting sedentary lifestyle
D. Eating a diet rich in red meat and protein
E. Limiting alcohol intake
A, C, and E
auscultation of _______, ________, or ______ in the lung fields indicates the presence of fluid
a lipid panel includes?
normal value for LDL?
less than 100
normal value for cholesterol?
normal value for HDL?
normal value for triglycerides?
what are the markers of heart disease?
normal value for CK-MB?
normal value for trop?
less than 0.4
normal value for BNP?
general marker of cellular injury
creatine kinase (CK)
preferred method for diagnosing cardiac injury
released from overstretched ventricular tissue
what does a CXR tell us in regards to heart disease?
CXR cannot diagnose heart disease but can highlight complications such as cardiac enlargement
uses US to provide information on the size and pumping function of the heart, blood-volume status, and valve function and integrity
is done to evaluate heart functioning during time of increased workload
cardiac stress test
what is the alternate form of cardiac stress test done in which the radioisotope becomes bound to damaged tissue, creating "hot spots"
isotope (nuclear) stress test
invasive x-ray procedure during which a radiopaque catheter is advanced through an artery or vein to the heart under fluoroscopy in order to evaluate cardiac filling pressures, CO, and valvular function
primary reason cardiac catheterization is performed
What is the most likely procedure to determine the cause of severe chest pain in the patient newly admitted to the hospital?
A. Coronary angiography
B. Nuclear stress testing
C. Right heart catheterization
What is an important nursing action following a cardiac catheterization intervention?
A. Early mobilization to prevent clot formation
B. Fluid restriction to avoid fluid overload
C. Bedrest to avoid stress on cannula insertion site
D. Head of bed at 30 degrees for respiratory support
Physical deconditioning with age leads to:
what can happen to the heart valves with age?
what can happen to the arterial walls with age?
the conduction system begins with the
the conduction system gives us waveforms which are:
what are some risk factors for dysrhythmias?
disruptions in the cardiac conduction pathway or disorders of the electrical impulse conduction within the heart
what are some clinical manifestations of dysrhythmias?
As the nurse, you know that the following can cause rhythm disorders: (Select all that apply.)
B. Electrolyte imbalances
C. Myocardial hypertrophy
D. Myocardial damage
E. Eating red meat
B, C, and D
the height of the boxes on an ECG represent?
amplitude (each little box = 1mm)
the small boxes on an ECG are _____ sec
the bigger boxes on an ECG are ____sec
15 of the bigger boxes is _______ sec
list the waveforms in order as they normally appear on the ECG:
the P wave represents the SA node sending out an electrical impulse and represents
the QRS complex represents
the T wave represents
the U wave represents
Purkinje fiber repolarization & is rarely seen
measure the amount of time it takes for the impulse to travel from one waveform to the next
what are the different intervals?
measure of time it takes an electrical impulse to depolarize the atria and travel to the ventricles
measure of time to depolarize the ventricles
measure of time that it takes the ventricle to depolarize and then repolarize
to measure the PR interval, start from the ____________ and count the number of small boxes to the beginning of the _________
start from the beginning of the P wave to the beginning of the QRS complex
the normal PR interval is from _______ to ______ in length
0.12 (3 small boxes) to 0.2 (five small boxes) sec
the QRS interval is measured from where to where?
from where the QRS complex waveform leaves the baseline to where the QRS returns to the baseline
the normal interval for QRS interval is
0.06 to 0.1 sec
to measure a QT interval start where and measure to where?
start where the QRS leaves baseline and measure to where the T wave returns to baseline
the QT interval is ______ dependent
the QT interval should never be more than?
half the distance from one QRS to the next
a normal QT is usually less than or equal to
steps in ECG interpretation?
6 seconds on an ECG equals ______ boxes
regularity can be determined by counting?
the waveforms being measured, such as P wave (P to P) or QRS complex to QRS complex (R to R)
determining the regularity on an ECG can also be called?
marching out the waveforms
As the nurse caring for a patient on a cardiac monitor, you understand that which of the following steps are necessary to correctly identify the rhythm? (Select all that apply.)
A. Determine the rate
B. Determine the regularity
C. Determine if there is a QRS for every P wave
D. Determine if there is a P wave for every QRS
E. Determine if there is a U wave for every QRS
A, B, C, and D
regular rhythm that has the same characteristics as NSR except the HR is <60bpm
what are some causes of sinus bradycardia?
when do we treat dysrhythmias?
if the patient is symptomatic
how do we treat sinus bradycardia if the pt is symptomatic?
atropine (0.5mg IVP)
regular rhythm that has the same characteristics as NSR except the HR is greater than 100 bpm
sinus tachycardia (ST)
what are some causes of ST?
treatment for ST?
treatment depends on the cause, but could be:
non-life-threatening dysrhythmias that can be seen in NSR
premature atrial contractions (PACs)
in a premature atrial contraction, what has happened with a pacemaker cell?
a pacemaker cell close to the SA node fires earlier than expected
what are some causes of PACs?
treatment for PACs?
has no P waves; best described as multiple pacemaker cells generating independent electrical impulses and causing chaos within the atria; characterized as irregularly irregular
atrial fibrillation (AF)
what are some causes of a-fib?
treatment for a-fib?
what are some possible complications of a-fib?
dysrhythmia produced by a pacemaker cell other than the SA node; does not have any P waves
atrial flutter (AFL)
what are some causes of atrial flutter?
treatment for atrial flutter?
controlled electrical discharge of energy at the peak of the R wave
uncontrolled electrical discharge of energy anywhere during the cardiac cycle
when is cardioversion indicated?
symptomatic tachy dysrhythmias with a pulse:
when is defibrillation indicated?
tachy dysrhythmias without a pulse:
think saw tooth with atrial flutter
rapid heart rhythm that originates above the ventricles; appears as a regular, narrow QRS complex tachycardia
supraventricular tachycardia (SVT)
treatment for supraventricular tachycardia (SVT)?
patients receiving adenosine may experience prolonged periods of _________ after administration
prior to the administration of adenosine, the pt should be on a ?
what should be readily available for patients who have been given adenosine?
transcutaneous pacemaker; should pacing of the pt be necessary
similar to ST except the electrical impulse is not generated from the sinus node, it's generated somewhere in the atria and can have uniform or nonuniform appearance
atrial tachycardia (AT)
rhythms that begin with the AV node at a rate of 40-60 bpm and have an inverted P wave
Which of the following is not an appropriate intervention for all atrial dysrhythmias?
A. An ECG
B. A pulse check
C. Blood pressure
wide and atypical (or bizarre-looking) QRS complexes that fire earlier than expected from within the ventricles
premature ventricular contraction (PVCs)
what are the causes of premature ventricular contractions (PVCs)?
3 or more PVCs (wide and fast impulses originating from the ventricles) in a row
ventricular tachycardia (VT)
a PVC that occurs every other beat
PVC falling every third beat
what are some causes of ventricular tachycardia (VT)?
the treatment for VT is based on the patient's presentation, which is either:
VT with a pulse treatment?
pulseless VT treatment?
lethal dysrhythmia requiring immediate treatment; occurs when the ventricle has multiple chaotic impulses firing rapidly
ventricular fibrillation (VF)
what are some causes of ventricular fibrillation?
how is ventricular fibrillation treated?
when the SA and AV nodes fail; rate will be 20-40
idioventricular rhythm (IVR)
no measurable electrical activity from the heart
treatment for asystole?
The nurse understands that rhythms originating in the ventricle have which of the following characteristics? (Select all that apply)
A. Wide QRS complexes
B. Narrow QRS complexes
C. Only QRS complexes
D. Only fast rates
E. Only slow rates
A and C
delay or blockage of electrical conduction at the AV node
causes of heart blocks?
looks very similar to an NSR except the PR interval is prolonged (>0.2 sec or 5 blocks long)
first-degree AV block
treatment for first-degree AV block?
more P waves than QRS complexes and the PR interval gets progressively longer until a QRS complex is dropped
type I second-degree AV block
also drops QRS complexes but the PR intervals are exactly the same length with each complex
type II second-degree AV block
what is the treatment for second-degree AV block type I and II?
when the AV node is completely blocked and prevents any impulses from entering or exiting; ECG records more P waves than QRS complexes
third-degree AV block
treatment for third-degree AV block?
What do second-degree and third-degree heart blocks have in common?
A. Wide QRS complexes
B. Narrow QRS complexes
C. Dropped QRS complexes
D. No commonalities
Transcutaneous pacing should be considered for which of the following dysrhythmias?
C. Symptomatic heart block
symptoms of cardiac dysrhythmias?
what are some modifiable risk factors of coronary artery disease?
what are some nonmodifiable risk factors of coronary artery disease?
atherosclerosis forms and occludes _____________
what can occur as a result of atherosclerosis?
chest pain that occurs at rest
plaque within the lumen of the vessels
initial injury with atherosclerosis?
injury to the vessel wall & then inflammatory response
clinical manifestations of coronary artery disesase?
chest pain alleviated with rest
coronary artery spasm that can occur at rest
what labs are drawn to diagnoses coronary artery disease diagnosed?
what tests are done to diagnose coronary artery disesae?
possible manifestations of coronary artery disease?
what is the purpose of administering medications to patients with coronary artery disease?
meds on pg. 596 & 597 (17:00)
statins, anticoagulants, antiplatelet, beta blockers, ACE inhibitors, calcium channel blockers, & vaso-dilators
surgical management for coronary artery disease?
complications with coronary artery disease?
what are some lifestyle management things for patients with CAD?
what foods should CAD patients avoid?
complications of CAD?
nonspecific symptoms of CAD?
when should statins be taken?
in the evening b/c that's when the liver works to make cholesterol
inflammation/infection of the valves (most commonly mitral & aortic)
risk factors of infective endocarditis:
infection of endocardium affecting heart valve; usually bacterial in origin
clinical manifestations of infective endocarditis?
painful nodes of the pads of the fingers and the toes
red painless spots on the palms of the hands and the soles of the feet
seen under nails; vertical looking splinters
how is infective endocarditis diagnosed?
medical management of infective endocarditis?
surgical management of infective endocarditis?
valve repair or replacement
complications of infective endocarditis?
what is a big teaching thing for your patients with infective endocarditis?
good oral hygiene; the mouth is a breeding ground
damage to myocardium; usually caused by virus
who is most affected by myocarditis?
men and young persons
clinical manifestations of myocarditis?
how is myocarditis diagnosed?
BNP tells me directly?
how significant heart failure it
treatment for myocarditis?
complications that can arise from myocarditis?
inflammation around the heart
clinical manifestations of pericarditis?
sac around the heart
inflammatory process of the innermost portion of the heart?
inflammation of the outermost portion or the sac of the heart?
stuff in and around the sac of the heart (can be fluid, blood, etc.)
how is pericarditis diagnosed?
what do we do for patients who have SOB?
medications given to pericarditis patients help to?
complications of pericarditis?
squeezing of the parts of the heart which ultimately give us our cardiac output
what is one of the most common manifestations seen with pericarditis?
pericardial friction rub
HOB with pericarditis?
chest pain relieved by sitting up and leaning forward is found in?
necessary teaching with steroids?
L or R sided heart failure; regurgitation & stenosis
clinical manifestations of valvular disease?
how is valvular disease diagnosed?
medications to treat valvular disease?
what are the valves of the heart?
possible complications of valvular disease?
surgical management for valvular disease?
you will need to be on anticoagulants for a lifetime with one of these***
failure of the valves to work properly can lead to: (in regards to VS)
what should we monitor for in patients taking -prils?
what should we monitor for in patients taking beta blockers?
risk factors of heart failure?
myocardial cell dysfunction; inability of heart to meet needs of body
clinical manifestations of heart failure?
R sided heart failure manifestations?
* think R ventricle not working appropriately
L sided heart failure manifestations?
* think L ventricle not working appropriately
how is heart failure diagnosed?
percentage of blood that is able to be ejected from ventricles (50-70% is normal)
treatment for heart failure?
medical management for heart failure?
surgical management of heart failure?
the amount or what is before the ventricles
what the ventricles have to overcome to get the blood out of the heart and into the body
how well the ventricles pump
a gain of 1 kg is equivalent to _______ mL of fluid
appropriate diet for heart failure patients?
fluid and sodium restriction
complications R/T heart failure?
hallmark manifestation of pulmonary/flash edema?
pink, frothy sputum
affects the afterload by decreasing BP
block sympathetic nervous system response
biggest side effect of beta blockers?
patients taking spironolactone are at risk for hyper/hypokalemia?
patients taking hctz or furosemide, patients are at risk for hyper/hypokalemia?
patients taking dig have increased risk for?
vessels contribute to overall healthy by transporting:
risk factors for atherosclerosis/arteriosclerosis?
normal cardiac output range?
L/min that your heart ejects in order for the body to function
hardening/thickening of vessels
total cholesterol range?
most significant cause of atherosclerosis?
injury to the vessel wall
clinical manifestations of atherosclerosis/arteriosclerosis?
atherosclerosis leads to many other disorders such as
risk factors for HTN?
cigarettes are a vaso?
sodium and water
clinical manifestations of HTN?
primary or essential HTN?
HTN with no identifiable cause
HTN as a result of some cause
how is HTN diagnosed?
two or more BP readings in more than 2 office visits
medications prescribed for HTN?
lifestyle management for HTN?
possible complications of HTN?
what labs do we assess with HTN?
modifiable risk factors for peripheral arterial disease?
nonmodifiable risk factors for peripheral arterial disease?
obstruction of blood flow through large peripheral arteries cause partial or total occlusion
peripheral arterial disease
stage 1 PAD clinical manifestations?
stage 2 PAD clinical manifestations?
stage 3 (rest pain) PAD clinical manifestations?
stage 4 PAD clinical manifestations?
how is PAD diagnosed?
medications for PAD?
surgical management for PAD?
non-surgical management for PAD?
complications of PAD?
risk factors for carotid artery disease?
vessel wall thickening and plaque formation occluding blood in carotid artery
carotid artery disease
clinical manifestations of carotid artery disease?
how is carotid artery disease diagnosed?
surgical management for carotid artery disease?
medications for carotid artery disease?
symptoms of stroke?
following a CEA or CAS if the pt becomes hypotensive, what position should we put them in?
flat with the HOB down to increase the blood flow which increases cerebral perfusion
risk factors for aortic artery disease (aneurysm)?
middle layer(media) of artery is weakened, stretching inner layer (intima); artery widens, tension increases, further widening occurs
aortic artery disease (aneurysm)
clinical manifestations of aortic artery disease (aneurysm)?
asymptomatic until dissection or rupture
how is aortic artery disease diagnosed?
medical management of aortic artery disease?
complications that can occur from aortic artery disease?
risk factors for deep vein thrombosis (DVT)?
clinical manifestations of DVT?
how is a DVT diagnosed?
medical management prevention for DVT?
medical management for development of DVT?
what labs have to be checked when on heparin?
what labs have to be checked when on warfarin?
antidot for warfarin?
antidote for heparin?
surgical management for DVT?
possible complications from DVT?
medications to know: