1
Q
perfusion
A
circulation of blood through the vascular bed of tissue
2
Q
pericardium
A
- double layer of fibroserous membrane covering the heart
- anchors heart to surrounding structures, forming pericardial sac
- snug fit prevents heart from over filling with blood
3
Q
layers of the pericardium
A
- inner: partiel pericardium
- outer: visceral pericardium or epicardium
4
Q
layers of the heart
A
- 3 layers
- endocardium
- myocardium
- epicardium
5
Q
epicardium
A
- covers entire heart and great vessels
- than folds over to form the parietal layer, lining the pericardium and adheres to the surface of the heart
6
Q
myocardium
A
- middle layer
- consists of specialized cardiac muscle cells (myofibrils)
7
Q
myofibrils
A
specialized cardiac muscle cells
8
Q
endocardium
A
- innermost layer
- thin membrane composed of 3 layers
9
Q
Chambers of the heart
A
- 4 hollow chambers
- 2 Atria (R/L)
- 2 Ventricles (R/L)
10
Q
Ventricles are separated by…
A
Interventricular Septum
11
Q
Blood flow through the heart (include all valves/oxygenated blood/arteries/veins)
A
- Right Atrium recieves deoxygenated blood from inf/sup vena cava
- Right Atrium pumps deoxygenated blood through (AV) tricuspid valve into the Right ventricle
- Right Ventricle pumps deoxygenated blood to the lungs through the pulmonary artery (semilunar)
- Oxygenated blood empties into Left atrium from lungs and pulmonary veins
- Left atrium pumps oxygenated blood into the left ventricle through the bicuspid(mitral) valve
- Left ventricle pumps oxygenated blood into the aorta through the aortic valve
- Blood flows to the rest of the body
12
Q
vein
A
blood from body to heart
13
Q
artery
A
heart to body
14
Q
Heart sounds are..
A
the sound made when the heart valves close
15
Q
“lub dub”
A
S1 and S2
16
Q
S1
A
AV valves closing
17
Q
S2
A
- “dub”
- semilunar (Aortic and Pulmonic) valves closing
18
Q
AV valves close when…
A
ventricles fill
19
Q
Semilunar valves close when…
A
ventricles empty
20
Q
Systole
A
- Phase of ventricle contraction
- ventricles filled and contract, expelling blood into aorta and pulmonary artery
- begins with closure of the AV valves (S1) and ends with the closure of the semilunar valves (S2)
21
Q
Diastole
A
- Phase of ventricular relaxation
- Ventricles relax and fill during atrial contraction
- begins with the closure of semilunar valves (S2) and ends with the closure of the AV valves (S1)
22
Q
Murmurs
A
harsh, blowing sounds cause by disruption of blood flow into the heart, between the chambers, or into the vascular system
23
Q
systolic murmur
A
S1 unclear and S2 amplified
24
Q
panstolic murmur
A
one beat, no “lub dub”
25
Who grades murmurs?
MD or ARNP - NOT nurses
26
Documentation of Heart sounds
* do not say "present"
* "S1 and S2 ausculated clearly, no murmur or extra heart sounds ausculated"
27
Pulse
* wave of blood created by contraction of the left ventricle
* Generally represents SV output or the amount of blood that enters the arteries with each ventricular contraction
28
Compliance of the artery
ability to contract and expel
29
peripheral pulse
away from the heart; foot or wrist
30
central pulse
carotid
31
PMI
point of maximal impulse; heart, apex
32
Pulse locations
33
Pulse: Increased age
decreased pulse
34
Pulse: after puberty, men..
lower pulse than females
35
Pulse: increased exercise
increased pulse (during), decreased pulse (resting)
36
Pulse: high stress
high pulse
37
Pulse: high fever
high pulse
38
Pulse: hypovolemia
(low blood volume) high pulse
39
Pulse: Meds
depends
40
Pulse: Position change
Usually, low BP, high pulse
41
Pulse: Pathology
depends
42
Assessment for Pulse
* fingertip pads
* radial -most common for adults
* brachial for infants
* assess rhythm
* pulse volume
* elasticity
* compare peripheral pulses
* check apical pulse
* count pulse for full min w/ infants/children
* count 30 sec x2 for adults
* apical-radial pulse - check for deficit
43
Pulse volume
* bounding (strong/hydrated)
OR
* threading (weak/dehydrated)
44
Elasticity of artery
* Smooth/soft
* hardened (hardens with age)
45
tachycardia
above 100 (anxiety, pain, exercise)
46
bradycardia
below 60 (usually athletes)
47
Tip for finding pulse
If you can't find it, take some pressure off
48
Apical-Radial Pulse Deficit
* Apical will never be lower than radial
* If a difference, there is a pulse deficit
49
Systolic BP
pressure in systemic arteries when left ventricle contracts
50
Diastolic BP
pressure between contractions - heart at rest
51
AHA Guidelines Recommended BP
(Sys) Lower than 120/Lower than 80 (Dia)
52
BP: Baby
low BP; increases slowly to puberty
53
BP: males
higher BP than women until menopause
54
BP: Blacks
higher BP than whites; sensitive to salt
55
BP: Obesity
high BP
56
BP: Exercise
high BP during exercise
57
BP: Stress
high BP
58
BP: diurnal variations
BPs lower in AM
59
Types of BP Assessment
* electronic
* manual
* doppler - noninvasive
* arterial line - invasive
locations: usually arm; can use thigh or wrist
60
Where to not take BP
limb if injured/diseased, cast or dressing, lymph nodes removed, IV in arm, AV fistula for dialysis
61
BP Measurement
* There is 1 step & 2 step
* cuff in correct position and correct size cuff
* Pump up cuff
* Slowly release pressure
* Watch manometer and listen for Korotkoff phases
62
Korotkoff Phases
1. **1st tapping sound heard- systolic**
2. swishing/whooshing sound
3. thump; softer than phase 1
4. softer blowing muffled sound that fades (some use this as diastolic)
5. **silence/last sound - diastolic**
63
Orthostatic Hypotension
* peripheral vasodilation occurs when standing up
* dizzy, lightheaded, may faint due to decreased blood to brain
* causes: dehydration, bleeding, BP meds or narcotics
64
How to access for Orthostatic Hypotension
* check BP/Pulse while in supine position
* Sit up and recheck BP/Pulse
* Repeat in 3 min and document
65
low ejection fraction
high BP due to not a lot of blood being pumped out
66
low CO (cardiac output)
low BP, high pulse
67
Perfusion Assessment Documentation
* color and warmth of extremities
* pulses
* heart sounds
* capillary refill
* presence of edema
68
Diagnostic tests of cardiac function
* Serum cholesterol
* Stress/Exercise test - chest pain
* Xray, CT, MRI
* Echocardiogram - heart activity
* cardiac catheterization
* EKG
* Serum cardiac enzymes
69
RN's role in diagnostic testing
Regardless of which test is being done, the nurse is responsible for the education of the procedure, montioring for appropriate meds, any prep needed.
70
Infant/children considerations for assessing CV health
* pediatric stethoscope in infants
* thigh & arm BP equal in infants
* thigh BP 10mmHg higher than arm in children
71
Older Adult considerations for assessing CV health
* skin fragile
* consider antihypertensive meds
72
Modifiable risks factors for cardiac health
* smoking
* HTN
* Hypercholesterolemia
* Obesity
* Physical activity
* Diabetes
73
Non-modifiable risk factors for cardiac health
* age
* gender
* race
* family hx
* personal health hx
74
Genetic/Ethnic Considerations for Cardiac health
* heart dx runs in families
* cardiomyopathies
* CAD:coronary artery dx
* Atherosclerosis
* Arrhythmias
* Blacks at higher risk for heart failure, HTN, low HDL
* High risk for MI in woman after menopause
* Men more likely to have MI earier in life
75
Cognition
LOC: level of conscientiousness
* low blood supply to brain; confusion/dizzy
76
Comfort
low perfusion may manifest as pain
77
Oxygenation
low perfusion can cause respiratory distress
78
Statins
inhibits cholesterol biosynthesis
79
Vasodilators
cause dilation of blood vessels, lowers BP
80
Beta Blockers
block beta-adrenergic sites in heart, lowers BP
81
ACE Inhibitors
inhibits vasoconstriction; lowers BP
Fundamentals Exam 1
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