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Questions and Answers
What is the term used to describe the ability of cardiac muscle to initiate a heartbeat continuously and regularly without external stimulation?
What is the term used to describe the ability of cardiac muscle to initiate a heartbeat continuously and regularly without external stimulation?
Autorhythmicity
Which of the following is a primary cause of sinus bradycardia?
Which of the following is a primary cause of sinus bradycardia?
Match the following terms related to cardiac hemodynamics with their respective definitions.
Match the following terms related to cardiac hemodynamics with their respective definitions.
Stroke Volume (SV) = Amount of blood ejected with each heartbeat Preload = Degree of stretch of cardiac muscle fibers at the end of diastole Afterload = Resistance to ejection of blood from the ventricle Ejection Fraction = Percentage of end diastolic volume ejected with each heartbeat Cardiac Output (CO) = Amount of blood pumped by the ventricle per minute
A 1-minute rhythm strip, used in electrocardiography, contains 300 large boxes and 1,500 small boxes.
A 1-minute rhythm strip, used in electrocardiography, contains 300 large boxes and 1,500 small boxes.
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Atrial fibrillation is the most common sustained dysrhythmia, characterized by rapid, disorganized, and uncoordinated twitching of the atrial musculature.
Atrial fibrillation is the most common sustained dysrhythmia, characterized by rapid, disorganized, and uncoordinated twitching of the atrial musculature.
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What specific type of diagnostic test or procedure is commonly used to diagnose structural and functional diseases of the heart and great vessels, often involving the measurement of cardiac chamber pressures?
What specific type of diagnostic test or procedure is commonly used to diagnose structural and functional diseases of the heart and great vessels, often involving the measurement of cardiac chamber pressures?
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What is the typical range for the heart rate in an adult with normal sinus rhythm?
What is the typical range for the heart rate in an adult with normal sinus rhythm?
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What is a common medication that may be used to address bradycardia that produces signs and symptoms of clinical instability?
What is a common medication that may be used to address bradycardia that produces signs and symptoms of clinical instability?
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Ventricular tachycardia (VT) is defined as the occurrence of three or more premature ventricular complexes (PVCs) in a row, at a rate exceeding 100 beats per minute.
Ventricular tachycardia (VT) is defined as the occurrence of three or more premature ventricular complexes (PVCs) in a row, at a rate exceeding 100 beats per minute.
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Which of the following is a common intervention in the medical management of atrial fibrillation?
Which of the following is a common intervention in the medical management of atrial fibrillation?
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What is the primary mechanism by which the heart's pumping ability is impaired by bradycardic rhythms and why does this occur?
What is the primary mechanism by which the heart's pumping ability is impaired by bradycardic rhythms and why does this occur?
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What is the crucial factor that differentiates cardioversion from defibrillation?
What is the crucial factor that differentiates cardioversion from defibrillation?
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Ventricular asystole is characterized by the absence of QRS complexes on an ECG, while P waves may be visible for a short duration.
Ventricular asystole is characterized by the absence of QRS complexes on an ECG, while P waves may be visible for a short duration.
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What is the specific term for the flat line on the ECG that indicates the absence of electrical activity in the ventricles?
What is the specific term for the flat line on the ECG that indicates the absence of electrical activity in the ventricles?
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What are the primary nursing diagnoses that might be considered for a patient experiencing a dysrhythmia?
What are the primary nursing diagnoses that might be considered for a patient experiencing a dysrhythmia?
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What is the commonly used term for a medical device that delivers a shock to the heart to terminate an arrhythmia.
What is the commonly used term for a medical device that delivers a shock to the heart to terminate an arrhythmia.
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In defibrillation, the delivery of electrical current is synchronized with the patient's electrical events.
In defibrillation, the delivery of electrical current is synchronized with the patient's electrical events.
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Which of the following is NOT a common cause of atrial fibrillation?
Which of the following is NOT a common cause of atrial fibrillation?
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Which type of dysrhythmia is most frequently associated with a risk of stroke?
Which type of dysrhythmia is most frequently associated with a risk of stroke?
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The electrical impulse that travels through the heart and is recorded on an electrocardiogram starts at the ______.
The electrical impulse that travels through the heart and is recorded on an electrocardiogram starts at the ______.
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The ST segment on an ECG represents early ventricular repolarization and is typically isoelectric.
The ST segment on an ECG represents early ventricular repolarization and is typically isoelectric.
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What is the term used to describe the electrical activity recorded on an ECG when there is no electrical activity detected, and the line remains flat?
What is the term used to describe the electrical activity recorded on an ECG when there is no electrical activity detected, and the line remains flat?
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What type of assessment is considered essential before a patient undergoes cardiac catheterization?
What type of assessment is considered essential before a patient undergoes cardiac catheterization?
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Which type of medication is commonly used to treat atrial flutter and often involves rapid IV administration?
Which type of medication is commonly used to treat atrial flutter and often involves rapid IV administration?
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One important aspect of nursing care for a patient with dysrhythmia is to educate the patient about self-care, including medication management, pulse monitoring, and recognizing symptoms.
One important aspect of nursing care for a patient with dysrhythmia is to educate the patient about self-care, including medication management, pulse monitoring, and recognizing symptoms.
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Besides medications, what other modalities are often used to manage dysrhythmias when medication alone proves ineffective or in certain emergency situations?
Besides medications, what other modalities are often used to manage dysrhythmias when medication alone proves ineffective or in certain emergency situations?
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The amount of voltage used in cardioversion and defibrillation is typically the same for both procedures.
The amount of voltage used in cardioversion and defibrillation is typically the same for both procedures.
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Which of the following is a key nursing intervention in the management of a patient with dysrhythmia?
Which of the following is a key nursing intervention in the management of a patient with dysrhythmia?
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Study Notes
Adult Care Nursing I / Theory 2024-2025 Lectures 12-14
- Unit 6, Chapter 25: Assessment of Cardiovascular Function
- Objectives include describing the relationship between anatomy and physiology of the cardiovascular system, and discussing indications, patient preparation, nursing implications for common tests & procedures used to assess & diagnose cardiovascular disease.
Anatomy of the Heart
- Structures like superior vena cava, right pulmonary artery, interatrial septum, pulmonary veins, pulmonic valve, right atrium, tricuspid valve, inferior vena cava, right ventricle, aortic arch, left pulmonary artery, descending aorta, pulmonary veins, left atrium, aortic valve, mitral valve, left ventricle, chordae tendinae, papillary muscle, interventricular septum, endocardium, myocardium, epicardium, visceral pericardium, parietal pericardium, and pericardial space are key anatomical components.
- Diagrams illustrate the flow of oxygenated and deoxygenated blood.
Cardiac Conduction System: Electrophysiology
- The SA node (60-100), AV node (40-60), right bundle branch (20-40), left bundle branch (20-40), and Purkinje fibers are part of the system, which create electrical impulses to control the heartbeat.
- Diagrams illustrate the locations and connections of these components.
Pulmonary and Systemic Circulation
- Diagrams illustrate the flow of blood through the pulmonary and systemic circuits, including the heart, arteries, veins, and capillaries.
- Key vessels and structures (e.g., anterior vena cava, pulmonary artery, capillaries of the right lung, pulmonary vein, right atrium, right ventricle, posterior vena cava, aorta, capillaries of the left lung, pulmonary vein, left atrium, left ventricle, and capillaries of abdominal organs and hind limbs) are highlighted.
Cardiac Hemodynamics
- Stroke volume (SV): The amount of blood ejected with each heartbeat (60-130 mL at rest).
- Preload: The degree of stretch of cardiac muscle fibers at the end of diastole (EDV).
- Afterload: The resistance to ejection of blood from the ventricle.
- Ejection fraction: The percentage of end-diastolic volume ejected with each heartbeat (55%-65% for the left ventricle).
- Cardiac output (CO): The amount of blood pumped by the ventricle per minute (about 4 to 6 L/min at rest).
- CO = SV × HR (L/min).
Assessment
- Health history: Includes family history, medications, nutrition, elimination, activity/exercise, sleep/rest, self-perception/self-concept, roles/relationships.
- Physical examination: Includes heart inspection, palpation, auscultation, vital signs, sexuality/reproduction, coping/stress tolerance, and prevention strategies.
- Risk factors: Modifiable and nonmodifiable risks.
Diagnostic Evaluation
- Laboratory tests: Include lipid profile, brain natriuretic peptide (BNP), C-reactive protein, homocysteine (atherosclerosis), blood chemistry, hematology, coagulation, & proteins.
- Cardiac biomarkers include creatine kinase (CK), CK isoenzymes (CK-MB), myoglobin, troponin T and I (indicative of cardiac damage).
Electrocardiography
- Techniques: 12-lead ECG, 15-lead ECG, 18-lead ECG, continuous monitoring (hardwire, telemetry, Holter monitor), cardiac event recorders, and cardiac implantable electronic devices (e.g., mobile cardiac telemetry).
- Cardiac Stress Testing: Pt walks on treadmill to measure heart response to added stress on heart (exercise stress test) or pharmacologic agents to mimic exercise.
- Echocardiography (noninvasive ultrasound): Used to measure ejection fraction and examine cardiac structures (e.g., valves, ventricular walls).
- Transthoracic or Transesophageal testing techniques.
- Radionuclide imaging (e.g., myocardial perfusion imaging, SPECT, PET): Used to assess ventricular function & wall motion.
- Additional imaging: Includes computed tomography (CT) scan and magnetic resonance angiography (MRA).
Cardiac Catheterization
- Invasive procedure for diagnosing structural & functional heart & great vessel diseases.
- Used to measure cardiac chamber pressures and assess coronary artery patency.
- Includes Right Heart Cath (evaluates right ventricle, tricuspid and pulmonary valves, pulmonary artery pressure, oxygen saturations), Left Heart Cath (evaluates aortic arch, major branches, coronary artery patency, mitral and aortic valves).
Nursing Interventions-Cardiac Cath
- Assessment: Health history, allergies, blood work, prior to and after the procedure. Post-procedure steps: Assess cath site for bleeding, hematoma and peripheral pulses, evaluate temp, color, and cap refill of the affected extremity, screen for dysrhythmias, impose activity restrictions, and monitor for complications including contrast-induced nephropathy.
Unit 6, Chapter 26: Management of Patients With Dysrhythmias & Conduction Problems
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Normal Electrical Conduction includes structures such as SA node, AV node, Bundle of His, and right & left bundle branches, Purkinje fibers. Depolarization (electrical stimulation) = Systole, and Repolarization (electrical relaxation) = Diastole
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Properties of cardiac muscle fibers include Autorhythmicity (ability to initiate a heart beat), Excitability (respond to strength on stimulus), Conductivity and Contractility.
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The Electrocardiogram (ECG) reflects the electrical activity of the heart, electrode placement and adhesion are key for interpreting the ECG.
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Types of ECG include 12, 15 or 18 lead ECG, Hardware monitoring, telemetry and Holter monitor. Components of an ECG include, P wave, QRS complex, T wave, U wave, PR interval, ST segment, QT interval, TP interval, and PP interval, and 12-Lead ECG placement diagrams.
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Measurements of components from the ECG include time and rate and amplitude. Time and rate measurements are on the horizontal axis and the amplitude is on the vertical axises. Deflection is positive when moved upward and negative when moved downwards on the paper.
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Diagrams of P wave and QRS complex, QRS complex, T wave and U wave.
Dysrhythmias
- Disorders in heart's electrical impulses, including rate or rhythm.
- Can have life-threatening consequences and affect rate, rhythm, or both.
- May alter blood flow, causing hemodynamic changes (decrease cardiac output & blood pressure).
- Diagnosed by analyzing ECG waveform interpretations (i.e. normal rhythms or abnormal rhythms)
Consequences of Dysrhythmias
- Interfere with the heart’s pumping ability.
- Bradycardic rhythms (impacts blood flow)
- Tachycardic rhythms (shortened diastolic filling time)
- Atrial dysrhythmias reduce cardiac output.
- Ventricular dysrhythmias dramatically reduce diastolic filling leading to low cardiac output, absence of pulse, and hypotension
Etiology (causes) of Dysrhythmias
- Hypoxia, Shock, Poisoning, Drug ingestion, Myocardial Infarction(MI), Congestive Heart Failure (CHF)
- Pulmonary disorders, Electrolyte imbalances (e.g. hypokalemia), Metabolic imbalances
- Mechanisms associated with Atrial Fibrillation (AF) include atrial scar, atrial stretch/hypertrophy, mitral stenosis/regurgitation, arterial stenosis/regurgitation, myocardial degeration, advanced age, tachycardia, etc)
- Manifestations (symptoms) of dysrhythmias include irregular rate/rhythm, palpitations, chest/neck/shoulder/arm pain, dizziness, dyspnea, extreme restlessness, decreased level of consciousness, weakness, fatigue, numbness of arms/legs, cold skin, nausea, and vomiting, decreased BP, and low oxygen saturation.
- Normal Sinus Rhythm (NSR): Normal electrical impulses, with ventricular & atrial rate of 60-100 beats/min, regular rhythm, normal QRS shape & duration less than 0.12 sec, consistent shape of P-wave, before QRS, consistent PR interval (0.12-0.20 seconds), and P:QRS ratio of 1:1.
- Types/causes of Sinus Node Dysrhythmias, Atrial Dysrhythmias, Junctional Dysrhythmias, and Ventricular Dysrhythmias are given.
- Examples of some types of dysrhythmias include sinus bradycardia, sinus tachycardia, and sinus arrhythmia, atrial flutter, atrial fibrillation (AF), premature atrial complexes (PACS), junctional dysrhythmias and ventricular tachycardia (VT), ventricular fibrillation (VF), and Ventricular asystole.
Nursing Process: Dysrhythmia Assessment
- Causes, contributing factors
- Assessment of cardiac output and oxygenation
- Review of prior occurrences & possible causes of the dysrhythmia
- Psychosocial assessment: (patient's perception) of dysrhythmia
- Physical Assessment: vital signs, signs of fluid retention (jugular venous distension, lung auscultation), signs of decreased cardiac output (altered LOC), heart sounds, blood pressure/pulse pressure.
Nursing Diagnoses
- Decreased cardiac output related to inadequate ventricular filling or altered heart rate
- Anxiety related to fear of the unknown outcome of altered health state
- Deficient knowledge about the dysrhythmia and its treatment
Collaborative Problems/Potential Complications
- Cardiac arrest
- Heart Failure (HF)
- Thromboembolic event (especially with AF)
Nursing Interventions
- Monitor and manage the dysrhythmia, minimize anxiety, promote home & community-based care, educate the patient about self-care and continuing care
- Assessments include assessing vital signs, light-headedness, dizziness, fainting, 12-lead ECG, continuous monitoring, rhythm strips periodically.
- Minimize anxiety: Stay with patient, maintain safety and security, discuss emotional response, help patient develop a system for identifying contributing factors, maximize patient control.
- Educate the patient on treatment options, therapeutic medication levels, pulse monitoring before medication administration, recognizing symptoms, measures to decrease recurrence, and plans of action for emergencies (CPR).
- Address adjunctive modalities (Pacemakers, Cardioversion, Defibrillation), and their medical management. These are used when medication alone is not effective
- Patient safety measures during cardioversion/defibrillation (e.g., good contact, conductive medium pressure, synchronizer).
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Description
This quiz covers Unit 6, Chapter 25 of Adult Care Nursing I, focusing on the assessment of cardiovascular function. It includes objectives related to the anatomy and physiology of the cardiovascular system and essential nursing implications for diagnostic procedures. Test your knowledge of heart structures and their roles in the circulatory system.
