Cardiovascular Nursing Care Quiz Medium

Cardiovascular Nursing Care

• Cardiac Function and Pathophysiology:
  • The heart has three layers and four chambers, with four valves.
  • The right side of the heart carries deoxygenated blood.
  • The left side of the heart carries oxygenated blood from the lungs.
  • Valves include tricuspid (between right atrium and ventricle), pulmonic (between right ventricle and pulmonary artery), mitral (between left atrium and ventricle), and aortic (between left ventricle and aorta).

Cardiac Output

• The amount of blood pumped by the left ventricle in one minute is cardiac output.
• Cardiac output is determined by stroke volume multiplied by heart rate.
• Factors affecting cardiac output include preload, afterload, and contractility.
• Ejection fraction measures the percentage of blood ejected from the left ventricle with each heartbeat (normally between 55-70%).
• Venous return (preload) equals the amount of blood returning to the right atrium.
• Contractility is the force of heart contraction, influenced by hormones and venous return

Pathophysiology – Aging and the Cardiovascular System

• Atherosclerosis narrows arterial lumens, increasing afterload and blood pressure.
• Rough arterial surfaces increase clot risk.
• Decreased blood flow occurs to vital organs.
• Heart muscles become less efficient.
• Cardiac output decreases.
• Atypical symptoms may mask myocardial infarction.
• Conduction cells become less efficient.
• Dysrhythmias become common.
• Valves thicken and calcify.
• Murmurs may be present.

Health Data Collection

• Patient health history, physical examination, and subjective data are gathered.
• Specific tables (21.1, 21.2) are likely referenced in the full text.

Measuring Blood Pressure

• Normal blood pressure is 120/80.
• Measure blood pressure in both arms for baseline comparison.
• If readings differ, use the higher-pressure arm for future measurements.

Orthostatic Blood Pressure

• Orthostatic blood pressure is assessed when the patient moves from lying to sitting to standing positions.
• A decrease of more than 15 mm Hg in systolic pressure and an increase of more than 20 beats per minute in pulse rate indicates orthostatic hypotension.
• Common associated symptoms include lightheadedness and syncope.
• Common causes are fluid volume deficit, diuretics use, and pain.

Pulses

• Count the apical pulse for a full minute.
• Normal apical pulse rate is 60-100 beats per minute.
• Compare apical and radial pulse rates and qualities.
• Peripheral pulse quality can range from 0 (non-palpable) to 3+ (bounding).

Respirations

• Respiratory rate and work of breathing are assessed.
• Pink, frothy sputum indicates pulmonary edema (acute heart failure).
• A dry cough may signal heart failure.

Inspection

• Observe skin color, mucous membranes, and peripheral extremities.
• Pale or ashen coloration can signal decreased arterial blood flow.
• Findings such as cyanosis, grayish skin, or discolored extremities signal potential hypoxia or other circulatory issues.
• Observe for dependent rubor (reddish purple discoloration in dependent areas) and pallor as clues to arterial or venous disorders; this would be seen when comparing lower extremities when elevated to when the patient is standing or sitting upright.
• Inspect for varicose veins, stasis ulcers, scars, and swelling (potentially venous thrombosis-related).
• Inspect for presence of jugular venous distention suggesting potential volume overload or right-sided heart failure.
• Look for clubbing (associated with congenital heart disease or chronic lung disease).

Palpation

• Assess the point of maximum impulse (PMI).
• Measure body temperature.
• Assess for edema.

Auscultation

• Auscultate heart sounds (S1, S2 are normal; S3, S4 abnormal).
• Listen for murmurs (turbulent blood flow through one or more valves that may indicate valve disorders).
• Listen for pericardial friction rubs.

Blood Tests-Cardiac Biomarkers

• Troponin and CK-MB measure proteins and enzymes released by damaged cardiac cells.
• These biomarkers are used to diagnose myocardial infarctions.
• Troponin elevations are detected 2-6 hours after an event and can remain elevated for 5-7 days.
• CK-MB elevation is apparent 4-6 hours after an event; it typically remains elevated for 24–36 hours.

Blood Tests-Lipids

• Lipid tests (e.g., cholesterol) assess risk for coronary artery disease (CAD).
• Patients usually fast for 6-12 hours to allow for accurate reading; avoid alcohol for 24 hours before.
• Water consumption before the test is okay.
• High levels of low-density lipoproteins (LDL) and triglycerides are risk factors for CAD.

Electrocardiogram(ECG)

• Records the electrical activity of the heart to assess for dysrhythmias, enlarged heart chambers, myocardial ischemia/infarction, electrolyte imbalances, and pericarditis.
• Includes ambulatory ECG monitoring and Holter monitoring, and specific lead placement locations are detailed in the provided diagrams.

Echocardiogram

• This is an ultrasound-based visual test that aids in determining structural heart problems.
• The method includes trans-esophageal ultrasound (requires throat anesthesia) and regular ultrasound and should be preceded by a 6-hour NPO period.
• The echocardiogram helps to assess heart structures (valves, size, shape), blood flow through the heart.

Exercise Stress Test

• Evaluates the heart's ability to respond to increased oxygen demands.
• Evaluates peripheral vascular disease
• A physical exerciser like a treadmill, stairs or stationary bicycle may be used
• A non-exercise stress test using drugs (dipyridamole, or adenosine) to stress the heart may be used for patients unable to exercise.
• The non-pharmacological test is stopped if intermittent claudication develops.

Doppler Studies

• Ultrasound images are used for assessing blood vessels for occlusions and clots.
• Arterial and venous issues are assessed.
• This is a non-invasive test.

Invasive Studies-Cardiac Catheterization

• This involves inserting a flexible tube into arteries or veins and guiding it to the heart to examine for obstructions, open occluded arteries, and measure pressure, oxygen saturations, and cardiac output.
• It can involve insertion in the wrist, groin, forearm, or neck.

Angiography and Cardiac Catheterization

• Pre-procedural considerations include assessing the patient for prior contrast dye reactions.
• Patients are given an NPO (nothing by mouth, except water which may be allowed) status 8 hours before the procedure.
• The procedure requires hydration and is performed under local anesthesia and sedation, potentially supplemented with IV fluids.
• Vital signs and ECG monitoring are continuously performed pre and post-procedure.

Post-Cardiac Catheterization

• Pressure is applied to insertion sites (likely groin) to prevent hematoma or retroperitoneal bleeding.
• Vital signs and pulses are closely monitored.
• Patients need bedrest and avoid leg flexion if a groin insertion site was used, for a prescribed time.
• Fluid intake is encouraged to flush dye.

Medications for the Cardiovascular System

• Common medication classes addressed are antihypertensives, antianginals, anticoagulants, cardiac glycosides, thrombolytics, and vasodilators.
• Grapefruit and some citrus fruits can interact with some medications, potentially increasing toxicity risk.

Evidence-based Therapeutic Measures

• Various devices and procedures for preventing blood clots and supporting the cardiovascular system and peripheral blood flow are mentioned.
• These include antiembolism devices, stockings, non-medical support hosiery, and intermittent pneumatic compression.
• Oxygen and medication treatment may be used as well as cardiac surgery as needed.

Health Teaching

• Patients benefit from education to manage cardiac conditions effectively.
• This includes advice on a healthy diet (e.g., limiting saturated fats, sodium) and healthy lifestyle choices, such as consuming more fruits, vegetables, and fish.
• Smoking cessation, oxygen safety (no smoking or open flames) , and proper application of antiembolism stockings are essential aspects of patient education.

Cardiovascular Disease in the U.S.

• Cardiovascular disease is a very significant problem and leading cause of death in the US, affecting millions.
• Lifestyle factors and access to high-quality care play vital roles.

Review

• The review includes key topics such as cardiac anatomy, physiology, health history, diagnostic tests, medications, evidence-based practice and health teaching specific to cardiovascular health in the United states.