Medsurg - Cardio (Short) PDF

MEDICAL SURGICAL NURSING EXTRA HEART SOUNDS PERFUSION S3-ventricular gallop → CHF S4 – atrial gallop → MI, HPN A. OVERVIEW OF THE STRUCTURE...

MEDICAL SURGICAL NURSING EXTRA HEART SOUNDS PERFUSION S3-ventricular gallop → CHF S4 – atrial gallop → MI, HPN A. OVERVIEW OF THE STRUCTURE & FUNCTION OF THE CARDIOVASCULAR SYSTEM I.HEART ❖ muscular pumping organ of the bodys ❖ Occupies most of the left mediastinum ❖ Covered by a serous membrane → pericardium 1. Parietal 2. Visceral IV. CORONARY ARTERIES ❖ Pericardial fluid in between - 10-30 cc Both supply the myocardium with blood ❖ Arises from the base of the aorta Layers 1. Epicardium 2. Myocardium 3. Endocardium II. CHAMBERS Atria – collecting/receiving chambers Ventricles – lower chambers, pumping/ contracting chamber V. CARDIAC CONDUCTION SYSTEM III. VALVES A. SA node Atrioventricular valves RA junction 1. Tricuspid pacemaker 2. Mitral Initiates electrical impulse (60-100 bpm) closure of AV valves = S1 or first heart sound → “LUB” B. AV node Semilunar valvesS Delay of electrical impulse allows 1. Pulmonic for ventricular filling 2. Aortic closure of SV – S2 or second heart sound →”DUB” C. Bundle of His R & L main bundle branch Interventricular septum D. Purkinje fibers FACTORS MODIFYING HEART RATE Ventricular contractions 1. Neural (ANS) controls Located at the walls of ventricles 2. Hormones & ions Purkinje cells 3. Physical factors Characteristics of a Cardiac Cell 1. Neural (ANS) controls ❖ Automaticity: ability to initiate an electrical ❖ sympathetic division of impulse the ANS stimulate SA & ❖ Excitability: ability to respond to an electrical AV nodes & the cardiac impulse muscle to beat more rapidly ❖ Conductivity: ability to transmit an electrical ❖ Sympathetic nerve pathway releases impulse from one cell to another noradrenaline which increases heart rate ❖ parasympathetic nerve STROKE VOLUME (vagus nerves) slow & ❖ volume of blood pumped out by a ventricle with steady the heart each heart beat (average 60 - 130 ml/min) ❖ Parasympathetic pathway releases acetylcholine which decreases heart rate Cardiac Output (CO) ❖ amount of blood pumped out by each ventricle in 1 min (average 4 - 6 L/min) Regulation of Stroke Volume (Epinephrine- adrenal medulla Starling’s Law of the Heart - Increases HR Thyroxine - thyroid gland ❖ how much the cardiac - Increases HR muscle cells are stretched Electrolyte Imbalances - interfere with muscle contraction) before they contract venous return 3. Physical factors ❖ amount of blood Age (fetus 140-160bpm) entering Sex- females ( 72-80 bpm); the heart - males (64-72 bpm) Exercise Muscular pump Body temperature ❖ enhanced squeezing action of active skeletal muscles B. CARDIOVASCULAR ASSESSMENT 1. History 2. PE 3. Diagnostic & Laboratory Findings (CV ASSESSMENT) HEALTH HISTORY Chief complaints description of present illness Chest pain (scale, quality, location, radiation, duration) dyspnea  syncope (dizziness, changes in LOC) ❖ LIPID PROFILE (Cholesterol, Triglycerides, pallor/ cyanosis LDL, HDL) edema/ weight gain (abdominal distention, ❖ HOMOCYSTEINE (tHcy) ascites) ❖ High-Sensitivity C-reactive protein (hs-CRP) palpitations LIPID PROFILE extremity pain cholesterol, triglycerides, & lipoproteins fatigue (vital exhaustion) ❖ evaluate a person’s risk of developing atherosclerosis PAST HEALTH, FAMILY & SOCIAL HISTORY ❖ Cholesterol & triglycerides + plasma proteins = Medications lipoproteins Nutrition ❖ Lipoproteins : low-density lipoproteins (LDLs) Elimination & high-density lipoproteins (HDLs) Sleep & rest ❖ CAD Activity & exercise ❖ blood specimen - after a12-hour fast Self perception & concept Roles & relationships Cholesterol (