Nursing Concepts 4 (Review Set 1)
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- How should blood pressure be taken for cardiovascular patients and what is this called?
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Orthostatic/postural blood pressure
(Sitting, lying and standing) - When checking vital signs for cardiovascular patients what should be noted as normal/abnormal findings
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15 –mm hg drop in systolicpressure
10-mm hg drop in diastolic
15 – 20 beats/min when measuring orthostatic/postural blood pressure - Explain the rational for appropriate cuff size
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Too small BP cuff = higher than normal reading
Too large BP cuff = lower than normal reading - When blood pressure is taken in both arms what are considered normal readings?
- 5 – 15 mm hg difference larger difference indicates pathology
- Explain: Assessment of large neck vein
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Head of bed should be elevated at 35 degrees
Distention and arterial pulsations can be seen with right atrial pressure elevation - A narrowed artery may create a buzzing sound, what is this called?
- bruit
- Normal pulses feel like a “tapâ€. A vessel wall will vibrate this is called a
- Thrilled
- Explain: Where should the PMI be palpated?
- Firth intercostals space (ICS), mid-clavicular line. If palpatred to the left of the mid-clavicular line, the heart may be enlarged. THE PMI should only palpated in one ICS in a healthy heart
- Explain: Aortic Area
- Reflects closure of the aortic valve, located at the second ICS right sternal border
- Explain: Pulmonic (as it relates to location)
- Reflects closure of the pulmonic valve at the second ICS to the left of the sternal border
- Explain: Erb’s Point (as it relates to location)
- Reflects closure of the pulmonic vlave at the third ICS left sternal border
- Explain: Tricuspid (as it relates to location)
- Closure of the tricuspid valve, best heard at the fifith ICS left of the sternal border
- Explain: Mitral Area (as it relates to location)
- Close of the mitral vavle at the fifth ICS mid-clavicular line
- Explain: “APE To Manâ€
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A = aortic area
P = pulmonic area
E = Erb’s point
T = tricuspid
M = mitral Area - Explain: Arteriosclerosis
- Loss of elasticity of the arteries due to build up of calcium on the arterial walls (Hardening of the arteries)
- Explain: Atherosclerosis
- Most common cause of arterial disease, condition in which the lumen (space within the artery) fills with fatty deposits.
- Explain: Atheromas
- A deposit or degenerative accumulation of lipid-containing plaques on the innermost layer of the wall of an artery. Can occur in any artery, but prefer the coronaries
- What is ASCHD.
- Atherosclerosis
- Explain: Fatty streaks as it relates to the development of atherosclerosis
- Earliest lesion, characterized by lipid-filled smooth mscle cells have a distinctive yellow tinge, observable at age 15 and probably reversible. Enlarge as times goes by
- Explain: Raised fibrous plaques Explain: as it relates to the development of atherosclerosis
- 2nd stage, low density lipoprotein and growth factor from platelets stimulate smooth muscle proliferation and thickening of the arterial wall. Appears around age 30, arterial wall changes are intiated with chronic endothelium injury (example Hypertension) Although, the endothelium repairs itself usually, the injured endothelium in CAD does not
- Explain: Complicated Lesions
- Final stage and most dangerous. The core of the lipid material from within the dead tissue acumlates and becomes complex. The necrotic tissues causes rigidty and harderning. The raisd, hard lesion occludes the artery . If it ruptues, thrombus may form and if blood flow is obstructured, sudden cardiac death maybe possible due to lack of oxygen
- What does carbon-monoxide, a by product of combustion (from smoking) affect
- The capacity of oxygen carrying capacity of hemoglobin by decreasing the sites available for oxygen transport
- Explain: The affects of nicotine
- Causes the body to release catecholamines (epinephrine and norepinephrine) which increases the heart rate and blood pressure by stimulating vasoconstriction.
- Explain: The effects of smoking as it relates to platelets
- The smoke initiates platelet aggregation, which increases the possibility of thrombus formation and occlusion of the coronary arteries
- Explain: Cholesterol
- Created by all animals as a by product of fat, solid oil
- Explain: Fat as it relates to solubility
- Insoluble in Water , but are encased in water-soluble lipoprotein
- What are desired cholesterol level?
- 200 mg/dl and a higher ratio of HDL to LDL for heart health 3.5 to 1. HDL level of 35mg/dl is desired and a level of 60 mg/dl is ideal.
- What makes up HDL, LDL & VLDL’s
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HDL – ½ protein , ¼ phospholids and cholerterol.
LDL – cholersterol and moderate amounts of phospholipids
VLDL’s – endogenous triglycerdes (mixture of fatty acids) - How are cardiac risk factors assessed with cholesterol?
- By dividing the total cholerstal by the HDL level
- What does the American heart association recommend in terms of daily fat intake?
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30% fat
Less than 10% being saturated
Less than 300mg cholesterol for the general public
Heart disease recommendations differ
7% saturated fat
200Mg Cholesterol -
What is Hypertension
Requirements - Defined as blood pressure over 140/90
- What effects does hypertension have on the heart?
- Increased workload causes the heart to enlarge and thicken (hypertrophy) which leads to cardiac failure
- What are the effects of prolonged stress of hypertension to the heart?
- High shearing force that causes a denuding injury of the vessel lining. This injury leads to an inflammatory response in the intima, which imitates the aggregation of monocytes and platelets, which in turn can lead to partial or complete occlusion of arteries
- What effects do diabetes mellitus have as it relates to the heart
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Higher rate of CAD
Higher risk for connective tissue degeneration which can result in atheromas
Higher cholesterol nd triglyceride levels - What does diabetes mellitus have a predisposition for as it relates to the heart?
- Atheroma formation
- What is considered normal effects of exercise
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Prespiration
Heart rate increase 30 – 50 beats/min are all considered helpful - What effects do stress have as it relates to the heart ?
- Considered a risk factor for CAD because stress increases release of epinephjrine and nonrephinphrine, both of which increase heart rate, force of contraction and thus myocardial oxygen consumption
- Explain the effects of estrogen levels as it relates to the heart ?
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It is believed estrogen assist the vessels to maintain elasticity
Blood vessels that can accommodate an increase blood volume during pregnancy can avoid CAD & angina
When vessels become narrowed due to atherosclerosis it stretches to maintain adequate blood flow through the narrowed vessel - What are three medications that increase coronary vasodilatation and decrease in blood pressure
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Nitroglycerin
Beta adrenergic blockers
Calcium channel blockers - Why are antihyperlipidemic medications given?
- Decrease blood cholesterol and triglycerides levels which prevent additional plaque buildup. Exercise alone does not lower the serum levels
- What three medications are considered antihyperlipidemic medication?
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Gemfibrozil (Lopid)
Lovastatin (Mevacor)
Simvastatin (Zocor) - Explain: Side effects and purpose of Nicotinic Acid
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also known as niacin is a B vitamin that interferes with synthesis of cholesterol and triglycerides.
Side effects: Severe flushing, pruitis & GI distress - Explain: Side effects and purpose of Clofibrate
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Lowers triglycerides and lowers cholesterol
Side effects:
Malaise, nausea, diarrhea, occasional increase in live enzymes - Explain: Side effects and purpose of Gemfibrozil
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Lowers VLDL levels, increases HDL leels
Side effects: GI irritability - Explain: Side effects and purpose of Fenofibrate
- Effective in treating high serum triglyceride levels, Should not be used with statins
- Provide examples of statins
- Lovastatin, Pravastatin, Simvastatin, & Cerivastatin
- What purpose to statins serve?
- Inhibitors of biosynthesis of cholesterol they reduce the synthesis of cholersterol in the liver by blocking HMG-COA reductase, a key enzyme in cholesterol synthesis.
- What are side effects of statins?
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Rash, gas, abdominal cramps, constipation or diarrhea, headache, opacities ofeyes lenses and increased liver enzymes.
Note: Monitor liver enzymes and obtain a baseline eye exam - What are CVA & MI ?
- Thromboembolic disorder
- What does Ticlopidine (Ticlid) do?
- Interfere with platelet membrane function
- Explain: Side effects and purpose of Dipyridamole (Persantine)
- a vasodilator believed to inhibit platelet function due to its platelet adhesion inhibition qualities. This drug produces dose-related decreases in systemic and coronary vacular resistance, leading to decrease in systemic blood pressure and increase in coronary blood flow. Adverse reactions are usually minimal and transient. Hypotension is the most frequent side effect other reported adverse reactions are dizziness, abdominal distress, flushing and pruitus.
- Explain recommended sublingual nitrates administration
- Pain relieved in approximately three minutes, effect last 20 – 30 mins. Normal dose is one tablet, if there is no relief after three tablets medical attention is indicated.
- Provide general information about Nitroglycerin Paste
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Effective angina prophylaxis that is effect for 3 – 6hrs
Paste is measured onto provided paper and applied to the skin
Sites should be changed after each administration
Useful for nocturnal and unstable angina
Disadvantages are application is messy and repeated applications are required. - Provide general information about transdermal controlled nitrates
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Dosing is controlled either by reservoir or matrix
Advantages are maintenance of steady plasma levels within two hours, requiring only one application per day
Disadvantages are potential dose dumping in reservoir types if membrane is punctured - Provide general information about Isorbide dinitrate (Isordil Sorbitrate)
- Only one dose is needed per day, because their long acting
- Provide general information about intravenous nitroglycerin
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Has an immediate onset
Can be titrated to prevent, treat and stop acute attacks of angina
May be used in the treatment of acute myocardial infraction (MI)
Reduces blood flow by 15% - Explain: Afterload
- Pressure against which the heart must pump
- Provide general information about beta-adrenergic blockers
- Compete with ephinephrine and norepinephrine for available peripheral beta-receptor sites, they block the agonistic effect of these sympathetic neuro sympathetic neurotransmitters. They function as antihypertensives, they depress the automaticity of the sinus node, decrease AV node and intraventricular conduction velocity, and reduce myocardial oxygen emand
- Provide general information about cardioselective beta-blockers (including drugs falling under this label)
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Have greater affinity for beta 1 receptors in cardiac muscle than beta 2 receptors in bronchial and vascular musculature
Preferred for pts with respiratory distress such as COPA or Asthma
Cardioselectiveity is lost when meds are given in high doses
Should be use cautiously because bronchospams may result even in low doses
Drugs: atonally (tenormin), esmolo (Brevibloc), Acebutolo (Sectral) - Provide general information about the most frequently prescribed medication for hypertension, angina and MI (Including the med name)
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Metoprolo (Lopressor)
Has a preferential effect on Beta 1 adrenoceptors and is paritucaly effective in reducing heart rate, cardiac output at rest or activity
Reduce systolic pressure with activity
Side effects: Fatigue and sexual dysfunction (also reasons patients d/c med without health care consultant)
Side effects cease after time
Can be effective in subsequent myocardial damage - Provide general information about calcium blocking agents
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Lower the intracellular concentrations of calcium by reducing the calcium influx through the membranes
Blockage prevents a rise in calcium influx into the cells prevents a rise in calcium levels with resultant diminished vascular tone and vascular smooth muscle relaxation
The result is vasodilatation and reduced blood pressure
Blood pressure is reduced by dilation of peripheral arteries and arterioles and reduction of total peripheral resistance or afterload, against which heart has to work.
This increases myocardial oxygen delivery - Explain When may calcium channel blockers be helpful and what is an added function of them
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Dilate coronary arteries both in normal and ischemic areas
Helpful with coronary artery spasms - Provide a general explanation of prinzmetal’s angina
- Coronary artery spasms
- What are the clinical manifestations of coronary artery disease
- Angina pectoris, acute myocardial infraction and sudden cardiac death
- What is stable angina ?
- Angina pa that is precipitated by physical activity, emotional stress or exposure to extremes in temperatures and relieved when the precipitating factor is removed.
- What is unstable angina pectoris ?
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Occurs at rest without a precipitating event. Relieved with rest and nitroglycerin
May progress to MI
Maybe the result of deterioration of plaque - Explain: Crescendo angina and pre-infraction angina
- Another term for unstable angina pectoris
- What is angina pectoris the result of
- Atherosclerotic heat disease and influenced by modifiable and nonmodifiable risk factors
- Provide general information about Prinzmetal’s angina (such as cause, relationships, contributing factors)
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A type of angina not related to ASCHD.
Also called Variant angina
Occurs at rest
Causes are coronary spasms, increase in catecholamines and myocardial oxygen consumption.
Disease is rare and can occur in the absence of atherosclerotic heart disease - Which enzymes are release during cardiac injury?
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Creatine Kinase (CK)
Lactic Dehydrogenase (LDH)
Serum Asparte Aminotransferase (AST) - Where are CK found?
- Heart muscle, skeletal muscle and brain tissue
- Define: Leukocytosis
- An elevated WBC and occurs infections, hemorrhage, tissue trauma and cancer
- Define: Leukopenia
- a decreased level of WBCs and may be seen with some viral infections, bonenarrow depression, radiation, chemotherapy and pernicious or aplastic, enemia
- Where are CKMM found?
- Isoenzyme found in the skeletal muscle
- Where are CKBB found?
- Found in brain and nervous tissue
- Provide the information about the enzyme “CKMBâ€
- Is the isoenzyme found in cardiac muscle, elevated CKMB is diagnostic of MI
- Explain: the Activated Partial Thromboplastin Time (APTT) test
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used to test fibrin clot formation. APTT is used to monitor patients receiving heparin. Prolonged APTT may be seen in hemophilia, vitamin K deficiency, liver disease and in disseminated intravascular coagulation
Reduced APT may be seen in cancer, immediately after acute hemorrhage or as an early indicator of DIC - Explain: the Prothrombin Time (PT) test
- Reflects the ability of prothrombin to be converted to thrombin, which is necessary for proper clotting. Production of prothrombin depends on adequate intake and absorption of vitamin K. PT is tested used to monitor patients receiving coumadin
- A cholesterol lever greater than ? is identified as a high risk for coronary artery disease
- 200mg/dl
- What are calcium and potassium necessary for as it relates to the hearts
- Muscle contraction