Fundamentals Test II
Terms
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- Where is the apical HR?
- Mitral valve, 5th intercostal, midclavicular line
- S1 and S2: Lub- Dub sounds
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S1: Atrial ventricular valves slapping shot
S2: Semilunar valves slapping shut - Cardiovascular System Primary Function and what the heart needs to do (3)
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Primary function: transport oxygen to rest of body
Needs (3): 1. ability to generate and conduct electrical impules, 2. heart needs to be able to fill and empty properly, 3. Strong enough to contract - What vein becomes distended if their is excess of blood into superior vena cava?
- Jugular Vein
- If the left pulmonary vein has an excess of blood, what is likely to fill with blood?
- Lungs
- Cardiac Output formula
- CO= SV x HR
- Cardiac Output definition and normal range
- Tells us how efficient the pump is, the cardiac output is the amount of blood pumped per minute (3.5-8L)
- Stroke Volume definition and normal range
- amount of blood pumped for every beat of contraction (70 ML)
- Heart Rate Definition and normal range
- Number of Beats per minute (60-100 BPM)
- Cardiac Output Varies by (3 things)
- body size, metabolic needs of tissues, age
- Definition of Afterload
- Amount of resistance the heart has to pump against (plague build up--heart has to pump harder)
- 4 areas of the heart to listen to
- aortic, pulmonic, tricuspid, mitral valve
- Risks for cardiovascular disease
- age, gender, inheritance, smoking (most modifiable), hypertension (25% of adults), stress, high cholesterol, obesity, lack of exercise, and diabetes
- arthroscerosis
- excessive build up of plague
- What is the most common factor of cardiovascular diesease?
- hypertension
- P Wave
- depolarization of the atria
- T Wave
- ventricular replorization
- QRS complex
- Depolarization of ventricles
- Preload
- Amount of blood that enters the heart)
- Risk factors for hypertension
- African American (genetics), overweight, inactiveness, pregnancy, alcohol, elderly men, high salt intake
- What kind of fat is most important when talking about CV disease?
- saturated
- What does exercise do (physiologically speaking)
- makes platelets less sticky, prevents thrombosis, increases HDL, increase muscle build-up
- What other factors could affect cardiovascular disease?
- medications, herbs, cocaine, emotional stress, pregnancy (weight on fetus puts pressure on pelvic vein, edema is likely, watch for CV problems!)
- What should nurses inspect the chest for?
- symmetry
- What should the nurse feel for? Over what area?
- The nurse should feel for thrill (which sounds like a cat purring) over the PMI
- 4 indications that a patient is having cardiac problems
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1. HR is above 100 bpm at rest.
2. If HR increases by 20BPM, changing body positions with mild activity.
3. No change in heart rate with exercise.
4. Short of breath with slight activity, or even just laying down. - Should examine all pulses bilaterally EXCEPT what pulse?
- Carotoid
- What should you feel the carotoid for?
- feel for a thrill, or a swishing sound which is called a BRUIT
- What does a bruit indicate?
- Narrowing of the carotoid
- What level should the bed be at when checking for jugular vein distention?
- 30-45 degress, or semi-fowler
- What is indicated by no hair on the big toe?
- Arterial clot
- What is a PTT?
- Partial thromobplastin time test, tells us about the body's ability to clot
- What is a PT?
- Prothroymbin test, tells us about the effects of Coumadin, and how lot it takes to clot
- What macromolecule can lead to a edema?
- Decrease in protein--specifically protein-albumin
- What would be in a lipid profile?
- Cholesterol (HDL, LDL, ratio), and triglycerides)
- Hemoglobian (Hgb) normal ranges
- 13.5g/ dL
- Hematocrit (HCT) normal ranges
- 40-50%
- ECG is used for what kind of diagnosis?
- for electrical problems in heart
- Cardiac Catherization
- put through the femoral artery into the right atrium, checking for pressure. After care--watch for external bleeding, have to keep leg straight, make sure patient doesn't bend leg!!!!!!! Check to make sure they don't have any sort of dysrrthemias.
- Echocardiogram checks what?
- Pressures
- What do treadmills do?
- Look at heart during exercise, what kind of electrical abnormalities do we see?
- Where would edemas present?
- feet, sacral area, periobrital (around the eye)
- Hematoma definition
- full of blood
- Pitting edema
- Push thumb down for 10-15 seconds and let go. If print is still there when you remove your thumb then pitting edema is present.
- Pitting edema measurements
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2 mm= +1 edema
4 mm= +2 edema
6 mm= +3 edema
8 mm= +4 edema - Brawny Edema Definiton
- full of fluid, no pitting because it is so hard
- 4 Normal Solutions for edema
- elevate edema above heart, measure circumfrence of limb or abdomen, where we have edema, might have to drain abdomen, may give diuretics
- Holman's Sign
- dorsiflex foot, if call hurts--positive, if it is positive it suggests that has a patient has a DVT
- Ineffective Tissue Perfusion- what does it look like?
- Depends on what part of the body it is in.
- Ischemia
- really pain, skin starts to "sluff off', treat like a burn
- Sickle Cell Anemia
- ischemia throughout the entire body, extremely painful
- Who is at risk for impaired skin intergirty?
- DVT patients
- Arterial Clot vs. DVT clot pain differences
- intermittent claudication vs. cramping-constant ahce
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Arterial Clot vs. DVT clot
pulse - decreased or absent below the clot vs. no change (we don't feel pulses in veins)
- Arterial Clot vs. DVT clot capillary reflex
- greater than 3 seconds, vs. no change
- Arterial Clot vs. DVT clot skin color
- pale vs. red (getting engourged)
- Arterial Clot vs. DVT clot temperature
- cool vs. hot
- Arterial Clot vs. DVT clot appearence
- shiny no hair on the tow (if on the leg) vs. patch brown
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Arterial Clot vs. DVT clot
edema - none vs. present
- Arterial Clot vs. DVT clot motor functions
- impaired vs. no change
- DVT Nursing care
- Do NOT massage, warm (heat may dilate), do not want to cause vasoconstriction (encourage to change position often, can not cross their legs! Increase pressure, constricts blood flow), elevative, but never so that their knees are bent
- SCUD:
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Sequential compression device
-dilate certain amounts of pressure
-changes where the air is, constantly changing where pressure is to try and prevent clots - Other Measures to prevent clots (4)
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1. passive or active ROM
2. Keep warm for vasodilation
3. encourage pt. to stop smoking
4. exercise regularly, and wear good shoes! - Indications of decreased CO (7)
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1. HR would increase.
2. BP would go down after a while.
3. Decreased LOC, restlessness, anxiety, and confusion.
4. Looks and is syonotic, not perfusing.
5. O2 sats would drop.
6. As BP decreases, urine output would decrease
7. edema in dependent areas