Heart and vascular ch 12

What are the main functions of the cardiovascular system?

Transports oxygen, nutrients, and other substances to body tissues and carries metabolic waste products to the kidneys and lungs.

How does the cardiovascular system adjust to changing blood demands?

By constricting or dilating blood vessels and altering cardiac output.

What does the right side of the heart do?

Receives blood from the superior and inferior venae cavae and pumps it through the pulmonary arteries to the lungs.

What does the left side of the heart do?

Receives blood from the pulmonary veins and pumps blood through the aorta into systemic circulation.

What are the three layers of the heart wall?

Pericardium, myocardium, and endocardium.

What is the pericardium?

The sac that encases the heart and protects it.

What are the layers of the pericardium, and what do they do?

It has a fibrous layer and two serous layers. The fibrous layer protects the heart from trauma and infection. One serous layer lies next to the fibrous pericardium, and the other lies next to the myocardium.

What is the pericardial space, and what is its function?

The space between the fibrous pericardium and serous pericardium that contains fluid to reduce friction as the heart contracts and relaxes.

What is the myocardium?

The thick muscular middle layer of the heart that contracts to eject blood from the ventricles.

What is the endocardium?

The inner layer that lines the heart chambers and valves.

What are atrioventricular (AV) valves?

Valves that separate the atria from the ventricles.

Which valve separates the right atrium and right ventricle?

The tricuspid valve.

Which valve separates the left atrium and left ventricle?

The mitral valve.

What are semilunar valves?

Valves with a half-moon shape that control blood flow out of the ventricles.

Which valve separates the left ventricle from the aorta?

The aortic valve

Which valve separates the right ventricle from the pulmonary artery?

the pulmonic valve.

What happens during diastole?

The ventricles relax, blood moves from the atria into the ventricles, and the ventricles fill with blood.

What happens during systole?

the ventricles contract, AV valves close to prevent backflow into the atria, semilunar valves open, and blood is ejected into the aorta and pulmonary arteries.

What causes the semilunar valves to close after systole?

Ventricular pressure decreases as blood is ejected, causing the semilunar valves to close.

What is the sinoatrial (SA) node?

The heart's normal pacemaker, which initiates electrical impulses at about 60–100 impulses per minute.

What is the function of the atrioventricular (AV) node?

It prevents excessive atrial impulses from reaching the ventricles. If the SA node fails, it can generate ventricular contractions at 40–60 impulses per minute.

What happens if both the SA and AV nodes fail to function effectively?

The bundle branches may generate contractions at a much slower rate of 20–40 impulses per minute.

What are the main blood vessels of the peripheral vascular system?

arteries, capillaries, and veins, which carry blood to and from body tissues.

What are the functions of arteries and arterioles?

They withstand pressure generated by heart contractions and help maintain blood pressure by constricting or dilating in response to stimuli.

How are veins different from arteries?

Veins have thinner, more expandable walls, operate at lower pressure, and can act as reservoirs for extra blood to reduce the heart's workload.

What is the function of valves in veins?

They keep blood flowing forward toward the heart.

What is the function of the lymphatic system?

It works with the peripheral vascular system to remove excess fluid from interstitial spaces and transport it to lymph nodes.

How does fluid move between capillaries, tissues, and the lymphatic system?

Oxygen- and nutrient-rich fluid leaves the arterial end of capillaries and enters interstitial spaces and cells. Cellular waste moves toward the venous end, while excess interstitial fluid is absorbed by the lymphatic system.

What is lymphatic fluid made of?

Clear fluid composed mainly of water and a small amount of protein, mostly albumin.

What are lymph nodes?

Small, oval clumps of lymphatic tissue usually located in groups along blood vessels.

What should the nurse ask about a patient's present health status and medications?

Ask about chronic illnesses, current medications, medication side effects, whether medications are taken as prescribed, and use of over-the-counter drugs, aspirin, and herbal medications.

Which family health conditions should the nurse ask about?

Diabetes mellitus, renal failure, chronic hypoxia, and hypertension.

What should the nurse ask about in a patient's personal and psychosocial history?

Drug use, exercise, personality type, relaxation habits, usual eating habits, alcohol use, caffeine consumption, and current or past smoking.

What should the nurse ask about in the patient's past medical history?

Childhood growing pains or unexplained joint pain, rheumatic fever, heart murmur, high cholesterol or triglycerides, and previous heart or blood vessel surgery.

What questions and symptoms should the nurse ask when assessing chest pain?

Ask where the pain is located, whether it radiates, when it started, whether it is intermittent or constant, associated symptoms, what preceded it, what worsens or relieves it, and how many nitroglycerin tablets are needed for relief.

Sweating, pale or gray skin, skipped or racing heartbeat, shortness of breath, vomiting, and anxiety.

What factors may precede chest pain, and what may relieve it?

Possible preceding factors include exercise, rest, highly emotional situations, and sexual intercourse. Ask whether rest or nitroglycerin relieves the pain and how many nitroglycerin tablets are needed.

What should the nurse ask when assessing shortness of breath?

How long it has occurred, whether it is happening now, when it occurs, how often, how long it lasts, and whether it interferes with daily activities.

foot swelling, what makes it worse, whether stairs or lying down worsen it, how many pillows are needed for sleep, whether the patient sleeps in a recliner, and what helps them breathe more easily.

What should the nurse ask when assessing a cough?

When it started, how often it occurs, whether anything is coughed up, and what the material looks like.

Whether it is associated with position, lying down, anxiety, talking, or activity; what makes it worse; and what relieves it.

What should the nurse ask when assessing nighttime urination?

How long it has occurred, how many times the patient gets up each night, what they have tried to prevent it, and how successful those efforts have been.

What should the nurse ask when assessing fatigue?

When it occurs, whether onset was sudden or gradual, whether it is worse in the morning or evening, and whether it prevents normal activities.

Ask about iron pills, iron-rich foods such as green leafy vegetables and liver, heavy menstrual flow when applicable, and other associated symptoms.

What symptoms should the nurse ask about when assessing fatigue?

Rapid heart rate, headache, pale skin, unusual sensations in the hands or feet, muscle weakness, and trouble thinking.

What symptoms should the nurse ask about before or during a fainting episode?

Nausea, chest pain, headache, rapid heart rate, and confusion.

What should the nurse ask when assessing swelling of the extremities?

Where the swelling is located, whether it affects one or both sides, what makes it go away, whether elevation helps, and whether it disappears after sleeping overnight.

What additional symptoms should the nurse assess with extremity swelling?

Shortness of breath, weight gain, and, when applicable, whether swelling is associated with the menstrual period.

What should the nurse ask when assessing leg cramps or pain?

Describe the pain and its location, what makes it worse or relieves it, and whether there are changes in leg skin.

What skin or vein changes should the nurse assess with leg pain?

Coldness, pallor, hair loss, sores, redness or warmth over veins, and visible veins.

What should the nurse inspect on the anterior chest wall during cardiac assessment?

Contour, pulsations, lifts, heaves, and retractions.

What should the nurse assess when palpating the apical pulse?

The location of the apical pulse.

What should the nurse assess when auscultating S1 and S2 heart sounds?

Rate, rhythm, pitch, and splitting.

What should the nurse inspect and palpate on the upper extremities?

Symmetry, skin integrity, color, temperature, and capillary refill.

What should the nurse assess when palpating the brachial and radial pulses?

Rate, rhythm, amplitude, and contour.

What should the nurse assess during the general cardiovascular examination?

General appearance, skin color, breathing effort, temporal and carotid pulse amplitude, jugular vein pulsations, and blood pressure.

What should the nurse inspect and palpate on the lower extremities?

Symmetry, skin integrity, color, temperature, capillary refill, hair distribution, nail bed color and angle, tenderness, and superficial veins.

Which pulses should the nurse palpate in the lower extremities?

Femoral, popliteal, dorsalis pedis, and posterior tibial pulses.

What special considerations apply when assessing infants and young children?

Use smaller blood pressure equipment, recognize that the examination sequence may differ, and account for anatomical differences that affect findings.

How does cardiovascular assessment differ for older children and adolescents?

Assessment generally follows the same procedures and produces similar expected findings as in adults. Electrocardiography is an exception because it is not typically performed.

What should the nurse know about cardiovascular assessment in older adults?

The same general assessment procedures are used as for other adults, but expected variations may occur in heart rate and blood pressure.

What is hypertension, and how does the PowerPoint describe its diagnosis?

Hypertension is elevated arterial blood pressure. The PowerPoint describes diagnosis using the mean of two or more properly measured seated readings on each of two or more occasions above 120/80 mm Hg in adults over 18.

what can cause hypertension?

Constriction of blood vessels, fluid volume overload, or both.

What blood pressure values does the PowerPoint list as normal?

Less than 120 mm Hg systolic and less than 80 mm Hg diastolic.

Why is periodic blood pressure screening important?

Hypertension often has no specific symptoms, so screening can identify elevated blood pressure.

What is venous thrombosis?

The development of a blood clot, or thrombus, within a vein.

What is thrombophlebitis?

inflammation of a vein that may or may not be accompanied by a blood clot.

What three factors contribute to venous thrombosis and thrombophlebitis?

Venous stasis, damage to the inner layer of veins, and hypercoagulability.

Where do venous thrombosis and thrombophlebitis commonly occur?

In the lower extremities, usually in deep veins. In the upper extremities, they may affect superficial veins.

What signs may indicate venous thrombosis in a leg?

Dilated superficial veins, edema, redness, and increased circumference of the affected leg.

What signs may indicate upper-extremity venous thrombosis or thrombophlebitis?

Redness, warmth, tenderness, and veins that are visible and palpable.

What is an aneurysm?

A localized dilation of an artery caused by weakness in the arterial wall.

What is angina pectoris?

Chest pain caused by ischemia, or inadequate blood supply, to the myocardium.

What is a myocardial infarction?

Sustained myocardial ischemia that causes death of heart muscle cells, known as necrosis.

What is heart failure?

A condition in which either ventricle fails to pump blood efficiently into the aorta or pulmonary arteries.

What is pericarditis?

Inflammation of the parietal and visceral layers of the pericardium and the outer myocardium.

What is infective endocarditis?

An infection of the endothelial layer of the heart, including the cardiac valves.