NURS 210 Module 9 - Cardiovascular

what is the bottom of the heart called?

apex

What is the top of the heart called?

base

what is the precordium?

area on anterior chest overlying heart and great vessels

What are the 4 chambers of the heart?

right atrium, right ventricle, left atrium, left ventricle

describe the atruim

think walled reservoir for holding blood

describe the ventricle

thick-walled muscular pumping chamber

what are great vessels?

major arteries and veins connected to the heart

arteries

carry blood away from the heart

veins

brings blood back to the heart

What are the 2 AV valves?

tricuspid and bicuspid

What are the 2 SL valves?

aortic and pulmonic

Describe diastole

ventricles relax and fill, AV open

Describe systole

ventricles contract and pump; AV valves close to prevent regurgitation of blood back up into atria as SL open to eject blood into aorta.

what are the common concerns of the heart?

Chest discomfort

Syncope or pre-syncope

Dyspnea

Orthopnea (hard time breathing when you lay down)

Fatigue

Palpitations

when assessing the neck vessels what should you inspect?

jugular pulsation

when assessing the neck vessels what should you palpate?

carotid

one at a time

when assessing the neck vessels what should you ascultate?

bruit

what artery would a bruit be located at in the neck ?

carotid

when assessing the heart what and how should you auscultate?

Bell & Diaphragm

Z-shape pattern

Separate sounds (try and isolate them)

Rate at apex (apical pulse)

Rhythm

when assessing the heart what should you palpate?

Thrills (palpable pulses)

Pulsations

Apical pulse

when assessing the heart what should you inspect?

Chest color/skin

Pulsations (forceful thrustings of the ventricle, usually visible at the sternal border, okay to see at point of maximum impulse)

Heaves

Lifts

First heart sound (S1)

Occurs with closure of AV valves—signals beginning of systole

Mitral component of first sound (M1) slightly precedes tricuspid component (T1).

Second heart sound (S2)

Occurs with closure of semilunar valves—signals end of systole

Aortic component of second sound (A2) slightly precedes pulmonic component (P2).

S1 louder at ________

apex

S2 louder at ________

base

Arterial pulse influences are?

Volume of blood ejected

Distensibility of aorta

Viscosity of blood

Rate of cardiac emptying

Peripheral arteriolar resistance

common concerns of the heart

Peripheral Edema

Leg pain/cramps

Lesions

Dizziness/headache

when assessing the Peripheral Vasculature what and how should you inspect?

Color/skin

Clubbing

Symmetry

Edema

Lesions

Pulsations

Distended veins

when assessing the Peripheral Vasculature what and how should you palpate?

Temperature

Cap refill

Edema

Motor/sensory

Pulses

what are the different pulses?

Brachial

Radial

Femoral

Popliteal

Posterior tibial

Dorsalis pedis

When assessing pulses note what?

Grade

Strength

Symmetry

Variation

Rate is not relevant to PV

what are the pulse grades?

0: absent

+1: weak

+2: normal

+3: bounding

Modified Allen test

provide information about adequacy of collateral circulation

abnormal findings cardiac

•Third heart sound (S3)

•Fourth heart sound (S4)

•Friction rubs

•Murmurs

•Dysrhythmia

Venous ulcers

Lower leg

Shallow but large

Irregular boarder

Red

Shiny, scaly

Wet

Dull aching pain

Arterial ulcers

Toe or foot

Round "punched out"

Brown, yellow, black, pale

Deep, thin surrounding skin

Loss of hair

Dry

Very painful

risk factors

hypertension

smoking

physical activity

cholesterol

aging changes with the cardiovascular system are?

Stiffening of the vasculature

Calcification of arteries; harder to identify pulses

Thicker, less elastic veins

Decreased cardiac reserve

Changes in the conduction system

more susceptible to hypotension

The nurse knows that which of the following statements are true about the first heart sound (S1)?

It is heard loudest at the apex

Which blood vessel brings unoxygenated blood to the heart?

Vena cava

What conduction system starts electrical impulses in the heart?

SA node

Which action by the student nurse requires immediate intervention?

The SN palpates both carotid arteries at the same time

The nurse understands that bilateral jugular vein distention?

Typically result from heart failure

The nurse notes that the base of the heart is located?

At the top

Which statement from the student nurse requires further education?

S1 occurs with the closure of semilunar valves

When auscultating heart sounds, the nurse hears a whooshing/blowing sound. The nurse notes that this suggests?

murmur

Which auscultatory can best be heard over the base of the heart?

Aortic

Which of the following assessment findings should the nurse note as the priority?

Heart rate of 135 BPM

What patient requires immediate intervention from the healthcare team?

A patient with an absent radial pulse

Which heart vessel pumps oxygenated blood from the heart to the body?

Aorta

The nurse notes that systole occurs from?

ejection

P wave indicates?

depolarization of the atria

The chamber of the heart where the most contraction takes place?

Left ventricle

Which of the following actions from the student nurse requires immediate intervention from the charge nurse?

Palpating the apical pulse under the right nipple

Apical pulse is under the _________ nipple

left

Which of the following findings is abnormal?

Pulsating chest wall

The apical pulse is located where?

5th intercostal space

Which artery is located in the arm?

brachial

The Allen test can be used to assess?

Blood flow/return

What is one of the arterials that the Allen test evaluates?

ulnar artery

Which of the following are manifestations of DVT?

- Asymmetric calf size

- Warm leg to touch

- Redness

The nurse knows that the popliteal pulse is found where?

behind the knee

The nurse knows that moderate pitting edema that subsides rapidly is what?

2+

What is the precordium?

the area on the anterior chest directly overlying the heart and great vessels

What are the great vessels?

major arteries and veins connected to the heart

What is the flow of the heart?

superior vena cava from head and arms, inferior vena cava from the rest of the body

to right atrium

to tricuspid valve/right ventricle

to pulmonic valve/ pulmonary trunk

- splits into R&L pulmonary arteries

to lungs

to pulmonary veins

to left atrium

to mitral valve/left ventricles

to aortic valve/aorta

what two loops are the blood vessels arranged in?

pulmonary circulation and systemic circulation

when the heart contacts -

it pumps blood

how is the apical pulse created?

during contraction the apex beats against the chest wall, producing this palpable pulse

What returns unoxygenated venous blood to the right side of the heart?

superior and inferior vena cava

What carries blood to the lungs?

pulmonary artery

What returns freshly oxygenated blood to the left side of the heart?

pulmonary veins

what carries the oxygenated blood out to the body?

aorta

What are the 3 heart wall layers?

1. epicardium- external layer (parietal and visceral pericardium)

2. myocardium- middle layer (cardiac muscle)

3. endocardium- inner layer (endothelium)

what is a thin walled reservoir in the heart that holds blood ?

atrium

what is the thick muscular walled ventricle in the heart that pumps the blood?

ventricle

what is the main purpose of the valve in the heart?

to prevent back flow

What are the AV valves?

tricuspid and mitral

When do the AV valves open?

During the hearts filling phase or diastole to allow the ventricles to fill with blood

When do the AV valves close?

during pumping phase, or systole, to prevent regurgitation of blood back up into atria

What are the semilunar valves?

pulmonary and aortic

When do the semilunar valves open?

during pumping, or systole, to allow blood to be ejected from heart

what happens during diastole?

the ventricles relax and fill with blood

what happens during systole?

heart contracts

The closure of the AV valves is known as heart sound

S1

the closure of the SL valves contributes to what heart sound

S2

when the ventricles are resistant to filling during the early and rapid filling phase this could produce what abnormal heart sound?

S3

at the end of diastole, at pre-systole, when the ventricle is resistant to filling what abnormal heart sound is heard?

S4

What is a murmur?

gentle, blowing, swooshing sound that can be heard on the chest wall

What is preload?

venous return that builds during diastole, filling phase of the heart

What is afterload?

the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure

explain P QRS and T waves

P wave - starts here, depolarize of atrium

QRS - depolarization

T - repolarization

what veins empty unoxygenated blood directly into the superior vena cava?

jugular veins

what significant changes should you look for in an older persons cardiovascular system?

- hypertension

- thickening and stiffening of the large arteries

- increase in pulse wave velocity

- left ventricular wall thickness increases

- dysrhythmias increase

- CV diseases increase

what lifestyle habits can cause heart disease?

alcohol use, obesity, lack of exercise, diet

What is orthopnea?

difficulty breathing while lying down

What is nocturia?

excessive urination at night

when palpating the carotid artery what is very important to remember?

only palpate one artery at a time

when should you auscultate the carotid artery?

if the pt has a brui

What is a heave or lift?

sustained forceful thrusting of the ventricle during systole