Unit 4 Assessment of Cardiac Function, Vascular Disorders, Hypertension, and Reproductive Health Flashcards

Vocabulary flashcards generated from lecture notes covering cardiovascular assessment, vascular disorders, hypertension, female reproductive disorders, breast disorders, male reproductive disorders, and LGBTQ+ health topics.

Normal Cardiac Output Range

The volume of blood pumped by the heart per minute in a healthy adult, which is $4\text{--}6\,L/min$.

Stroke Volume (SV)

The volume of blood ejected from the left ventricle per heartbeat, normally approximately $70\,mL$.

Preload

The degree of myocardial stretch and ventricular filling at the end of diastole.

Afterload

The vascular resistance against which the ventricles must contract to eject blood.

Contractility

The intrinsic force or strength of myocardial contraction, independent of preload and afterload.

Right Atrium

The cardiac chamber that receives deoxygenated blood from systemic circulation via the superior and inferior vena cavae.

Right Ventricle

The cardiac chamber that pumps deoxygenated blood into the pulmonary circulation via the pulmonary artery.

Left Atrium

The cardiac chamber that receives oxygenated blood from the pulmonary veins.

Left Ventricle

The thickest and strongest cardiac chamber that pumps oxygenated blood into systemic arterial circulation via the aorta.

Tricuspid Valve

The atrioventricular valve located between the right atrium and right ventricle that prevents backflow into the atrium during systole.

Pulmonic Valve

The semilunar valve located between the right ventricle and the pulmonary artery.

Mitral Valve

The bicuspid atrioventricular valve located between the left atrium and left ventricle.

Aortic Valve

The semilunar valve located between the left ventricle and the aorta.

Ejection Fraction (EF)

The percentage of end-diastolic ventricular blood volume ejected with each cardiac contraction.

Diastole

The phase of the cardiac cycle when the heart muscle relaxes and the chambers fill with blood.

Systole

The phase of the cardiac cycle when the heart muscle contracts, pumping blood from the chambers into the arteries.

MONA

An acronym for the initial treatment for acute coronary syndromes, which stands for Morphine, Oxygen, Nitroglycerin, and Aspirin.

Nitroglycerin

A medication used to relieve chest pain (angina) by relaxing the blood vessels, which decreases the heart's workload and improves blood flow.

Coronary Artery Perfusion Timing

The specific phase of the cardiac cycle during which blood flows into the coronary arteries, occurring primarily during diastole.

CARDIOVASCULAR & CHEST PAIN

ASSESSMENT

Common: chest pain, dyspnea, palpitations, fatigue, edema, dizziness/syncope

• Chest pain → location, quality, severity, radiation, onset/duration

• Assess precipitating & relieving factors

• Associated: dyspnea, diaphoresis, N/V, palpitations

• New/worsening symptoms require evaluation

Syncope

A temporary loss of consciousness due to a decrease in blood flow to the brain, often resulting from a drop in blood pressure or heart rate.

Palpitations

A sensation of having a fast-beating, fluttering, or pounding heart, which can be triggered by stress, exercise, or underlying heart conditions.

PHYSICAL CARDIAC ASSESSMENT

Inspect → color, respiratory effort, edema, JVD

• Palpate → pulses, temperature, cap refill, PMI

• Auscultate → rate/rhythm, S1/S2, extra sounds/murmurs

• JVD → ↑ right-sided pressure/fluid overload

• Pulses: 0 absent | 1+ weak | 2+ normal | 3+ bounding

Orthopnea

Shortness of breath that occurs when lying flat and is relieved by assuming an upright sitting or standing position.

Troponin

A highly specific cardiac protein marker evaluated through serial blood draws to identify acute myocardial injury or infarction.

BNP / NT

Cardiac neurohormones released by the ventricles in response to increased wall tension, stretch, and volume-pressure overload. BNP > 100 is heart failure and is fluid

Lipid panel

a blood test measuring cholesterol levels and other fats to assess cardiovascular risk.

LDL

• “Bad” cholesterol

• Deposits cholesterol in arteries

• ↑ LDL → ↑ atherosclerosis risk

HDL

• “Good” cholesterol

• Helps remove cholesterol from arteries

• Higher HDL generally protective

Major heart electrolytes

Electrolytes crucial for heart function, magnesium, potassium, and calcium. They help regulate heart rhythm and muscle contraction.

Transthoracic Echocardiogram (TTE)

A noninvasive ultrasound procedure utilizing an external transducer on the chest wall to visualize cardiac structures and motion.

Transesophageal Echocardiogram (TEE)

An invasive ultrasound procedure requiring an esophageal probe, moderate sedation, pre-procedure NPO status, and post-procedure gag reflex assessment.

Arterial Line

A thin catheter placed in an artery for continuous blood pressure monitoring and blood sampling, often used in critical care settings.

Arterial Line Nursing Care Precautions

Maintaining a pressurized flushing system, monitoring distal tissue perfusion, avoiding air bubbles, and ensuring medications are never administered through the line.

Cellulitis

An acute bacterial infection of the dermis and subcutaneous tissues, characteristically presenting with localized erythema, warmth, edema, and pain.

Arterial insuffiency

• Cool, pale, shiny skin

• ↓/absent pulses

• Minimal edema

• Pain with activity/rest

• Deep, painful ulcers

• Elevation → pallor

Venous Insuffiency

• Warm/discolored skin

• Pulses present

• Moderate–severe edema

• Aching/heaviness

• Superficial irregular ulcers

• Elevation → improves edema

Intermittent Claudication

Ischemic muscle pain, cramping, or fatigue in the lower extremities brought on by exertion and promptly relieved by a short period of rest.

Arteriosclerosis

A condition characterized by the thickening and hardening of arterial walls, leading to reduced elasticity and blood flow.

Atherosclerosis

A progressive vascular disease marked by fatty plaque accumulation within the arterial intima, causing luminal narrowing and reduced blood flow.

Risk factors for arteriosclerosis and artherosclerosis

nicotine, diabetes, HTN, hyperlipidemia, inactivity, obesity/diet,

age/genetics

PAD

Peripheral artery disease (PAD) is a condition where atherosclerotic blockages primarily affect the arteries supplying the lower extremities, leading to symptoms such as claudication and critical limb ischemia.

• Atherosclerotic obstruction → usually lower extremities

• Findings → claudication, coolness/numbness, ↓ pulses, shiny skin/hair loss

• Rest pain/ulcers/gangrene → advanced ischemia

• Management → stop nicotine, walking, antiplatelet, statin, cilostazol

• Severe disease → angioplasty/stent or bypass

• Care → dependent position, avoid cold/heat/tight clothing, protect feet

Dependent Positioning for Peripheral Artery Disease

Lowering the affected legs below heart level to utilize gravity to facilitate arterial blood supply.

Six Ps of Acute Arterial Occlusion

Pain, pallor, pulselessness, paresthesia, poikilothermia, and paralysis.

Arterial Embolus Origin vs Thrombus Origin

Emboli typically travel from a distant origin (such as the heart), whereas thrombi form locally over a pre-existing atherosclerotic lesion.

Thoracic Aortic Aneurysm Symptoms

Chest or upper back pain, dyspnea, dry cough, hoarseness from vocal cord nerve compression, and dysphagia.

Abdominal Aortic Aneurysm (AAA) Classic Triad of Rupture

Severe abdominal or back pain, profound hypotension, and a sudden drop in hematocrit leading to hemorrhagic shock.

Surgical Threshold for AAA Repair

An abdominal aortic aneurysm diameter reaching or exceeding $5.5\,cm$.

Aortic Dissection

A life-threatening condition caused by a tear in the aortic intima, manifesting as sudden, severe tearing or ripping chest and back pain.

acute arterial occlusion

• Embolus → clot travels to artery

• Thrombus → clot forms locally

• Sudden loss of distal blood flow

Raynaud Phenomenon Trigger

Bilateral, intermittent vasospasm of small cutaneous arteries in the fingers or toes precipitated by cold temperatures or emotional stress.

Arterial Ulcer Characteristics

Deep, small, circular, pale or necrotic lesions located on distal toes or heel pressure points accompanied by sharp pain and absent peripheral pulses.

Arterial Bypass Post-Op Assessment

Serial neurovascular checks evaluating pulse presence via Doppler, skin color, temperature, capillary refill, motor function, and signs of compartment syndrome.

VTE

• VTE = DVT + PE

• DVT → clot in deep vein

• PE → clot travels to pulmonary circulation

• May be asymptomatic

• Major complication → pulmonary embolism

Deep Vein Thrombosis (DVT) Symptoms

Unilateral lower extremity edema, localized warmth, tenderness along the deep vein route, and prominent superficial veins.

DVT Prevention Measures

Early ambulation, leg exercises, sequential compression devices (SCDs), anti-embolism stockings, and prophylactic anticoagulation.

DVT Treatment

• Anticoagulants

• Heparin/LMWH

• Warfarin

• Thrombectomy → selected cases

• Thrombolytics → selected cases

• Monitor for PE

Anticoagulant Patient Teaching Safety Points

Instructing the patient to use a soft toothbrush and electric razor, avoid contact sports, and report hematuria or melena.

Pulmonary Embolism (PE) Key Signs

Sudden onset of dyspnea, pleuritic chest pain, tachypnea, tachycardia, apprehension, and hemoptysis.

Severe PE Complication

Acute right-sided heart failure (cor pulmonale) leading to obstructive shock and systemic circulatory collapse.

Chronic Venous Insufficiency (CVI)

Incompetence of venous valves resulting in persistent venous hypertension, chronic lower extremity edema, brown skin pigmentation, and stasis dermatitis.

Compression Stockings Application Rule

Applying the stockings early in the morning before getting out of bed when leg edema is minimal, and removing them at night.

Venous Ulcer Characteristics

Superficial, irregularly shaped lesions located near the medial malleolus with a beefy red wound bed, moderate-to-severe surrounding edema, and present pulses.

Positioning Recommendation for Venous Insufficiency

Elevating the lower extremities above heart level periodically throughout the day to promote venous drainage.

Varicose Veins Cause

Incompetent venous valves permitting retrograde blood flow and pooling, producing enlarged, tortuous superficial veins.

Leg Positioning Comparison (Arterial vs Venous)

Dangling legs in a dependent position enhances arterial flow, whereas elevating legs improves venous return.

Phlebitis Manifestations and Care

Erythema, warmth, and a palpable cord along a peripheral vein; managed by removing the cannula, applying warm moist heat, and elevating the extremity.

Inferior Vena Cava (IVC) Filter Indication

Recurrent pulmonary embolism or deep vein thrombosis occurring despite therapeutic anticoagulation, or absolute contraindications to anticoagulant therapy.

Negative Pressure Wound Therapy (Vacuum-Assisted Closure)

An advanced wound management technique that applies subatmospheric pressure to clear exudate, reduce edema, and stimulate granulation tissue growth.

Hypertension

• Chronic elevation of blood pressure

• Often asymptomatic → “silent killer”

• Major risk factor for:

• Stroke

• MI/CAD

• Heart failure

• Chronic kidney disease

• Goal: prevent target-organ damage and premature death

Normal Blood Pressure Definition

A blood pressure measurement defined as systolic $< 120\,mm\,Hg$ AND diastolic $< 80\,mm\,Hg$.

Elevated Blood Pressure Definition

A blood pressure measurement defined as systolic $120\text{--}129\,mm\,Hg$ AND diastolic $< 80\,mm\,Hg$.

Stage 1 Hypertension Definition

A blood pressure classification defined as systolic $130\text{--}139\,mm\,Hg$ OR diastolic $80\text{--}89\,mm\,Hg$.

Stage 2 Hypertension Definition

A blood pressure classification defined as systolic > 140 OR diastolic >90

Primary (Essential) Hypertension Cause

Chronic blood pressure elevation without a single identifiable medical cause, accounting for approximately $90\%$ of hypertension cases.

Secondary Hypertension Causes

Blood pressure elevation resulting from underlying pathology such as renal parenchymal disease, obstructive sleep apnea, Cushing syndrome, or pheochromocytoma, hyperaldosteronism.

Hypertension risk factors

• NONMODIFIABLE

• Increasing age

• Family history

• Race

• Sex

• MODIFIABLE

• Obesity

• High-sodium/poor diet

• Physical inactivity

• Tobacco/nicotine

• Excess alcohol

• Stress

• Diabetes/hyperlipidemia

• Sleep apnea

Clinical manifestations of hypertension

Hypertension often has no symptoms, but it can lead to headaches, shortness of breath, nosebleeds, and visual disturbances in severe cases. Long-term effects include damage to the heart, kidneys, and blood vessels.

Isolated Systolic Hypertension

A pattern common in older adults characterized by systolic blood pressure $> 160\,mm\,Hg$ with diastolic blood pressure $< 90\,mm\,Hg$ secondary to arterial stiffness.

White Coat Hypertension

Elevated blood pressure readings recorded specifically within healthcare settings while ambulatory home measurements remain normal.

Masked Hypertension

Normal blood pressure readings obtained in clinical environments paired with elevated readings recorded during daily life.

DASH Diet Sodium Target

Dietary restriction recommending a daily sodium intake limit of $< 2000\,mg/day$ ($< 2\,g/day$).

First-Line Antihypertensive Medications

• Thiazide diuretics

• ACE inhibitors

• ARBs

• Calcium channel blockers

• Goal BP → <130/80 mm Hg

Thiazide Diuretic Monitoring Points

Assessing laboratory values for hypokalemia, hyponatremia, hyperuricemia, and monitoring for orthostatic hypotension.

ARBs- Valsartan

• ↓ Peripheral resistance → ↓ BP

• Monitor for hypotension

• Report angioedema

ACE Inhibitors- Lisinopril

• Prevent vasoconstriction → ↓ BP

• Monitor BP

• Watch for hypotension

• Can cause dry cough & angioedema

Loop Diuretics - Furosemide (Lasix)

• ↑ Sodium & water excretion → ↓ BP

• Causes potassium loss

• Monitor for hypokalemia

• Encourage potassium-rich foods when appropriate

ACE Inhibitor Adverse Effects

A persistent dry cough, hyperkalemia, orthostatic hypotension, and potential life-threatening angioedema.

Advantage of ARBs over ACE Inhibitors

Providing effective renin-angiotensin-aldosterone system inhibition without inducing the dry cough caused by bradykinin accumulation.

Calcium Channel Blocker Subgroups

Dihydropyridines (e.g., amlodipine) cause peripheral vasodilation and edema, whereas non-dihydropyridines (e.g., diltiazem) decrease heart rate and AV conduction.

Second-Line Antihypertensive Medications

• Loop diuretics → furosemide

• Potassium-sparing → amiloride, triamterene

• MRAs → spironolactone

• Beta blockers → metoprolol, carvedilol

• Alpha-1 blockers → prazosin, doxazosin

• Central alpha2 agonists → clonidine

• Vasodilators → hydralazine, minoxidil

Beta Blocker

• Metoprolol

• Carvedilol

• Atenolol

• ↓ HR + contractility → ↓ BP

• Monitor HR + BP

• Can cause bradycardia/hypotension

• Do NOT stop abruptly

Checking heart rate and blood pressure prior to administration and avoiding abrupt withdrawal to prevent rebound hypertension or severe tachycardia.

Direct Vasodilators

• Hydralazine

• Minoxidil

• Directly relax vascular smooth muscle

• ↓ peripheral vascular resistance

• Can cause:

• Reflex tachycardia

• Fluid retention

• Headache/flushing

Choosing Antihypertensives With Comorbidities

• CAD/MI → beta blocker, ACEI or ARB

• HFrEF → ACEI/ARB, ARNI, beta blocker, MRA, diuretic

• CKD → ACEI; ARB if intolerant

• Diabetes + albuminuria → ACEI or ARB

• A-fib → beta blocker or nondihydropyridine CCB

• Pregnancy → labetalol, nifedipine, methyldopa

Hypertensive Urgency

Severe blood pressure elevation ((\ge 180/120\,mm\,Hg)) WITHOUT evidence of acute target-organ damage, managed with oral medications.

Hypertensive Emergency

Severe blood pressure elevation ((\ge 180/120\,mm\,Hg)) WITH acute, progressive target-organ damage requiring ICU monitoring and intravenous therapy.

Target-Organ Damage Manifestations in Hypertensive Crisis

Acute encephalopathy, ischemic stroke, acute coronary syndrome, pulmonary edema, renal failure, or aortic dissection.

Sodium Nitroprusside Toxicity Risk

Cyanide and thiocyanate accumulation during prolonged or high-dose intravenous administration.

Resistant Hypertension Definition

Uncontrolled blood pressure despite concurrent adherence to at least three antihypertensive medication classes, one of which is a diuretic.

Endometrium

The inner mucosal lining of the uterus that proliferates and sheds in response to estrogen and progesterone cycles.