NPN-120 Quiz 2

Conduction system of the heart

Generates and delivers (conducts) the electricity to all the muscle fibers of the heart resulting in a smooth, complete contraction of the cardiac muscle fibers, which forcefully ejects the blood outside the heart.

SA node, AV node, Bundle of HIS, Bundle Branches, Purkenji fibers

SA node

pacemaker of the heart; causes atrial contraction, P-wave

AV node

(atrioventricular node) region of the heart between the right atrium and right ventricle from which electrical impulses spread to the ventricles during a heartbeat; PR interval is amount of time AV node holds the impulse to allow ventricles to fill; watch this segment for heart blocks

QRS complex

ventricular depolarization and atrial repolarization

t-wave

ventricular repolarization

Sinus Rhythm

the normal (optimal) heart rhythm arising from the sinoatrial node

Characteristics of sinus rhythm

Rhythm: R-R and P-P intervals are regular

Rate: 60 to 100

beats/min

P waves: Positive (upright) in lead II; one precedes each QRS complex;

P waves look alike

PR interval: 0.12 to 0.20 seconds and constant from beat to beat

QRS duration: 0.11 seconds or less unless abnormally conducted

Atrial Fibrillation

occurs when the normal rhythmic contractions of the atria are replaced by rapid irregular twitching of the muscular heart wall; jello

These patients are on blood thinners to prevent embolus

Atrial Flutter

irregular beating of the atria; often described as "a-flutter with 2 to 1 block or 3 to 1 block"; saw-tooth

Ventricular fibrillation

the rapid, irregular, and useless contractions of the ventricles; v-fib = defib

Ventricular tachycardia

A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest; tombstones

Heart Blocks

Conduction is excessively delayed or stopped at AV node or bundle of His; First degree, Second degree Type I and Type II, Third degree

Circulation of the heart

RA-> Tricupsid Valve-> RV -> Pulmonic Valve-> Lungs-> Back into pulmonary veins-> LA-> Mitral Valve (bicupsid)-> LV-> Aorta-> Body

Atria

the two upper chambers of the heart, receiving chambers

Ventricles

Lower chambers of the heart; pumping chambers

cardiovascular disease

A general term for all diseases of the heart and blood vessels.

Modifiable risk factors for cardiovascular disease

-poor diets

-physical inactivity

-obesity

-smoking

-excessive alcohol consumption

-heart-related conditions

Non-modifiable risk factors for cardiovascular disease

age, gender, genetics

Pulmonary edema

fluid in the air sacs and bronchioles

Treatment for pulmonary edema

low sodium diet, fluid restriction, diuretics

Symptoms of pulmonary edema

Dyspnea, Cyanosis, tachypnea, tachycardia, pink frothy sputum, restlessness, wheezing, crackles, decreased urine output, sudden weight gain.

Loop diuretics

furosemide, bumetanide, torsemide; monitor potassium regularly; best given in the morning since they cause increased urination

Cardiomyopathy

the term used to describe all diseases of the heart muscle

Common causes of cardiomyopathy

hypertension

alcohol and drug abuse

Inflammation, e.g. sarcoiidosis,

Endocrine, e.g. Diabetes,

hyper/hypo thyroidism, obesity

Infection, e.g. HIV, Hep C

genentics

Endocarditis

inflammation of the inner lining of the heart

Common causes of endocarditis

infection in the mouth that spread

valve replacement surgery

Primary cause - IV DRUG USE

Symptoms of endocarditis

Fever, night sweat, petechiae, splinter hemorrhage, heart murmur, N/V, chills

Treatment of infective endocarditis

identification of causative agent, long-term agent specific therapy, bed rest, oxygen therapy, antipyretics, surgical valve repair, and prosthetic valve replacement; prophylactic use of ATB prior to dental procedures, good oral hygiene

Pericarditis

inflammation of the sac surrounding the heart

Symptoms of pericarditis

Fever

Fatigue

Irregular heart beat

Dry cough

Constant pain in center of chest (sharp stabbing worse laying down than sitting up)

Right-sided heart failure

1. Jungular Vein Distention

2. Ascending Dependent Edema

3. Weight Gain

4. Hepatomegaly (Liver Enlargement)

Left-sided heart failure

1. Dyspnea, SOB

2. Crackles

3. Oliguria

4. Frothy Sputum

5. Displaced Apical Pulse (Hypertrophy)

Nursing interventions for patients with heart failure

1. Raise HOB

2. Allow pt to talk about their thoughts and feelings

3. Elevate lower extremities

4. Assess lung sounds

5. Daily weights and assessment of abdomen

myocardial infarction (heart attack)

When blood and oxygen supply to the heart is reduced which causes the heart muscle to suddenly die; ST segment elevation is STEMI

Angina

a condition of episodes of severe chest pain due to inadequate blood flow to the myocardium

Symptoms of angina

Classic: substernal chest pain (constricting, squeezing, suffocating)

May radiate to jaw, neck, shoulder, back, down the arm(s)

Women: epigastric or back discomfort

Older adults: atypical symptoms

Persons w/ diabetes: not classic

Nitroglycerine (Nitrostat)

vasodilator; nitrates

take for onset of angina

3 doses five minutes apart

Will relieve angina, not MI

CK-MB

creatine kinase-MB

Troponin

A protein of muscle that together with tropomyosin forms a regulatory protein complex controlling the interaction of actin and myosin and that when combined with calcium ions permits muscular contraction; used to determine MI

Peripheral Vascular Disease

Vascular disease affecting blood vessels outside of the heart and especially those vessels supplying the extremities.

Symptoms of PVD

edema, pain, irregular shaped legs, red wheepy legs

Peripheral artery disease

A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.

Symptoms of PAD

decreased to absent peripheral pulses, cool skin, loss/thinning of hair on extremities, shiny skin, pain during exercise

Venous insufficiency

an abnormal circulatory condition characterized by decreased return of venous blood from the legs to the trunk of the body; lower extremity pitting edeam

aneurysm

ballooning of a weakened portion of an arterial wall

Symptoms of aneurysm

Severe headache, nausea, vomiting, blurred vision, sensitivity to light, seizures, loss of consciousness

Risk factors for aneurysm

Smoking

HTN

Hyperlipidemia

Heavy alcohol use

aortic dissection

diagnosis in which the arterial wall splits apart

Symptoms of aortic disection

- "Sharp", "tearing", "ripping", "stabbing" pain that moves from point of origin; back pain

- Diaphoresis

- Nausea and vomiting

- Faintness

- Pallor

- Rapid, weak pulse

- Apprehension

- May mimic MI → pain is slightly different

Anticoagulant therapy

Medication to prevent blood clot formation.

Warfarin (Coumadin)

Anticoagulant, Vitamin K Antagonist; monitor blood with PT/INR values to determine need to adjust the dose

Eliquis (Apixaban)

Anticoagulant; monitor patients for any signs of bleeding

Hypertension

abnormally high blood pressure

Symptoms of hypertension

Can be a silent killer with no symptoms, but some symptoms may include blurred vision, angina, vertigo, dyspnea, fatigue, headaches, flushing, nosebleeds, and palpitations.

Treatment of hypertension

Lifestyle changes

Reduction of sodium intake

Weight reduction

Reduction of stress

Drugs

--Diuretics, ACE inhibitors, drug combinations