Cardiology Nursing Flashcards

Anatomy and Physiology of the Heart

• Heart Characteristics:

  • Hollow muscular organ
  • Location: Middle of mediastinum
  • Resembles: closed fist
  • Weight: approx. 300-400 grams

• Heart Valves:

  • Atrioventricular (AV) Valve:
  • Tricuspid Valve
  • Bicuspid (Mitral) Valve
  • Semilunar (SL) Valve:
  • Pulmonary Valve
  • Aortic Valve

• Blood Flow Pathway:

  • Deoxygenated blood flows:
  1. Superior & Inferior Vena Cava →
  2. Right Atrium →
  3. Tricuspid Valve →
  4. Right Ventricle →
  5. Pulmonary Artery →
  6. Lungs (to be oxygenated)
  • Oxygenated blood:
  1. Pulmonary Vein →
  2. Left Atrium →
  3. Bicuspid Valve →
  4. Left Ventricle →
  5. Aortic Valve →
  6. Systemic Circulation

• Heart Wall Layers:

  1. Myocardium: middle/muscular layer
  2. Endocardium: innermost layer
  3. Epicardium: outermost layer

• Pericardium:

  • Surrounds the heart comprising:
  1. Visceral Layer (Inner)
  2. Parietal Layer (Outer)
  3. Pericardial Sac (Middle)
  • Contains 5-20 mL of fluid to reduce friction

• Conduction System:

  • Regulates electrical activity of the heart.
  • Key structures:
  1. SA Node: natural pacemaker
  2. AV Node
  3. Bundle of His: Left & Right branches
  4. Purkinje Fibers
  • Sequence of electrical impulse:
  1. SA Node → R & L Atria contract →
  2. AV Node → Bundle of His →
  3. R & L Ventricles contract.

Assessments in Cardiology

• Nursing History:

  • Assess modifiable and non-modifiable risk factors such as:
  • Modifiable: Diet, Exercise, Stress, Obesity, Smoking, etc.
  • Non-Modifiable: Age, Gender, Race, Family History.

• Physical Examination Techniques (IPPA):

  • Inspection: Skin color, Respiratory rate, Peripheral edema, Neck vein.
  • Palpation: Feeling peripheral pulses (Carotid, Radial, etc.) and Apical pulses.
  • Percussion: Should primarily reveal dullness.
  • Auscultation: Listening for heart sounds (S1, S2, S3, S4)
  • Normal: S1 (closure of AV valves) and S2 (closure of SL valves)
  • Abnormal: S3 (heart failure) and S4 (atrial gallop)

• Common Clinical Manifestations:

  • Dyspnea: Types include Dyspnea on exertion, Orthopnea, and Paroxysmal Nocturnal Dyspnea.
  • Chest Pain
  • Edema: Interstitial fluid accumulation.
  • Syncope: Fainting due to reduced cerebral perfusion.
  • Palpitations and Fatigue: Poor cardiac output.

• Diagnostic Tests:

  • CBC: Check for elevated RBCs (hypoxia), elevated WBCs (infection).
  • Serum Cardiac Markers:
  • Cardiac enzymes: AST, LDH, CK-MB, Troponin I (most indicative).
  • Electrocardiogram (ECG):
  • Records electrical activity; PQRST waves indicate different phases of heart function.

Disorders of the Heart

Angina Pectoris

• Definition: Transient chest pain due to insufficient blood flow to the myocardium.
• Causes: Atherosclerosis, Hypertension, Diabetes.
• Manifestations:
  • Pain characteristics: Substernal, vague, exertion-related, relieved by rest/NTG.
  • Other symptoms: Pallor, diaphoresis, dyspnea.
• Management:
  • Medications: Nitrates, Beta-blockers, Calcium channel blockers.
  • Nursing interventions: Management of nitroglycerin therapy including evidence of potency, patient education on usage.

Myocardial Infarction (Heart Attack)

• Definition: Localized necrosis in the myocardium due to occlusion of blood flow.
• Pathophysiology: Coronary occlusion due to atherosclerosis, thrombosis.
• Manifestations:
  • Severe, crushing pain; not relieved by angina treatment; often lasts >30 minutes.
  • Other symptoms: feeling of doom, skin changes (clammy).
• Management (Initial): MONA (Morphine, Oxygen, Nitroglycerin, Aspirin).

Pericarditis

• Definition: Inflammation of the pericardium.
• Causes: May follow MI or surgery; can be infectious.
• Manifestations:
  • Pain aggravated by breathing/movement.
  • Pericardial friction rub.
• Management: Pain relief, pharmacotherapy (ASA, corticosteroids).

Congestive Heart Failure (CHF)

• Definition: Myocardial disease leading to impaired heart function.
• Causes: Can result from various cardiac issues (MI, hypertension).
• Pathophysiology:
  • Right vs Left-sided failure leads to systemic or pulmonary congestion.
• Manifestations: Dyspnea, edema, JVD, fatigue.
• Management: Medications (Digitalis, Diuretics, Dilators), monitoring weight, symptom relief.

Vascular Disorders

Disorders Affecting Arteries

1. Atherosclerosis: buildup of plaque, narrowing arteries.
2. Aneurysms: abnormal dilation due to wall integrity loss, with types defined based on shape.
3. Raynaud's Disease: intermittent vasospasm leading to color changes in digits.

Disorders Affecting Veins

1. DVT: clot formation in deep veins due to Virchow’s triad.
2. Varicosities: abnormally dilated superficial veins.

Nursing Management Principles

• Promote tissue perfusion for arterial disorders.
• Promote venous return for venous disorders.

Blood Pressure Management

Hypertension

• Definition: Sustained elevated BP (SBP ≥ 140 mmHg; DBP ≥ 90 mmHg).
• Risk Factors and Classifications: Primary vs Secondary hypertension with known causes.
• Management: Pharmacotherapy (Beta-blockers, ACE inhibitors), lifestyle modifications including diet control and exercise.