NR 302 Chapter 17 - Cardiovascular System

Pericarditis

Fluid between the layers of the pericardium

Pariteal

Further from organ

Stroke Volume

SV= Cardiac Output/Heart Rate The amount of blood that is ejected with every heartbeat. Normal: 55-100 ml/beat

Semilunar Valves

Separate the ventricles from the vascular system. Open in response to rising pressure within the contracting ventricles. -Pulmonic -Aortic

Atrial Flutter

Atrial rate can be as high as 200 beats/min and exceeds the ventricular response and rate

Septal Defects

Atrial septal defect: opening between the right and left atria Ventricular septal defect: opening between the right and left ventricles. -->Both may result from congenital heart disease and MI

Stroke Volume

-Preload -Afterload (Resistance) -Contractibility

A heart sound heard during the interval between the first heart sound (S1) and the second sound (S2) is called: 1. A systolic sound 2. A diastolic sound 3. An atrial filling sound 4. A ventricular contraction sound

1. A systolic sound -The period between S1 and S2 is systole. Any sound heard after S1 and before S2 would be called a systolic sound. The period between S2 and the next S1 is diastole. Any sound heard during this would be called a diastolic sound. Filling of the atria does not produce a sound. The ventricles do not produce a sound when contracting.

A client has been diagnosed with pericarditis. The nurse knows that which structures are involved in this disease? 1. Between the parietal and visceral pericardium 2. Between the myocardium and the endocardium 3. Between the pericardium and the mediastinal space 4. Between the myocardium and the epicardium

1. Between the parietal and visceral pericardium. -The pericardial space is between the parietal and visceral pericardial layers. The parietal layer is the outer layer. The visceral layer is the inner layer, which lines the surface of the heart. This is the location where infection or inflammation can occur and lead to pericarditis. The myocardium is the thick, muscular layer of the heart and the innermost layer is the endocardium. The pericardium surrounds the heart. The area between the lungs and above the diaphragm is called the mediastinal space.

A nurse, explaining the cardiac circulation to cardiac rehabilitation clients, wants to include the oxygenation of the heart muscle. Which of the following structures carries deoxygenated blood to the lungs? 1. Pulmonary artery 2. Pulmonary vein 3. Great cardiac vein 4. Anterior cardiac vein

1. Pulmonary artery. -The pulmonary artery is the only artery in the body to carry deoxygenated blood. Deoxygenated blood flows into the right atrium. It is ejected through the tricuspid valve into the right ventricle and passes through the pulmonic valve into the pulmonary artery and pulmonary circulation. Oxygenated blood is then returned to the left atrium via the pulmonary veins, which are the only veins to carry oxygenated blood. The great cardiac vein carries deoxygenated blood to the coronary sinus. The anterior cardiac vein carries deoxygenated blood to the great cardiac vein, which then empties into the coronary sinus.

During the cardiac assessment, the nurse finds that a client has jugular vein distention. What does this finding suggest? 1. The client could have fluid overload. 2. The client is dehydrated. 3. The client has an infection. 4. This is an expected finding for the jugular veins.

1. The client could have fluid overload. -Distention of the neck veins indicates elevated central venous pressure commonly seen with heart failure, fluid overload, or pressure on the superior vena cava. With dehydration, the neck veins would be flat, not distended. Infection would not impact the jugular veins. Distention of the jugular veins is not a normal finding.

The nurse is auscultating across the precordial surface and is focusing on the second heart sound. Which heart valves produce this sound? 1. Mitral and tricuspid 2. Aortic and pulmonic 3. Mitral and pulmonic 4. Aortic and tricuspid

2. Aortic and pulmonic. -The second heart sound is produced by the closure of the aortic and pulmonic valves. Closure of the aortic and pulmonic valves produces the first heart sound. Closure of the mitral and tricuspid valves produce the first heart sound. The mitral and pulmonic valves do not close at the same time to produce a heart sound. The aortic and tricuspid valves do not close at the same time to produce a heart sound.

During cardiac auscultation, the nurse hears a split S2 heart sound. Which of the following is true regarding this physiologic sound? 1. The aortic valve is closing slightly before the triscupid valve. 2. The pulmonic valve is closing slightly after the aortic valve. 3. This is an abnormal finding. 4. The mitral valve closes slightly before the tricuspid valve.

2. The pulmonic valve is closing slightly after the aortic valve. -A split S2 is heard during inspiration in many individuals. It is the result of the semilunar valves closing at slightly different times. The aortic valve closes slightly faster than the pulmonic valve due to changes in intrathoracic pressure caused by inspiration. A split S2 during inspiration is a normal (physiologic) sound and doesn't signify cardiac pathology. The mitral valve closes slightly before the tricuspid valve and is responsible for the S1 heart sound, not a split S2.

During the assessment of the precordial surface of an adult client, the nurse inspects and palpates a heave at the apex of the heart with each heartbeat. What does this finding suggest to the nurse? 1. This is a normal finding in an athletic adult. 2. This is an abnormal finding possibly due to left ventricular hypertrophy. 3. The client is likely having a myocardial infarction. 4. The client likely has a history of a heart murmur.

2. This is abnormal finding possibly due to left ventricular hypertrophy. -The presence of a heave is considered abnormal over any location on the precordial surface. In this case, it may be indicative of hypertrophy of the left ventricle. The presence of a heave is an abnormal finding regardless of the age or athletic condition of the client. The presence of a lift is not associated with a current MI, nor is it indicative of the presence of a heart murmur.

A client has an S3 heart sound. The nurse knows: 1. An S3 heart sound is indicative of heart disease in almost all individuals. 2. An S3 heart sound is a systolic sound. 3. A physiologic S3 is common in children and young adults. 4. The presence of an S3 heart sound is an expected and normal finding in the elderly client.

3. A physiologic S3 is common in children and young adults. -An S3 heart sound, also called a ventricular gallop, occurs early in diastole when blood is flowing from the atria into the ventricles and causes vibrations. S3 is a physiologic heart sound in children, young adults, and pregnant females in their third trimester. The presence of an S3 heart sound may be associated with pathologic conditions such as myocardial infarction (MI) or heart failure; however, it is not indicative of heart disease in the majority of individuals. The S3 heart sound is an early diastolic sound. The presence of an S3 sound is not an expected sound in an elderly adult and may signify the presence of heart failure or a previous MI.

During the cardiac assessment, the nurse learns that a client had rheumatic fever as a child. For which of the following cardiac conditions should this client be assessed? 1. Chest pain 2. Mitral valve prolapse 3. Mitral stenosis 4. Pulmonic stenosis

3. Mitral stenosis. -Mitral stenosis, the narrowing of the mitral valve, can be caused by rheumatic fever or another cardiac infection. Mitral stenosis produces a diastolic murmur heard best at the apex of the heart. Rheumatic fever does not cause chest pain. Mitral valve prolapse has unknown etiology. Pulmonic stenosis is congenital in origin and not related to rheumatic fever.

The nurse is instructing a client about his high cholesterol level and wants to include behavioral considerations. Which of the following should be included in this instruction? 1. The need for an annual cholesterol panel 2. The need for annual flu inoculation 3. The need to stop smoking 4. The need to reduce stress

3. The need to stop smoking. -Behavioral considerations to include in this instruction include smoking cessation, diet, and the need for regular exercise. Behavioral considerations include factors that the client can modify. The client may need an annual cholesterol panel, but it is not related to behavioral modification. Influenza immunization is not related to high cholesterol. Stress may be related to the onset of chest pain, but not elevated cholesterol.

The nurse is palpating the precordial surface of an adult and notes a mild pulsation in the fifth intercostal space at the midclavicular line. What does this finding suggest to the nurse? 1. The client may have had a myocardial infarction. 2. This is an abnormal finding related to emphysema. 3. This is a normal finding and the location of the point of maximum impulse (PMI). 4. The client likely has a heart murmur.

3. This is a normal finding and the location of the point of maximum impulse (PMI). -The presence of a palpable pulsation in this location identifies the point of maximum impulse (PMI) or apical impulse. This is a normal and expected finding. This doesn't signify that the client has had an MI. It is a normal, not an abnormal finding and not related to the presence of emphysema. Heart sounds should not be altered based on this normal finding.

A client has been diagnosed with a myocardial infarction that has damaged a part of the right atrium. Which of the following could happen as a result of this damage? 1. Shortness of breath 2. Increase in collateral circulation 3. Onset of aortic regurgitation 4. A change in the rate and rhythm of the client's heartbeat

4. A change is rate and rhythm of the client's heartbeat. -The sinoatrial node, which initiates the electrical impulse, is called the pacemaker of the heart and has a rate of 60-100 per minute. This node is located at the junction of the superior vena cava and the right atrium. Shortness of breath would be seen with left-sided heart failure. A myocardial infarction would not cause an increase in the collateral circulation. Aortic regurgitation would be seen with abnormalities of the aortic valve, which is located in the left side of the heart, not the right atrium.

Which of the following actions produces the second heart sound? 1. Opening of the mitral and tricuspid valves 2. Closing of the mitral and triscupid valves 3. Opening of the aortic and pulmonic valves 4. Closing of the aortic and pulmonic valves

4. Closing of the aortic and pulmonic valves. -Closure of the aortic and pulmonic valves produces the second heart sound. Opening of the valves should be a silent phenomenon. Closure of the mitral and tricuspid valves produces the first heart sound.

During the examination of an eight-month-pregnant client, the nurse measures the blood pressure at 160/98 and notes bilateral edema of the ankles. What do these findings suggest to the nurse? 1. This is a normal finding during the eighth month of pregnancy. 2. The client may have a prolapsed mitral valve. 3. The client may go into early labor. 4. The client could be preeclamptic.

4. The client could be preeclamptic. -Hypertension and edema are symptoms of preeclampsia and can place the mother and infant at risk if not treated. This is not a normal finding at any stage of pregnancy. Elevated blood pressure and edema are not related to a prolapsed mitral valve. Hypertension and edema do not indicate early labor.

Coarctation of the Aorta

Aorta is severely narrowed in the region inferior to the left subclavian artery. Restricts blood flow from the left ventricle into the aorta and out into the systemic circulation, which contributes to the development of congestive heart failure in the newborn. Can be surgically treated

Aortic Regurgitation

Backflow of blood from the aorta into the left ventricle -Causes: rheumatic heart disease, endocarditis, marfan's syndrome, syphilis -Findings: murmur with client leaning forward, click in second ICS

Mitral Regurgitation

Backflow of blood from the left ventricle into the left atrium -Causes: rheumatic fever, MI, rupture of chordae tendineae -Findings: murmur at apex, sound is transmitted to left axillae

Cardiac Output

CO= Stroke Volume x Heart Rate The amount of blood ejected from the left ventricle over 1 min. Normal: 4-8 liters/minute

Right-sided Heart Failure

Causes backup of the blood into the systemic circulation and leads to distended neck veins, liver congestion and peripheral edema

Left-sided Heart Failure

Causes blood to back up into the pulmonary system and results in pulmonary edema

Visceral

Closer to organ

Myocardial Infarction

Complete disruption of oxygen and nutrient flow to the myocardial tissue in the area below a total occlusion. Leads to the death of the myocardial tissue unless flow of blood is reestablished

Tetralogy of Fallot

Congenital disease that can be life threatening to newborn. Involves 4 cardiac defects: -dextroposition of the aorta -pulmonary stenosis -right ventricular hypertrophy -ventricular septal defect

Patent Ductus Arteriosus

Ductus arteriosus: opening between the aorta and pulmonary artery that is present in the fetus. -Should spontaneously close permanently between 24-48 hours after delivery. If not, this condition occurs

Atrial Fibrillation

Dysrhythmic atrial contraction with no regularity or pattern

Heart Mumurs

Harsh, blowing sounds caused by disruption of blood flow into the heart, between the chambers of the heart, or from the heart into the pulmonary or aortic systems.

S1

Heard when the AV valves close. Closure of these valves occurs when the ventricles have been filled

S2

Heard when the aortic and pulmonic valves close. These semilunar valves close when the ventricles have emptied their blood into the aorta and pulmonary arteries

Heart Failure

Inability of the heart to produce a sufficient pumping effot

Endocardium

Innermost layer of the heart

Mitral Valve (Apical Pulse)

Left mid clavicular line 5th intercostal space

Pulmonic Valve

Left sternal border 2nd intercostal space

Erb's Point

Left sternal border 3rd intercostal space

Tricuspid Valve

Left sternal border 4th intercostal space

S4

May be heard in children, well-conditioned athletes, and healthy elderly individuals without cardiac distress. Heard before S1. -Known as atrial gallop

S3

May be heard in children, young adults or pregnant females in their third trimester. Heard after S2. -Known as a ventricular gallop

Aortic Stenosis

Narrowing of the aortic valve Causes: congenital bicuspid valves, rheumatic heart disease, arterosclerosis Findings: murmur at aortic area, RSB, second ICS

Mitral Stensosis

Narrowing of the left mitral valve. Caused by: rheumatic fever or cardiac infection Findings: murmur heard at the apical area with client in left lateral position

Pulmonic Stenosis

Narrowing of the opening between the pulmonary artery and the right ventricle -Causes: congenital -Findings: murmur at pulmonic area radiates to neck, thrill in left 2nd and 3rd ICS

Tricuspid Stenosis

Narrowing or stricture of the tricuspid valve -Causes: rheumatic heart disease, congenital defect, right atrial myxoma (tumor) -Findings: murmur heard with the bell of the stethoscope over the tricuspid area

Ventricular Hypertrophy

Occurs in response to pumping against high pressures. RIGHT: occurs with pulmonary hypertension, congenital heart disease, pulmonary disease, pulmonary stenosis and right ventricular infarction LEFT: occurs in the presence of systemic hypertension, congenital heart disease, aortic stenosis or MI to the left ventricle

Epicardium

Outer layer of the heart

Atrioventricular Valves (AV)

Separate the atria from the ventricles. Open as a result of atrial contraction and the concomitant buildup of pressure within the atria. -Mitral -Tricuspid

Systole

Phase of ventricular CONTRACTION when ventricles have been filled and then contract to expel blood into the aorta and pulmonary arteries. Begins with the closure of the AV valves (S1) and ends with the closure of the aortic and pulmonic valves (S2)

Diastole

Phase of ventricular RELAXATION. Ventricles relax and are filled as the atria contact. Beigins with the closure of the aortic and pulmonic valves (S1) and ends with the closure of the AV valves (S2)

Myocardial Ischemia

Problem where oxygen needs of the body are heightened, increasing the work of the heart. The oxygen needs of the heart are not met as it works harder, causing ischemia.

Ventricle Tachycardia

Rapid, regular heartbeat as high as 200 beats/min

Aortic Valve

Right sternal border 2nd intercostal space

Normal Heart Sounds

S1, S2. Lub, Dub. Heard when auscultated over the precordium, the area of the chest that lies over the heart

Heart Block

Slow heart rate can be as low as 20 to 40 beats/min. Conduction between the atria and ventricles is disrupted

Myocardium

Thick, muscular "middle" layer

Pericardium

Thin sac composed of a fibroserous material that surrounds the heart

Ventricular Fibrillation

Total absence of regular heart rhythm

Pulse Deficit

When apical pulse is greater than carotoid rate. Rate, rhythm and regularity must be evaluated

Mediastinal Space

Where the heart sits in the thoracic cavity