Adult 1- Cardiovascular

Heart Rate Determination

A. Determine heart rate with a regular rhythm by counting the number of small boxes within a RR interval and divide 1,500 by that number. Example: ten small boxes, 1,500/10 = 150 bpm. B. Used when rhythm is irregular. Count the number of RR intervals in 6 seconds and multiply that number by 10.

A nurse educator is reviewing expected findings in a client who has right-sided valvular heart disease with a group of nurses. Which of the following findings should the nurse include in the discussion? (Select all that apply) A. Dyspnea B. Client report of fatigue C. Bradycardia D. Pleural fiction rub E. Peripheral edema

A. Dyspnea B. Client report of fatigue E. Peripheral edema

A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? (Select all that apply) A. Surgical repair of an atrial septal defect at age 2 B. Measles infection during childhood C. Hypertension for 5 years D. Weight gain of 10 lb in past year E. Diastolic murmur present

A. Surgical repair of an atrial septal defect at age 2 C. Hypertension for 5 years E. Diastolic murmur present

A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following manifestations are expected findings? (Select all that apply) A. Tachypnea B. Persistent cough C. Increased urinary output D. Thick, yellow sputum E. Orthopnea

A. Tachypnea B. Persistent cough E. Orthopnea

Cardiac catheterization

Invasive procedure study used to measure cardiac pressures, assess patency of coronary arteries. Involves the insertion of a catheter into a femoral (sometimes a brachial) vessel and threading it into the right or left side of the heart. Visualizes patency of the coronary arteries and evaluate ventricular function. Can be diagnostic and/or curative. Requires ECG, hemodynamics monitoring; emergency equipment must be available. Allergies and blood work (metabolic, renal + coagulation) should be assessed prior to test. Assessment of patient postprocedure: circulation, potential for bleeding, potential for dysrhythmias. Activity is restricted for 24-48 hours post-procedure.

Sinus arrhythmia

Irregular rhythm that varies with respiration. (Not the same distance apart on ECG).

Radionuclide imaging

Noninvasive tests that use radioisotopes to evaluate coronary artery perfusion, detect myocardial ischemia and infarction, and/or assess left ventricular function.

CVD

cardiovascular disease

CAD

coronary artery disease

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? a. Pulmonary embolism b. Myocardial infarction c. Pericarditis d. Heart failure

d. Heart failure

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? a. Rudor b. Cellulitis c. Dermatitis d. Ulceration

d. Ulceration

Angina pectoris

- A syndrome characterized by episodes of paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow. - Physical exertion or emotional stress increases myocardial oxygen demand, and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand. - Types of angina: stable, unstable, silent.

Three layers of the heart

(Inner to outer) 1. Endocardium 2. Myocardium 3. Epicardium

Criteria for Metabolic Syndrome

*At least three of the following*: - Fasting blood glucose > 100 mg/dL. - Central obesity (waist circumference more than 35 inches in females, > 40 inches in males). - Dyslipidemia (triglycerides > 150 mg/dL, HDL < M: 40 mg/dL, F: 50 mg/dL). - BP > 130/85. - Prothrombotic state- high fibrinogen level. - Proinflammatory state- high levels of C-reactive protein (CRP).

Lab Values

*BUN*: 10-20 mg/dL. *Calcium*: 8.5-10.5 mg/dL. *Creatinine*: 0.7-1.4 mg/dL. *Magnesium:* 1.8-3.0 mg/dL. *Potassium:* 3.5-5 mEq/L. *Sodium*: 135-145 mEq/L. *Hematocrit*: M: 42-52%, F: 35-47%. *Hemoglobin*: M: 14-18 g/dL, F: 12-16 g/dL. *Platelets*: 150,000-400,000 mm3. *White blood cell (WBC)*: 5,000-10,000.

Nursing management: Valvuloplasty and Valve Replacement

*Balloon valvuloplasty:* - Monitor for heart failure and emboli. - Assess heart sounds every 4 hours. - Same care as after cardiac catheterization. *Surgical valvuloplasty or valve replacements*: - Focus is hemodynamic stability and recovery from anesthesia. - Frequent assessments with attention to neurologic, respiratory, and cardiovascular systems.

Pathophysiology of Atherosclerosis

*Cell injury*- injury occurs to the cells that line the artery walls. *Migration of inflammatory cells*- macrophages are attracted to the area and bind to the injured cells. Macrophages further injure the vessel wall. *Lipid accumulation*- macrophages engulf LDL (now a foam cell) which penetrates the lining of the vessel. Foam cells accumulate and form a fatty streak. Macrophages release growth factors that stimulate smooth muscle proliferation. *Plaque structure*- those smooth muscle cells migrate over the fatty streak and form a fibrous plaque. Plaques may protrude into the vessel and obstruct blood flow. May plaques are "unstable", also known as a complicated plaque.

Surgical management: Valvular Heart Disorders

*Valvuloplasty* (depends on what part of the valve they're fixing, doesn't require long-term coagulation therapy)- - Commissurotomy - Balloon valvuloplasty - Annuloplasty - Leaflet repair - Chordoplasty *Valve replacement*- - Mechanical: most durable. Requires long-term coagulation therapy (Warfarin- monitoring INR + PT). - Tissue- — Bioprosthesis ("heterografts"): pig (porcine), cows (bovine), horses (equine). Used for women of childbearing age (or pregnant) and patients older than 70 years old. — Homografts ("allografts"): human cadaver. — Autografts: uses patient's own pulmonic valve and a portion of the pulmonary artery.

Medications for Angina

- *Nitroglycerin*: short- and long-term reduction of myocardial oxygen consumption through selective vasodilation. Systolic blood pressure must be over 90 mmHg before administration. Common side effect: headache. Available: SL, patch, IV. - Beta-adrenergic blocking agents - Calcium channel blocking agents - Antiplatelet and anticoagulant medications - *Aspirin*: administer 162 - 325 mg in ER, know if they did that at home. - Clopidogrel and ticlopidine - Heparin - Glycoprotein IIb/IIIa agents

Elements of an ECG strip

- *P wave*: atrial depolarization. - *QRS complex*: ventricular depolarization. - *T wave*: ventricular repolarization. - *PR interval*: from the beginning of the P wave to the beginning of the QRS complex. - *ST segment*: look for elevation: STEMI or NSTEMI. - *QT interval*: represents the total time for ventricular depolarization and repolarization. Beginning of the QRS complex to the end of the T wave. Varies with heart rate, gender, and age. Prolongation may be due medications (Zofran, Levaquin, Anti-psychotics, etc), at risk for lethal dysrhythmia (Torsades de pointes).

Valvular Disorders

- *Regurgitation*: "Leaky valve." The valve does not close properly, and blood backflows through the valve. - *Stenosis*: The valve does not open completely, and blood flow through the valve is reduced. (Causing low cardiac output, poor perfusion). - *Valve prolapse*: The stretching of an atrioventricular valve leaflet into the atrium during systole.

Methods of Electrocardiography

- 12-lead ECG - Continuous monitoring: hardwire, telemetry. - Signal-averaged ECG. - Continuous ambulatory monitoring: Holter monitors. - Transtelephonic monitoring. - Wireless mobile monitoring.

Nursing Interventions for Treating Angina

- A *priority*! - Patient is to stop all activity and sit or rest in bed (Semi-Fowler's position): minimize demand. - Assess the patient while performing other necessary interventions. Assessment includes VS, observation for respiratory distress, and assessment of pain. In the hospital setting, the ECG is assessed or obtained. - Administer medications as ordered or by protocol, usually nitroglycerin (NTG). Reassess pain and administer NTG up to three doses. - Administer oxygen 2 L/min by nasal cannula.

Treatment for Angina

- Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply. - Medications (next slide). - Oxygen: increase supply. - Reduce and control risk factors (long term treatment). - Reperfusion therapy may also be done.

Patient education after Valvuloplasty and Valve Replacement

- Anticoagulation therapy: frequent follow-up appointments and blood laboratory studies. Length of therapy depends on procedure. - Prevention of infective endocarditis: antibiotic prophylaxis before dental and invasive respiratory procedures. - Follow up. - Repeat echocardiograms: 3-4 weeks after hospital discharge, repeat every 1 to 2 years.

Infectious diseases of the heart

- Any of the layers of the heart may be affected by an infectious process. - Diseases are named by the layer of the heart that is affected (endo-, myo-). - Diagnosis is made by patient symptoms and echocardiogram. - Blood cultures may be used to identify the infectious agent and to monitor therapy. - Treatment is with appropriate antimicrobial (IV) therapy. Patients require teaching to complete the course of appropriate antimicrobial therapy and require teaching for infection prevention and health promotion.

Coronary Atherosclerosis

- Atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen. - In coronary atherosclerosis, blockages and narrowing of the coronary vessels reduce blood flow to the myocardium. - Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups. - CAD, coronary artery disease, is the most prevalent cardiovascular disease in adults.

Nursing Intervention for Angina: Patient Teaching

- Balance activity with rest. - Follow prescribed exercise regimen. - Avoid exercising in extreme temperatures. - Use resources for emotional support (counselor). - Avoid OTC medications that may increase Hr or BP before consulting with a healthcare provider. - Stop using tobacco products (nicotine increases HR and BP). - Eat a diet low in fat and high in fiber. - Medication teaching: carry NTG at all times! Can be used as prophylactic treatment before sex/exercise. - Follow up with healthcare provider. - Report an increase in S/S to provider. - Maintain normal BP and blood glucose levels.

Laboratory tests

- Cardiac biomarkers: CK, CK-MB, Myoglobin, Troponin. - Lipid profile - Brain (B-type) natriuretic peptide (measurement for Heart Failure). - C-reactive protein (inflammatory marker, > 3) - Homocysteine (amino acid, damages arteries). - Electrolytes: potassium, calcium, sodium, magnesium. - Renal function: BUN + creatinine. - CBC: hemoglobin, hematocrit

Prevention of Coronary Artery Disease (CAD)

- Control cholesterol: check lipids at least once every 5 years. Desired level: LDL less than 100 mg/dL, total cholesterol less than 200 mg/dL, HDL greater than 40 mg/dL (males) or 50 mg/dL (females), triglycerides less than 150 mg/dL. - Dietary measures: increase fiber, lower saturated fat. - Physical activity. - Medications (next slide). - Cessation of tobacco use: nicotine leads to the release of catecholamines which raises HR and BP; increases oxidation of LDL-> atherosclerosis; increases carbon monoxide level + decreases supply of oxygen to the myocardium. - Manage hypertension. - Control diabetes.

A 12-lead ECG is used to diagnose-

- Dysrhythmias - Conduction abnormalities - Chamber enlargement - Myocardial ischemia, injury, or infarction. Suggests cardiac effects of electrolyte disturbances (high or low calcium and potassium levels) and the effects of antiarrhythmic medications.

Risk factors for Coronary Artery Disease (CAD)

- Four major modifiable factors: Cholesterol abnormalities, tobacco use, hypertension, and diabetes. Plus: obesity, physical inactivity. - Elevated LDL: primary target for cholesterol-lowering medication. - Framingham risk calculator: risk of having a cardiac event within the next 10 years. - Metabolic syndrome (next slide). - hs-CRP (high-sensitivity C-reactive protein).

Care of the patient with a dysrhythmia- Assessment

- Identify causes of dysrhythmia + contributing factors: stress, anxiety, caffeine + nicotine (stimulants), electrolytes. - Assess indicators of cardiac output and oxygenation: lethargy, SOB, dizziness, low BP. - Heath history: include presence of coexisting conditions, indications of previous occurrence. - All medications (prescribed and OTC). - Psychosocial assessment: patient's perception of dysrhythmia, are they bothered by it? - Physical assessment includes: skin (pale and cool), signs of fluid retention (JVD, lung auscultation), signed of decreased cardiac output (altered LOC); rate, rhythm of apical, peripheral pulses; heart sounds (S3 + S4), blood pressure, pulse pressure.

Angina- Nursing Assessment

- May be described as tightness, choking, or a heavy sensation. - Frequently retrosternal and may radiate to neck, jaw, shoulders, back or arms (usually left). - Anxiety frequently accompanies the pain. - Other symptoms may occur: dyspnea or shortness of breath, dizziness, nausea, and vomiting. - The pain of typical (stable) angina subsides with rest or NTG. - Unstable angina is characterized by increased frequency and severity and is not relieved by rest and NTG. Requires medical intervention!

Nursing management for Valvular heart disorders

- Patient education: at increased risk for infection, which further damages valves. - Monitor VS trends: blood pressure going up or down. - Monitor for Complications: Heart failure (pale/cool extremities), Dysrhythmias (affects blood flow even more), Other symptoms (dizziness, syncope, weakness; angina- could give NTG if severe- be careful w/BP). - Medication schedule - Daily weights: monitor for weight gain (sign of HF). - Plan activity with rest periods. - Sleep with HOB elevated (to decrease/prevent pulmonary congestion).

Nursing Process: The Care of the Patient with Angina Pectoris: Diagnoses

- Risk for decreased cardiac tissue perfusion. - Anxiety related to cardiac symptoms and possible death. - Deficient knowledge about the underlying disease and methods for avoiding complications. - Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes.

Clinical Manifestations of CAD

- Symptoms are caused by myocardial ischemia (no oxygen/blood supply -> tissue death -> chest pain). - Symptoms and complications are related to the location and degree of vessel obstruction. - Angina pectoris (pain: most common manifestation). - Other symptoms: epigastric distress, pain that radiates to jaw or left arm, SOB, atypical symptoms in women. - Myocardial infarction. - Heart failure. - Sudden cardiac death.

Types of Radionuclide imaging

-Myocardial perfusion imaging -Test of ventricular function, wall motion -Computed tomography -Positron emission tomography -Magnetic resonance angiography (involves contrast: can damage kidneys, be aware of allergies. Not for pregnant women d/t radiation).

Cardiac conduction system

1. SA node 2. AV node 3. Bundle of His 4. Bundle branches 5. Purkinje fibers

Normal sinus rhythm

60-100 bpm. P wave in front of QRS. PR interval is between 0.12-0.20 seconds.

Electrocardiogram (ECG)

A graphic representation of the electrical activity of the heart. Obtained by placing disposable electrodes in standard positions on the skin of the chest wall and extremities.

Echocardiography

A noninvasive ultrasound test that is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures. *Transthoracic (TTE)*: handheld transducer applied to the front of the chest. *Transesophageal (TEE)*: thread a small transducer through the mouth and into the esophagus. Provides clearer images. Moderate sedation + topical anesthetic.

A nurse is caring for a client who asks why her provider prescribed a daily aspirin. Which of the following is an appropriate response by the nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relieves the pain due to myocardial ischemia." C. "Aspirin dissolves clots that are forming in your arteries." D. "Aspirin relieves headaches that are caused by other medications."

A. "Aspirin reduces the formation of blood clots that could cause a heart attack."

A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. The client asks the nurse how to determine the appropriate amount of fluid he is allowed. Which of the following statements is an appropriate response by the nurse? A. "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink." B. "Each glass contains 8 ounces. There are 30 milliliters per ounce, so you can have a total of 8 glasses or cups of fluid each day. C. "This is the same as 2 quarts, or about the same as two pots of coffee." D. "Take sips of water or ice chips as you will not take in too much fluid."

A. "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink."

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin. B. The pain of an MI resolved in less than 15 min. C. The type of activity that causes an MI can be identified. D. Angina can occur for longer than 30 min.

A. Angina can be relieved with rest and nitroglycerin.

A nurse at a provider's office is reviewing the laboratory test results for a group of clients. The nurse should identify which of the following results indicates the client is at risk for heart disease? (Select all that apply) A. Cholesterol (total) 245 mg/dL B. HDL 90 mg/dL C. LDL 140 mg/dL D. Triglycerides 125 mg/dL E. Troponin I 0.02 ng/mL

A. Cholesterol (total) 245 mg/dL C. LDL 140 mg/dL

Which of the following best defines stroke volume? A. The amount of blood ejected with each heartbeat. B. Amount of blood pumped by the ventricle in liters per minute. C. Degree of stretch of the cardiac muscle fibers at the end of diastole. D. Ability of the cardiac muscle to shorten in response to an electrical impulse.

A. The amount of blood ejected with each heartbeat.

Contractility

Ability of the cardiac muscle to shorten in response to an electrical impulse. Increases with catecholamine release, digoxin. Decreases with beta blockers, hypoxia, acidosis.

Cardiac Output (CO)

Amount of blood pumped by each ventricle in liters per minute. Average: 4-6 L/minute. Stroke volume x Heart rate = Cardiac output

Dysrhythmias

Disorders of formation or conduction (or both) of electrical impulses within heart Can cause disturbances of: - Rate - Rhythm - Both rate and rhythm Potentially can alter blood flow and cause hemodynamic changes Diagnosed by analysis of electrographic (ECG) waveform.

A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statements by the client indicates understanding of the teaching? A. "I will be glad to get back to my exercise routine right away." B. "I will have my prothrombin time checked on a regular basis." C. "I will talk to my dentist about no longer needing antibiotics before dental exams." D. "I will continue to limit my intake of foods containing potassium."

B. "I will have my prothrombin time checked on a regular basis."

A nurse is caring for a 72-year-old client who is to undergo a percutaneous balloon valvuloplasty. The client's daughter asks the nurse to explain the expected outcome of the procedure. Which of the following responses should the nurse give? A. "This will improve blood flow in your mother's coronary arteries." B. "This will permit your mother to resume her activities of daily living." C. "This will prolong your mother's life." D. "This will reverse the effects to the damaged area."

B. "This will permit your mother to resume her activities of daily living."

A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh-high compression stockings. Which of the following actions should the nurse take? A. Elevate the legs for 10 min, two to three times daily while wearing stockings. B. Apply the stockings in the morning upon awakening and before getting out of bed. C. Roll the stockings down to the knees to relieve discomfort on the legs. D. Remove the stockings while out of bed for 1 hr, four times a day, to allow the legs to rest.

B. Apply the stockings in the morning upon awakening and before getting out of bed.

A nurse is caring for a client who has heart failure and reports increased shortness of breath. The nurse increases the client's oxygen per protocol. Which of the following actions should the nurse take first? A. Obtain the client's weight. B. Assist the client into high-Fowler's position. C. Auscultate lung sounds. D. Check oxygen saturation with pulse oximeter.

B. Assist the client into high-Fowler's position.

A nurse is caring for four clients. Which of the following clients should the nurse identify as being at risk of acquiring rheumatic endocarditis? A. Older adult who has chronic obstructive pulmonary disease. B. Child who has streptococcal pharyngitis. C. Middle-age adult who has lupus erythematosus D. Young adult who recently received a body tattoo

B. Child who has streptococcal pharyngitis.

Where does the nurse auscultate the apex of the heart? A. Erb's point (Third ICS, left sternal border). B. Mitral area (Fifth ICS, left mid-clavicular line). C. Pulmonic area (Second (ICS), left sternal border). D. Tricuspid area (Fourth ICS, left sternal border).

B. Mitral area (Fifth ICS, left mid-clavicular line).

The nurse is caring for a patient who has severe chest pain after working outside on a hot day and is brought to the emergency center. The nurse administers nitroglycerin to help alleviate chest pain. What side effect should concern the nurse the most? A. Dry mucous membranes B. Heart rate of 88 bpm C. Blood pressure of 86/58 mmHg D. Complaints of headache

C. Blood pressure of 86/58 mmHg

A nurse is completing the admission physical assessment of a client who has a history of mitral valve insufficiency. Which of the following findings should the nurse expect? A. S4 heart sound B. Petechiae C. Crackles in lung bases D. Splenomegaly

C. Crackles in lung bases

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made *first*? A. Diet modification B. Relaxation exercises C. Smoking cessation D. Takin omega-3 capsules

C. Smoking cessation

ECG Graph and Commonly Measured Components

Can figure out HR by counting squares. 1 square = 0.04 seconds. (More on next slide)

A nurse is teaching a client who is scheduled for an angiography (cardiac catheterization). Which of the following statements should the nurse include in the teaching? A. "You should have nothing to eat or drink for 4 hours prior to the procedure." B. "You will be given general anesthesia during the procedure." C. "You should not have this procedure done if you are allergic to eggs." D. "You will need to keep your affected leg straight following the procedure."

D. "You will need to keep your affected leg straight following the procedure."

A nurse is caring for a client who has pericarditis. Which of the following findings should the nurse expect? A. Petechiae B. Murmur C. Rash D. Friction rub

D. Friction rub

The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin (Lipitor). What serum levels should be monitored monitored in this patient? A. Complete blood count (CBC) B. Blood cultures C. Na and K levels D. Liver enzymes

D. Liver enzymes

A nurse is assessing a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect? A. Edema around the ankles and feet. B. Ulceration around the medial malleoli. C. Scaling eczema of the lower legs with stasis dermatitis. D. Pallor in elevation of the limbs, and rubor when the limbs are dependent.

D. Pallor in elevation of the limbs, and rubor when the limbs are dependent.

A nurse is teaching a client who has been a new diagnosis of severe peripheral artery disease. Which of the following instructions should the nurse include? A. Wear tightly fitted insulated socks with shoes when going outside. B. Elevate both legs above the heart when resting. C. Apply a heating pad to both legs for comfort. D. Place both legs in dependent position while sleeping.

D. Place both legs in dependent position while sleeping.

Preload

Degree of stretch of the cardiac muscle fibers at the end of diastole. "Diastolic pressure" Increased with IV fluids, blood (increased volume). Decreased with dehydration, diuretics, blood loss, nitrates.

Specific valvular disorders

Diagnosed via echocardiogram (non-invasive) or cardiac catheterization (invasive). - Mitral valve prolapse - Mitral regurgitation: systolic murmur - Mitral stenosis: diastolic murmur - Aortic regurgitation: diastolic murmur - Aortic stenosis: systolic murmur

True or False: Valvular heart disorders are first recognized by the patient experiencing symptoms.

False. Valvular heart disorders are usually first recognized through a healthcare provider hearing a murmur.

Sinus tachycardia

Greater than 100 bpm. May be due to stress, medications, autonomic dysfunction. As the heart rate increases, the diastolic filling time decreases, possibly resulting in reduced cardiac output and subsequent symptoms of syncope and low BP. Worst case may lead to: pulmonary edema.

Sinus Bradycardia

Less than 60 bpm. Could be normal (in athletes) or due to medications. May be due to sinus node dysfunction (sick sinus syndrome).

Semilunar valves

Located between the ventricles and their corresponding arteries. *Pulmonic valve*: between the right ventricle and the pulmonary artery. *Aortic valve*: between the left ventricle and the aorta.

Disorders of which valves cause more symptoms, require treatment, and cause more complications?

Mitral and Aortic (Left side of the heart- more pressure)

Cardiac stress testing

Monitors how the heart responds to increased demands. Patient is hooked up to ECG leads for HR, rhythm, and ischemic changes; and BP, skin temperature, physical appearance, perceived exertion, and symptoms. Can either be 1) Exercise: treadmill, bike, or 2) Pharmacologic: vasodilating agents. Test is stopped when the target heart rate is achieved or if the patient experiences signs of myocardial ischemia.

Ejection fraction

Percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat. 55-65% Low ejection fraction is indicative of heart failure.

Atrioventricular valves

Separate the atria from the ventricles. *Tricuspid valve*: separates right atrium from the right ventricle. *Mitral valve*: separates left atrium from the left ventricle.

Cholesterol medications

Six types of lipid-lowering agents: affect the lipid components somewhat differently- - *3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) (or statins)*: lowers LDL. - Nicotinic acids. - Fibric acids (or fibrates). - Bile acid sequestrants (or resins). - Cholesterol absorption inhibitors. - Omega-3 acid-ethyl esters.

Blood flow through the heart

Superior vena cava--> Right atrium --> Tricuspid valve --> Right ventricle --> Pulmonic valve --> Lungs --> Left atrium --> Mitral valve --> Left ventricle --> aortic valve --> aorta --> Body.

Stroke Volume (SV)

The amount of blood pumped out of the heart with each contraction. 60-130 mL

Afterload

The amount of resistance to ejection of blood from the ventricles Affected by systemic resistance and pressure.

Relationship of ECG complex, lead system, and electrical impulse

Wave appearance depends on the lead/"view".

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication? a. 160-190 mg/dL b. 210-240 mg/dL c. 250-275 mg/dL d. 280-300 mg/dL

a. 160-190 mg/dL

A patient asks the nurse how long he will have to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? a. 3 minutes b. 15 minutes c. 30 minutes d. 60 minutes

a. 3 minutes

A patient had a cardiac catheterization and is now in the recovery area. What nursing interventions should be included in the plan of care? (Select all that apply). a. Assessing the peripheral pulses in the affected extremity b. Checking the insertion site for hematoma formation c. Evaluating temperature and color in the affected extremity d. Assisting the patient to the bathroom after the procedure e. Assessing vital signs every 8 hours

a. Assessing the peripheral pulses in the affected extremity b. Checking the insertion site for hematoma formation c. Evaluating temperature and color in the affected extremity

The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.) a. Avoid constricting garments. b. Elevate the legs about the heart level for 30 minutes every 2 hours. c. Sit as much as possible to rest the valves in the legs. d. Sleep with the foot of the bed elevated about 6 inches. e. Sit on the side of the bed and dangle the feet.

a. Avoid constricting garments. b. Elevate the legs about the heart level for 30 minutes every 2 hours. d. Sleep with the foot of the bed elevated about 6 inches.

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) a. Cool and cyanotic skin b. Initial absence of edema c. Sharp pain that may be relieved by the elevation of the extremity d. Full superficial veins e. Brisk capillary refill of the toes

a. Cool and cyanotic skin c. Sharp pain that may be relieved by the elevation of the extremity d. Full superficial veins

The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is location? a. The thin fibrous sac encasing the heart b. The inner lining of the heart and valves c. The heart's muscle fibers d. The exterior layer of the heart

a. The thin fibrous sac encasing the heart

A patient has been experiencing increasing shortness of breath and fatigue. The physician has ordered a diagnostic test in order to determine what type of heart failure the patient is having. What diagnostic test does the nurse anticipate being ordered? a. A chest x-ray b. An echocardiogram c. An electrocardiogram d. A ventriculogram

b. An echocardiogram

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and an MI. How should the nurse describe the pain experienced during an MI? (Select all that apply). a. It is relieved by rest and inactivity b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms. e. It subsides after taking nitroglycerin.

b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms.

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? a. Elevating the limb about heart level b. Lowering the limb so that it is dependent c. Massaging the limb after application of cold compresses d. Placing the limb in a plane horizontal to the body

b. Lowering the limb so that it is dependent

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? a. "As soon as you feel pain, we will go back and elevate your legs." b. "If you feel pain during the walk, keep walking until the end of the hallway is reached." c. "Walk to the point of pain, rest until the pain subsided, then resume ambulation." d. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

c. "Walk to the point of pain, rest until the pain subsided, then resume ambulation."

A patient is seen in the emergency department (ED) with heart failure. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure? a. Blood urea nitrogen (BUN) b. Complete blood count (CBC) c. B-type natriuretic peptide (BNP) d. Serum electrolytes

c. B-type natriuretic peptide (BNP)

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a. Cholesterol, 280 mg/dL b. Low density lipoprotein (LDL), 160 mg/dL c. High-density lipoprotein (HDL), 80 mg/dL d. A ratio of LDL to HDL of 4.5 to 1.0

c. High-density lipoprotein (HDL), 80 mg/dL

The nurse is educating a patient at risk for atherosclerosis. What nonmodifiable risk factor does the nurse identify for the patient? a. Stress b. Obesity c. Positive family history d. Hyperlipidemia

c. Positive family history

A patient is admitted to the intensive care unit (ICU) with left- sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) a. Jugular vein distention b. Ascites c. Pulmonary crackles d. Dyspnea e. Cough

c. Pulmonary crackles d. Dyspnea e. Cough

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? a. PP interval b. QT interval c. RR interval d. TP interval

c. RR interval

PAD

peripheral artery disease

PVD

peripheral vascular disease