NUR 114
EXAM 3 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Exam 3 content from the
Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
,1
NUR 114 – Exam 3 Study Guide
Heart: Function
Electrophysiologic properties of the heart muscle are responsible for regulating the HR
Cardiac cells are automaticity, excitability, conductivity, contractility, and refractoriness
Diastole: consists of relaxation and filling of the atria and ventricles and comprises about two-
thirds of the cardiac cycle
Systole: consists of contraction and emptying of the atria and ventricles
Myocardial contraction results from the release of large numbers of Ca ions from the
sarcoplasmic reticulum and the blood…and a bunch of other fancy mechanisms that you can look
at on pg 645 of Iggy if you want to know lol. All in all, it forms an electrical impulse that causes
contraction.
Cardiac output: blood flow from the heart into the systemic arterial circulation, the amount of
blood pumped from the left ventricle each minute. Cardiac depends on the relationship between
HR and stroke volume. Cardiac output = HR x Stroke Volume. Ranges from 4-7 L/min
Cardiac index: can be determined by dividing the CO by the body surface area. Normal range:
2.8-4.2 L/min/m^2
Heart rate: refers to the number of times the ventricles contract each minute. 60-100 beats/min
Stroke volume: amount of blood ejected by the left ventricle during each contraction
Preload: refers to the degree of myocardial fiber stretch at the end of diastole and just before
contraction. The stretch imposed on the muscle fibers results from the volume contained within
the ventricle at the end of diastole
Ejection Fraction: percentage of blood ejected from the heart during systole. Normal: 55-70%.
<40% is considered heart failure.
Starlings Law of the Heart: the more the heart is filled during diastole (within limits), the more
forcefully it contracts
Afterload: pressure or resistance that the ventricles must overcome to eject blood through the
semilunar valves and into the peripheral blood vessels. The amount of resistance is directly
related to arterial blood pressure and the diameter of the blood vessels
Vascular System:
Serves several purposes:
Provides route for blood to travel from the heart to nourish the various tissues of the body
Carries cellular wastes to the excretory organs
Allows lymphatic flow to drain tissue fluid back into circulation
Returns blood to the heart for recirculation
The vascular system is divided into the arterial and venous systems.
Arterial system: blood moves from the larger arteries to a network of smaller blood vessels called
arterioles which meet the capillary bed. Primary responsibility is to deliver oxygen and nutrients
to tissues of the body. Arteries transport cellular wastes to the excretory organs (kidneys and
lungs) to be reprocessed or removed. They also contribute to temperature regulation in the tissues
because blood can either move toward the skin to promote heat loss of diverted away from the
skin to conserve heat.
o Blood pressure: force of blood exerted against the vessel walls. Determined primarily by
the quantity of blood flow or cardiac output and by the resistance of arterioles. Any factor
that increases CO or totally peripheral vascular resistance increases BP. Blood pressure is
regulated by balancing the sympathetic and parasympathetic nervous system.
Systolic BP: amount of pressure/force generated by the left ventricle to distribute
blood into the aorta with each contraction of the heart
,2
Diastolic BP: amount of pressure/force against the arterial walls during the
relaxation phase of the heart
Baroreceptors: in the arch of the aorta and at the origin of the internal carotid
arteries are stimulated when the arterial walls are stretched by an increased BP
Peripheral chemoreceptors: receptors in the carotid arteries that are sensitive
primarily to hypoxemia, and when stimulated the receptors to signals to the
vagus nerve to activate vasoconstrictor response and raise BP
Hypercapnia: increase in partial pressure of the arterial PaCO2. Central
chemoreceptors detect these changes
Emotional behaviors can stimulate sympathetic nervous system to increase BP
and HR.
Increase physical activity can increase BP and HR
o Three mechanisms mediate and regulate BP:
Autonomic nervous system (ANS) – excites or inhibits sympathetic nervous
system activity in response to impulses from chemoreceptors and baroreceptors
Kidneys – sense a change in blood flow and activate the renin-angiotensin-
aldosterone mechanism
Endocrine system – releases various hormones (catecholamine, kinins, serotonin,
histamine) to stimulate the sympathetic nervous system at the tissue level
Venous system: blood travels from capillaries to the venules and to the larger system of veins,
eventually returning in the vena cava to the heart for recirculation. It is composed of veins that are
located next the arterial system. A second superficial venous circulation runs parallel to the
subcutaneous tissue of the extremity. These two venous systems are connected by communicated
veins that provide a means for blood to travel from the superficial veins to the deep veins. Blood
flow is directed toward the deep venous circulation. Veins have superficial and deep systems
(except the smallest and the largest veins) have valves that direct blood back to the heart to
prevent backflow. Skeletal muscles in extremities provide force that helps push the venous blood
forward. Gravity exerts an increase in hydrostatic pressure in the capillaries when the patient is in
an upright position, delaying venous return. Hydrostatic pressure is decreased in dependent areas
such as the legs when the patient is lying down; thus, there is less hinderance of venous return to
the heart.
Cardiovascular changes associated with age:
Calcification and mucoid degeneration occur in the mitral and aortic valves
Pacemaker cells decrease in number. Fibrous tissue and fat in the sinoatrial node increase
Few muscle fibers remain in the atrial myocardium and bundle of His.
Conduction time increases
The left ventricle increases in size, becomes stiff and less distensible, and fibrotic changes in the
left ventricle decrease the speed of early diastolic filling by about 50%
The aorta and other large arteries thicken and become stiffer and less distensible
Systolic BP compensates for the stiffness of arteries
Systemic vascular resistance increases as the result of less distensible arteries; therefore the LV
pumps against greater resistance, contributing to left ventricle hypertrophy
Baroreceptors become less sensitive
Heart sounds review:
First heart sound (S1): created by the closure of the mitral and tricuspid valves (atrioventricular
valves), Softer and longer, low pitch best heart of the apex of the heart. “Lub”
Second heart sound (S2): created by the closing of the aortic and pulmonic valves (semilunar
valves). Higher pitched and is heard best at the base of the heard at the end of ventricular systole.
“Dub”
, 3
Splitting of heart sounds can be difficult to differentiate from diastolic filling sounds (gallops).
Splitting of S1 (closure of mitral valve followed by closure of the tricuspid valve occurs
physiologically because left ventricular contraction occurs slightly before right ventricular
contraction. Normal splitting of S2 occurs because of the longer systolic phase of the right
ventricle. Splitting of S1 and S2 can be accentuated by inspiration (due to increased venous
pressure), and narrows during expiration
Abnormal heart sounds:
o Paradoxical splitting: abnormal splitting of S2 and has a wider split heard on expiration.
Seen in patients with myocardial depression that causes early closure of the pulmonic
valve or a delay in aortic valve closure. (MI, left bundle branch block, aortic stenosis,
right ventricular pacing)
o Diastolic filling sounds (S3 and S4): produced when blood enters a noncompliant
chamber during rapid ventricular filling. Best heard when patient is laying on left side
and the bell of the stethoscope is placed at the apex and during expiration
Ventricular gallop (S3): produced during the rapid passive filling phase of
ventricular diastole when blood flows from the atrium to noncompliant ventricle.
Sounds arises from vibrations of the valves and supporting structures. Normal
finding in adults younger than 35. Older than 35 is abnormal because it
represents a decrease in left ventricular compliance. Can be early sign of heart
failure of ventricular septal defect.
Atrial gallop (S4): occurs as blood enters the ventricles during the active filling
phase at the end of ventricular diastole. May be heard in patients with
hypertension, anemia, ventricular hypertrophy, MI, aortic/pulmonic stenosis, PE.
Can be heard in the elderly but shouldn’t hear in children.
o Murmurs: reflect turbulent blood flow through normal or abnormal valves. Can be graded
from I-VI (grading scale on pg. 655 in Iggy). They can be described as harsh, blowing,
whistling, rumbling, or squeaking. Usually high or lower pitch.
Systolic murmurs: occur between S1 and S2
Diastolic murmurs: occur between S2 and S1
o Pericardial friction rub: originates from the pericardial sac and occurs with the
movements of the heart during the cardiac cycle. Signs of inflammation, infection, or
infiltration
1. Exemplar: Hypertension
Hypertension: aka high blood pressure, is the most common health problem seen in primary care settings
can cause stroke, myocardial infarction (MI), kidney failure, and death if not treated effectively. HTN is a
world-wide epidemic. In the US it is estimated that 80 million people have HTN.
Desired BP for people 60 years and older is below 150/90
Desired BP for people <60 years of age is below 140/90
BP’s that are above desired range for their age group should begin pharmacological management
Adult patients with specific risk factors for developing HTN should be treated at any age
Mechanisms that control blood pressure:
Systemic arterial blood pressure is a product of cardiac output and total peripheral vascular resistance.
Peripheral vascular resistance (vessel constriction or dilation) is maintained by the autonomic nervous
system and circulating hormones (such as norepinephrine and epinephrine). Consequently, any factor that
increases peripheral vascular resistance, heart rate, or stroke volume increases the systemic arterial
EXAM 3 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Exam 3 content from the
Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
,1
NUR 114 – Exam 3 Study Guide
Heart: Function
Electrophysiologic properties of the heart muscle are responsible for regulating the HR
Cardiac cells are automaticity, excitability, conductivity, contractility, and refractoriness
Diastole: consists of relaxation and filling of the atria and ventricles and comprises about two-
thirds of the cardiac cycle
Systole: consists of contraction and emptying of the atria and ventricles
Myocardial contraction results from the release of large numbers of Ca ions from the
sarcoplasmic reticulum and the blood…and a bunch of other fancy mechanisms that you can look
at on pg 645 of Iggy if you want to know lol. All in all, it forms an electrical impulse that causes
contraction.
Cardiac output: blood flow from the heart into the systemic arterial circulation, the amount of
blood pumped from the left ventricle each minute. Cardiac depends on the relationship between
HR and stroke volume. Cardiac output = HR x Stroke Volume. Ranges from 4-7 L/min
Cardiac index: can be determined by dividing the CO by the body surface area. Normal range:
2.8-4.2 L/min/m^2
Heart rate: refers to the number of times the ventricles contract each minute. 60-100 beats/min
Stroke volume: amount of blood ejected by the left ventricle during each contraction
Preload: refers to the degree of myocardial fiber stretch at the end of diastole and just before
contraction. The stretch imposed on the muscle fibers results from the volume contained within
the ventricle at the end of diastole
Ejection Fraction: percentage of blood ejected from the heart during systole. Normal: 55-70%.
<40% is considered heart failure.
Starlings Law of the Heart: the more the heart is filled during diastole (within limits), the more
forcefully it contracts
Afterload: pressure or resistance that the ventricles must overcome to eject blood through the
semilunar valves and into the peripheral blood vessels. The amount of resistance is directly
related to arterial blood pressure and the diameter of the blood vessels
Vascular System:
Serves several purposes:
Provides route for blood to travel from the heart to nourish the various tissues of the body
Carries cellular wastes to the excretory organs
Allows lymphatic flow to drain tissue fluid back into circulation
Returns blood to the heart for recirculation
The vascular system is divided into the arterial and venous systems.
Arterial system: blood moves from the larger arteries to a network of smaller blood vessels called
arterioles which meet the capillary bed. Primary responsibility is to deliver oxygen and nutrients
to tissues of the body. Arteries transport cellular wastes to the excretory organs (kidneys and
lungs) to be reprocessed or removed. They also contribute to temperature regulation in the tissues
because blood can either move toward the skin to promote heat loss of diverted away from the
skin to conserve heat.
o Blood pressure: force of blood exerted against the vessel walls. Determined primarily by
the quantity of blood flow or cardiac output and by the resistance of arterioles. Any factor
that increases CO or totally peripheral vascular resistance increases BP. Blood pressure is
regulated by balancing the sympathetic and parasympathetic nervous system.
Systolic BP: amount of pressure/force generated by the left ventricle to distribute
blood into the aorta with each contraction of the heart
,2
Diastolic BP: amount of pressure/force against the arterial walls during the
relaxation phase of the heart
Baroreceptors: in the arch of the aorta and at the origin of the internal carotid
arteries are stimulated when the arterial walls are stretched by an increased BP
Peripheral chemoreceptors: receptors in the carotid arteries that are sensitive
primarily to hypoxemia, and when stimulated the receptors to signals to the
vagus nerve to activate vasoconstrictor response and raise BP
Hypercapnia: increase in partial pressure of the arterial PaCO2. Central
chemoreceptors detect these changes
Emotional behaviors can stimulate sympathetic nervous system to increase BP
and HR.
Increase physical activity can increase BP and HR
o Three mechanisms mediate and regulate BP:
Autonomic nervous system (ANS) – excites or inhibits sympathetic nervous
system activity in response to impulses from chemoreceptors and baroreceptors
Kidneys – sense a change in blood flow and activate the renin-angiotensin-
aldosterone mechanism
Endocrine system – releases various hormones (catecholamine, kinins, serotonin,
histamine) to stimulate the sympathetic nervous system at the tissue level
Venous system: blood travels from capillaries to the venules and to the larger system of veins,
eventually returning in the vena cava to the heart for recirculation. It is composed of veins that are
located next the arterial system. A second superficial venous circulation runs parallel to the
subcutaneous tissue of the extremity. These two venous systems are connected by communicated
veins that provide a means for blood to travel from the superficial veins to the deep veins. Blood
flow is directed toward the deep venous circulation. Veins have superficial and deep systems
(except the smallest and the largest veins) have valves that direct blood back to the heart to
prevent backflow. Skeletal muscles in extremities provide force that helps push the venous blood
forward. Gravity exerts an increase in hydrostatic pressure in the capillaries when the patient is in
an upright position, delaying venous return. Hydrostatic pressure is decreased in dependent areas
such as the legs when the patient is lying down; thus, there is less hinderance of venous return to
the heart.
Cardiovascular changes associated with age:
Calcification and mucoid degeneration occur in the mitral and aortic valves
Pacemaker cells decrease in number. Fibrous tissue and fat in the sinoatrial node increase
Few muscle fibers remain in the atrial myocardium and bundle of His.
Conduction time increases
The left ventricle increases in size, becomes stiff and less distensible, and fibrotic changes in the
left ventricle decrease the speed of early diastolic filling by about 50%
The aorta and other large arteries thicken and become stiffer and less distensible
Systolic BP compensates for the stiffness of arteries
Systemic vascular resistance increases as the result of less distensible arteries; therefore the LV
pumps against greater resistance, contributing to left ventricle hypertrophy
Baroreceptors become less sensitive
Heart sounds review:
First heart sound (S1): created by the closure of the mitral and tricuspid valves (atrioventricular
valves), Softer and longer, low pitch best heart of the apex of the heart. “Lub”
Second heart sound (S2): created by the closing of the aortic and pulmonic valves (semilunar
valves). Higher pitched and is heard best at the base of the heard at the end of ventricular systole.
“Dub”
, 3
Splitting of heart sounds can be difficult to differentiate from diastolic filling sounds (gallops).
Splitting of S1 (closure of mitral valve followed by closure of the tricuspid valve occurs
physiologically because left ventricular contraction occurs slightly before right ventricular
contraction. Normal splitting of S2 occurs because of the longer systolic phase of the right
ventricle. Splitting of S1 and S2 can be accentuated by inspiration (due to increased venous
pressure), and narrows during expiration
Abnormal heart sounds:
o Paradoxical splitting: abnormal splitting of S2 and has a wider split heard on expiration.
Seen in patients with myocardial depression that causes early closure of the pulmonic
valve or a delay in aortic valve closure. (MI, left bundle branch block, aortic stenosis,
right ventricular pacing)
o Diastolic filling sounds (S3 and S4): produced when blood enters a noncompliant
chamber during rapid ventricular filling. Best heard when patient is laying on left side
and the bell of the stethoscope is placed at the apex and during expiration
Ventricular gallop (S3): produced during the rapid passive filling phase of
ventricular diastole when blood flows from the atrium to noncompliant ventricle.
Sounds arises from vibrations of the valves and supporting structures. Normal
finding in adults younger than 35. Older than 35 is abnormal because it
represents a decrease in left ventricular compliance. Can be early sign of heart
failure of ventricular septal defect.
Atrial gallop (S4): occurs as blood enters the ventricles during the active filling
phase at the end of ventricular diastole. May be heard in patients with
hypertension, anemia, ventricular hypertrophy, MI, aortic/pulmonic stenosis, PE.
Can be heard in the elderly but shouldn’t hear in children.
o Murmurs: reflect turbulent blood flow through normal or abnormal valves. Can be graded
from I-VI (grading scale on pg. 655 in Iggy). They can be described as harsh, blowing,
whistling, rumbling, or squeaking. Usually high or lower pitch.
Systolic murmurs: occur between S1 and S2
Diastolic murmurs: occur between S2 and S1
o Pericardial friction rub: originates from the pericardial sac and occurs with the
movements of the heart during the cardiac cycle. Signs of inflammation, infection, or
infiltration
1. Exemplar: Hypertension
Hypertension: aka high blood pressure, is the most common health problem seen in primary care settings
can cause stroke, myocardial infarction (MI), kidney failure, and death if not treated effectively. HTN is a
world-wide epidemic. In the US it is estimated that 80 million people have HTN.
Desired BP for people 60 years and older is below 150/90
Desired BP for people <60 years of age is below 140/90
BP’s that are above desired range for their age group should begin pharmacological management
Adult patients with specific risk factors for developing HTN should be treated at any age
Mechanisms that control blood pressure:
Systemic arterial blood pressure is a product of cardiac output and total peripheral vascular resistance.
Peripheral vascular resistance (vessel constriction or dilation) is maintained by the autonomic nervous
system and circulating hormones (such as norepinephrine and epinephrine). Consequently, any factor that
increases peripheral vascular resistance, heart rate, or stroke volume increases the systemic arterial
