NUR 213
EXAM 2 3
STUDY GUIDE
Complex Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 213 at Forsyth Technical
Community College focuses on Exam 2 content from the
Complex Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 213 – Exam 2 Study Guide
1. Concept of Perfusion – Review
The cardiovascular system is responsible for supplying oxygen to the body organs and other tissues. It is
made of up of the heart and blood vessels (arteries and veins).
The heart muscle, myocardium, must receive sufficient oxygen to pump blood to other parts of the body.
The arteries must be patent, so the pumped blood can reach the rest of the body. Oxygen in the blood is
required for cells to live and function properly. When diseases or other problems of the CV system occur,
gas exchange and perfusion decrease, often resulting in life-threatening events or a risk of these events.
Cardiovascular disease (CVD) continues to be the number one cause of death in the US. Leading cause of
death for women. One in three adults are living with some form of the disease.
Anatomy and Physiology Student Self-Review:
Heart: Structure
Fist sized, muscular organ located mediastinum between the lungs
Each beat pumps about 5L/min
Pericardium: covering around that heart that helps protect it
Septum: muscular wall that separates the heart into two halves; right and left
Right atrium: receives deoxygenated venous blood, which is returned from the body through the
superior and inferior vena cava. It also receives blood from the heart muscle through the coronary
sinus. Most of the venous return flows passively from the RA, through the tricuspid valve, and
into the right ventricle during ventricular diastole, or filling. RA actively propels the remaining
venous return in to the right ventricle during atrial systole, or contraction.
Right ventricle: propels blood into the pulmonary artery and to the lungs to be oxygenated
Left atrium: receives oxygenated blood from the pulmonary veins. Blood flows through the mitral
valve into the left ventricle during ventricular diastole. When the left ventricle is almost full, the
left atrium contracts pumping the remaining blood into the left ventricle
Left ventricle: generates enough pressure to close the mitral valve and open the aortic valve.
Blood is propelled into the aorta and the systemic arterial circulation
Cardiac valves: responsible for maintaining the forward flow of blood through the chambers of
the heart. These valves open and close when pressure and volume change within the heart’s
chambers. They have two classified types:
o Atrioventricular valves: separate the atria from the ventricles – tricuspid valve separates
RA from RV. Mitral (bicuspid) valve separate LA from LV. Act as funnels during diastole
to help move blood from the atria to the ventricles. During systole they close to prevent
backflow of blood going back into the atria
o Semilunar valves: pulmonic (separates the right ventricle from the pulmonary artery) and
aortic valve (separates the left ventricle from the aorta) prevent backflow from blood
flowing back into the ventricles during diastole
Coronary arteries originate from an area on the aorta just beyond the aortic valve. All coronary
arteries feeding the left heart originate from the left main coronary artery (LMCA). The right
coronary artery (RCA) branches from the aorta to perfuse the right ride of the heart and inferior
wall of the left side of the heart.
To maintain adequate blood flow through the coronary arteries, mean arterial pressure (MAP)
must be at least 60 mmHg
, MAP between 60-70 mmHg is necessary to maintain perfusion of major body organs, such as the
kidneys and the brain
Left main artery: has two branches: left anterior descending (LAD) and left circumflex (LCX).
LAD branches towards the anterior wall and the apex of the left ventricle and supplies blood to
the LV, ventricular septum, chordae tendineae, papillary muscle, and to a lesser extent the right
ventricle. LCX supplies blood to the left atrium, lateral and posterior surfaces of the left ventricle,
and sometimes portions of the interventricular septum. For some people LCX supplies that SA
node, and small number of people the AV node.
Right coronary artery (RCA): originates from the right sinus of Valsalva, encircles the heart, and
descends toward the apex of the right ventricle. RCA supplies the RA, RV, and inferior portion of
the LV. Some people is will supply the SA node and almost everyone is supplies the AV node.
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
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
EXAM 2 3
STUDY GUIDE
Complex Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 213 at Forsyth Technical
Community College focuses on Exam 2 content from the
Complex Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 213 – Exam 2 Study Guide
1. Concept of Perfusion – Review
The cardiovascular system is responsible for supplying oxygen to the body organs and other tissues. It is
made of up of the heart and blood vessels (arteries and veins).
The heart muscle, myocardium, must receive sufficient oxygen to pump blood to other parts of the body.
The arteries must be patent, so the pumped blood can reach the rest of the body. Oxygen in the blood is
required for cells to live and function properly. When diseases or other problems of the CV system occur,
gas exchange and perfusion decrease, often resulting in life-threatening events or a risk of these events.
Cardiovascular disease (CVD) continues to be the number one cause of death in the US. Leading cause of
death for women. One in three adults are living with some form of the disease.
Anatomy and Physiology Student Self-Review:
Heart: Structure
Fist sized, muscular organ located mediastinum between the lungs
Each beat pumps about 5L/min
Pericardium: covering around that heart that helps protect it
Septum: muscular wall that separates the heart into two halves; right and left
Right atrium: receives deoxygenated venous blood, which is returned from the body through the
superior and inferior vena cava. It also receives blood from the heart muscle through the coronary
sinus. Most of the venous return flows passively from the RA, through the tricuspid valve, and
into the right ventricle during ventricular diastole, or filling. RA actively propels the remaining
venous return in to the right ventricle during atrial systole, or contraction.
Right ventricle: propels blood into the pulmonary artery and to the lungs to be oxygenated
Left atrium: receives oxygenated blood from the pulmonary veins. Blood flows through the mitral
valve into the left ventricle during ventricular diastole. When the left ventricle is almost full, the
left atrium contracts pumping the remaining blood into the left ventricle
Left ventricle: generates enough pressure to close the mitral valve and open the aortic valve.
Blood is propelled into the aorta and the systemic arterial circulation
Cardiac valves: responsible for maintaining the forward flow of blood through the chambers of
the heart. These valves open and close when pressure and volume change within the heart’s
chambers. They have two classified types:
o Atrioventricular valves: separate the atria from the ventricles – tricuspid valve separates
RA from RV. Mitral (bicuspid) valve separate LA from LV. Act as funnels during diastole
to help move blood from the atria to the ventricles. During systole they close to prevent
backflow of blood going back into the atria
o Semilunar valves: pulmonic (separates the right ventricle from the pulmonary artery) and
aortic valve (separates the left ventricle from the aorta) prevent backflow from blood
flowing back into the ventricles during diastole
Coronary arteries originate from an area on the aorta just beyond the aortic valve. All coronary
arteries feeding the left heart originate from the left main coronary artery (LMCA). The right
coronary artery (RCA) branches from the aorta to perfuse the right ride of the heart and inferior
wall of the left side of the heart.
To maintain adequate blood flow through the coronary arteries, mean arterial pressure (MAP)
must be at least 60 mmHg
, MAP between 60-70 mmHg is necessary to maintain perfusion of major body organs, such as the
kidneys and the brain
Left main artery: has two branches: left anterior descending (LAD) and left circumflex (LCX).
LAD branches towards the anterior wall and the apex of the left ventricle and supplies blood to
the LV, ventricular septum, chordae tendineae, papillary muscle, and to a lesser extent the right
ventricle. LCX supplies blood to the left atrium, lateral and posterior surfaces of the left ventricle,
and sometimes portions of the interventricular septum. For some people LCX supplies that SA
node, and small number of people the AV node.
Right coronary artery (RCA): originates from the right sinus of Valsalva, encircles the heart, and
descends toward the apex of the right ventricle. RCA supplies the RA, RV, and inferior portion of
the LV. Some people is will supply the SA node and almost everyone is supplies the AV node.
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
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
