NUR 242
EXAM 4 STUDY GUIDE
Medical-Surgical Nursing Concepts
Galen College of Nursing
, Exam 4
Care of the patient with common perfusion problems
Mechanical properties of the heart
Cardiac output (CO)
The amount of blood pumped from the left ventricle each minute
Stroke volume (SV)
Amount of blood ejected by the left ventricle during each contraction
Heart rate (HR)
Number of times ventricles contract each minute
CO=HR x SV
Preload
Degree of myocardial fiber stretch at the end of diastole and just before
contraction. Measured by CVP.
How much fluid in heart
Meds that decrease: diuretic, nitro, ACE,ARBs
Afterload
Pressure or resistance that the ventricle must overcome to eject blood through
the semilunar valves and into peripheral blood vessels
Meds decrease afterload: ACE, ARBS, BB, CCB, hydralazine, nitro in high doses
Arterial system
Blood pressure: force of blood exerted against vessel walls
Systole 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
Mean arterial pressure (MAP): no less than 60 to maintain adequate perfusion
2x diastolic +systolic/3
Example 140/90 90x2+140/3=107
MAP is what drives organ perfusion
MAP is important
Left does the most work-blood to the rest of the body
Orthostatic changes also referred to as postural hypotension when the client changes
positions
A decrease of more then 20 mm Hg systolic or more than 10 mm Hg of the diastolic
pressure; combines with a increase in HR
Supine (3 minutes) > sitting (1 minute) > standing
Cuff remains in the same position throughout
Contribute to falls causes: prolonged bed rest, drugs, hydration (most common), AMS
Cardiovascular system physical assessment
General appearance
Skin
Weight
Edema
, Pitting
CCB therapy
Anasarca
Extremities: circulation
Clubbing
Blood pressure
HTN
Hypotension
1L=1kg=2.2lbs
Assess pt-LOC, WT, Anasarca (edema throughout the body)
Hypotension-vasodilation-no force so blood slowly does not have the pressure to flow
Symptoms of decreased cardiac output
Decreased BP-> decreased LOB-> decreased urine output-> fatigue -> dizziness -> SOB ->
chest pain -> anxiety -> cool, clammy skin
Less than 30cc-urine
Decrease pulses
Decreased LOC-not enough profusion
LDL vs. HDL
Good cholesterol-HDL
The HDL cholesterol scrapes away necessary LDL from atery walls, preventing the
formation of plaques. That’s why HDL cholesterol is commonly called good
Bad cholesterol-LDL
LDL, on the contrary, deposits excess cholesterol on the artery walls, thus
promoting plaque formation. For this reason the LDL cholesterol is defined bad
NUGGET**
Too much LDL-plaque deposits
Serum markers of myocardial damage
Troponin-exclusive cardiac mark (damage)
Creatinine kinase (CK)-peaks in 24hrs
CK-MD- concentrated in myocardium, also found in other muscles
Serum lipids***
Total cholesterol <200 mg/dL
Triglyceride <150 mg/dL
HDL >40 mg/dL
LDL <70 mg/dL
Non cardiovascular pts <130 mg/dL
Diagnostic testing
Electrocardiography (ECG)
12 lead
Client should lay still
Echocardiography
Transesophageal echocardiography (EF)
Cardiac catheterization
Informed consent
, Patent IV
Assess for allergies-iodine and shellfish
NPO 6-8hrs
Height and weight
Sensations (distal from sight)
Post procedure
Bed rest for 6 hrs
Keep the leg straight-avoid bending
Assess VS and pulse frequently
EF-% of blood ejected
55%-65% is normal
Less than 40 % is HF (requires intervention)
40-50% is low normal
Rhythms
Normal sinus rhythm 60-100
Sinus bradycardia less than 60
Dizziness, faint, lightheaded, don’t feel well, symptomatic
Atropine when symptomatic
Interventions:
Fix the cause (hold meds like bb or CCB)
NUGGET**
S/S: dizziness
Sinus tachycardia greater than 100
Interventions
Fix the cause (like dehydration, exercise, bleeding)
Atrial fibrillation
Most common
Irregular, no p waves, wavily baseline
Tx: #1 rate control (BB, CCB), digoxin, amiodarone, #2 anticoagulants
Atrial fibrillation
Associated with atrial fibrosis and loss of muscle mass
Common in heart disease such as hypertension, heart failure, obesity, and coronary
artery disease
Cardiac output can decrease by as much as 20% to 30%
Concerning for a hr >130
Places pt at high risk for stroke
Pt centered collaborative care
Drug therapy
Calcium channel blockers
Diltiazem (Cardizem, verapamil
Beta blockers
Metoprolol (Toprol)
Antiarrhythmic drugs
Amiodarone (cordarone)
EXAM 4 STUDY GUIDE
Medical-Surgical Nursing Concepts
Galen College of Nursing
, Exam 4
Care of the patient with common perfusion problems
Mechanical properties of the heart
Cardiac output (CO)
The amount of blood pumped from the left ventricle each minute
Stroke volume (SV)
Amount of blood ejected by the left ventricle during each contraction
Heart rate (HR)
Number of times ventricles contract each minute
CO=HR x SV
Preload
Degree of myocardial fiber stretch at the end of diastole and just before
contraction. Measured by CVP.
How much fluid in heart
Meds that decrease: diuretic, nitro, ACE,ARBs
Afterload
Pressure or resistance that the ventricle must overcome to eject blood through
the semilunar valves and into peripheral blood vessels
Meds decrease afterload: ACE, ARBS, BB, CCB, hydralazine, nitro in high doses
Arterial system
Blood pressure: force of blood exerted against vessel walls
Systole 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
Mean arterial pressure (MAP): no less than 60 to maintain adequate perfusion
2x diastolic +systolic/3
Example 140/90 90x2+140/3=107
MAP is what drives organ perfusion
MAP is important
Left does the most work-blood to the rest of the body
Orthostatic changes also referred to as postural hypotension when the client changes
positions
A decrease of more then 20 mm Hg systolic or more than 10 mm Hg of the diastolic
pressure; combines with a increase in HR
Supine (3 minutes) > sitting (1 minute) > standing
Cuff remains in the same position throughout
Contribute to falls causes: prolonged bed rest, drugs, hydration (most common), AMS
Cardiovascular system physical assessment
General appearance
Skin
Weight
Edema
, Pitting
CCB therapy
Anasarca
Extremities: circulation
Clubbing
Blood pressure
HTN
Hypotension
1L=1kg=2.2lbs
Assess pt-LOC, WT, Anasarca (edema throughout the body)
Hypotension-vasodilation-no force so blood slowly does not have the pressure to flow
Symptoms of decreased cardiac output
Decreased BP-> decreased LOB-> decreased urine output-> fatigue -> dizziness -> SOB ->
chest pain -> anxiety -> cool, clammy skin
Less than 30cc-urine
Decrease pulses
Decreased LOC-not enough profusion
LDL vs. HDL
Good cholesterol-HDL
The HDL cholesterol scrapes away necessary LDL from atery walls, preventing the
formation of plaques. That’s why HDL cholesterol is commonly called good
Bad cholesterol-LDL
LDL, on the contrary, deposits excess cholesterol on the artery walls, thus
promoting plaque formation. For this reason the LDL cholesterol is defined bad
NUGGET**
Too much LDL-plaque deposits
Serum markers of myocardial damage
Troponin-exclusive cardiac mark (damage)
Creatinine kinase (CK)-peaks in 24hrs
CK-MD- concentrated in myocardium, also found in other muscles
Serum lipids***
Total cholesterol <200 mg/dL
Triglyceride <150 mg/dL
HDL >40 mg/dL
LDL <70 mg/dL
Non cardiovascular pts <130 mg/dL
Diagnostic testing
Electrocardiography (ECG)
12 lead
Client should lay still
Echocardiography
Transesophageal echocardiography (EF)
Cardiac catheterization
Informed consent
, Patent IV
Assess for allergies-iodine and shellfish
NPO 6-8hrs
Height and weight
Sensations (distal from sight)
Post procedure
Bed rest for 6 hrs
Keep the leg straight-avoid bending
Assess VS and pulse frequently
EF-% of blood ejected
55%-65% is normal
Less than 40 % is HF (requires intervention)
40-50% is low normal
Rhythms
Normal sinus rhythm 60-100
Sinus bradycardia less than 60
Dizziness, faint, lightheaded, don’t feel well, symptomatic
Atropine when symptomatic
Interventions:
Fix the cause (hold meds like bb or CCB)
NUGGET**
S/S: dizziness
Sinus tachycardia greater than 100
Interventions
Fix the cause (like dehydration, exercise, bleeding)
Atrial fibrillation
Most common
Irregular, no p waves, wavily baseline
Tx: #1 rate control (BB, CCB), digoxin, amiodarone, #2 anticoagulants
Atrial fibrillation
Associated with atrial fibrosis and loss of muscle mass
Common in heart disease such as hypertension, heart failure, obesity, and coronary
artery disease
Cardiac output can decrease by as much as 20% to 30%
Concerning for a hr >130
Places pt at high risk for stroke
Pt centered collaborative care
Drug therapy
Calcium channel blockers
Diltiazem (Cardizem, verapamil
Beta blockers
Metoprolol (Toprol)
Antiarrhythmic drugs
Amiodarone (cordarone)
