CARDIOLOGY
STUDY GUIDES
Chapter Thirty One and Thirty-Two 1.Review the following terms: Action potential, afterload, arterial blood pressure, blood pressure, cardiac index (CI), cardiac output (CO), cardiac reserve, coronary angiography, diastole, diastolic
blood pressure, ejection fraction (EF), heaves, hypertension, hypertensive crisis, Kortotkoff sounds, mean arterial blood pressure (MAP), murmur, orthostatic hypotension, point of maximal impulse (PMI), prehypertension, primary hypertension, preload, pulse pressure, systole, systolic blood pressure, secondary hypertension, and systemic vascular resistance (SVR).
●Action potential- The creation and transport of electrical impulse
●Afterload- the peripheral resistance against which the left ventricle must pump
●Arterial blood pressure- a measure of the pressure exerted by Blood against the walls of the arterial system
●Cardiac index (CI) - is the cardiac output divided by the body surface area
●Cardiac output (CO) - the amount of blood pumped by each ventricle in one minute and is calculated by multiplying the amount of blood ejected from The ventricle with each heartbeat: stroke volume times heart rate per minute: CO = SV X HR
●Coronary angiography- done with a left-sided heart catheterization. the catheter is positioned at the origin of the coronary arteries and contrast medium is injected into the arteries. The images identify the location and severity of any coronary blockages.
●Diastole- relaxation of The myocardium
●Diastolic blood pressure- the residual pressure in the arterial system during ventricular relaxation or filling
●Systolic blood pressure- the pit pressure exerted against the arteries when the heart contracts.
●Systole- contraction of the heart muscle
●Ejection fraction-The percentage of end-diastolic blood volume that is ejected during systole
●Heaves- sustained lifts of the chest wall in the precordial area that can be seen or palpated.
●Hypertension- a persistent systolic blood pressure of 140 mmhg or more, diastolic blood pressure of 90 mmhg or more, or current use of antihypertensive medication
●Hypertensive crisis- term used to indicate either a hypertensive urgency or emergency. Hypertensive crisis occurs at systolic blood pressure greater than 180 mmhg and or diastolic blood pressure greater than 110 mmhg. The difference between a hypertensive urgency and emergency is the absence or presence of target organ damage.
●Korotkoff sounds- sounds of turbulent blood flow through a compressed artery
●Mean arterial pressure (MAP) -The average pressure within the arterial system that is felt by organs in the body
●Murmur- turbulent blood flow across affected valve
●Orthostatic hypotension- occurs when a patient moves from a supine to standing position, and there is a decrease of 20 mmhg or more in systolic blood pressure, a decrease of 10 mmhg or more in diastolic blood pressure, and/or an increase in the heart rate of 20 beats per minute.
●Point of maximal impulse (PMI)-apical pulse
●Preload volume of blood in the ventricles at the end of diastole, before the next contraction ●Pulse pressure- the difference between the SBP and DBP
●Prehypertension is defined as SBP of 120 to 130 mmhg or DBP of 80 to 89 mmhg
●Primary hypertension elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension
●Secondary hypertension- elevated BP with a specific cause that often can be identified and corrected
●Systemic vascular resistance (SVR)- force opposing the movement of blood within the blood vessels
2.Describe structures and functions of the cardiovascular system. (for review of structures and functions see pg 658-663)
3.Review assessment of cardiovascular system.
a.Subjective
i.History of present illness
ii.Past health history
iii.Medications
iv.Surgery or other health treatments
v.Activity-exercise pattern
b.Objective
i.Vital signs
ii.Palpation of pulse
1.0 = Absent
2.1+ = Weak
3.2+ = Normal
4.3+ = Increased, full, bounding
iii.Capillary refill
iv.Skin temperature (warm or cool)
v.Skin color (cyanotic?)
4.Describe diagnostic studies for cardiovascular system (ie: ECG, Stress test, Echocardiogram, coronary angiography).
a.ECG: The basic P, QRS, and T waveforms are used to assess heart activity. There are many types of ECG monitoring, including a resting 12-lead ECG, ambulatory ECG monitoring, and exercise or stress testing
b.Stress test:Exercise testing is used to evaluate the heart's response to physical stress. This helps to assess CVD and set limits for exercise programs. Exercise testing is used for persons who are able to walk unassisted or use a bicycle. It is also helpful for those with normal ECGs that limit diagnostic interpretation (e.g., pacemakers)
c.Echocardiogram: Uses ultrasound (US) waves to record the movement of the structures of the heart. It provides information about abnormalities of (1) valvular structures and motion, (2) heart chamber size and contents, (3) ventricular and septal motion and thickness, (4) pericardial sac, and (5) ascending aorta. The ejection fraction (EF), or the percentage of end-diastolic blood volume that is ejected during systole, can also be measured.
d.Coronary Angiography: Done with a left-sided heart catheterization. The catheter is positioned at the origin of the coronary arteries and a contrast medium is injected into the arteries.
5.Review classification of hypertension (i.e.: normal, prehypertension, tage I, stage II).
Properly measure BP at 2 or more office visits. Normal: <120 and <80 Prehypertension: 120-139 or 80-89
Hypertension:
i.Stage I: 140-159 or 90-99
ii.Stage II: >160 or >100
6.Identify risk factors of hypertension.
D-BP rises until approximately age 55 and then declines. (note)
The hemodynamic hallmark of hypertension is persistently increased SVR.
1.Age (SBP increases with aging. At 55 >140 is a greater risk factor)
2.Alcohol (limit to 1oz. /day)
3.Tobacco Use: duh!
4.Diabetes (can lead to target organ disease)
5.Elevated Serum lipids: (Cholesterol [<200] and Triglycerides [>160])
6.Excess dietary sodium
7.Gender (male <55, women at 64)
8.Family history
9.Obesity
10.Ethnicity (x2 in AA)
11.Sedentary lifestyle
12.Socioeconomic Status
13.Stress
7.Identify clinical manifestations of orthostatic hypotension including assessment for and patient teaching to prevent.
a. Take orthostatic (postural) BPs and HRs while the patient is supine, sitting with legs dangling, and standing. SBP should not decrease more than 20 mm Hg from the supine to the standing position. HR should not increase more than 20 beats/minute from the supine to the standing position.
8.Describe etiology, clinical manifestations, complications, diagnostic studies, collaborative care, and nursing interventions for hypertension (including diet, patient education).
1.Etiology:
1.Primary – without a cause (90-95%)
2.Secondary- with and identifiable cause Cirrhosis,
2.Clinical Manifestations- the “silent killer” (713)
1.Increased workload on heart
2.Various organ issues
3.Secondary: fatigue, dizziness, palpitations, angina, dyspnea
3.Complications
1.Target organ disease of the
1.Ht eartCAD – stiff arterial walls with narrow lumen, HF
2 .Bnrain CVD, stroke
3.Pseripheral VesselsPVD
4.Ksidneys Nephrosclerosis
5.Eyes Retinal Damage
4.Diagnostic Studies
1.BUN and Creatinine for renal function
2.Potassium (hyperaldostersone = low potassium)
3.ECG – detects LVH, ischemia, or MI
5.Collaborative Care
i.Periodic monitoring of BP 1.Home BP monitoring
2.Ambulatory BP monitoring (if indicated)
3.Every 3-6 month by health care provider once BP is stabilized
ii.Nutritional therapy (see Table 33-1)
1.Restrict salt and sodium
2.Restrict cholesterol and saturated fats
3.Maintain adequate intake of potassium
4.Maintain adequate intake of calcium and magnesium
iii.Weight management
iv.Regular, moderate physical activity
v.Tobacco cessation (see Tables 11-4 through 11-6)
vi.Moderation of alcohol consumption
vii.Management of psychosocial risk factors (see Chapter 7)
viii.Antihypertensive drugs (see Tables 33-7 and 33-8)
ix.Patient and caregiver teaching
x.Review drug therapy for hypertension (including side effects). This should be a review from pharmacology-remember you don’t need to know every single individual drug, just classification, what does it do, side effects
xi.Discuss hypertensive crisis, clinical manifestations, and nursing management.
9.Nursing Interventions for (including diet, patient education).
xii.A weight loss of 22 lb. (10 kg) may decrease SBP by approximately 5 to 20 mm Hg.
xiii.DASH eating plan. fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Less meat.
xiv.Restrict sodium to less than or equal to 1500 mg/day
1.Avoid canned goods and frozen meals
xv.Moderate sodium restriction lessens the risk of hypokalemia associated with diuretic therapy
xvi.Hypertension is a chronic illness that cannot be cured
xvii.Supplement diet with foods high in potassium (e.g., citrus fruits, green leafy vegetables) if taking potassium-wasting diuretics.
Chapter Thirty-Three (CC 1-4) 1.Define the following terms: Angina, atherosclerosis, chronic stable angina, coronary artery disease, coronary revascularization
Angina - chest pain, is the clinical manifestation of reversible myocardial ischemia ( 740) Atherosclerosis - Greek words: athere, meaning “fatty mush,” and skleros, meaning “hard.” It begins as soft deposits of fat that harden with age. [“hardening of the arteries”] (731)
Chronic Stable Angina - chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms (741)
Coronary Artery Disease - a type of blood vessel disorder that is included in the general category of atherosclerosis
Coronary Revascularization - restoration of perfusion to a part of the heart that has suffered ischemia. (If a coronary blockage is amenable to treatment, coronary revascularization with an elective percutaneous coronary intervention (PCI) may be recommended.)
2.Describe etiology, risk factors, medication management for CAD, collaborative care, diagnostic studies, nursing management (including nutritional therapy, exercise).
STUDY GUIDES
Chapter Thirty One and Thirty-Two 1.Review the following terms: Action potential, afterload, arterial blood pressure, blood pressure, cardiac index (CI), cardiac output (CO), cardiac reserve, coronary angiography, diastole, diastolic
blood pressure, ejection fraction (EF), heaves, hypertension, hypertensive crisis, Kortotkoff sounds, mean arterial blood pressure (MAP), murmur, orthostatic hypotension, point of maximal impulse (PMI), prehypertension, primary hypertension, preload, pulse pressure, systole, systolic blood pressure, secondary hypertension, and systemic vascular resistance (SVR).
●Action potential- The creation and transport of electrical impulse
●Afterload- the peripheral resistance against which the left ventricle must pump
●Arterial blood pressure- a measure of the pressure exerted by Blood against the walls of the arterial system
●Cardiac index (CI) - is the cardiac output divided by the body surface area
●Cardiac output (CO) - the amount of blood pumped by each ventricle in one minute and is calculated by multiplying the amount of blood ejected from The ventricle with each heartbeat: stroke volume times heart rate per minute: CO = SV X HR
●Coronary angiography- done with a left-sided heart catheterization. the catheter is positioned at the origin of the coronary arteries and contrast medium is injected into the arteries. The images identify the location and severity of any coronary blockages.
●Diastole- relaxation of The myocardium
●Diastolic blood pressure- the residual pressure in the arterial system during ventricular relaxation or filling
●Systolic blood pressure- the pit pressure exerted against the arteries when the heart contracts.
●Systole- contraction of the heart muscle
●Ejection fraction-The percentage of end-diastolic blood volume that is ejected during systole
●Heaves- sustained lifts of the chest wall in the precordial area that can be seen or palpated.
●Hypertension- a persistent systolic blood pressure of 140 mmhg or more, diastolic blood pressure of 90 mmhg or more, or current use of antihypertensive medication
●Hypertensive crisis- term used to indicate either a hypertensive urgency or emergency. Hypertensive crisis occurs at systolic blood pressure greater than 180 mmhg and or diastolic blood pressure greater than 110 mmhg. The difference between a hypertensive urgency and emergency is the absence or presence of target organ damage.
●Korotkoff sounds- sounds of turbulent blood flow through a compressed artery
●Mean arterial pressure (MAP) -The average pressure within the arterial system that is felt by organs in the body
●Murmur- turbulent blood flow across affected valve
●Orthostatic hypotension- occurs when a patient moves from a supine to standing position, and there is a decrease of 20 mmhg or more in systolic blood pressure, a decrease of 10 mmhg or more in diastolic blood pressure, and/or an increase in the heart rate of 20 beats per minute.
●Point of maximal impulse (PMI)-apical pulse
●Preload volume of blood in the ventricles at the end of diastole, before the next contraction ●Pulse pressure- the difference between the SBP and DBP
●Prehypertension is defined as SBP of 120 to 130 mmhg or DBP of 80 to 89 mmhg
●Primary hypertension elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension
●Secondary hypertension- elevated BP with a specific cause that often can be identified and corrected
●Systemic vascular resistance (SVR)- force opposing the movement of blood within the blood vessels
2.Describe structures and functions of the cardiovascular system. (for review of structures and functions see pg 658-663)
3.Review assessment of cardiovascular system.
a.Subjective
i.History of present illness
ii.Past health history
iii.Medications
iv.Surgery or other health treatments
v.Activity-exercise pattern
b.Objective
i.Vital signs
ii.Palpation of pulse
1.0 = Absent
2.1+ = Weak
3.2+ = Normal
4.3+ = Increased, full, bounding
iii.Capillary refill
iv.Skin temperature (warm or cool)
v.Skin color (cyanotic?)
4.Describe diagnostic studies for cardiovascular system (ie: ECG, Stress test, Echocardiogram, coronary angiography).
a.ECG: The basic P, QRS, and T waveforms are used to assess heart activity. There are many types of ECG monitoring, including a resting 12-lead ECG, ambulatory ECG monitoring, and exercise or stress testing
b.Stress test:Exercise testing is used to evaluate the heart's response to physical stress. This helps to assess CVD and set limits for exercise programs. Exercise testing is used for persons who are able to walk unassisted or use a bicycle. It is also helpful for those with normal ECGs that limit diagnostic interpretation (e.g., pacemakers)
c.Echocardiogram: Uses ultrasound (US) waves to record the movement of the structures of the heart. It provides information about abnormalities of (1) valvular structures and motion, (2) heart chamber size and contents, (3) ventricular and septal motion and thickness, (4) pericardial sac, and (5) ascending aorta. The ejection fraction (EF), or the percentage of end-diastolic blood volume that is ejected during systole, can also be measured.
d.Coronary Angiography: Done with a left-sided heart catheterization. The catheter is positioned at the origin of the coronary arteries and a contrast medium is injected into the arteries.
5.Review classification of hypertension (i.e.: normal, prehypertension, tage I, stage II).
Properly measure BP at 2 or more office visits. Normal: <120 and <80 Prehypertension: 120-139 or 80-89
Hypertension:
i.Stage I: 140-159 or 90-99
ii.Stage II: >160 or >100
6.Identify risk factors of hypertension.
D-BP rises until approximately age 55 and then declines. (note)
The hemodynamic hallmark of hypertension is persistently increased SVR.
1.Age (SBP increases with aging. At 55 >140 is a greater risk factor)
2.Alcohol (limit to 1oz. /day)
3.Tobacco Use: duh!
4.Diabetes (can lead to target organ disease)
5.Elevated Serum lipids: (Cholesterol [<200] and Triglycerides [>160])
6.Excess dietary sodium
7.Gender (male <55, women at 64)
8.Family history
9.Obesity
10.Ethnicity (x2 in AA)
11.Sedentary lifestyle
12.Socioeconomic Status
13.Stress
7.Identify clinical manifestations of orthostatic hypotension including assessment for and patient teaching to prevent.
a. Take orthostatic (postural) BPs and HRs while the patient is supine, sitting with legs dangling, and standing. SBP should not decrease more than 20 mm Hg from the supine to the standing position. HR should not increase more than 20 beats/minute from the supine to the standing position.
8.Describe etiology, clinical manifestations, complications, diagnostic studies, collaborative care, and nursing interventions for hypertension (including diet, patient education).
1.Etiology:
1.Primary – without a cause (90-95%)
2.Secondary- with and identifiable cause Cirrhosis,
2.Clinical Manifestations- the “silent killer” (713)
1.Increased workload on heart
2.Various organ issues
3.Secondary: fatigue, dizziness, palpitations, angina, dyspnea
3.Complications
1.Target organ disease of the
1.Ht eartCAD – stiff arterial walls with narrow lumen, HF
2 .Bnrain CVD, stroke
3.Pseripheral VesselsPVD
4.Ksidneys Nephrosclerosis
5.Eyes Retinal Damage
4.Diagnostic Studies
1.BUN and Creatinine for renal function
2.Potassium (hyperaldostersone = low potassium)
3.ECG – detects LVH, ischemia, or MI
5.Collaborative Care
i.Periodic monitoring of BP 1.Home BP monitoring
2.Ambulatory BP monitoring (if indicated)
3.Every 3-6 month by health care provider once BP is stabilized
ii.Nutritional therapy (see Table 33-1)
1.Restrict salt and sodium
2.Restrict cholesterol and saturated fats
3.Maintain adequate intake of potassium
4.Maintain adequate intake of calcium and magnesium
iii.Weight management
iv.Regular, moderate physical activity
v.Tobacco cessation (see Tables 11-4 through 11-6)
vi.Moderation of alcohol consumption
vii.Management of psychosocial risk factors (see Chapter 7)
viii.Antihypertensive drugs (see Tables 33-7 and 33-8)
ix.Patient and caregiver teaching
x.Review drug therapy for hypertension (including side effects). This should be a review from pharmacology-remember you don’t need to know every single individual drug, just classification, what does it do, side effects
xi.Discuss hypertensive crisis, clinical manifestations, and nursing management.
9.Nursing Interventions for (including diet, patient education).
xii.A weight loss of 22 lb. (10 kg) may decrease SBP by approximately 5 to 20 mm Hg.
xiii.DASH eating plan. fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Less meat.
xiv.Restrict sodium to less than or equal to 1500 mg/day
1.Avoid canned goods and frozen meals
xv.Moderate sodium restriction lessens the risk of hypokalemia associated with diuretic therapy
xvi.Hypertension is a chronic illness that cannot be cured
xvii.Supplement diet with foods high in potassium (e.g., citrus fruits, green leafy vegetables) if taking potassium-wasting diuretics.
Chapter Thirty-Three (CC 1-4) 1.Define the following terms: Angina, atherosclerosis, chronic stable angina, coronary artery disease, coronary revascularization
Angina - chest pain, is the clinical manifestation of reversible myocardial ischemia ( 740) Atherosclerosis - Greek words: athere, meaning “fatty mush,” and skleros, meaning “hard.” It begins as soft deposits of fat that harden with age. [“hardening of the arteries”] (731)
Chronic Stable Angina - chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms (741)
Coronary Artery Disease - a type of blood vessel disorder that is included in the general category of atherosclerosis
Coronary Revascularization - restoration of perfusion to a part of the heart that has suffered ischemia. (If a coronary blockage is amenable to treatment, coronary revascularization with an elective percutaneous coronary intervention (PCI) may be recommended.)
2.Describe etiology, risk factors, medication management for CAD, collaborative care, diagnostic studies, nursing management (including nutritional therapy, exercise).
