lOMoARcPSD|21646696
MED SURG 2 EXAM 1-Comprehensive
Review of Medical Surgical Nursing II
Exam
, lOMoARcPSD|21646696
MED SURG 2 EXAM 1
Ch. 25 – ASSESSMENT OF CARDIOVASCULAR
FUNCTION
Conduction System
• Automaticity = ability to initiate an electrical impulse
• Excitability = ability to respond to an electrical impulse
• Conductivity = ability to transmit an electrical impulse from one cell to another
SA node à AV node à bundle of his à right bundle branch à left bundle branch à
purkinje fibers
*SA node is the primary pacemaker of the heart
Depolarization: electrical activation of cell caused by influx of sodium into cell while
potassium exits cell
Repolarization: return of cell to resting state caused by re-entry of potassium into
cell while sodium exits
Refractory periods
► Effective refractory period: phase in which cells are incapable of depolarizing
► Relative refractory period: phase in which cells require stronger-than-normal
stimulus to depolarize
Cardiac Action Potential Phases (won’t ask but understand)
Phase 0 = Na comes into the actual cell (RAPID depolarization, SODIUM IN)
Phase 1 = early cell repolarization – K+ coming out of the cell (POTASSIUM
OUT) Phase 2 = plateau phase (rate of repolarization slows); Ca+ ENTER CELL
Phase 3 = complete repolarization (return of cell to resting state)
Phase 4 = resting phase before the next depolarization
Aorta has the highest pressure (biggest) high force…pressure in left ventricle + aorta
highest pressure is higher pressure in the cardiac system
** Majority of MI occurs in left ventricle!
CO = HR x SV
Cardiac output = total amt. of blood ejected by one of the ventricles in L/min (in resting
adult about 4-6 L/min)
Stroke volume = amount of blood ejected from one of the ventricles per heartbeat
(average = 60-130 mL)
Changes in HR are due to inhibition or stimulation of the SA node by the
parasympathetic and sympathetic divisions.
PNS travels to SA node through vagus nerve à vagal stimulation = slows the HR
, lOMoARcPSD|21646696
SNS increases HR by innervation of the beta-1 receptors located within SA node (occurs
through an increase in circulation catecholamines (secreted by the adrenal gland) and by
excess thyroid hormone, which produces a catecholamine-like effect
HR also affected by CNS and baroreceptor activity (sensitive to changes in BP) à
when BP is high – baroreceptors stimulate PNS activity, lowering HR. When BP is low à
they stimulate SNS activity, raising HR.
SV is determined by preload, afterload, and contractility.
Preload = how much blood is within the ventricle before you pump it out (at the end of
diastole right before systole occurs)
Afterload = the resistance of ejection of blood from the ventricle
Contractility = the force generated by the contracting myocardium
Women usually develop CAD 10 years later than men b/c they benefit from female
hormone estrogen and its cardioprotective effects
1. Increase in HDL (transports cholesterol out of arteries
2. Reduction in LDL (deposits cholesterol in the artery)
3. Dilation of the blood vessels (enhances blood flow to the heart)
*post-menopausal women = higher risk of CAD b/c estrogen levels slowly disappear
COMMON SYMPTOMS of CVD
► Chest pain
► Dyspnea
► Peripheral edema, weight gain, abdominal distention
► Palpitations
► Fatigue
► Dizziness, syncope, changes in level of consciousness
Chest pain – identify quantity (0-10), location, and quality. Radiation of pain? Associated
S/S like sweating or nausea; duration? Assess for other cardiac conditions; assess for
other significant conditions
► Pneumonia, pulmonary embolism
► Hiatal hernia, GERD
► Costochondritis
► Vascular
“Costochondritis – inflammation process in the cartilage (pain can be so severe that
they think they’re having a heart attack); TX would be rest… would still do an EKG”
ASSESSMENT:
► Medications – aspirin = common OTC med that improves outcomes in CAD pts
► Nutrition – nut. risk factors = hyperlipidemia, HTN, diabetes
► Height + weight
► BMI ** (assessment for obesity)
► Lab results – glucose, glycosylated Hb (diabetes), cholesterol, HDL, LDL,
triglyceride levels
, lOMoARcPSD|21646696
► Diet & eating habits (commercially prepared foods, high-sodium, etc)
► Elimination – nocturia = common in pts with HF **
► Screen for bloody urine or stools in pts taking platelet-inhibiting meds
(ex. aspirin, Plavix; platelet aggregation inhibitors, or anticoagulants (ex.
heparin, warfarin (Coumadin), Lovenox, etc.
► Activity, exercise – activity-induced angina or SOB may indicate CAD
► Sleep, rest:
► orthopnea (need to sit upright or stand to avoid feeling SOB) often occurs
in pts with worsening HF
► paroxysmal nocturnal dyspnea – sudden awakening with SOB = another
symptom of worsening HF
► Self-perception/concept – quit smoking (to reduce risk of future CV probs)
► Roles, relationships – assess the pts support system (esp. bc many invasive
cardiac procedures like cardiac catheterization and percutaneous coronary
intervention (PCI) are being performed as outpatient procedures!
► Sexuality, reproduction – impotence may develop in men as a side effect of
cardiac meds (ex. beta blockers) – may cause some men to stop taking it!
► Coping, stress tolerance
► high levels of anxiety are assoc. with increased incidence of CAD
► pts with CAD and HF should be assessed for depression (pts with score of
3 or higher should be referred for further eval.)
► social readjustment rating scale – widely used tool to measure life stress
► pts with a score less than 150 = slight risk for future illness
► score of 150-299 = moderate risk
PHYSICAL ASSESSMENT
(Any deviations from the normal?)
► Heart as a pump à reduced pulse pressure, displaced PMI from 5th ICS
mid- clavicular line, gallop sounds, murmurs
► Atrial/ventricular filling volumes à JVD, peripheral edema, ascites,
crackles, postural BP changes
► Cardiac output à reduced pulse pressure, hypotension, tachycardia, reduced
urine output, lethargy, disorientation
► Compensatory mechanisms à peripheral vasoconstriction, tachycardia
“Best diagnostic tool – echocardiogram (DX choice to pick up a regurgitation or
stenosis)”
CARDIAC-SPECIFIC
► General appearance – changes to LOC, BMI > 30
► Assessment of skin/extremities
► S/S of acute obstruction of arterial blood flow in extremities = “6 P’s”= Pain,
pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis
► Should be assessed during the first few hours after invasive cardiac
procedures like cardiac catheterization, PCI, or cardiac
electrophysiology testing
► Hematoma
► Edema (peripheral edema = feet, ankles, or legs à common in HF or
PVDs like DVT or chronic venous insufficiency) or pitting edema
► Prolonged capillary refill
MED SURG 2 EXAM 1-Comprehensive
Review of Medical Surgical Nursing II
Exam
, lOMoARcPSD|21646696
MED SURG 2 EXAM 1
Ch. 25 – ASSESSMENT OF CARDIOVASCULAR
FUNCTION
Conduction System
• Automaticity = ability to initiate an electrical impulse
• Excitability = ability to respond to an electrical impulse
• Conductivity = ability to transmit an electrical impulse from one cell to another
SA node à AV node à bundle of his à right bundle branch à left bundle branch à
purkinje fibers
*SA node is the primary pacemaker of the heart
Depolarization: electrical activation of cell caused by influx of sodium into cell while
potassium exits cell
Repolarization: return of cell to resting state caused by re-entry of potassium into
cell while sodium exits
Refractory periods
► Effective refractory period: phase in which cells are incapable of depolarizing
► Relative refractory period: phase in which cells require stronger-than-normal
stimulus to depolarize
Cardiac Action Potential Phases (won’t ask but understand)
Phase 0 = Na comes into the actual cell (RAPID depolarization, SODIUM IN)
Phase 1 = early cell repolarization – K+ coming out of the cell (POTASSIUM
OUT) Phase 2 = plateau phase (rate of repolarization slows); Ca+ ENTER CELL
Phase 3 = complete repolarization (return of cell to resting state)
Phase 4 = resting phase before the next depolarization
Aorta has the highest pressure (biggest) high force…pressure in left ventricle + aorta
highest pressure is higher pressure in the cardiac system
** Majority of MI occurs in left ventricle!
CO = HR x SV
Cardiac output = total amt. of blood ejected by one of the ventricles in L/min (in resting
adult about 4-6 L/min)
Stroke volume = amount of blood ejected from one of the ventricles per heartbeat
(average = 60-130 mL)
Changes in HR are due to inhibition or stimulation of the SA node by the
parasympathetic and sympathetic divisions.
PNS travels to SA node through vagus nerve à vagal stimulation = slows the HR
, lOMoARcPSD|21646696
SNS increases HR by innervation of the beta-1 receptors located within SA node (occurs
through an increase in circulation catecholamines (secreted by the adrenal gland) and by
excess thyroid hormone, which produces a catecholamine-like effect
HR also affected by CNS and baroreceptor activity (sensitive to changes in BP) à
when BP is high – baroreceptors stimulate PNS activity, lowering HR. When BP is low à
they stimulate SNS activity, raising HR.
SV is determined by preload, afterload, and contractility.
Preload = how much blood is within the ventricle before you pump it out (at the end of
diastole right before systole occurs)
Afterload = the resistance of ejection of blood from the ventricle
Contractility = the force generated by the contracting myocardium
Women usually develop CAD 10 years later than men b/c they benefit from female
hormone estrogen and its cardioprotective effects
1. Increase in HDL (transports cholesterol out of arteries
2. Reduction in LDL (deposits cholesterol in the artery)
3. Dilation of the blood vessels (enhances blood flow to the heart)
*post-menopausal women = higher risk of CAD b/c estrogen levels slowly disappear
COMMON SYMPTOMS of CVD
► Chest pain
► Dyspnea
► Peripheral edema, weight gain, abdominal distention
► Palpitations
► Fatigue
► Dizziness, syncope, changes in level of consciousness
Chest pain – identify quantity (0-10), location, and quality. Radiation of pain? Associated
S/S like sweating or nausea; duration? Assess for other cardiac conditions; assess for
other significant conditions
► Pneumonia, pulmonary embolism
► Hiatal hernia, GERD
► Costochondritis
► Vascular
“Costochondritis – inflammation process in the cartilage (pain can be so severe that
they think they’re having a heart attack); TX would be rest… would still do an EKG”
ASSESSMENT:
► Medications – aspirin = common OTC med that improves outcomes in CAD pts
► Nutrition – nut. risk factors = hyperlipidemia, HTN, diabetes
► Height + weight
► BMI ** (assessment for obesity)
► Lab results – glucose, glycosylated Hb (diabetes), cholesterol, HDL, LDL,
triglyceride levels
, lOMoARcPSD|21646696
► Diet & eating habits (commercially prepared foods, high-sodium, etc)
► Elimination – nocturia = common in pts with HF **
► Screen for bloody urine or stools in pts taking platelet-inhibiting meds
(ex. aspirin, Plavix; platelet aggregation inhibitors, or anticoagulants (ex.
heparin, warfarin (Coumadin), Lovenox, etc.
► Activity, exercise – activity-induced angina or SOB may indicate CAD
► Sleep, rest:
► orthopnea (need to sit upright or stand to avoid feeling SOB) often occurs
in pts with worsening HF
► paroxysmal nocturnal dyspnea – sudden awakening with SOB = another
symptom of worsening HF
► Self-perception/concept – quit smoking (to reduce risk of future CV probs)
► Roles, relationships – assess the pts support system (esp. bc many invasive
cardiac procedures like cardiac catheterization and percutaneous coronary
intervention (PCI) are being performed as outpatient procedures!
► Sexuality, reproduction – impotence may develop in men as a side effect of
cardiac meds (ex. beta blockers) – may cause some men to stop taking it!
► Coping, stress tolerance
► high levels of anxiety are assoc. with increased incidence of CAD
► pts with CAD and HF should be assessed for depression (pts with score of
3 or higher should be referred for further eval.)
► social readjustment rating scale – widely used tool to measure life stress
► pts with a score less than 150 = slight risk for future illness
► score of 150-299 = moderate risk
PHYSICAL ASSESSMENT
(Any deviations from the normal?)
► Heart as a pump à reduced pulse pressure, displaced PMI from 5th ICS
mid- clavicular line, gallop sounds, murmurs
► Atrial/ventricular filling volumes à JVD, peripheral edema, ascites,
crackles, postural BP changes
► Cardiac output à reduced pulse pressure, hypotension, tachycardia, reduced
urine output, lethargy, disorientation
► Compensatory mechanisms à peripheral vasoconstriction, tachycardia
“Best diagnostic tool – echocardiogram (DX choice to pick up a regurgitation or
stenosis)”
CARDIAC-SPECIFIC
► General appearance – changes to LOC, BMI > 30
► Assessment of skin/extremities
► S/S of acute obstruction of arterial blood flow in extremities = “6 P’s”= Pain,
pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis
► Should be assessed during the first few hours after invasive cardiac
procedures like cardiac catheterization, PCI, or cardiac
electrophysiology testing
► Hematoma
► Edema (peripheral edema = feet, ankles, or legs à common in HF or
PVDs like DVT or chronic venous insufficiency) or pitting edema
► Prolonged capillary refill
