CHAPTER 33 ASSESSMENT OF THE CARDIOVASCULAR SYSTENM Right atrium Left atrium Fou
ID: 240324 • Letter: C
Question
CHAPTER 33 ASSESSMENT OF THE CARDIOVASCULAR SYSTENM Right atrium Left atrium Four cardiac valves ow Tricuspid valve Circumflex Bicuspid valwe Automaticity MAP RCA DIASTOLIE Cardiac output Cardiac index Vascular system STROKE VOLUME PRELOAD Blood pressure Afterload Peripheral chemoreceptors Hypercapnia Central chemoreceptors Hydrostatic pressureIntermittent PND Near syncope Decreased perfusion Hypertension Central cyanosis Hypotension Peripheral cyanosis Pulse pressure Anasarca Paradoxical BP TBP Pericardial friction rub Creatine kinase TriglyceridesHomocystelne Troponin Myoglobin What things should you assess What are nonmodifiable risk factors What is modifiable risk factors Describe the four classes of cardiovascular disability How is chest discomfort assessed HOW IS PRECORDIIM ASSESSED? What is the point of maximum impulse? Describe auscultation with the bell and diaphragm of the heart? What part do the kidneys play in regulating cardiac ectivity? l What are the effects of sodium on the heart Prothrombin time DOLL 8 8 6Explanation / Answer
1.
2.
Non-modifiable risk factors include:
Age
The older you are, the more likely you are to develop coronary heart disease or to have a cardiac event
(angina, heart attack or stroke).
Ethnic background
South Asians living in the UK are twice as likely to develop coronary heart disease compared to the rest of
the UK population. Also, people from African Caribbean backgrounds have a higher than average risk of
developing high blood pressure.
But remember that you can still reduce your risk as much as possible by controlling your other risk factors.
Family history
Your own risk of developing coronary heart disease is increased if:
your father or brother was diagnosed with the disease, or had a cardiac event under the age of 55
your mother or sister was diagnosed with the disease or had a cardiac event under 65.
If you have a family history of heart disease, it may help to reduce your own risk if you look at what the risk
factors affecting your family member were.
3. The modifiable risk factors of cardiovascular disease includes
smoking
high blood pressure
diabetes
physical inactivity
being overweight
high blood cholesterol.
4. Criteria for use of the terms minimal, moderately severe, and severe disease cannot be defined precisely. Grading is based on the individual physician's judgment. The objective assessment of a patient with cardiac disease who has not had specific tests of cardiac structure or function is classified as undetermined.
5.
6.
When conducting the precordial exam, it is important to identify specific landmarks.
7. Listening to heart and lung sounds is a routine—but challenging—part of your patient care. Even in the best circumstances these sounds can be difficult to hear. In addition, heart sounds last slightly more than 0.10 seconds, and their pitch begins at the lowest level detectable by the human ear.
Use a stethoscope with a bell and a diaphragm. (If your stethoscope is electronic, it will have bell and diaphragm modes that you can alternate between with the press of a button.) The bell is best suited for hearing low-pitched sounds, and the diaphragm for high-pitched sounds. The ear pieces—no matter what type of stethoscope you are using—should fit snugly and align with the angle of your ear canals.
To avoid transmission of extraneous noise, be sure to remove any item you may have hung on your stethoscope. (Avoid the habit some nurses have of using their stethoscope to hang rolls of tape, tourniquets, or a hospital badge.) Then, expose the patient's chest and place the head of the stethoscope directly on the skin instead of listening through the patient's gown. Stand at the patient's right side with the stethoscope tubing extended across the chest. Make sure that the tubing is not touching the chest or resting on the sheets or side rail.
You may begin auscultation at the top (base) of the heart and proceed down to the apex, or follow the reverse order, listening first at the apex and proceeding up to the base.2,3 Either approach is acceptable; what is important is that you use the same approach for the entire exam. Here, I'll describe the base-to-apex approach.
Start with the patient supine with the head of the bed elevated 30 degrees. Auscultate all areas first with the diaphragm. To begin, place it firmly against the right side of the chest in the second intercostal space close to the sternum. Then move to the left side and listen in the same space at the left sternal border. Continue down the left sternal border, auscultating in the third and fourth intercostal spaces. Finish by auscultating the apex, which is usually found in the fifth left intercostal space just below the nipple—the midclavicular line.
Repeat the sequence, using the bell of the stethoscope. When you position the bell, use just enough pressure to create a seal between it and the skin. Exerting greater pressure than that will stretch the skin across the bell, creating a diaphragm and thereby reducing your ability to hear low-pitched sounds.
8. The kidneys play a central role in cardiovascular homeostasis by ensuring a balance between the fluid taken in and that lost and excreted during everyday activities. This ensures stability of extracellular fluid volume and maintenance of normal levels of blood pressure. Renal fluid handling is controlled via neural and humoral influences, with the former determining a rapid dynamic response to changing intake of sodium whereas the latter cause a slower longer-term modulation of sodium and water handling. Activity in the renal sympathetic nerves arises from an integration of information from the high and low pressure cardiovascular baroreceptors, the somatosensory and visceral systems as well as the higher cortical centers. Each sensory system provides varying input to the autonomic centers of the hypothalamic and medullary areas of the brain at a level appropriate to the activity being performed. In pathophysiological states, such as hypertension, heart failure and chronic renal disease, there may be an inappropriate sympathoexcitation causing sodium retention which exacerbates the disease process.
9. When there’s extra sodium in your bloodstream, it pulls water into your blood vessels, increasing the total amount (volume) of blood inside your blood vessels. With more blood flowing through your blood vessels, blood pressure increases. It’s like turning up the water supply to a garden hose — the pressure in the hose increases as more water is blasted through it. Over time, high blood pressure may overstretch or injure the blood vessel walls and speed the build-up of gunky plaque that can block blood flow. The added pressure also tires out the heart by forcing it to work harder to pump blood through the body.
Functional Capacity Objective Assessment Class I. Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. A. No objective evidence of cardiovascular disease. Class II. Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. B. Objective evidence of minimal cardiovascular disease. Class III. Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain. C. Objective evidence of moderately severe cardiovascular disease. Class IV. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased. D. Objective evidence of severe cardiovascular disease