Basic Anatomy
Name the 3 layers of the heart from outermost to innermost
Epicardium,Myocardium,Endocardium
What is a hypertensive crisis?
Rapidly progressive type of hypertension in which the systolic pressure >180 and/or diastolic pressure is usually > 120 mmHg
S/S: headache, blurry vision
Extremely high BP can rupture cerebral vessels (hemorrhage stroke or ruptured aneurysm) or cause cerebral edema
What is heart failure?
Heart failure is not the same as a heart attack/MI. Heart failure is a term used to describe a weak heart i.e. the heart is not working as efficiently as it should.
What is a normal sinus rhythm?
Represents the SA node/pacemaker of the heart working normally, producing a rate of 60-100 bpm, regular P-QRS-T sequence.
What is pericarditis? What will the nurse hear when auscultating the patient?
Pericarditis is inflammation of the pericardial sac that causes sharp, positional chest pain. The nurse will hear a pericardial friction rub when auscultating the patient?
Which layer of the heart is responsble for pumping blood and makes up the musculer middle layer of the heart wall?
Myocardium
Describe the difference between arteriosclerosis vs. atherosclerosis.
-
What is the difference between left-sided and right-sided heart failure?
Left-sided heart failure occurs when the left ventricle is unable to pump blood out to the body, so the blood pools into the lungs - causing pulmnary symptoms.
Right-sided heart failure occurs when the right ventricle can't pump blood to the lungs, so the blood pools into rest of the body - causing edematic symptoms.
a. Normal sinus rhythm
b. Tachycardia
c. ST elevation
d. A-fib
c. ST elevation is indicative of a STEMI (ST elevation Myocardial Infarction). STEMI occurs when there is total blockage of the coronary arteries. This is a medical emergency!!!
What is the difference between a PE and DVT?
Do we move the leg with a suspected DVT?
Pulmonary embolism is a blood clot that broke away and has now traveled to a pulmonary artery.
DVT is a blood clot that is attached to the vessel wall in the leg(s).
DO NOT move the leg i.e. avoid leg manipulation due to the risk of the blood clot breaking away and traveling elsewhere in the body such as the pulmonary arteries
Name the 4 chambers of the heart along with which have deoxygenated blood or oxygenated blood and which valves they contain.
Right Atrium, Right Ventricle - deoxygenated blood; contains the tricuspid valve ("tright")
Left Atrium, Left Ventricle - oxygenated blood; contains the bicuspid valve aka mitral valve
What can atherosclerosis lead to? SATA.
a. Party time for the heart
b. Myocardial Infarction (MI)
c. Ischemia
d. Thrombosis
B, C,and D occur b/c atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregation (clumping), thrombus (clot) formation, and vasoconstriction, which leads to ischemia and possible infarction (necrosis) of the heart
If blood and O2 not going to heart, the heart will die
A patient presents to the clinic after complaining of a 10 pound weight gain in one week and severe swelling of the stomach. Upon examination, the nurse notes that the patient has jugular vein distention, 3+ pitting edema in the lower extremities, and ascites. What condition does the nurse suspect the patient has?
a. Left-sided heart failure
b. Appendicitis
c. Abdominal hemorrhage
d. Right-sided heart failure
The patient presents with the classic signs and symptoms of right-sided heart failure:
-systematic congestion
-Peripheral and sacral edema
-JVD
-Hepatomegaly (enlarged liver) and ascites
-Weight gain due to fluid retention
What is A-fib? What medication should the patient be taking?
A-fib is atrial fibrillation and occurs when the atria do not contract, but rather fibrillate (quiver/tremble), leading to the ventricles not receiving enough blood and the blood pooling into the atria. Blood clots are a concern!!!
The patient should be taking an anticoagulant such as Warfarin or Eliquis aka Apixaban.
What are the most common cause of Abdominal Aortic Aneurysm (AAA)?
Hypertension and atherosclerosis
HTN - the blood vessels can become so damaged that the aneurysm eventually ruptures
Atherosclerosis - the plaque damages the arteries to the point it can cause the aneurysm to rupture
Describe the blood flow throughout the heart.
What are the classic signs & symptoms of Peripheral Arterial Disease (PAD)? SATA:
a. Pinkeye
b. Pallor
c. Paresthesia
d. Pinky finger
e. Platypus
f. Paralysis
g. Pain
h. Polar
i. Pulseless
6 P's - Pallor, Paresthesia, Paralysis, Pain, Polar, Pulseless
Which symptoms does the nurse expect in a patient with left-sided heart failure?
a. systematic congestion
b. warmth, tenderness, fever
c. pulmonary symptoms
d. edema, JVD, ascites
c. pulmonary symptoms due to blood pooling/collecting in the lungs
A patient presents to the clinic for his annual physical. The patient is an avid marathon runner and a gym bro. The nurse completes the physical assessment and sets up the EKG for the doctor to assess. The nurse sees that the patient is in sinus bradycardia, with a heart rate of 54 bpm. Should the nurse be concerned?
a. Yes
b. No
c. I'm not sure
d. What are we studying again??
No, the nurse should not be concerned, as the patient has a very healthy heart that can work less hard in order to sustain normal functioning of the body.
Which lab is the most indicative marker for an MI?
a. elevated Myoglobin
b. elevated Sodium
c. elevated Troponin
d. elevated Potassium
c. elevated Troponin
Troponin is cardiac specific, meaning it is only in the heart and an elevated level indicates the heart is injured such as in a MI
A nurse is teaching a student about the Frank-Starling Law and its attributes. Which statement indicates understanding by the student?
a. A severely, overstretched heart ensures adequate pumping of blood to the body.
b. The more the heart muscle is stretched during filling (preload), the stronger the subsequent contraction -- up to a phsyiological limit (breaking point).
c. An enlarged left ventricle is more efficient than a normal sized left ventricle.
d. Frank Starling Law describes the cause of atherosclerosis.
B.
Frank Starling Law: the more the heart muscle is stretched during filling (preload), the stronger the subsequent contraction -- up to a physiological limit (breaking point) i.e. overstretch --> lose contractility/form/effectiveness as in types of heart failure or dialted cardiomyopathy (a progressive condition where the heart's main pumping chamber -- the left ventricle -- becomes enlarged, stretched, and weakened, making it harder to pump blood effectively.
*Think about a rubberband that is overstretched --> eventually it will snap*
A patient presents to the clinic for an annual physical visit. The patient states he has been having pain in his legs when walking around, but his pain subsides at rest. The nurse suspects which issue is occurring?
a. DVT
b. PE
c. Intermittent Claudication (PAD)
d. MI
C. Peripheral Artery Disease (PAD) occurs due narrowed arteries that reduce blow flow to the limb such as atherosclerosis. This causes intermittent claudication, which is muscle pain that happens when you're active and stops when you rest
A patient with a history of left-sided heart failure presents to the ED with worsening symptoms. What symptoms does the nurse expect the patient to have?
a. JVD
b. Ascites
c. Dyspnea
d. Crackles in the lungs upon auscultation
e. Decreased urine output
f. Worsening fatigue
The patient will present with pulmonary symptoms due to blood pooling into the lungs.
c. Dyspnea
d. Crackles in the lungs upon auscultation
e. Decreased urine output -- occurs due to the kidneys not being perfused well, so they retain fluid such as urine to continue working as best as they can.
f. Worsening fatigue
What are the characteristics of an A-fib EKG rythm? SATA.
a. normal P wave
b. absent P wave
c. Narrow QRS complexes
d. Wide QRS complexes
e. Irregular rythm
d. Regular rythm
b. absent P wave
c. Narrow QRS complexes
e. Irregular rythm
What is metabolic syndrome?
Metabolic syndrome - a cluster of risks that increases the patient's risk of developing certain conditions such as cardiovascular disease, HTN, stroke, DM, atherosclerosis
The risk of stroke increases due to ischemia to the brain.