Chapter 3"

#ssessment of the Cardiovas ular System

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Surfa e #natomy of the $eart

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%lood &lo' (hrough the $eart

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Cardia *alves
1! 2! 3! )! (ri uspid valve +itral valve ,ulmoni valve #orti valve

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+ean #rterial ,ressure -+#,.

+ust be at least 60 mm $g to maintain ade/uate blood flo' through oronary arteries and perfuse ma0or organs -brain. +#, 1 S%, 2 23%+, divided by 3

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"

Se/uen e of Events 3uring the Cardia Cy le

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+e hani al ,roperties of the $eart

Cardia output $eart rate Stro5e volume ,reload Impedan e +yo ardial ontra tility

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+e hani al ,roperties of the $eart - ont7d.

Cardia Inde8 -CI. 1 Cardia 9utput : %ody Surfa e #rea -%S#.

CI normal range 1 2!4 to 3!2 ;<min<m2 %S#

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Cardia 9utput

#mount of blood pumped from left ventri le per minute $eart >ate ? Stro5e *olume

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#rterial System

%lood pressure is for e of blood e8erted against vessel 'alls

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10

%lood ,ressure >egulation

#utonomi nervous system@

%arore eptors Chemore eptorsAhyper apnia

>enal system Endo rine system E8ternal fa tors also affe t %,

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11

Cardiovas ular System #ssessment

,atient history Butritional history &amily history and geneti ris5 Current health problems

,ain, dis omfort 3yspnea, 39E, orthopnea, ,B3 &atigue ,alpitations Edema Syn ope E8tremity pain
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,oint to >ememberC

%est indi ator of fluid balan e is 'eight 2!2 lb 1 1 5g 1 1 ; of fluid

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13

Cardiovas ular System ,hysi al #ssessment

Deneral appearan e S5in

Cyanosis, rubor Clubbing, edema $ypotension and hypertension ,ostural -orthostati . hypotension

E8tremities

%lood pressure

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1)

,re ordium

#ssessment@

Inspe tion ,alpation ,er ussion #us ultation Bormal heart sounds ,arado8i al splitting Dallops and murmurs ,eri ardial fri tion rub

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1"

Serum +ar5ers of +yo ardial 3amage

(roponinA(roponin ( and troponin I Creatine 5inase -CE. +yoglobin Serum lipids

(otal holesterol F200 mg<d; (rigly eride F1"0 mg<d; $3; G)0 mg< d; ;3; F40 mg<d; for ardiovas ular patients

$omo ysteine $ighly sensitive CHrea tive protein

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;aboratory #ssessment

+i roalbuminuria %lood oagulation studies

,(<IB( ,((

#%D &IE Erythro yte ount $I$ ;eu5o yte ount

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14

3iagnosti #ssessment

,# and lateral CJ> #ngiography #rteriography Cardia atheteriKation

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16

Cardia CatheteriKation

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1=

9ther 3iagnosti #ssessment

ECD Ele trophysiologi study -E,S. Stress test E ho ardiography

,harma ologi stress e ho ardiogram (EE

+yo ardial nu lear perfusion imaging -+B,I.

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20

$emodynami +onitoring

Invasive system provides /uantitative information about vas ular apa ity, blood volume, pump effe tiveness, tissue perfusion ,ulmonary artery atheter Invasive arterial atheter Impedan e ardiography

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21

$emodynami +onitoring - ont7d.

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22

Luestion 1
# 'oman 'ho is having a myo ardial infar tion may e8perien e 'hi h set of symptoms instead of intense pain or pressure in the hestM #! Indigestion, feelings of hroni fatigue, and a ho5ing sensation %! +oderate a he in the hest that is 'orse on inspiration C! Sudden, intermittent, stabbing pain 3! ,ain that spreads a ross the hest and ba 5 and<or radiates do'n the arm
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Luestion 2
# patient is admitted 'ith a 'eight loss of 2!3 5g over 36 hours, diarrhea, nausea, and vomiting! %ased on this information, the nurse should assess 'hi h ardiovas ular parameter more loselyM
#! ,reload %! #fterload C! Stro5e volume 3! $eart rate
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Luestion 3
Nhat is the best indi ator of fluid retentionM #! (a hy ardia %! Cra 5les in the lungs C! Neight gain 3! In reased blood pressure

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2"