Cardiovascular Unit Self Study

NAME___ ________ BLOCK__ _____

1. List and describe the phases of the cardiac cycle.

The cardiac cycle is the sequence of events that occur when the heart beats. The cycle
has two main phases: diastole, when the heart ventricles are relaxed, and systole, when
the ventricles contract. One cardiac cycle is defined as the contraction of the two atria
followed by contraction of the two ventricles.

The heart is a muscular organ that works as a pumping system. It takes in blood with
reduced levels of oxygen from the veins (deoxygenated blood), and delivers it to the lungs
for oxygenation. When it receives the oxygenated blood back from the lungs, it pumps the
blood back into the arteries to be distributed throughout the body.

The heart is divided into four hollow chambers, two on the left and two on the right. The
right chambers are the right atrium and the right ventricle. They receive blood from the
veins. The left chambers are the left atrium and the left ventricle. They receive blood
from the pulmonary circulation, and the left ventricle forces blood into the systemic
circulation.

In a cardiac cycle, blood enters the right atrium of the heart from the superior and
inferior vena cavae, and flows across the tricuspid valve into the right ventricle. From
the right ventricle the blood flows into the pulmonary artery, which is separated from the
ventricle by the pulmonary valve. After oxygenation in the lungs, blood returns to the
heart via four pulmonary veins that enter the left atrium. From the left atrium, blood
flows across the mitral valve and into the left ventricle. From the left ventricle blood is
ejected across the aortic valve into the aorta. Together, the mitral and tricuspid valves
are known as the atrioventricular valves and the aortic and pulmonary valves as the
semilunar valves.

2. Discuss the variables that affect cardiac output.

These variables include HR, preload, afterload, and contractility.
Any factor that increases CO or total peripheral vascular resistance increases the BP. In
general, BP is maintained at a relatively constant level. Therefore an increase or
decrease in total peripheral vascular resistance is associated with a decrease or increase
in CO, respectively. Three mechanisms mediate and regulate BP: ANS, kidneys, and
endocrine system.

3. Differentiate between the terms arteriosclerosis and atherosclerosis.

Arteriosclerosis is hardening of the arteries. This condition not only thickens the wall of
arteries, but also causes stiffness and a loss of elasticity. Over time, the arteries become
harder and harder as they are slowly damaged by high blood pressure. Arteriosclerosis
may be present in any artery of the body, but the disease is most concerning when it
attacks the coronary arteries and threatens to cause a heart attack.

Atherosclerosis is the most common type of arteriosclerosis, or hardening of the arteries,

and caused by plaque building up in the vessel. Over time the plaque causes thickening
of the walls of the artery. Stiffness and a loss of elasticity also result.

To clarify, a patient with arteriosclerosis (hardened arteries) may not have

atherosclerosis (plaque), but a patient with atherosclerosis does have arteriosclerosis.
Patients often have both conditions, which can cause a decrease in the blood flow to the
heart muscle.

In severe cases, coronary artery bypass surgery, or CABG surgery, is required to insure
adequate blood flow to the heart.

Atherosclerosis is made worse by cigarette smoking, high cholesterol and high blood
pressure. Eliminating or controlling those factors, as well as making dietary changes,
can often halt the progression of the disease or even improve the condition.

4. Make a chart to depict the category, sample drugs (2), unique side effects (at least
3), and nursing implications (at least 3) for the following:
diuretics, beta-adrenergic blocking agents, calcium channel blockers, ACE
inhibitors, angiotension II blockers (ARBs) and vasodilators
1. Antenolol
Side effects AV nodal block, tachycardia, hallucinations
Nursing implications Hx for patient (pregnant, lactation, renal failure, sinus
bradycardia). Assess patient baseline weight, skin condition, neurologic status, P, BP,
ECG, resp. status, renal, thyroid function test, blood and urine glucose, cholesterol,
triglycerides.

2. Lisinopril
Side effects Death has been reported with airway obstruction, angioedema( face, lip,
tongue, larynx), hepatocellular injury.
Nursing implications Hx of allergies to lisinopril or enalapril, impaired renal function,
heart failure, salt or volume depletion, lactation, pregnancy. Assess patient skin color,
lesions, turgors; T, P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver
evaluation, urinalysis, LFTs, renal function test, CBC, and differential, potassium.

5. Compare and contrast the clinical findings pertinent to peripheral arterial and
venous disorders.
Peripheral Arterial Peripheral Venous
Rest pain usually present No rest pain
Pain at ulcer site Moderate ulcer discomfort/ pt report leg/ankle swelling
Location/appearance
End of toes Ankle area
Between toes Brown pigmentation
Deep Ulcer bed pink
Ulcer bed pale, with even edges Usually superficial, with uneven edges
Little granulation tissue Granulation tissue present
Cold/cool foot Ankle discoloration and edema
Decreased/absent pulses Full veins when leg slightly dependent
Hair loss No neurologic deficit
Pallor with elevation Pulse present

6. Compare and contrast three types of anemia with causes, clinical findings, and
treatments.

1. Sickle cell anemia

Autosomal recessive inheritance of two defective gene alleles for hemoglobin synthesis
Red blood cells destruction, the release of bilirubin, and also tissue damage.
Hydroxyurea(droxia), keep the room warm, hydration by oral or iv routes.

2. Vitamin B12 deficiency anemia

Failure to absorb vitamin B12 from intestinal tract as a result of partial gastrectomy,
pernicious anemia, dietary deficiency.
Inhibiting folic acid transport and reducing DNA synthesis in precursor cells.
Patient needs to food rich in vitamin B12. Some patients may receive vitamin B12
injections

3. Iron deficiency anemia

Inadequate iron intake caused by iron-deficient diet, chronic alcoholism, malabsorption
syndrome, partial gastrectomy, rapid metabolic activity caused by pregnancy,
adolescence, infection.
The problem is decreased iron supply for the developing RBC.
Patient needs to increase oral intake of iron from food sources ( e.g. red meat, organ
meat, egg yolks, kidney beans, leafy green veggies, and raisins).

7. List five pertinent nursing interventions for a client in a sickle cell crisis.

Administer oxygen
Administer medication
Hydration (normal saline, fluids, no caffeine)
Have patient to keep extremities extended to promote venous return
Remove any constrictive clothing
Check circulation in extremities every hour:
Pulse oximetry of the finger and toes
Capillary refill
Peripheral pulses
Toe temperature
8. Develop a teaching plan for a client with hypertension. Emphasize diet,
medication, and lifestyle modifications.

9. Develop a concept map for a client with congestive heart failure. List three
nursing diagnoses with three critical interventions. List a reasonable goal and
optimal outcome for each nursing diagnosis.