Nursing Board Review

Cardiovascular System
The Cardiovascular System
Normal Anatomy
The heart is located in the LEFT side of the
mediastinum
Consists of Three layers- epicardium,
myocardium and endocardium
The Cardiovascular System
The epicardium covers the outer surface of
the heart
The myocardium is the middle muscular
layer of the heart
The endocardium lines the chambers and
the valves
The Cardiovascular System
The layer that covers the heart is the
PERICARDIUM
There are two parts- parietal and visceral
pericardium
The space between the two pericardial
layers is the pericardial space
The Cardiovascular System
The heart also has four chambers-
two atria and two ventricles
The Left atrium and the right
atrium
The left ventricle and the right
ventricle
The Cardiovascular System
The heart chambers are guarded by
valves
The atrio-ventricular valves-
Tricuspid and bicuspid
The semi-lunar valves- Pulmonic and
aortic valves
The Cardiovascular System
The Blood supply of the heart comes from
the Coronary arteries
1. Right coronary artery supplies the
RIGHT atrium and RIGHT ventricle,
inferior portion of the LEFT ventricle,
the POSTERIOR septal wall and the two
nodes- AV (90%) and SA node (55%)
The Cardiovascular System
2. Left coronary artery- branches into the
LAD and the circumflex branch
The LAD supplies blood to the anterior
wall of the LEFT ventricle, the anterior
septum and the Apex of the left ventricle
The CIRCUMFLEX branch supplies the
left atrium and the posterior LEFT
ventricle
The Cardiovascular System
The CONDUCTING SYSTEM OF THE
HEART
Consists of the
1. SA node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the Right
and the Left bundle branch
4. Purkinje fibers- fastest conduction
The Cardiovascular System
The Heart sounds
1. S1- due to closure of the AV valves
2. S2- due to the closure of the semi-lunar
valves
3. S3- due to increased ventricular filling
4. S4- due to forceful atrial contraction
The Cardiovascular System
Heart rate
Normal range is 60-100 beats per minute
Tachycardia is greater than 100 bpm
Bradycardia is less than 60 bpm
Sympathetic system INCREASES HR
Parasympathetic system (Vagus)
DECREASES HR
The Cardiovascular System
Blood pressure
Cardiac output X peripheral resistance
Control is neural (central and
peripheral) and hormonal
Baroreceptors in the carotid and aorta
Hormones- ADH, aldosterone,
epinephrine can increase BP; ANF can
decrease BP
The Cardiovascular System
The vascular system consists of the arteries,
veins and capillaries
The arteries are vessels that carry blood
away from the heart to the periphery
The veins are the vessels that carry blood to
the heart
The capillaries are lined with squamos cells,
they connect the veins and arteries
The Cardiovascular System
The lymphatic system also is part of the
vascular system and the function of this
system is to collect the extravasated fluid
from the tissues and returns it to the blood
The Cardiovascular System

Cardiac Assessment
 The Cardiovascular System
Laboratory Test Rationale
1. To assist in diagnosing MI
2. To identify abnormalities
3. To assess inflammation
 The Cardiovascular System
Laboratory Test Rationale
4. To determine baseline value
5. To monitor serum level of
medications
6. To assess the effects of
medications
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC Proteins and
enzymes
CK- MB ( creatine kinase)
Elevates in MI within 4
hours, peaks in 18 hours
and then declines till 3 days
The Cardiovascular System
LABORATORY PROCEDURES

CARDIAC Proteins and

enzymes
CK- MB ( creatine
kinase)
Normal value is 0-7 U/L
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC Proteins and
enzymes
Lactic Dehydrogenase (LDH)
Elevates in MI in 24 hours,
peaks in 48-72 hours
Normally LDH1 is greater
than LDH2
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC Proteins and
enzymes
Lactic Dehydrogenase (LDH)
MI- LDH2 greater than
LDH1 (flipped LDH pattern)
Normal value is 70-200 IU/L
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC Proteins and
enzymes
Myoglobin
Rises within 1-3 hours
Peaks in 4-12 hours
Returns to normal in a day
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC Proteins and
enzymes
Myoglobin
Not used alone
Muscular and RENAL disease
can have elevated myoglobin
The Cardiovascular System
LABORATORY PROCEDURES
Troponin I and T
Troponin I is usually utilized for MI
Elevates within 3-4 hours, peaks in 4-24 hours and
persists for 7 days to 3 weeks!
Normal value for Troponin I is less than 0.6 ng/Ml

REMEMBER to AVOID IM injections before

obtaining blood sample!
Early and late diagnosis can be made!
 The Cardiovascular System
LABORATORY PROCEDURES
SERUM LIPIDS
Lipid profile measures the serum cholesterol,
triglycerides and lipoprotein levels
Cholesterol= 125-200 mg/dL (for ages 20 years and
older both men and women)
Triglycerides- 40- 150 mg/dL
LDH- 130 mg/dL
HDL- 30-70- mg/dL
NPO post midnight (usually 12 hours)
The Cardiovascular System
LABORATORY PROCEDURES
ELECTROCARDIOGRAM
(ECG)
A non-invasive procedure that
evaluates the electrical activity
of the heart
Electrodes and wires are
attached to the patient
The Cardiovascular System
LABORATORY PROCEDURES
Holter Monitoring
A non-invasive test in
which the client wears a
Holter monitor and an
ECG tracing recorded
continuously over a period
of 24 hours
 The Cardiovascular System
LABORATORY PROCEDURES

Holter Monitoring
Instruct the client to resume
normal activities and maintain
a diary of activities and any
symptoms that may develop
The Cardiovascular System
LABORATORY PROCEDURES
ECHOCARDIOGRAM
Non-invasive test that studies
the structural and functional
changes of the heart with the
use of ultrasound
No special preparation is
needed
The Cardiovascular System
LABORATORY PROCEDURES
Stress Test
A non-invasive test that
studies the heart during
activity and detects and
evaluates CAD
Exercise test, pharmacologic
test and emotional test
The Cardiovascular System
LABORATORY PROCEDURES
Stress Test
Treadmill testing is the most
commonly used stress test
Used to determine CAD,
Chest pain causes, drug
effects and dysrhythmias in
exercise
The Cardiovascular System
LABORATORY PROCEDURES
Stress Test
Pre-test: consent may be
required, adequate rest ,
eat a light meal or fast for
4 hours and avoid
smoking, alcohol and
caffeine
The Cardiovascular System
LABORATORY PROCEDURES
Post-test: instruct client to
notify the physician if any
chest pain, dizziness or
shortness of breath . Instruct
client to avoid taking a hot
shower for 10-12 hours after
the test
The Cardiovascular System
LABORATORY PROCEDURES
Pharmacological stress test
Use of dipyridamole
Maximally dilates
coronary artery
Side-effect: flushing of
face
The Cardiovascular System
LABORATORY PROCEDURES
Pharmacological stress test
Pre-test: 4 hours fasting,
avoid alcohol, caffeine
Post test: report
symptoms of chest pain
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC catheterization
Insertion of a catheter into
the heart and surrounding
vessels
Determines the structure and
performance of the heart
valves and surrounding
vessels
The Cardiovascular System
LABORATORY PROCEDURES
CARDIAC catheterization
Used to diagnose CAD,
assess coronary atery
patency and determine
extent of atherosclerosis
The Cardiovascular System
LABORATORY PROCEDURES
Pretest: Ensure Consent,
assess for allergy to
seafood and iodine, NPO,
document weight and
height, baseline VS, blood
tests and document the
peripheral pulses
The Cardiovascular System
LABORATORY PROCEDURES

Pretest: Fast for 8-12

hours, teachings,
medications to allay
anxiety
The Cardiovascular System
LABORATORY PROCEDURES
Intra-test: inform patient of
a fluttery feeling as the
catheter passes through the
heart; inform the patient
that a feeling of warmth and
metallic taste may occur
when dye is administered
The Cardiovascular System
LABORATORY PROCEDURES
Post-test: Monitor VS and cardiac
rhythm
Monitor peripheral pulses, color and
warmth and sensation of the
extremity distal to insertion site
Maintain sandbag to the insertion site
if required to maintain pressure
Monitor for bleeding and hematoma
formation
 The Cardiovascular System
LABORATORY PROCEDURES
Maintain strict bed rest for 6-12 hours
Client may turn from side to side but bed
should not be elevated more than 30 degrees
and legs always straight
Encourage fluid intake to flush out the dye
Immobilize the arm if the antecubital vein
is used
Monitor for dye allergy
The Cardiovascular System
LABORATORY PROCEDURES
CVP
The CVP is the pressure
within the SVC
Reflects the pressure under
which blood is returned to
the SVC and right atrium
 The Cardiovascular System
LABORATORY PROCEDURES
CVP
Normal CVP is 0 to 8 mmHg/ 4-10
cm H2O
Elevated CVP indicates increase
in blood volume, excessive IVF or
heart/renal failure
Low CVP may indicated
hypovolemia, hemorrhage and
severe vasodilatation
The Cardiovascular System
LABORATORY PROCEDURES
Measuring CVP
1. Position the client supine with bed
elevated at 45 degrees
2. Position the zero point of the CVP
line at the level of the right atrium.
Usually this is at the MAL, 4th ICS
3. Instruct the client to be relaxed
and avoid coughing and straining.
CARDIAC ASSESSMENT
ASSESSMENT
1. Health History
Obtain description of present
illness and the chief
complaint
Chest pain, SOB, Edema, etc.
Assess risk factors
CARDIAC ASSESSMENT
2. Physical examination
Vital signs- BP, PP, MAP
Inspection of the skin
Inspection of the thorax
Palpation of the PMI, pulses
Auscultation of the heart
sounds
CARDIAC ASSESSMENT
3. Laboratory and diagnostic studies
CBC
cardiac catheterization
Lipid profile
arteriography
Cardiac enzymes and proteins
CXR
CVP
EEG
Holter monitoring
Exercise ECG
CARDIAC IMPLEMENTATION
1. Assess the cardio-pulmonary
status
VS, BP, Cardiac assessment
2. Enhance cardiac output
Establish IV line to administer
fluids
CARDIAC IMPLEMENTATION
3. Promote gas exchange
Administer O2
Position client in SEMI-Fowler’s
Encourage coughing and deep
breathing exercises
CARDIAC IMPLEMENTATION
4. Increase client activity tolerance
Balance rest and activity periods
Assist in daily activities
5. Promote client comfort
Assess the client’s description of
pain and chest discomfort
Administer medication as
prescribed
CARDIAC IMPLEMENTATION
6. Promote adequate sleep
7. Prevent infection
Monitor skin integrity of lower
extremities
Assess skin site for edema, redness
and warmth
Monitor for fever
Change position frequently
CARDIAC IMPLEMENTATION

8. Minimize patient anxiety

Encourage verbalization of
feelings, fears and concerns
Answer client questions.
Provide information about
procedures and medications
THANK
YOU