Study Guide for Cardiac:

Assessment:
o Vital signs
Always check Level of Consciousness
Decreased in level of consciousness is an ominous sign
Inspection
Skin color
o Pale
o Mottled
Skin temperature
o Cool
o Clammy
o Diaphoretic
o Cyanosis
Peripheral cyanosis
Bluish or purplish tinge in extremities
or in nose or ears
Central cyanosis
Bluish tinge In tongue, conjunctiva,
inner surface of lips
Clubbing
o Clubbing of nail beds suggests prolonged oxygen
deficiency
Xanthalelasma
o Yellowish, slightly raised plaques in the skin usually
along the nasal portion of one or both eyelids
Suggests cholesterolemia
Edema
o Common sign of heart failure (HF) especially
dependant pitting edema
o Development of ankle edema or sudden weight
gain of more than 3 lb. in 2 days is one of the
biggest indicators of heart failure or worsening of
heart failure
Capillary refill
Capillary refill greater than 3 seconds
suggest decreased cardiac output and
impaired tissue perfusion
Blood pressure is BP = CO X SVR
Normal blood pressure
o Systolic less than 120 but greater than 100
o Diastolic less than 80
Pre-hypertension
o Systolic 120-139
o Diastolic 80-90
Hypertension

o Systolic 140 or higher

o Diastolic 90 or higher
Hypertensive crisis
o Sever and abrupt elevation of BP
o Generally defined as diastolic BP > 140
Rise in BP rate is more important than the
absolute value
BP alone is not a good indicator of the
seriousness of the patients condition
Mean arterial pressure (MAP) is often
used instead of systolic and diastolic
readings to guide treatment
MAP normal is 70-100
A MAP of greater than 60 is
necessary to sustain vital
organs
MAP is calculated as follows:
MAP= (SBP + 2 X DBP)
___________
3
OR
MAP = (SBP + 2 X DBP) 3
Life threatening target organ damage can occur
Hypertensive emergencies include:
Hypertensive encephalopathy
Sudden rise in BP associated with
headache, N/V, seizures, confusion,
stupor and coma
Headaches may be difficult to
evaluate
Renal insufficiency ranging from minor
impairment to complete renal
shutdown
Neurologic manifestations are often
similar to the presentation of a stroke
A definitive sign would be
paralysis of an extremity
Pulse pressure
o Difference between the systolic and diastolic
pressure
Reflects stroke volume, ejection velocity and
systemic vascular resistance
Normal range is 30-40 mm/Hg
Increased
o
o

Elevated stroke volume

Anxiety
Exercise
Bradycardia
Atherosclerosis
Aging
Hypertension
Decreased
Reduced stroke volume
Shock
Heat failure
Hypovolemia
Orthostatic blood pressure
o Record BP lying, sitting, and standing

Pulses
Monitor heart rate
o Normal is 60-100 beats per minute
o Note rate, rhythm, and quality
Grade pulses
Absent
+1- difficult to palpate, weak, thread
y, and easily obliterated with pressure
+2 -diminished pulse but cannot be
obliterated
+3-easy to palpate, full and cannot be
obliterated
4+-strong, bounding pulse which is
not normal
Apical impulse assessment
Use palmar surface of hand than with finger pads palpate
the precordium at the 5th intercostal space, mid-clavicular
line
o Left ventricular hypertrophy would be lateral to the
mid-clavicular line at the 5th intercostals space
Jugular venous distention
Provides a means of estimating the central venous
pressure
o Reflects right end-diastolic filling pressure (Preload)
Present when noted with increased filling when sitting at a
45 angle
o Never attempt to assess the clients JVD when lying
flat
Heart rate / rhythm (Precordial Heart Sounds)
o Aortic: 2nd intercostal, right sternal border
o Pulmonic: 2nd intercostal, left sternal border

Ejection fraction: normal EF is 55%to 65 % of the ventricular

volume (55% is going out) for instance an ejection fraction of
65% means that 65% of the total amount of blood in the left
ventricle is ejected by the left ventricle with each heartbeat.
How to determine ejection fraction decreased tissue perfusion.
Fatigue
Activity intolerance
Respiratory Status
Dyspnea on exertion
o Any type of exercise, even talking can cause
dyspnea
Orthopnea
o Client is unable to lie flat in order to breathe
Paroxysmal nocturnal dyspnea
o Affects clients with left sided heart failure because
they have oliguria during the day which caused
edema. At night after lying in bed for approximately
2 hours fluid absorption is promoted from the legs
and the heart is unable to cope with the added
volume
Clients usually wake up gasping for breath

Risk factors for CAD (Coronary Artery Disease)

Non modifiable risk factors
Age, gender, ethnicity, positive family history for CAD, genetic
risk,
o Modifiable risk
BP, cigarette smoking, lipid profile, physical activity, dietary
history, psychological factors
Definition for Pericardial Tamponade:
o Compression of the heart produced by buildup of pericardial fluid.
Normal Labs:
o Sodium 135 to 145 mmol/L
o Potassium - 3.5 to 5 mmol/L
o BUN - 5 25 mg/dl
o Creatinine - .8 1.5 mg/dl
o Hemoglobin know normal values for men and women
o

o Tricuspid: 3rd to 5th intercostal, left sternal border

o Mitral: 5th intercostal, mid-clavicular line
Heart Sounds
Normal S1 and S2 should be heart
S1, S2, and S3 suggest heart failure

Cardiac Specific Lab Data:

o Troponin T and Tropinin 1 are specific to myocardial tissue. Troponin is
the best diagnostic tool of myocardial injury b/c its detectible within
one hour of injury with high specificity at 3 6 hours following onset of
symptoms. It has a wide diagnostic timeframe.
o CKMB serum levels increase after 3 hours of myocardial necrosis
o C -reactive protein, a marker of inflammation that can predict risk of
cardiac disease
o Homocystein amino acid produced during protein catabolism, has
been identified as risk factor of cardiovascular disease. (higher
homocystein levels, higher the risk of CAD)
o Brain Natriuretic Peptide ( BNP) this is released when ventricular
dydtolic pressure increases which occurs in heart failure. BNP release
serves to cause dieresis. (higher BNP, the more significant the heart
failure). Less than 100 is no damage
o Cholesterol
Overall cholesterol normal range is 140 -200 mg/dl
Triglycerides normal range 40 -190 mg/dl
LDL normal range is 60 180
HDL normal male is greater than 45 mg/dl, females greater than
50 mg/dl
Diagnostic Testing
o ECG to determine effects of hypertension on the heart (left
ventricular hypertrophy, ischemia) or presence of underlying heart
disease (should be 1st test done)
o ECG stress test symptom that requires most immediate attention is
the ECG indicating coronary ischemia
o Echocardiogram is the best test for evaluating the cardiac valves
o Transesophageal Echocardiogram
o Cardiac catheterization nurse will need to instruct client that a warm
to hot feeling with occur when IV contrast is being injected they may
feel as though they are E metformin must be discontinued 48 hours
prior to procedure.
o MRI nurses must report immediately if a patient has an implanted
pace maker, ICD or any metallic device (pins, piercings)
Heart Failure
o Left sided heart failure best indicator is breath sounds during
assessment
o Worsening heart failure nursing diagnosis (these are all related to the
hearts requirement for adequate oxygenation)
Activity intolerance
Impaired gas exchange
Decreased cardiac output
o Symptoms of Right ventricular heart failure
Liver congestion
Edema of ankles

Unexplained weight gain of more than 3 to 5 lbs in a week

Distended jugular veins
JVD must be evaluated at 45 degree angle, cannot be properly
evaluated lying flat
Nocturia
Weakness
o Symptoms of Left sided heart failure signs and symptoms
Blood back up into pulmonary veins
SOB
Bilateral cracks
Dyspnea on exertion
Oliguria during the day
Dependant edema during the day
Weak peripheral pulses
Tachycardia
Cool extremities
Cough, maybe dry and unproductive
Pink frothy sputum (very bad, indicating pulmonary edema)
Angina
o Know stable, versus unstable, versus variant or Prinzmetals angina
o Understand the difference between ischemia and necrosis
Myocardial infarction
o Significant because the myocardium is the contractile force (pump) of
the heart
o One drug with beneficial properties besides nitrates and aspirin are
beta-blockers
beta blockers commonly used b/c cardio selective, cardio
protective
Overall beta blockers decrease the workload of the heart
Beneficial effects for patients suffering from an MI
Ppost MI large levels of catecholamines are released and
have harmful effects if they go unopposed