Assessment of Cardiovascular Function Hinkle PPT Ch 25

Smeltzer Textbook of Medical Surgical NursingChapter 25
Assessment of
Cardiovascular Function
Overview of Anatomy and Physiology
Three layers: endocardium, myocardium, epicardium
Four chambers: Right atrium and ventricle, left atrium and ventricle
Atrioventricular valves: tricuspid and mitral
Semilunar valves: aortic and pulmonic
Coronary arteries
Anatomy of the Heart
Cardiac Conduction System: Electrophysiology
Question
Which of the following is the primary pacemaker for the myocardium?
Atrioventricular junction
Answer
Sinoatrial node
Rationale: The sinoatrial node is the primary pacemaker for the myocardium.
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Cardiac Action Potential
Depolarization: electrical activation of cell caused by influx of sodium into cell while potassium exits cell
Repolarization: return of cell to resting state caused by reentry of potassium into cell while sodium exits
Cardiac Hemodynamics
Stroke volume(SV): amount of blood ejected with each heartbeat
Preload: degree of stretch of cardiac muscle fibers at end of diastole
Afterload: resistance to ejection of blood from ventricle
Contractility: ability of cardiac muscle to shorten in response to electrical impulse
Cardiac Hemodynamics (cont’d)
Ejection fraction: percent of end diastolic volume ejected with each heart beat (left ventricle)
Cardiac utput (CO): amount of blood pumped by ventricle in liters per minute.
CO = SV × HR
Question
Which of the following best defines stroke volume?
The amount of blood ejected with each heartbeat
Amount of blood pumped by the ventricle in liters per minute
Degree of stretch of the cardiac muscle fibers at the end of diastole
Ability of the cardiac muscle to shorten in response to an electrical impulse
Answer
The amount of blood ejected with each heartbeat
Rationale: Stroke volume is the amount of blood ejected with each heartbeat. Cardiac output is the amount of blood pumped by the ventricle in liters per minute. Preload is the degree of stretch of the cardiac muscle fibers at the end of diastole. Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse.
Health History
Demographic information
Family/genetic history
Cultural/social factors
Risk factors
Most Common Clinical Manifestations
Assessment
Assessment (cont’d)
Health Promotion, Perception, and Management Questions
Ask regarding health promotion, preventive practices
What type of health issues do you have? Are you able to identify any family history or behaviors that put you at risk of this health problem?
What are your risk factors for heart disease? What do you do to stay healthy?
How is your health? Have you noticed any changes?
Health Promotion, Perception, and Management Questions (cont’d)
Ask regarding health promotion, preventive practices
Do you have a cardiologist or primary health care provider? How often do you go for checkups?
Do you use tobacco or alcohol?
What medications do you take?
Laboratory Tests
Cardiac biomarkers
CK, CK-MB
Electrocardiography
Electrocardiography (cont’d)
Cardiac stress testing
Exercise stress testing
Pharmacologic stress testing
Diagnostic Tests
Radionuclide imaging
Computed tomography
Cardiac Catherization
Invasive procedure study used to measure cardiac chamber pressures, assess patency of coronary arteries
Requires ECG, hemodynamic monitoring; emergency equipment must be available
Assessment prior to test; allergies, blood work
Cardiac Catherization (cont’d)
Activity restrictions
Hemodynamic Monitoring
Pulmonary artery pressure measures left ventricular function
Intra-arterial BP monitoring is used to obtain direct and continuous BP measurements
Phlebostatic Level
Figure 25-10
Pulmonary Artery Catheter and Pressure Monitoring System
Figure 25-12

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Assessment of Cardiovascular Function Hinkle PPT Ch 25