79. When measuring pulse rate, if the rhythm is irregular or the patient has a pacemaker, count the beats for a full minute.
80. When taking a patient's pulse for the 1st time or when obtaining baseline data, count the beats for 1 full minute.
81. Use the pads of your middle and 4th fingers to take a pulse. Don’t use your thumb; it has a strong pulse of its own.
82. Don't palpate both carotid arteries at the same time or press too firmly; patient could faint or become bradycardic.
83. If you need to repeat a BP measurement, wait at least 2 minutes before retaking.
84. To calculate mean arterial pressure (MAP), add systolic BP and twice the diastolic BP, then divide result by 3.
85. Three positions for cardiac auscultation - supine with HOB elevated 30-45 degrees, sitting up, lying on left side.
86. If heart sounds are faint, try repositioning patient in left lateral decubitus position or seated, forward-leaning position.
87. Six characteristics of heart sounds: location, intensity, duration, pitch, quality, and timing.
88. Thrill = palpable vibration felt over the heart or a blood vessel; results from turbulent blood flow
89. A displaced apical impulse may indicate an enlarged left ventricle. Possible causes = heart failure or hypertension.
90. Describing a murmur - crescendo = increases in intensity; decrescendo = decreases in intensity.
91. Four valves of the heart - 2 atrioventricular (tricuspid & mitral valves) and 2 semilunar (pulmonic & aortic valves)
92. The first heart sound, S1, which produces the "lub" sound, is associated with closure of mitral and tricuspid valves.
93. The second heart sound, S2, which produces the "dub" sound, is associated with closure of pulmonic and aortic valves.
94. S4 heart sound may be heard in elderly patients or those with hypertension, aortic stenosis, or history of MI.
95. Blood from the myocardium returns to the heart through the coronary sinus which empties into the right atrium.
96. Right side of heart pumps blood to lungs to get oxygen; left side of heart pumps oxygenated blood to rest of body.
97. Three layers of the heart wall - epicardium (outer), myocardium (middle), endocardium (inner).
98. Myocardium is middle layer of heart wall; has striated muscle fibers that cause heart to contract. Myocardium=Middle=Muscle
99. Pericardium is the sac that surrounds the heart and roots of the great vessels; two layers: fibrous pericardium and serous pericardium.
100. Cardiac output (CO) is the amount of blood the heart pumps in 1 minute. CO= heart rate X stroke volume (amount of blood ejected with each heartbeat).
101. Stroke volume depends on 3 factors: preload, contractility, and afterload.
102. Preload = stretching of muscle fibers in the ventricles. This stretching results from blood volume in the ventricles at end-diastole.
103. Contractility = inherent ability of the myocardium to contract normally; influenced by preload (the greater the stretch, the more forceful the contraction).
104. Afterload = pressure that the ventricular muscles must generate to overcome the higher pressure in the aorta to get blood out of the heart.
105. The normal pacemaker of the heart is the sinoatrial (SA) node; generates impulses 60-100 times/minute.
106. On the horizontal axis of ECG paper, a large block = 0.2 seconds & a small block = 0.04 seconds.
107. The QRS complex represents ventricular depolarization; it's normally 0.10 second or less.
108. The QRS complex in bundle branch block is 0.12 second or greater because the ventricles aren't depolarized simultaneously.
109. Predisposing factors for VTE (Virchow triad) - venous stasis, endothelial or vessel wall injury, & hypercoagulable states.
110. A serious consequence of atrial fibrillation is the development of thrombi in the atrium.
111. Post-op afib usually occurs within 5 days after open heart surgery, with peak incidence on day 2.
112. Clinical consequences of atrial fibrillation: Decreased cardiac output and potential for thrombus formation.
113. Administering supplemental oxygen to patient experiencing an MI is top priority of care.
114. An enlarged waist circumference indicates central obesity, a key risk factor for metabolic syndrome.
115. Classic signs of cardiac tamponade - increased JVP, hypotension, and muffled heart sounds - also known as Beck's triad.
116. Prehypertension = systolic BP between 120-139 mm Hg and diastolic BP between 80 - 89 mm Hg.
117. Narrow pulse pressure and tachycardia are two of the earliest signs of sepsis.
118. ARVC = arrhythmogenic right ventricular cardiomyopathy. Characterized by severely thinned and dilated right ventricle.
119. Educate patients about heart disease modifiable risk factors - tobacco use, physical activity, diet, weight management, BP, and lipid levels.
120. From the American Heart Association - 7 D's of stroke care: Detection, Dispatch, Delivery, Door, Data, Decision, Drug.
121. An S3 is a normal finding in a child. In an adult, however, this heart sound can indicate heart failure.
122. Pulsus paradoxus = increases and decreases in pulse amplitude associated with the respiratory cycle (decreased with inhalation). Associated with pericardial tamponade, heart failure, constrictive pericarditis.
123. Pulsus alternans = alternating pattern of weak and strong pulse; associated with left-sided heart failure.
124. A fever, plus a new or changed heart murmur, is the classic sign of endocarditis.
125. The most common causes of orthostatic hypotension are volume depletion and autonomic dysfunction.
126. Patients with metabolic syndrome are at increased risk for coronary artery disease, stroke, and type 2 diabetes.