Chapter 21 Cardiovascular System Function, Assessment, and Therapeutic Measures

Answers CHAPTER 21 CARDIOVASCULAR SYSTEM FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES AUDIO CASE STUDY Mr. Flores Is Undergoing a Cardiac Catheterization questions the health care provider (HCP) can answer, has Mr. Flores sign informed consent and witnesses his signature, and explains preprocedure instructions. 2. Pressure in cardiac and pulmonary blood vessels, heart chambers, and cardiac output. 3. Nothing to eat or drink 8 hours before test; register in lobby; arrival time; procedure sensations and details (movable table and a warm, flushing sensation when the dye is injected); blood pressure, heart rate, respirations, and heart rhythm will be monitored constantly; procedure length is 2 to 3 hours. 1. The nurse asks about allergies, reads the consent for the cardiac catheterization to Mr. Flores, asks if there are any STRUCTURES OF THE CARDIOVASCULAR SYSTEM Four pulmonary veins Coronary arteries Left atrium SA node Aortic semilunar valve Internodal pathway Pulmonary semilunar valve Mitral valve Left ventricle Right atrium Bundle of His AV node Tricuspid valve Chordae tendineae Papillary muscles Purkinje fibers Right ventricle Bundle branches 1 Chapter 21 2 Answers it may hypertrophy. The heart valves may become thickened by fibrosis, leading to heart murmurs. Arrhythmias become more common in older adults as the cells of the conduction pathway become less efficient. CARDIAC BLOOD FLOW 1. (1) 2. (11) 3. (2) 4. (4) 5. (14) 6. (7) 7. (6) 8. (8) 9. (13) 10. (9) 11. (10) 12. (12) 13. (3) 14. (5) CARDIOVASCULAR SYSTEM AGING AND THE CARDIOVASCULAR SYSTEM 1. cardiovascular 2. heart’s 3. vascular, capillaries 4. stiffen 5. lub, diastole 6. absent, normal 7. cardiac, catheterization 8. peripheral, pain, paresthesia, poikilothermia 9. vascular, venography 10. Homocysteine Corrections are in boldface. ACUTE CARDIOVASCULAR DATA COLLECTION It is believed that the “aging” of blood vessels, especially arteries, begins in childhood. Average resting blood pressure tends to increase with age and may contribute to stroke or left-sided heart failure. The thinner walled veins, especially those of the legs, may also weaken and stretch, making their valves incompetent. With age, the heart muscle becomes less efficient, and there is a decrease in both maximum cardiac output and heart rate. The health of the myocardium depends on its blood supply. Hypertension causes the left ventricle to work harder, so 1. Allergies 2. Smoking 3. Pain 4. Weight gain 5. Crackles 6. Dizziness 7. Fatigue 8. Pink-tinged sputum 9. Capillary refill 10. Clubbing CRITICAL THINKING: SUGGESTED ANSWERS Teaching Preprocedure prep NPO Constant monitoring of vital signs, ECG Procedure is 2 to 3 hours Movable table used Sensory preparation Consent Allergies—dye Room has a lot of equipment Awake Warm, flushing sensation with dye Cardiac Catheterization Teaching Plan Dressing removal Postprocedure care Pulses Activity restriction Vital signs Insertion site pressure applied/monitoring Discharge Follow-up care Activity Insertion site care Chapter 21 REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is correct. (1, 2, 4) are incorrect. 2. (3) is correct. (1, 2, 4) are incorrect. 3. (4) is correct. (1, 2, 3) are incorrect. 4. (2) is correct. (1, 3, 4) are incorrect. 5. (1) is correct. (2, 3, 4) are incorrect. 6. (4) is correct. (1, 2, 3) are incorrect. 7. (1) is correct. (2, 3, 4) are incorrect. 8. (3) is correct. (1, 2, 4) are incorrect. 9. (2) is correct. (1, 3, 4) are incorrect. 10. (3) is correct. (1, 2, 4) are incorrect. 11. (2) is correct. (1, 3, 4) are incorrect. 12. (2) is correct. (1, 3, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 13. (1) is correct. The leg reading is 10 mm Hg higher. (2, 3, 4) are incorrect. 14. (2) is correct. The right arm is the arm with the higher reading, which is what should be used. (1) is incorrect. The reading is lower. (3) is incorrect. It is not as practical to use the leg because the higher reading arm is available, although the leg could be used. (4) is incorrect. The arm with the lower reading should not be used. 15. (2) is correct. Blood pressure can drop by up to 15 mm Hg when a patient sits or stands. (1, 3) are incorrect, and (4) does not address the patient’s concerns or explain the reason for the change. 16. (3) is correct. Pulse normally increases up to 20 beats per minute to compensate for the position change. (1) is incorrect. The patient does not need to return to bed. (2, 4) are incorrect. No cardiac symptoms are expected because the body is compensating normally, and orthostatic hypotension is not present. Answers 3 17. (2) is correct. Reduced arterial blood supply results in a lack of oxygen and nutrients that contribute to the signs seen so the legs should not be elevated because elevation reduces arterial blood flow. (1, 3, 4) are incorrect. They may be performed. 18. (2) is correct. Medication is used in lieu of exercise when the patient cannot tolerate exercise to simulate how blood flow would increase with exercise. (1, 3, 4) are incorrect. 19. (1, 3, 4, 6) are data related to a possible cardiac event or arrhythmia, which could be causing the fatigue and dizziness. (2, 5) are not of acute importance for these symptoms. 20. (1, 4, 5, 6) occur during a cardiac catheterization. (2) is incorrect. The procedure takes 2 to 3 hours. (3) is incorrect. A moveable table is used. 21. Pitting peripheral edema supports the diagnosis of right-sided heart failure.