METHODICAL INSTRUCTION FOR STUDENTS OF THE RN-BSN PROGRAM 1 COURSE
Nursing Faculty
LESSON № 21 (PRACTICAL – 6 HOURS)
Theme 1: Cardiovascular system: Anatomy and Physiology.
Aim: To know the anatomy and physiology of cardiovascular system.
Professional orientation of students The cardiovascular system transports oxygeutrients, and other substances to all the body’s tissues and carries metabolic waste products to the kidneys and lungs. The heart and blood vessels provide this transportation .The heart is about the size of a fist and beats 60 to 100 times a minute without rest, responding to both external and internal demands such as exercise, temperature changes, and stress. Many of these stimuli are communicated to the cardiovascular system through the endocrine and nervous systems. In turn, the cardiovascular system adjust to these stimuli by constricting or dilating of blood vessels, altering the cardiac output, and redistributing blood flow.
Methodology of Practical Class. (9.00-12.00)
Algorithm of students’ communication with patients with pathology in subject (communication skills) (for clinical department):
During examination of the patient students have to use such communicative algorithm:
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Take complaints and anamnesis in a patient.
5. Explain to the patient results of his/her lab tests correctly and accessibly.
6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.
7. Conversation accomplishment.
Objective examination:
Physical methods of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient, what examinations will be carried out and get his/her informed consent.
5. Find a contact with the patient and make an attempt to gain his/her trust.
6. Inform about the possibility of appearing of unpleasant feelings during the examination.
7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).
8. Examination (demonstration of clinical skill).
9. Explain to the patient results of his/her lab tests correctly and accessibly.
10. Conversation accomplishment.
Estimation of laboratory and instrumental investigations
Informing about the results of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient results of his/her lab tests correctly and clearly.
5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).
Planning and prognosis the results of the conservative treatment
Friendly facial expression and smile.
1. Gentle tone of speech.
2. Greeting and introducing.
3. Correct and clear explanation of necessary treatment directions.
4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.
5. Conversation accomplishment.
Work 1. Anatomy and Physiology
1. Structure and function of the cardiovascular system
2. Cardiac cycle
3. Conduction
4. Pumping ability
5. Developmental considerations
Individual Students Program.
1. Learn the structure and function of heart.
2. Learn the structure and function of left coronary artery.
3. Learn the structure and function of right coronary artery.
4. Conduction system of the heart.
5. Meshanical properties of the heart.
Seminar discussion of theoretical issues. (12.00-14.00)
Student’s Individual Work (14:15-15:00)
Students who have passed Moodle tests the day before class are free from test control during the class
Test evaluation and situational tasks
1. A client has had a recent myocardial infarction. Why is damage to the myocardium problematic for this client?
|
a. |
Damage to this area causes plaque to build up on the heart valves. |
|
b. |
Damage to this layer can decrease the contractile force of the heart. |
|
c. |
Damage to this layer can lead to excessive cortisol and endorphin release. |
|
d. |
Damage to this area causes striated heart muscle fibers to release damaging high-density lipoproteins. |
____ 2. A client with mitral valve disease has presented to the clinic for further evaluation of the mitral valve. Which chamber of the heart will be affected if the mitral valve is narrowed?
|
a. |
Right atrium |
|
b. |
Left atrium |
|
c. |
Right ventricle |
|
d. |
Left ventricle |
____ 3. What is the minimum mean arterial pressure (MAP) necessary to ensure adequate blood flow through the coronary arteries?
|
a. |
80 mm Hg |
|
b. |
70 mm Hg |
|
c. |
60 mm Hg |
|
d. |
50 mm Hg |
____ 4. What is the function of the property of automaticity in heart muscle?
|
a. |
To initiate an impulse in response to a stimulus |
|
b. |
To transmit electrical impulses that are received |
|
c. |
To respond to a stimulus only after repolarization |
|
d. |
To spontaneously and repetitively initiate an impulse |
____ 5. A client’s heart rate and rhythm are sinus bradycardia at 45 beats/minute. Alteration of function in which of the cardiac conduction system structures can cause this rate and rhythm?
|
a. |
Sinoatrial (SA) node |
|
b. |
Bachmann’s bundle |
|
c. |
Bundle of His |
|
d. |
Purkinje fibers |
____ 6. A client brought to the emergency room following a myocardial infarction is found to be hypotensive. What effect from baroreceptor stimulation on this client’s heart rate would be expected?
|
a. |
The heart rate would increase. |
|
b. |
The heart rate would decrease. |
|
c. |
There would be no effect on heart rate. |
|
d. |
The heart rate would vacillate between accelerations and deceleration. |
____ 7. A client with a history of having several myocardial infarctions has excessive filling of the ventricles as a result. What physiologic response would the nurse expect to see manifested in this client?
|
a. |
Excessive LVED (left ventricular end-diastolic) volume and decreased cardiac output |
|
b. |
Reduced LVED volume and increased cardiac output |
|
c. |
Excessive impedance of the left ventricle |
|
d. |
Reduced impedance of the left ventricle |
____ 8. A client’s heart disease has resulted in a reduced stroke volume. What physiologic response would be expected to maintaiormal cardiac output?
|
a. |
Mean arterial pressure would increase. |
|
b. |
Mean arterial pressure would decrease. |
|
c. |
Heart rate would increase. |
|
d. |
Heart rate would decrease. |
____ 9. Which conditions would lead to an increase in stroke volume?
|
a. |
Increased preload, increased afterload |
|
b. |
Increased preload, decreased afterload |
|
c. |
Decreased preload, increased afterload |
|
d. |
Decreased preload, decreased afterload |
____ 10. What effect on blood pressure should the nurse expect when the client is given a drug that causes vasoconstriction?
|
a. |
Increased diastolic blood pressure |
|
b. |
Decreased diastolic blood pressure |
|
c. |
Increased systolic blood pressure |
|
d. |
Decreased systolic blood pressure
|
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.
(the instructor has tests & situational tasks)
Student should know:
1. Learn the structure and function of heart.
2. Learn the structure and function of left coronary artery.
3. Learn the structure and function of right coronary artery.
4. Conduction system of the heart.
5. Mechanical properties of the heart.
Student should be able to:
1. Communication skills with the patient
2. To promote the interview with the patients
3. To collect all the subjective and objective data of the patient
Correct answers of test evaluations and situational tasks:
1. ANS: B
The myocardium is the layer responsible for the contractile force of the heart.
2. ANS: B
The mitral valve separates the left atrium from the left ventricle. Narrowing of this valve results in a damming of blood in the left atrium.
3. ANS: C
Coronary artery blood flow occurs primarily during diastole. MAP of 60 mg Hg is necessary for adequate blood flow to coronary arteries and MAP of 60 to 70 mm Hg is necessary for adequate perfusion to major body organs.
4. ANS: D
Automaticity refers to the ability of cardiac cells to spontaneously and repetitively initiate an impulse. The initiation of an impulse in response to a stimulus refers to excitability. The transmission of electrical impulses that are received refers to the property of conductivity, and the response to a stimulus only after repolarization refers to refractoriness.
5. ANS: A
The SA node is composed of pacemaker cells that normally initiate electrical impulses at a rate of 60 to 100/minute. Altered function of the SA node may result in slow or rapid heart rates.
6. ANS: A
When a client experiences hypotension, baroreceptors in the aortic arch sense a pressure decrease in the vessels. The parasympathetic system responds by lessening the inhibitory effect on the SA node, and this results in an increase in heart rate.
7. ANS: A
According to Starling’s law, the more the heart is filled during diastole, the more forcefully it contracts. This is true, within limits. Overstretching or excessive filling of the ventricles results in excessive LVED volume and pressure and decreased cardiac output.
8. ANS: C
Cardiac output is equal to stroke volume times the heart rate.
9.ANS: B
An increased preload increases contractility; decreased afterload reduces the amount of resistance to ejection of blood from the left ventricle. Both changes together increase stroke volume of the left ventricle.
10. ANS: A
Diastolic pressure is determined by the amount of vasoconstriction in the periphery. An increase in peripheral vascular resistance increases diastolic pressure.
References:
Jarvis, C. (2011). Physical examination and health assessment. (6th ed.). Philadelphia: W.B. Saunders
В – Additional:
Weber, J. & Kelley, J., (2010). Health assessment iursing. (4th Ed.). Lippincott ISBN: 978-0-781-78160-2
Weber, J. & Kelley, J., (2010). Health assessment iursing lab manual. (4th Ed.). Lippincott ISBN: 978-0-781-78161-9
Mosby’s Dictionary of Medicine, Nursing, and Health Professions,
(2009). (8th ed.) St. Louis: Elsevier ISBN: 9780323052900
Venes, D. editor (2009) Taber’s Cyclopedia Medical Dictionary (21th ed.). Philadelphia: F.A. Davis. ISBN: 9780803615595
Methodical instruction has been worked out by: O. Krekhovska-Lepyavko MD, BSN, MSN
Methodical instruction was discussed and adapted at the Department sitting
June 12, 2013. Minute № 13
