1. 1. Define important words in this chapter
anemia a condition in which the amount of red blood cells or hemoglobin in the body is less than normal. angina pectoris chest pain, pressure, or discomfort. anti-embolic stockings special stockings used to help prevent swelling and blood clots and aid circulation; also called elastic stockings. artery vessel that carries blood away from the heart.

2. 1. Define important words in this chapter
atria the upper two chambers of the heart. capillaries tiny blood vessels in which the exchange of gases, nutrients, and waste products occurs between blood and cells. cardiomyopathy a weakening of the heart muscle due to enlargement or thickening, which reduces the heart’s ability to pump blood effectively. congestive heart failure (CHF) a condition in which the heart muscle is damaged and fails to pump effectively.

3. 1. Define important words in this chapter
coronary artery disease (CAD) a condition in which the coronary arteries become damaged and narrow over time, causing chest pain and other symptoms. diastole phase when the heart muscle relaxes. heart four-chambered pump that is responsible for the flow of blood in the body. hypoxia a condition in which the body does not receive enough oxygen.

4. 1. Define important words in this chapter
ischemia a lack of blood supply to an area. myocardial ischemia a condition in which the heart muscle does not receive enough blood and lacks oxygen; can cause angina pectoris. nitroglycerin medication that relaxes the walls of the coronary arteries. occlusion a complete obstruction of a blood vessel.

5. 1. Define important words in this chapter
orthopnea shortness of breath when lying down that is relieved by sitting up. peripheral vascular disease (PVD) a condition in which the legs, feet, arms, or hands do not have enough blood circulation. phlebitis inflammation of the veins in the lower extremities. pulmonary edema a condition in which there is an accumulation of fluid in the lungs; usually due to heart failure.

6. 1. Define important words in this chapter
sequential compression device (SCD) a machine used to help improve circulation, reduce fluid build-up, and prevent blood clots; compression sleeves are placed around the legs and are inflated and deflated regularly. stable angina chest pain that occurs when a person is active or under severe stress. systole phase where the heart is at work, contracting and pushing blood out of the left ventricle. unstable angina chest pain that occurs while a person is at rest and not exerting himself.

7. 1. Define important words in this chapter
vein vessel that carries blood to the heart. ventricles the lower two chambers of the heart.

8. 2. Explain the structure and function of the circulatory system
Define the following terms: heart four-chambered pump that is responsible for the flow of blood in the body. atria the upper two chambers of the heart. ventricles the lower two chambers of the heart. systole phase where the heart is at work, contracting and pushing blood out of the left ventricle.

9. 2. Explain the structure and function of the circulatory system
Define the following terms: diastole phase when the heart muscle relaxes. artery vessel that carries blood away from the heart. capillaries tiny blood vessels in which the exchange of gases, nutrients, and waste products occurs between blood and cells. vein vessel that carries blood to the heart.

10. Transparency 19-1 The Circulatory System

11. 2. Explain the structure and function of the circulatory system
Remember these points about the circulatory system:
Made up of heart, blood vessels, and blood
White blood cells protect the body from bacteria and viruses and other foreign substances.
Plasma, the liquid portion of the blood, carries nutrients, waste products, hormones, salts, antibodies, and the substance necessary for the blood to clot.

12. 2. Explain the structure and function of the circulatory system
The heart is composed of four main chambers: the atria (the upper left and right chambers) and the ventricles (the lower left and right chambers). The right atrium receives de-oxygenated blood from the body. It is delivered via the superior vena cava from the head and upper extremities and the inferior vena cava, which delivers blood from the rest of the body.

13. 2. Explain the structure and function of the circulatory system
Function of the heart:
Pumps blood through blood vessels to every cell in the body

14. 2. Explain the structure and function of the circulatory system
Know these points about circulation:
Blood is pumped from the right atrium to the right ventricle.
The right ventricle pumps the de-oxygenated blood into the lungs via the pulmonary arteries. These are the only arteries in the body that carry de-oxygenated blood; the other arteries carry oxygen-rich blood.
The exchange of carbon dioxide for oxygen is made during this process.
The blood then travels back into the heart through the pulmonary veins. These are the only veins in the body that carry oxygen-rich blood.

15. 2. Explain the structure and function of the circulatory system
Functions of the blood:
Transports oxygen, food, and hormones to cells
Removes carbon dioxide and other waste products from the cells
Controls pH level and body temperature
Clots the blood and fights pathogens and poisons

16. 3. Discuss changes in the circulatory system due to aging
Normal changes of aging in the circulatory system:
Heart pumps less efficiently.
Blood vessels narrow and become less efficient.
Blood vessels become less elastic.
Blood flow decreases.

17. 4. Discuss common disorders of the circulatory system
Define the following terms: occlusion a complete obstruction of a blood vessel. ischemia a lack of blood supply to an area.

18. 4. Discuss common disorders of the circulatory system
Remember these points about hypertension:
Causes: hardening and narrowing of blood vessels, kidney disease, adrenal tumors, pregnancy, stress, pain, or medication
Prehypertension means that a person does not have hypertension now, but is likely to in the future.
Symptoms: headache, blurred vision, dizziness
Can lead to MI, CVA, kidney disease, or blindness
Treatment: medication, including diuretics; exercise program; diet; stopping smoking

19. 4. Discuss common disorders of the circulatory system
Define the following terms: coronary artery disease (CAD) a condition in which the coronary arteries become damaged and narrow over time, causing chest pain and other symptoms. myocardial ischemia a condition in which the heart muscle does not receive enough blood and lacks oxygen; can cause angina pectoris. angina pectoris chest pain, pressure, or discomfort. stable angina chest pain that occurs when a person is active or under severe stress.

20. 4. Discuss common disorders of the circulatory system
Define the following terms: unstable angina chest pain that occurs while a person is at rest and not exerting himself. nitroglycerin medication that relaxes the walls of the coronary arteries.

21. 4. Discuss common disorders of the circulatory system
Remember these points about coronary artery disease (CAD):
Cause: vessels in coronary arteries narrow after build-up of arterial plaque, reducing blood to heart
Symptom: angina pectoris

22. 4. Discuss common disorders of the circulatory system
Know these care guidelines for angina:
Reduce emotional stress.
Keep nitroglycerin pills nearby at all times.
Encourage rest.
Resident should avoid big meals.
Encourage resident to follow exercise plan.
Resident may need to avoid hot, humid weather.
Encourage residents who are quitting smoking.

23. 4. Discuss common disorders of the circulatory system
Define the following term: cardiomyopathy a weakening of the heart muscle due to enlargement or thickening, which reduces the heart’s ability to pump blood effectively.

24. 4. Discuss common disorders of the circulatory system
Know these points about cardiomyopathy:
Causes: extensive CAD, heart muscle that no longer pumps effectively, virus, diabetes, thyroid problems, drug and alcohol use, birth defect, or unknown cause
Most common reason for heart transplants

25. 4. Discuss common disorders of the circulatory system
Remember these points about myocardial infarctions (MIs):
Cause: block of blood flow to heart muscle
Chapter 8, page 130 of textbook lists warning signs of MI.

26. 4. Discuss common disorders of the circulatory system
Know the components of cardiac rehabilitation:
Low-cholesterol, low-fat, low-sodium diet
Regular exercise program
Medication to regulate heart rate and blood pressure
Stopping smoking
Stress management program
Avoidance of cold temperatures

27. 4. Discuss common disorders of the circulatory system
Define the following terms: peripheral vascular disease (PVD) a condition in which the legs, feet, arms, or hands do not have enough blood circulation. phlebitis inflammation of the veins in the lower extremities. anti-embolic stockings special stockings used to help prevent swelling and blood clots and aid circulation; also called elastic stockings.

28. 4. Discuss common disorders of the circulatory system
Know these points about peripheral vascular disease (PVD):
Causes: build-up of arterial plaque over time, reduction in cardiac output, phlebitis
Most common type is peripheral arterial disease (PAD).
Symptoms: cramping in hips, thighs, legs, or calves, cyanotic hands or feet, bluish nailbeds, arms and/or legs that are cool to the touch, edema in hands or feet, ulcers on legs or feet, gangrene

29. 4. Discuss common disorders of the circulatory system
Points about PVD (cont’d.):
Report: complaints of pain or change in hands, legs or feet; change in vital signs, increased edema, weight gain, I&O change; headache; inability to see clearly; discomfort in chest, back, jaw or shoulder; disorientation, dizziness, or confusion
Treatment: fluid restrictions or special diets, quitting smoking, anti-embolic stockings

30. Putting knee-high elastic stockings on a resident
Equipment: elastic stockings
Identify yourself by name. Identify the resident. Greet the resident by name.
Wash your hands.
Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
Provide for the resident’s privacy with a curtain, screen, or door.
Adjust bed to safe working level, usually waist high. Lock bed wheels.

31. Putting knee-high elastic stockings on a resident
The resident should be in the supine position (on his back) in bed. With resident lying down, remove his or her socks, shoes, or slippers, and expose one leg. Expose no more than one leg at a time.
Take one stocking and turn it inside-out at least to the heel area.
Gently place foot of stocking over toes, foot, and heel. Make sure the heel is in the right place (heel should be in heel of stocking).

32. Putting knee-high elastic stockings on a resident
Gently pull top of stocking over foot, heel, and leg.
Make sure there are no twists or wrinkles in stocking after it is on the leg. It must fit smoothly. The opening in the stocking that allows observation of skin color should be either on the top or the bottom of the toe area, depending upon the manufacturer. Check toes for possible pressure from stocking and adjust as needed.

33. Putting knee-high elastic stockings on a resident
Repeat steps 7 through 10 for the other leg.
Make resident comfortable.
Return bed to lowest position. Remove privacy measures.
Leave call light within resident’s reach.
Wash your hands.
Be courteous and respectful at all times.

34. Putting knee-high elastic stockings on a resident
Report any changes in the resident to the nurse. Document procedure using facility guidelines.

35. 4. Discuss common disorders of the circulatory system
Define the following term: sequential compression device (SCD) a machine used to help improve circulation, reduce fluid build-up, and prevent blood clots; compression sleeves are placed around the legs and are inflated and deflated regularly.

36. 4. Discuss common disorders of the circulatory system
Remember these points about sequential compression devices (SCDs):
Used to improve circulation and prevent blood clots
Applied during or after surgery
Report damaged equipment to nurse

37. 4. Discuss common disorders of the circulatory system
Define the following terms: congestive heart failure (CHF) a condition in which the heart muscle is damaged and fails to pump effectively. orthopnea shortness of breath when lying down that is relieved by sitting up.

38. 4. Discuss common disorders of the circulatory system
Know these points about congestive heart failure (CHF):
Cause: failure of heart muscle to pump effectively due to damage
Symptoms: fatigue, reduction in ability to be active, dyspnea, orthopnea, increased pulse, irregular heartbeat, chest pain, dizziness, confusion, weight gain, lack of appetite, edema, abdominal distention or pain, increased urination
Symptoms associated with each side of the heart: Left-sided failure: fatigue, orthopnea, coughing, rapid pulse, and weight gain

39. 4. Discuss common disorders of the circulatory system
Points about CHF (cont’d.):
Right-sided failure: fatigue, weakness, edema of the extremities (especially the ankles), bulging neck veins, irregular heartbeat, and fainting
Treatment: medication, care plan that includes rest

40. 4. Discuss common disorders of the circulatory system
Remember these care guidelines for CHF:
Encourage rest.
Measure daily weight and I&O.
Encourage resident to follow fluid and diet orders.
Use special stockings, as ordered.
Extra pillows in bed may help.
Assist with ADLs.

41. 4. Discuss common disorders of the circulatory system
Care guidelines for CHF (cont’d.):
ROM exercises improve muscle tone.
Report dizziness, confusion or fainting; fatigue; increased respiratory or pulse rate or BP; irregular heartbeat; palpitations; dyspnea; coughing; wheezing; chest tightness or pain; lack of appetite; abdominal swelling or pain; edema; weight gain; bulging neck veins; change in urinary output

42. 4. Discuss common disorders of the circulatory system
Define the following term: pulmonary edema a condition in which there is an accumulation of fluid in the lungs; usually due to heart failure.

43. 4. Discuss common disorders of the circulatory system
Know these points about pulmonary edema:
Cause: buildup of fluid in the lungs
Symptoms: shortness of breath; wheezing; coughing; gurgling when breathing; anxiety; restlessness
Emergency treatment is necessary.

44. 4. Discuss common disorders of the circulatory system
Define the following terms: anemia a condition in which the amount of red blood cells or hemoglobin in the body is less than normal. hypoxia a condition in which the body does not receive enough oxygen.

45. 4. Discuss common disorders of the circulatory system
Know these points about anemia:
Cause: amount of red blood cells or hemoglobin in the body is less than normal
Symptoms: fatigue, weakness, pale skin, problems with the tongue, brittle nails, difficulty concentrating
Treatment for iron-deficiency anemia: diet of foods rich in iron, vitamins, iron supplements, and methods to treat constipation that can occur

46. Exam
Multiple Choice. Choose the correct answer. 1. Oxygen-rich blood is pumped from the left ventricle via the: (A) Right ventricle (B) Aorta (C) Capillaries (D) Veins 2. About 55% of blood is made up of _______. (A) Erythrocytes (B) Leukocytes (C) Plasma (D) Platelets

47. Exam (cont’d.)
3. Which of the following is one of the functions that the circulatory system performs? (A) Senses and interprets information from the environment (B) Cushions the brain and spinal cord (C) Allows humans to reproduce (D) Transports oxygen, nutrients, and hormones to cells 4. A normal age-related change for the circulatory system is: (A) The heart pumps less efficiently (B) Blood vessels widen (C) Blood vessels become more elastic (D) Blood flow increases

48. Exam (cont’d.) 5. The medical term for high blood pressure is:
(A) Myocardial infarction
(B) Hypotension
(C) Hypertension
Peripheral vascular disease
6. One way for a person to keep hypertension under control and prevent complications is to:
(A) Take medications to increase fluid in the body
(B) Increase the intake of sodium
(C) Stop smoking
(D) Avoid exercise

49. Exam (cont’d.)
7. The medical term for chest pain, pressure, or discomfort is: (A) Myocardial ischemia (B) Angina pectoris (C) Coronary artery disease (D) Hypertension 8. Which of the following is true of residents who have angina? (A) Residents need to reduce emotional distress as much as possible. (B) Nursing assistants need to give residents nitroglycerin. (C) Residents should eat large meals to stay satisfied. (D) Nursing assistants should encourage residents to exercise most of the time.

50. Exam (cont’d.)
9. One component of cardiac rehabilitation is: (A) A diet high in sodium will be ordered (B) Resident will be discouraged from exercising (C) A stress management program will be initiated (D) Residents will be encouraged to smoke to help deal with stress 10. The most common type of peripheral vascular disease (PVD) is: (A) Phlebitis (B) Myocardial infarction (MI) (C) Peripheral arterial disease (PAD) (D) Coronary artery disease (CAD)

51. Exam (cont’d.)
11. When should anti-embolic stockings be applied? (A) In the evening (B) In the morning (C) Mid-afternoon (D) After residents have finished exercising 12. Residents with congestive heart failure may: (A) Be on a high-sodium diet (B) Take medications that cause a decrease in urinary output (C) Have a “force fluids” order (D) Need to do range of motion exercises to improve muscle tone

52. Exam (cont’d.)
13. The most common form of anemia is: (A) Iron-deficiency anemia (B) Hypoxia (C) Pernicious anemia (D) Pulmonary anemia