Physical Assessment Cardiac/peripheral vascular

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Physical Assessment Cardiac/peripheral vascular
2010-10-23 20:45:05
Physical Assessment Cardiac peripheral vascular

Physical Assessment Cardiac/peripheral vascular - Nursing
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  1. Heart extends vertically from....
    2nd left intercostal space to the 5th left intercostal space
  2. Heart extends horizontally from...
    right sternal border to left midclavicular line
  3. Upper portion of the heart is called the
  4. Lower portion of the heart is called the..
  5. Anterior chest overlying heart and great vessels is call the
  6. Return blood to right atrium from upper and lower torso
    Superior and inferior vena cava
  7. Exits the right ventrical, bifurcates and carries 02 poor blood to the lungs
    pulmonary artery
  8. Return 02 rich blood to the left atrium
    pulmonary veins
  9. transports 02 rich blood from left ventrical to the body
  10. Thin walled chanbers
    Right and left atria
  11. Receive blood returning to the heart and pump into the ventricles
  12. Thicker-walled chambers
  13. Which ventricle is thicker?
  14. Pump blood out of the heart
  15. Valves between the atria and ventricles
    Atrioventricular valves
  16. Name the two atrioventricular valves
    Tri cuspid and mitral valves
  17. Separate ventircles from major arteries
    Semilunar valves
  18. Name the two semilunar valves
    Aortic and pulmonary valve
  19. Direct the flow of blood
  20. Ensure blood only moves in "forward" direction
  21. Valve between the right atrium and right ventricle
  22. Vlave between the left atrium and left ventricle
  23. Separates the left ventricle from the aorta
    Aortic valve
  24. Separates the right ventricle from the pumonary artery
    Pulmonary valve
  25. Achor AV valves to papillary muscles within the ventricles
    Chordae tendineae
  26. Ensures that valves do not turn inside out
    chardae tendinae
  27. 3 layers of the heart
    • Pericardium
    • myocardium
    • endocardium
  28. tough, inextensible, loose-fitting fibroserous sac that attaches to great vessels and surrounds the heart
  29. pericardial fluid secreted by the parietal pericardium and allows for smooth friction-free movement of the heart
  30. Electrical impulse originates in the
    SA node in the superior aspect of the right atrium
  31. Avter electric impulse leaves the SA node, it travels to
    the AV node located in the inferior aspect of the right atrium
  32. SA node normally discharges between how many beats per minute?
  33. After electrical impulse leaves teh AV node, the impulses tranmit to
    Bundle of His and pukinje fibers
  34. Results in ventricular contraction
    impulse through the bundle of his, purkinje fibers in the myocardium
  35. What prevents excessive atrial impulses from reaching the ventricles?
    AV node
  36. If the SA node fails to dicharge, what heppens?
    AV can generate ventricular contractions but at 40-60 per min
  37. If SA and AV stop firing, what happens?
    Bundle branches may contract but at slow 20-40
  38. Ventricles are relaxed, AV valves are open
  39. high pressure in the ventricles lead to closing of the AV valves....called
  40. first heart shound
    • Lub
    • S1
    • Closing of the AV valves
    • Heard during systole
  41. End of systole, when the aortic and pulmonic valves close...
    • Dub
    • S2
  42. Closing of AV and semilunar valves
    • Lub Dub
    • S1 and S2
  43. opening of valves is
  44. S1 is the closing of the AV valves...which valves?
    Mitral and tricuspid
  45. S2 is the closing of what valves?
    Aortic and pulmonic
  46. S1 and S2 normally heard as one sound (separate). But may be heard as 2 if the associated valves close ealier thant he tricuspid. If the aortic valve closes before the pulmonic valve, it's called
    Split S2
  47. Known as diastolic filling sounds or extra filling sounds
    S3 S4
  48. Caused by ventricular vibration due to rapid ventricular filling
  49. Heard in early diastole after S2
  50. Known as a ventricular gallp
  51. Sounds like Ken Tuck E
  52. Caused by ventricular vibration but due to ventricular noncompliance during atrial contraction
  53. Blood being forced into stiff ventricles
  54. Heard in late diastole just before the S1
  55. Known as an atrial gallop
  56. Sounds like Ten'nes'see
  57. Can be normal or innocent in many children and some athletes
  58. Caused by CHF, Ischemic heart disease, anemia, restrictive myocardial disease
    Pathologic S3
  59. Can be normal or innocent in childrend and some atheletes
  60. Can be caused by hypertension, CAD, failing left ventricle, Restrictive cardiomyopathy
  61. Quadruple gallop
    S3 and S4
  62. Cuased by turebulent blood flow, causing swooshing or blowing sounds
  63. Heard over the precordium
  64. Conditions contributing to turbulent blood flow
    • Increased blood velocity
    • Structural vavle defects
    • Valve malfuction
    • Abmnormal chamber opening
  65. Valves do not close tightly enough to prevent backlfow
  66. Narrowing, stiffening, thickening, fusion or blockage of one or more of the valves of the heart
  67. vibratory sensation that feels similar to the purring of a cat
  68. a sustained, systolic outward movement of the percordium, associated with heart failure
    Heave or lift
  69. Most comon heart murmors
    • Mitral regurgitation
    • Aortic valve stenosis
    • Aortic valve reguritation
    • Mitral valve stenosis
  70. Very faint, listener has to be really tuned in; may not be audible in all position...grade this murmur
    Grade I
  71. Quiet, but heard as soon as listener puts stehtoscope on client's chest, grade this mumer
    Grade II
  72. Moderately loud...grade this murmor
    Grade III
  73. Loud with a palpable thrill, grade this murmur
    Grade IV
  74. Very loud with thrill, may hera with stethoscope only partly on chest, grade this murmor
    Grade V
  75. Very loud with thrill; may hear w/o stethoscope, grade this murmur
    Grade 6
  76. A very faint murmor would be documented as
  77. Amount of blood pumped by the ventricles in a given period of time, usually calculated in one minutes period of time
    Cardiac output
  78. Determined by stroke volume
    Cardiac output
  79. CO = SV x HR
    Cardiac output
  80. Normal adult cardiac output is
    5-6 liters/min
  81. Amount of blood pumped from the heart with each contraction
  82. SV from left ventricle is usually
  83. the greater the preload, the greater the
    stroke volume
  84. Increased afterload leads to
    decreased stroke volume
  85. Uniform, synchronized contraction of the myuocardium
    contraction synergy
  86. Conditions causing synchronous contractions decrease stroke volume
    contraction synergy
  87. increased myocardial contractility leads to
    increased stroke volume
  88. Sympathetic and parasympatheic stimulation can impact cardiat output by
    increasing or decreaing the heart rate
  89. Supply neck and head with oxygen and nutrients
    Carotid arteries
  90. Pressure wave closely coincides with S1
    Carotid arteries
  91. Pulse should have a smooth rapid upstroke and more dradual downstroke
    carotid arteries
  92. Return blood from head and neck to heart by way of the superior vena cave
    jugular veins
  93. two set, internal and external veings
    Jugular veins
  94. assessment is importatn for dtermining hemodynamics of right side of heart
    jugular veins
  95. level of jugular venous pressure reflects...
    right atrial pressure
  96. Right sided heart failure causes
    increased jugular venous pressure
  97. Cardiac tamponade
    increased jugular venous pressure
  98. Hypervolemia causes
    increased jugular venous pressure
  99. Chronic constrictuve pericarditis
    increased jugular venous pressure
  100. superior vena cava obstruction causes
    increased jugular venous pressure
  101. Pulmonary embolis causes
    increased jugular venous pressure
  102. Decreased jugular pressure occurs with decreased...
    left ventricular output or decreased blood volume
  103. Right internal jugular veingg most directly connected to _________ and provides best assessment for pressure changes
    right atrium
  104. 5 traditional areas for auscultating heart sounds
    • Aortic
    • pulmonic
    • erbs point
    • tricuspid
    • mitral
  105. the 4 valve sounds are not heard dirctly over the valvues...they
    radiate to specific areas of the chest.
  106. APETM
    • Aortic
    • pulmonic
    • erbs point
    • tricuspid
    • mitral
  107. can hear systolic blood flwo from left ventricle through aortic valve into the aorta
    Aortic area
  108. can hear systolic blood flow from right ventricle through pulmonic valve into main pulmonary artery
    pulmonic area
  109. 2nd ICS at right sternal border
    aortic area
  110. 2nds or 3rd ICS at left sternal border (base of heart)
    pulmonic area
  111. 3-5th ICS at left sternal border
    Erb's point
  112. 4th or 5th ICS at lower sternal border
    tricuspid area
  113. 5th ICS near left MCL (apex of heart)
    Mitral area
  114. Can hear aortic and pulmonc sounds
    Erb's point
  115. Can hear blood flowing from right atria, through tricuspid valve into the right ventricle during diastole
    Tricuspid area
  116. Can hear blood flow through the mitral valve into the left ventricle during diastole
    Mitral area
  117. Causes inflammation of all layers of the heart, which leads to impaired contractility and valvular function
    Rheumatic carditits
  118. Rheumatic carditis caused by
  119. Dyslipidemia highly predictive of development of?
  120. Which clients hsould monitor their own heart rate or BP?
    Those on cardiotonic and antihypertesive medications
  121. Genetic predisoption for these diseases
    hypertension, myocardial infarction, CHD, dylipidemai or DM
  122. If a client can walk one block or climb 2 flights of stairs without symptoms, usually safe for what?
  123. Can you take nitro before intercourse?
  124. what position may decrease cardiac workload in sexual intercourse?
    side lying
  125. Inability to breath in a supine position (orthopnea) may indicate
    heart failure
  126. If unable to palpate the apical pulse with a client in semi fowlers postion, ask to turn to
    left side
  127. what position to auscletate and palpate neck vessels and inspection, plapation and auusclutation of precordium performed in a.......position
    supine, hob 30 degrees
  128. Fully distended jugular veins indicates increased...
    central venous pressure
  129. abbnormal to see protrusion of jugular vein past _____ elevation
    45 degree
  130. Normal CVP __ CM
  131. Distension, buling or protrusion at 45, 60 or 90 may indicate
    RS heart failure
  132. Clients with COPD amy have elevated venous pressure only during____
  133. An increase in venous pressure during inspiration (kussmaul's sign) amy occur in client's with
    severe constrictive pericarditis
  134. When do you auscultate the cartid arteries?
    If the client is middle-aged or older or if you suspect CV disease
  135. How do you auscultate for any bruits?
    Place the bell of teh stethoscope over the carotid artery and ask the client to hold his/her breath so that any burits can be aucletated.
  136. When assesing carotid arteris, always do what prior to palpation?
  137. Normal for arteries to be elastic?
  138. What are bruits indicitive of?
    occlusive arterial disease
  139. If more than 2/3 occluded may not be able to hear
  140. absent on pulse amplitude scale
  141. normal on pule amplitude scale
  142. bounding on pulse amplitude scale
  143. Pulse inequality may indicate what?
    arterial constriction or occlusion in one carotid artery
  144. Weak pulses may indicate what?
    hypovolemai, shock or decreased CO
  145. a boudning firm pulse may indicate what?
    hypervolemia or increased CO
  146. Loss of elasticity may indicate
  147. may indicate narrowing of artery
  148. Apical may or may not be vislbe...normal?
  149. pulsations of the precordium may be caused by
    left ventricle moving outward during systole
  150. heaves or lifts...abnormal?
  151. normal amplitude of the apical pulse should feel like a
    gentle tap
  152. May not be able to palpate apical pulse in clintss with
    pulmonary emphysema
  153. where is S1 loudest?
  154. where is s2 loudest
  155. S1 best heard using
  156. S2 best heard using
  157. Systolic pause between
    s1 s2
  158. diastolic pause between
    S2 S3
  159. S4 may be heard at the end of diastole in well conditioned athletes and adults older than
    40 oir50, especially after exercise
  160. Walls are thick and strong, contain elastic fibers which allow them to stretch
  161. Lymph drains into
    venous system
  162. after being filtered, lumph travels to either the
    right lymphatic duct or the thoracic duct
  163. What drains the right side of the body?
    Right lymphatic duct
  164. What drains the body except the right side
    Thoracic lymphatic duct
  165. how is lymp returne dto venous system?
    subclavian veins
  166. Removes excess fluid left behind in interstial spaces
    lymphatic capillaries
  167. cold, pale, clammy skin of hte extremities caused by
    arterial insufficiency
  168. warm skin and brown pigmentation around ankles is a characteristic of
    venous insufficiency
  169. Cramping in legs is indicitive of
    intermittent claudication
  170. associated with arterial disease
    intermittent claudication
  171. heavy aching sendsation aggravated by standing or sitting and relieved with rest is indicitive of
    venouse disease
  172. leg pain that wakes you up
    associated with chronic arterial occlusive disease
  173. who won't experience classic signs of venous or arterial disease?
    diabetic neuropathy
  174. May only hav e coldness, color change, numbness and ablnormal sensations
    diabetic neuropathy
  175. Heriditary but also accur with prolonged standing and pregnancy
    varicose veins
  176. ulcers on legs
    arterial disease
  177. ulcerns on toes feet and lateral ankles
    arterial disease
  178. painless ulcers on medial ankle on lower leg
    venous disease ulcers
  179. causes of peripheral edema
    • Incompetent valves
    • Decreased capillary osmotic pressure
    • DVT
  180. Enlarged lymph nodes are indicative of
    local or system infective process
  181. Estrogen increwases a womens risk for
    • thromboembolic events
    • raynauds
    • hypertension
    • edema
  182. what is prescribed to increase blood flow
    Pletal (cilostazol) and plavix (clopidogrel)
  183. Increases blood flow and reduces tissue hypoxia
  184. Topical medicatio that improves blood flow
  185. Helps prevent venous pooling and increases blood return to the heart
    support hose
  186. Normal documentation for radial pulse
    Radial pulse equal at +2 bilaterally
  187. where to palpate the epitrochlear lymph node
    between biceps and triceps muscles
  188. abnormal or normal to not be able to palpate the epitrochlear lymph nodes
  189. hair loss of extremeities is normal or abnormal in older clients?
  190. loss of hair on extremeties is suggestive of what?
    arterial insufficiency
  191. smooth, even margins
    occur at pressure areas asuch as toes and lateral ankle
    arterial insufficiency ulcer
  192. irregular edges
    bleeding, possible bacterial infection
    medial ankle
    venous insufficiency ulcer
  193. 2mm edema
  194. 4mm
  195. 6mm
  196. 8mm
  197. Non pitting edema seen with
    • lymphedema
    • pretibial myxedema (sign of hyperthyroidism)
  198. local edema caused by
    enous insufficiency such as varicose veins or thrombophlebitis
  199. estemic edema caused by
    • diseases of the heart
    • liver
    • kidneys
  200. bilateral coolness of the lower extremeties may be due to
    • cold room
    • recently smoking cigarette
    • anemia
    • anxiety
  201. nontender movable lymph nodes up to 1-2 cm, normal or abnormal?
  202. Auscultate femoral pulses if
    arterial occlusion suspected
  203. marked by redness, thickening, tenderness along vein
    Aching or cramping may accompany walking,
    swelling and inflammation also often noted
    superficial thrombophlebitis
  204. Risk factors for DVT
    • Age over 60
    • immobile 3 days +
    • Pregnancy and postpartum
    • major surgery > 45 minutes in duration
    • Long plane rides or car trips
    • Cancer
    • H.O previos DVT
    • Stroke
    • Acute MI
    • CHF