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95 Cards in this Set
- Front
- Back
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Blood flow |
Vena cava > right atrium> tricuspid valve >right ventricle > pulmonic valve>pulmonary artery>lungs Lungs>pulmonary veins >left atrium> bicuspid valve/mitral valve >left ventricle >aortic valve>aorta>rest of the body |
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Mediastinum |
Heart and great vessels |
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AV VALVES |
open during diastole (filling) Closed during systole (pumping phase) Prevent regurgitation into atrium |
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SL valves |
Open during systole Closed during diastole Allows blood to be ejected from heart |
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Electrical Conduction |
SA NODE INTERNODAL PATHWAYS AV NODE BUNDLE OF HIS LEFT AND RIGHT BUNDLE BRANCH PURKENJI FIBERS |
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Cardiac cycle (diastole) |
2/3 of cardiac cycle |
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Atrial kick |
Near end of diastole, atria contracts rose push last amount of blood out |
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Systole |
1/3 of cardiac cycle “Lub” s1 av valves shut, heard best at the apex “Dub” s2 SL valves close heard best at the base |
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LUB |
“Lub” s1 av valves shut, heard best at the apex |
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DUB |
“Dub” s2 SL valves close heard best at the bas |
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If pt had a split s2 sound what should you NOT ask them to do ? |
Hold their breath |
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Ventricular Gallop |
S3 ; heard immediately after s2 associated with heart failure, abnormal after age 35 |
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Atrial gallop |
S4 heard just before s1 (early diastole) |
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MURMURS |
1 barely audible 2 clearly audible 3easy to hear 4loud *associated with thrill 5very loud 6 loudest |
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Grade 1 murmur |
Barely audible |
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Clearly audible |
Grade 2 murmur |
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Grade 3 murmur |
Easy to hear |
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Loud *associated with thrills |
Grade 4 murmur |
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How to you auscultate heart sounds ? |
Aorta =right 2nd intercostal space Pulmonic =left 2nd intercostal space Erbs point Tricuspid Mitral |
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Special Pops (cardio) PREGNANT WOMEN |
-Bp decreases due to peripheral vasodilation 2nd trimester -orthostatic Hypotension -blood volume increases -posture bp rises |
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Special pop (cardio) Infants/children |
Foramen ovale closes within 1hr of birth -ductus arteriosis closes within 10-15 hours -100-180 bmp is normal |
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Special pop (cardio) Aging adults |
Systolic bp is higher (top number) Enlarged left ventricle S3 and s4 sounds are common Arteriosclerosis |
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Heave from an enlarged right ventricle will be where ? |
At the right sternal border |
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Heave from and enlarged left ventricle would be where ? |
Heave will be at the apex |
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Brachial artery |
Upper arm felt @anticubital fossa |
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Ulnar pulse |
Hard to feel |
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Racial pulse |
Near the thumb; usually used on adults Brachial pulse is used on infants/small children |
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Femoral artery |
Supplies blood to legs |
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Posterior tibialis artery |
Inner ankle behind medial malleus |
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Peripheral artery disease |
Caused by artherosclerosis (plaque) Intermittent claudication (cramping pain in legs usually relieved by walking) |
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Intralumenal valves |
Ensure unidirectional flow in veins |
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Superficial veins |
Found in arms and have the most venous return |
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Superficial veins |
Great and small saphenous veins |
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Deep veins |
Femoral and popliteal Normally cannot be palpated |
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Venous stasis |
Venous return impeded from lack of muscular activity Chronic venous stasis can lead to brown discoloration. |
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Arterial insufficiency |
Intermittent claudication Diminished or absent Pulse Cold skin, loss of hair, thick and rigid nails Ulcers that have no bleeding normally on the heels, toes, outer angle |
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Venous insufficiency |
-Aching cramping pain -diminished or absent balls -Edema ashy dark angles -warm skin -relieved with elevations -ulcers in inner ankles that bleed and have granulation tissue |
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Lymphedema |
No pitting unilateral but can be bilateral no ulceration and pigmentation normally the same |
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A woman who had her breast removed but has a swollen arm |
Lymphedema caused by the lymph node being removed, which would cause swelling because the lymph is not able to drain |
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Deep vein Thrombosis |
Intense sharp deep muscle pain Causes enlarge calf Can cause pulmonary embolism |
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Homan’s sign |
A positive Homans sign Calf pain with Dorsi flex (pointed toes up) Indicated DVT |
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Right lymphatic duct |
Drains upper right side of the body and empties at the subclavian vein |
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Thoracic duct |
Empties at the left subclavian vein |
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Cervical nodes |
Drains head and neck |
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Epitroclear node |
Drains lower arm and hand |
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Ancillary node |
Drains breast and upper arm |
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Inguinal node |
Drains leg and external genitalia lower abdomen and Botox |
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Main lymphatic organs |
Spleen tonsils Thymus |
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Special considerations (peripheral vas) Infants |
Lymph nodes are palpable and normal Veins and arteries intact at birth Acrocynosis = blue hands and feet are normal Skin mottling is normal |
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Special considerations (peripheral vas) Pregnant women |
Dependent edema because uterus obstructs drainage of iliac and inferior vena cava
-varicose veins normal |
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Special considerations (peripheral vas) Aging adults |
Posterior tibialis and dorsalis pedis are hard to find due to loss of blood flow Thick rigid nails Loss of hair |
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Pitting edema |
1+ mild (no perceptible swelling) 2+ moderate (subsided quickly) 3+ deep (remains for a short period of time and legs look swollen) 4+ very deep (lasts a long time,grossly swollen/distorted skin |
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Raynauds disorder |
G |
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Allen test |
Make a fist Occlude radial/ulnar pulse Then have or open hands as you release pulses Color should return in 3-5 seconds |
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Position change test |
Used if you suspect arterial insufficiency |
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Ankle Brachial Index |
Tests the extend of PVD Normal range 1.0-1.2 Cardio risk : .9-1.0 PAD : 0.9 or less Ischemia: less that 0.3 (could lead to necrotic tissue |
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Solid viscera |
Organs that maintain their shape Liver Pancreas |
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Hollow viscera |
Organs that change shape Bladder Stomach Colon |
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Right kidney |
1-2cm lower than left kidney |
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RUQ |
Liver 6-12cm long |
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RLQ |
Appendix |
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LUQ |
Spleen |
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Aorta, Uterus, prostate glad are ? |
Midline |
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Supra public region |
Is where the bladder is located |
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Black tary stool |
GI BLEED |
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Red blood stool |
Cancer/hemrroids |
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NSAIDS |
can cause GI ulcers |
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Tylenol |
Can damage liver |
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Tylenol |
Can damage liver |
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Special considerations (abdomen) Infants |
Umbilical cord has 2 arteries and1 vein (falls off in 10-14 days) Brest fed babies should have mustard colored stool |
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Special considerations (abdomen) Pregnant women |
Abdominal muscles stretch and are displaced Striae Linea Negra |
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Special considerations (abdomen) Aging adults |
Decrease gastric secretions |
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Loss of appetite |
Anorexia |
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Difficulty swallowing |
Dysphasia |
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Heart burn |
Pyrosis |
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Ascitess |
Swelling from fluid in admonish cavity |
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Protuberant |
When abdomen is distended |
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Protuberant |
When abdomen is distended |
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Scaphoid |
Abdomen is inverted/sunken |
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How far should umbilicus protrude ? |
1/2 cm anything more is considered abnormal it should also be Midline |
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Assessments of the abdomen |
Inspect Auscultation Percuss Palpate |
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Percuss abdomen |
Tymphany should be heard over all 4 quads Dullness over liver and spleen |
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Bowel sounds should sound ? |
High pitched with gurgling If no bowel signs are present you must listen for 5 minutes |
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Borborygmus |
Stomach growling |
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if pt feels CVA tenderness what does that indicate ? |
Kidney infection |
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Fluid wave test |
If you feel fluid that means pt had ascities |
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Shifting dullness test |
Tests for ascities |
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WHY DONT WE PALPATE BOUNDING PULSATING MIDLINE MASS ? |
It could be an aortic aneurysm |
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Is the spleen always palpable |
Only if enlarged If enlarged do not continuously palpate because it can rupture |
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List all 3 signs for appendicitis |
Psoas sign Obturator sign Rousing sign |
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List all 3 signs for appendicitis |
Psoas sign Obturator sign Rousing sign |
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Murphy’s sign |
Gallbladder inflammation |
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List all 3 signs for appendicitis |
Psoas sign Obturator sign Rousing sign |
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Murphy’s sign |
Gallbladder inflammation |
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Blumberg sign |
“Rebound sign” Peritoneal inflammation |
