Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/79

Click to flip

79 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Dyspnea on Exertion (DOE)-

subjective assessment
quantify exactly.
Paroxysmal (sudden)
Constant or intermittent
Recumbent (lying down)
Paroxysmal Nocturnal Dyspnea (PND)
Subjective assessment
This occurs with heart failure.

Lying down increases volume of intrathoracic blood and heart can not keep up. typically, person awakens 2 hours after falling asleep not being able to breath.
orthopnea- Subjective assessment
Ask how many pillows they use when sleeping or lying down.

Orthopnea is the need to be in a more upright position to breath.

Note exact number of pillows.
Coughing: subjective assessment
Note Duration, frequency, type and discharge. Also what makes it worse/better.

Sputum, or even hemoptysis, is often pulmonary but can also occur with mitral stenosis.
Fatigue- subj assessment
Note onset, time of day.

Fatigue from dec. CO= worse in the evening

Fatigue from anxiety/depression= occurs all day or is worse in the morning.
Cyanosis/pallor- subj Assessment
occurs with MI or low CO as a result of decreased tissue perfusion.
Edema- subjective assessment
Is dependent when caused by HF

Cardiac edema is worse at evening and better in the morning after elevating legs all night

Cardiac edema is bilatera; unilateral swelling has a local vein cause.
Nocturia- subj assessment
Recumbency at night promotes fluid reabsorption and excretion. Occurs with HF in persons who are ambulatory during the day.
Collecting Risk factors for CAD
Collect date regarding:
- elevated cholesterol
-elevated BP
-elevated BG levels above 130
-obesity
-smoking
-low activity
-length of any hormone replacement therapy for postmenopausal women.
Special subj assessment questions for the elderly
Ask about environment- stairs, living alone, etc.

current meds and compliance towards them

Any known diseases
What position should the pt be to assess carotid arteries?
Sitting up
What position should the pt be to assess jugular and precordium?
supine with the head and chest slightly elevated
What is the order of performing a regional cardiovascular assessment?
1. pulse and BP
2. extremities
3. neck vessels
4. precordium

Logic: observation is made peripherally and towards the heart.
Order of Assessing neck vessels
1. palpate carotid artery
2. auscultate the carotid artery
3. inspect the jugular venous pulse
4.estimate the jugular venous pressure
Palpating Carotid Arteries
- palpate each one medial to the sternomastoid muscle

-avoid excessive pressure.
- excessive vagal stimulation could slow down HR (esp. in elderly)
-palpate one artery at a time to avoid compromising blood to the brain
normal: contour should be smooth, pulse +2 or moderate, bilaterally.
What is Carotid Sinus Hypersensitivity?
it is the condition in which pressure over the carotid sinus leads to a decreased HR, BP and cerebral ischemia with syncope (temp. loss of consciousness)
Auscultating the carotid Artery
Done on its who show sx of CV dz. auscultate for a BRUIT

-apply bell of stetho over carotid at three levels: 1. the angle of the jaw, 2. the midcervical area and 3. the base of the neck.
What is a bruit? and when is it most audible?
a blowing, swishing sound indicating blood flow turbulence. normally not present.
It is most audible when the lumen is occluded by half or two thirds. its loudness increases as the atherosclerosis worsens until its 2/3s blocked.
after that, sounds decrease.
complete occlusion, sounds disappear.
Auscultation characteristics of murmurs
Sounds the same as a bruit but is caused by a cardiac disorder. Some Aortic valve murmurs radiate to the neck and must be distinguished from a local bruit.
Inspecting jugular venous pulse
you can assess central venous pressure (CVP) here, which tells you the heart's efficiency as a pump.

-stand on Right side of Pt. (cuz these have direct route to heart)
-person is in supine (30 or 45 degrees
- turn head and direct strong light at the neck.

contd
Then look for pulsation of internal jugulars in the suprasternal notch.
make sure to distinguish from carotid. Refer to pg 472
What position should the pt be to assess carotid arteries?
Sitting up
What position should the pt be to assess jugular and precordium?
supine with the head and chest slightly elevated
What is the order of performing a regional cardiovascular assessment?
1. pulse and BP
2. extremities
3. neck vessels
4. precordium

Logic: observation is made peripherally and towards the heart.
Order of Assessing neck vessels
1. palpate carotid artery
2. auscultate the carotid artery
3. inspect the jugular venous pulse
4.estimate the jugular venous pressure
Palpating Carotid Arteries
- palpate each one medial to the sternomastoid muscle

-avoid excessive pressure.
- excessive vagal stimulation could slow down HR (esp. in elderly)
-palpate one artery at a time to avoid compromising blood to the brain
normal: contour should be smooth, pulse +2 or moderate, bilaterally.
What is Carotid Sinus Hypersensitivity?
it is the condition in which pressure over the carotid sinus leads to a decreased HR, BP and cerebral ischemia with syncope (temp. loss of consciousness)
Auscultating the carotid Artery
Done on its who show sx of CV dz. auscultate for a BRUIT

-apply bell of stetho over carotid at three levels: 1. the angle of the jaw, 2. the midcervical area and 3. the base of the neck.
What is a bruit? and when is it most audible?
a blowing, swishing sound indicating blood flow turbulence. normally not present.
It is most audible when the lumen is occluded by half or two thirds. its loudness increases as the atherosclerosis worsens until its 2/3s blocked.
after that, sounds decrease.
complete occlusion, sounds disappear.
Auscultation characteristics of murmurs
Sounds the same as a bruit but is caused by a cardiac disorder. Some Aortic valve murmurs radiate to the neck and must be distinguished from a local bruit.
Inspecting jugular venous pulse
you can assess central venous pressure (CVP) here, which tells you the heart's efficiency as a pump.

-stand on Right side of Pt. (cuz these have direct route to heart)
-person is in supine (30 or 45 degrees
- turn head and direct strong light at the neck.

contd
Then look for pulsation of internal jugulars in the suprasternal notch.
make sure to distinguish from carotid. Refer to pg 472
What does Unilateral jugular distention signify?
local cause (kinking or aneurysm)
What does full distended external jugular veins above 45 degrees signify?
Increased CVP (as with HF)
How and why do you assess hepatojugular reflux?
How-
In supine position, instruct pt to breath out of open mouth. press down on upper right abdomen under rib, and watch the level of jugular pulsation when you push.
hold for 30 seconds. If the heart can manage this volume, the veins will rise for a few seconds then recede back to previous level. If HF= jugulars will be elevated as long as you push
Why? when you suspect the person has elevated venous pressure or is suspect HF
Order of Assessment of precordium
1. Inspect anterior chest
2. Palpate the apical pulse
3. Palpate across the precordium
4. Percuss
5. Auscultation
Inspecting Anterior chest
Check for pulsations (apical pulse). It will be in the 4th and 5th intercostal space at midclavicular line (if present).
What does a heave or a lift found upon inspection signify?
It signifies a sustained forceful thrusting of the ventricles. Occurs with ventricular hypertrophy as a result of increased workload.

Right- seen at the sternal border
Left- seen at the apex.
Palpating the apical impulse
find apical impulse using one finger pad

-if can't find, ask person to exhale and hold, or turn to the left (note: this moves it further to the left)
What will the apical impulse feel like in cardiac enlargement?
-Left ventricular dilation (volume overload) displaces impulse down and to the left and increases size more than one space.-

sustained impulse with increased force and duration but no change in location occurs with left ventricular hypertrophy.
When is the apical pulse not palpable?
Obese persons
thick chest walls
or if the person has pulmonary emphysema due to overriding lungs.
Palpating across the precordium
-with base of fingers, palpate apex. normally, no pulsations can be felt.

-you may find a thrill (palpable vibration)
-accentuated first and second heart sounds and extra heart sounds also cause abnormal pulsations.
Auscultating the valve areas
These are sites on the chest wall where sounds produced by the valves are best heart. Sound radiates in the direction of the blood flow.

VALVE AREAS:
2nd right interspace- aortic valve area
2nd left interspace- pulmonic valve area
Left Lower Sternal Border- tricuspid valve area
Fifth Interspace (in L Midclavicular line)- mitral valve area.
Routine for assessing heart sounds (one by one)
1) note the rate and rhythm
2) ID S1 and S2
3) Assess S1 and S2 separately
4) Listen for extra heart astounds
5) listen for murmurs
What is sinus arrhythmia?
It is when the rhythm varies with the person's breathing (inc. in resp, dec with exp)

-occurs normally in young adults and children.
What is a premature beat>?
An isolated beat is early or a pattern occurs in which every third or fourth beat sounds early.
What is a pulse deficit?
This is assessed by auscultating the apical beat while simultaneously palpating the radial pulse. If different, subtract radial rate from apical and record remainder as a deficit.

-will signal a weak contraction of the ventricles. occurs with A fib, premature beats and HF.
Characteristics of S sounds
-S1 is louder than S2 at apex' S2 is louder than S1 at base.

-S1 coincides with carotid artery pulse.

-S1 coincides with r wave (if ECG monitor)
Split S1
Normal- occurs rarely.
Split S2
Normal- occurs at the end of inhalation. Expiration synchronizes closure of Semilunar valves again.

-occurs every fourth heart beat.
Which valve is a mid systolic click associated with?
It is associated with mitral valve prolapse.
What is a fixed split?
A split that is unaffected by respiration; the split is always there.

Caused by atrial septal defect or

R vent failure
What is a paradoxical Split?
A split where the sounds fuse on inspiration and split on expiration.

caused by Aortic stenosis or

L bundle branch block or

Patent ductus arteriosus
Pathologic S3
AKA ventricular Gallop-

occurs with heart failure and volume overload
Pathologic S4
AKA Atrial Gallop

occurs with CAD
Characteristics of Murmurs
-Timing: does it occur in Systole or diastole?

-Loudness: Intensity in terms of 6 grades

-pitch: which depends on pressure

-Pattern
-Quality
-Location
-Radiation
-Posture: some disappear or become enhanced in diff postures
What changes occur with aging?
Aorta becomes stiff, dilated and elongated (which may compress the left neck veins and obscure pulsations on the L side)

Chest in anteroposterior diameter

S4 is normal finding, as well as systolic murmurs

-S3 is associated with HF and is ALWAYS abnormal over the age of 35
What can cause a loud S1?
Increased blood velocity
mitral stenosis with leaflets still mobile
What can cause a faint S1?
First degree heart block

Mitral insufficiency

Severe hypertension- systemic or pulmonary
What can cause varying intensities in S1 sounds?
AFib- irregular irregular rhythm

Complete heart block
What can cause loud S2?
Systemic HTN
What can cause diminished S2?
Shock,

aortic or pulmonic stenosis
What causes a "wide split S2"?
When the R vent has delayed electrical activation, the split is very wide on inspiration and still there on expiration

- caused by right bundle branch block.
What is an ejection click?
It is a short and high pitched sound heard in early systole at the start of ejection because of aortic stenosis which causes the semilunar valves to make the sound as they open.
What is mid systolic click?
(Not an ejection click)
It is associated with mitral valve prolapse, where the mitral leaflets close with contraction and balloon back up into the L atrium

occurs in mid-to-late systole and is a high pitched clock.
Pericardial Friction Rub
R/t inflammation of the pericardium, making a high pitched, scratchy sound.

best heard in apex and left lower sternal border.
-common during the first week after MI, and only lasts a few hours
What does a thrill in the 2nd and 3rd interspaces signify?
Right-It occurs with severe aortic stenosis and systemic HTN

Left- Occurs with pulmonic stenosis and pulmonic HTN
What does a lift (heave) signify?
It occurs with right ventricular hypertrophy (like in pulmonic valve disease, HTN and chronic lung disease.
Patent Ductus Arteriosus (PDA)
Persistence of the channel joining left pulmonary artery to aorta. common in fetus and usually closes after birth. -congenital
Atrial Septal Defects (ASD)
Abnormal opening in the atrial septum, resulting usually in left to right shunt and causing large increase in pulmonary blood flow.

congenital
Ventricular Septal defect (VSD)
Abnormal opening in the septum between the ventricles, usually sub aortic area. The size and exact position vary.
Tetralogy of Fallot
Four components:
1) R vent outflow stenosis
2)VSD
3)R ven hypertrophy
4) Overriding aorta.

REsult: shunts a lot of venous blood directly into aorta away from pulmonary system, so blood never gets oxygenated.
Coarctation of the Aorta
Severe narrowing of descending aorta. Results in increased workload on left ventricle.
Aortic stenosis
Calcification of aortic valve cusps restricts forward flow of bblood during systole; LV hypertrophy develops.
Pulmonic stenosis
Calcification of pulmonic valves, restricts forward flow of blood.
Mitral regurgitation
Stream of blood regurgitates back into LA during systole through incompetent mitral valve. In diastole, blood passes back into LV again along with new flow; results in LV dilation and hypertrophy.
Tricuspid regurgitation
Backflow of blood through incompetent tricuspid valve into the RA
Mitral Stenosis
A Calcified mitral valve that will not open properly, impedes forward flow of blood into LV during diastole. Results in LA enlarged and LA pressure increased.
Tricuspid Stenosis
Calcification of tricuspid valve, impedes forward flow into the RV during diastole.
Aortic Regurgitation
Stream of blood regurgitates back through incompetent aortic valve into LV during diastole. Lv dilation and hypertrophy due to increased LV stroke volume. Rapid ejection of large stroke volume into poorly filled aorta, then rapid runoff in diastole as part of blood pushed back into LV
Pulmonic Regurgitation
Back flow of blood through incompetent pulmonic valves, from pulmonary artery to RV