Chapter 19, 20, 21

Front 1

Direction of Blood Flow

Back 1

From liver though IVC & SVC drains blood from head and upper extremities to Right Atrium then Tricuspid Valve to Right Ventricle to Pulmonic Valve to Pulmonary artery unoxygenated blood to lungs. Lungs oxygenate blood. oxygenated blood flows to heart through pulmonary veins to Left Atrium. Then through Mitral valve into the Left ventricle. last through the Aortic Valve into the Aorta which delivers oxygenated blood to the body

Front 2

first heart sound S1

Back 2

LUB

closure of the Atrioventricular valves

signals beginning of systole

loudest at Apex

(mitral then tricuspid components)

Front 3

Second Heart sound S2

Back 3

DUP

closure of the semilunar valves

signals end of systole

loudest at the base

(Aortic then pulmonic component)

Front 4

Atrial Systole

Back 4

active filling phase "atrial kick"

Toward end of dystole the atrial contract and push the last amount of blood into the ventricles.

Atrial diastole occurs during ventricular diastole

Front 5

Atrioventricular (AV) Valve

Back 5

separate the atria and the ventricle. open during filling phase (diastole) to allow ventricles to fill with blood. Close during pumping phase (systole) to prevent regurgitation of blood in atria

right - tricuspid

left - mitral

Front 6

Semilunar (SL) valves

Back 6

located between the ventricles and arteries. valves have three cusps that look like half moons.

Opens during pumping (systole) to allow blood to be ejected from the heart.

Right - Pulmonic

Left - Aortic

Front 7

Heart Location

Back 7

heart extends from 2nd to 5th intercostal space and from right border of sternum to the left midclavicular line.

Front 8

Base

Back 8

top of heart and is broader

Front 9

Apex

Back 9

Bottom of heart and points down and to the left.

beats against chest wall during contraction producing an apical impulse. Most palpable at the 5th intercostal space 7-9cm from mid-sternal line

Front 10

Cardiac Cycle

Back 10

the rhythmic movement of blood through the heart. two phases systole and diastole

diastole- 2/3 cycle ventricles relax and fill with blood

systole- 1/3 cycle hearts contraction. blood is pumped from ventricles to pulmonary and systemic arteries

order = diastole -systole -diastole again

Front 11

Diastole

Back 11

Ventricles relaxed and AV valves are open

First passive filling (early or protodiastolic filling) blood flows from atria to ventricle passively

Second Active filling (presystole or atrial systole) atria contracts and push last amount of blood

Front 12

ventricular diastole

Back 12

Period when ventricles are filling (re-polarization) and relaxing.

Atrial diastole occurs during ventricular diastole

Front 13

Systole

Back 13

pressure in ventricle is higher than atria. Mitral and Tricuspid (AV) valves shut.

S1 signals beginning AV valves close

S2 signals ending SL valves close

Front 14

Normal splitting of S2

Back 14

T-DUP

when the Aortic valve closes significantly earlier then the pulmonic valve you can hear the two components separately at 2nd left interspace

normal - S1-S2

splitting - S1 - S2 S2

Front 15

S3

Back 15

normally diastole and silent.

some conditions ventricular filling can cause vibrations that are heard during protodiastole, immediately after S2.

heard as S3-S3

Front 16

S4

Back 16

normally diastole and silent

occurs at end of diastole (presystole) when ventricle is resistant to filling. Atria contract pushing blood into non-compliant ventricle creating vibrations heard as S4-S4

Front 17

Assessment of Jugular Vein pulsation

Back 17

Using the JV you can assess the Central Venous Pressure and judge heart. stand on persons right side (veins have direct route to heart). position person supine 30-45 degrees. higher venous pressure higher position you need

Front 18

Bruit

Back 18

blowing swishing sound indicating blood flow turbulence: normally none is present

-indicates turbulence due to a local vascular cause, such as atherosclerotic narrowing

Front 19

Auscultation of the Carotid Artery

Back 19

for persons middle aged who show signs or symptoms of cardiovascular disease. Auscultate for the presence of a bruit.

keep neck in neutral position. Lightly apply bell over

1) angle of the jaw 2) midcervical area 3) base of the neck

Front 20

Thrill

Back 20

palpable vibration. feels like the throat of a purring cat. signifies turbulent blood flow and accompanies loud murmurs. (absence doesn't necessarily rule out a murmur)

Front 21

Pulse

Back 21

Temporal Artery Carotid Artery Apical Brachial Artery Ulnar Artery Radial Artery Femoral Artery Popiteal Artery Dorsalis Pedis Artery Posterior Tibal Artery

Front 22

Arteries

Back 22

heart pumps freshly oxygenated blood through arteries to all body tissues. High Pressure system with strong tough and tense walls to withstand pressure. Elastic fibers allows walls to stretch. Create PULSE at sites where arteries lie close to skin over a bone.

Front 23

Veins

Back 23

course of veins parallels arteries but the body has more veins close to the surface. Drains deoxygenated blood and its waste products back to the heart. Low Pressure System and thinner walls.

Front 24

Venous Flow

Back 24

Mechanism to keep blood moving.

1) contracting skeletal muscles milk blood proximally back to heart 2) pressure gradient created by breathing. inspiration decreases thoracic pressure and increases abdominal pressure. 3) intraluminal valves, which ensure unidirectional flow.

Front 25

Lymphatics

Back 25

retrieves excess fluid from the tissue spaces and returns it to the bloodstream. two main trunks that empty into the subclavian veins. without lymphatic drainage fluid would build up in interstitial spaces and produce edema.

Front 26

Right Lymphatic duct

Back 26

empties into Rt Subclavian Vein. DRains rt side of head and neck, right arm,right sie of thorax, right lung and pleura, right side of heart and upper right section of liver.

Front 27

Thoracic duct

Back 27

empties into LT Subclavian vein. and drains the rest of body

Front 28

functions of lymphatic system

Back 28

1) conserve fluid and plasma proteins that leak out of the capillaries

2) form a major part of the immune system that defends the body against disease

3)absorbs lipids from the intestinal tract

Front 29

Lymph nodes

Back 29

small oval clumps of lymphatic tissue located at the intervals along the vessels. Filter fluid before it is returned to the bloodstream. There pathogens are exposed to B and T lymphocytes.

(cervical, Axillary, epitrochlear, and inguinal are palpable nodes)

Front 30

spleen

Back 30

located in upper left quadrant of abdomen 4 functions

1. destroy old red blood cells 2. produce antibodies 3. store red blood cells 4. filter microorganisms from the blood

Front 31

Capillary Refill

Back 31

depress and blanch nail beds: normal time is 1-2 seconds.

refill lasting longer signifies vasoconstriction or decreased cardiac output

Front 32

pulse grades

Back 32

0 =absent

1+ = weak, thready (shock peripheral arterial disease)

2+ = normal

3+ = increased, full. bounding (occurs with hyperkinetic states, anemia, and hyperthyroidism)

Front 33

Right Upper Quadrant (RUQ)

Back 33

Liver

Gallbladder

Spleen

Duodenum

head of pancreas

Right Kidney and adrenal

hepatic flexure of colon

part of ascending and transverse colon

Front 34

Left Upper Quadrant (LUQ)

Back 34

stomach

spleen

left lobe of liver

body of pancreas

left kidney and adrenal

splenic flexure of colon

part of transverse descending colon

Front 35

Right Lower Quadrant (RLQ)

Back 35

Cecum

Appendix

Right ovary and tube

right ureter

right spermatic cord

Front 36

Left Lower Quadrant (LLQ)

Back 36

part of descending colon

sigmoid colon

left ovary of tube

left ureter

left spermatic cord

Front 37

midline

Back 37

Aorta

uterus

bladder

Front 38

Dysphagia

Back 38

difficulty swallowing

occurs with disorders of the throat or esophogus

Front 39

hernia

Back 39

protusion of abdominal viscera through abdominal opening in muscle wall

Front 40

contour of abdomen

Back 40

flat

schaphoid (caves in)

round

protuberant

Front 41

Auscultate Bowel sounds

Back 41

begin in RLQ because bowel sounds are normally present here

Hyperactive- loud high pitched rushing, tinkling sound that signal increased motility. (borborygmus)

Hypoactive- follow abdominal surgery or with inflammation of peritoneum

Front 42

Costoverbal Angle

Back 42

sharp pain here occurs with inflammation of the kidney or paranephric area

Front 43

Ascites

Back 43

Free fluid in the peritoneal cavity