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107 Cards in this Set
- Front
- Back
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The sac that surrounds and protects the heart is called the:
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pericardium
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The direction of blood flow through the heart is best described by which of these?
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Right atrium → right ventricle → pulmonary artery → lungs → pulmonary vein → left atrium → left ventricle
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The nurse is reviewing anatomy and physiology of the heart. Which statement best describes what is meant by atrial kick?
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The atria contract toward the end of diastole and push the remaining blood into the ventricles
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When listening to heart sounds, the nurse knows that the valve closures that can be heard best at the base of the heart are:
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aortic and pulmonic
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Which of these statements describes the closure fo the valves in a normal cardiac cycle?
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The tricuspid valve closes slightly later than the mitral valve
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The component of the conduction system referred to as the pacemaker of the heart is the:
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sinoatrial (SA) node
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The electrical stimulus of the cardiac cycle follows which sequence?
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AV node → SA node → bundle of His → bundle branches
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The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates:
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elevated pressure related to heart failure
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When assessing a newborn infant who is 5 minutes old, the nurse knows that which of these statements would be true?
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There is an opening in the atrial septum where blood can flow into the left side of the heart.
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A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous exam, the nurse notes that her blood pressure in her second month was 124/80 mm Hg. In evaluatin this change, what does the nurse know to be true?
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This is a result of peripheral vasodilatation and is an expected change.
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In assessing a 70-year-old, the nurse finds the following: blood pressure 140/100 mm Hg; heart rate 104 and slightly irregular; split S2. Which of these findings can be explained by expected hemodynamic changes related to age?
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Increase in systolic blood pressure
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A 45-year-old man is in the clinic for routine physical. During the history the patient states he's been having difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't get my breath." The nurse's best response to this would be:
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"Do you have any history of problems with your heart?"
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Increasing assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a history?
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Smoking, hypertension, obesity, diabetes, high cholesterol
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The mother of a 3-month-old infant states that her baby has not been gaining weight. With further questioning, the nurse finds that the infant falls asleep after nursing and wakes up after a short amount of time, hungry again. What other information would the nurse want to have?
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Presence of dyspnea of diaphoresis when sucking
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In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:
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listen with the bell of the stethoscope to assess for bruits.
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During an assessment of a 68-year-old man with a recent onset of right-sided weakness, the nurse hears a blowing, swishing sound with the bell of the stethoscope over the left carotid artery. This finding would indicate:
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blood flow turbulence
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During inspection of the precordium of an adult patient, the nurse notices the chest moving in a forceful manner along the sternal border. This finding most likely suggests:
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enlargement of the right ventricle.
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During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?
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Fifth left intercostal space at the midclavicular line
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The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?
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Studies show that percussed cardiac borders do not correlate well with the true cardiac border.
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The nurse is preparing to auscultate for heart sounds. Which technique is correct?
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Listen by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex.
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While counting the apical pulse on a 16-year-old patient, the nurse notices an irregular rhythm. His rate speeds up on inspiration and slows on expiration. What would be the nurse's response?
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No further response is needed because this is normal
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When listening to heart sounds, the nurse knows that S1:
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coincides with the carotid artery pulse
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During the cardiac auscultation the nurse hears a sound occuring immediately after S2 at the second left intercostal space. To further assess this sound, what should the nurse do?
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Watch the patient's respirations while listening for effect on the sound.
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Which of these findings would the nurse expects to notice during a cardiac assessment on a 4-year-old child?
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Murmur at second left intercostal space when supine
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While auscultating heart sounds on a 7-year-old child for a routine physical, the nurse hears an S3, a soft murmur at left midsternal border, and a venous hum when the child is standing. Which of these would be a correct interpretation of these findings?
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These can all be normal findings in a child.
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During the precordial assessment on a patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:
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displacement of the heart from elevation of the diaphragm
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In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:
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bell at the apex with the patient in the left lateral position.
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A 70-year-old patient with a history of hypertension has a blood pressure of 180/100 mm Hg and a heart rate of 90 beats per minute. The nurse hears an extra heart sound at the apex immediately before S1. The sound is heard only with the bell while the patient is in the left lateral position. With these findings and the patient's history, the nurse knows that the extra heart sound is most likely a(n):
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atrial gallop
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The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her myocardial infarction. Heart sounds are normal when she is supine, but when she is sitting and leaning forward, the nurse hears a high-pitched, scratchy sound with the diaphragm of the stethoscope at the apex. It disappears on inspiration. The nurse suspects:
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inflammation of the precordium
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The mother of a 10-month-old infant tells the nurse that she has noticed that she has noticed that her son becomes blue when he is crying and that the frequency of this is increasing. He is also not crawling yet. During the examination the nurse palpates a thrill at the left lower sternal border and auscultates a loud systolic murmur in the same area. What would be the most likely cause of these findings?
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Tetralogy of Fallot
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A 30-year-old woman with a history of mitral valve problems states that she has been "very tired." She has started waking up at night and feels like her "heart is pounding." During the assessment, the nurse palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse also auscultates a blowing, swishing sound right after the S1. These findings would be most consisent with:
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mitral regurgitation
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During a cardiac assessment on a 38 year-old patient in the hospital for "chest pain," the nurse finds the following: jugular vein pulsations 4 cm above sternal angle when he is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty in breathing when supine, and and S3 on auscultation. Which of these conditions best explains the cause of these findings?
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heart failure
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The nurse knows that normal splitting fot he second heart sound is associated with:
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inspiration
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During a cardiovascular assessment, the nurse knows that a "thrill" is:
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a vibration that is palpable
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During a cardiovascular assessment, the nurse knows that an S4 heart sound is:
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heard at the end of ventricular diastole
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The nurse is assessing a patient's apical impulse. Which of these statements is true regarding the apical impulse?
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Its location may be indicative of heart size
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During an assessment, the nurse notes that the patient's apical impulse is displaced laterally, and it is palpable over a wide area. This indicates:
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volume overload, as in mitral regurgitation
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When the nurse is auscultating the caroitd artery for bruits, which of these statements reflects correct technique?
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Lightly apply the bell of the stethoscope over the carotid artery, and while listening, have the patient take a breath, exhale, and hold it briefly.
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The nurse is preparing for a class on rish factors for hypertension, and reviews recent statistics. Which racial group has the highest prevalence of hypertension in the world?
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African-Americans
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The nurse is assessing a patient with possible cardiomyopathy and assesses the hepatojugular reflux. If heart failure is present, then the nurse should see which finding while pushing on the right upper quadrant of the patient's abdomen, just below the rib cage?
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The jugular veins will remin elevated as long as pressure on the abdomen is maintained.
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The nurse is assessing the apical pulse of a 3-month-old infant and finds that the heart rate is 135 beats per minute. The nurse interprets this result as:
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normal for this age
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The nurse is presenting a class on risk factors for cardiovascular disease. Which of these are considered modifiable risk factors for myocardial infarction (MI)? Select all that apply.
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Abnormal lipids
Smoking Hypertension Diabetes |
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Trace a drop of blood starting from deoxy
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Superior/Inferior vena cava - R atrium - tricuspid valve - R ventricle - pulmonic semi lunar valve - pulmonary arteries - lungs - pulmonary veins - L atrium, Mitral/bicuspid valve - L ventricle - aortic semi lunar valve - aorta
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Where is the base of the heart? The apex?
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Base - Top
Apex - Bottom |
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What are the four heart valves in order of flow?
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Toilet Paper My Ass
T - Tricuspid AV P - Pulmonic Semilunar M - Mitral Valve/Bicuspid AV A - Aortic Semilunar |
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What is systole?
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SI - Lub - heart PUMPING phase
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What is diastole?
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S2 - dub - heart filling phase
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What do the valves look like during systole?
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AV - CLOSED to prevent regurgitation into atria
SemiLunar - OPEN |
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What do the valves look like during diastole?
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AV - OPEN
SemiLunar - CLOSED |
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Do the ventricles passively fill with blood in systole or diastole?
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Diastole
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Contracting heart =
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Systole
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Filling heart =
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Diastole
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Where between S1 and S2 do you hear an S3 sound?
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Lub, Dub, Dub
Ken - Tuck - Y Right after S2 |
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When between S1 and S2 do you hear an S4 sound?
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Da, Lub, Dub
Ten - Ness - Eee At the end of diastole, right before systole |
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What does a gallop sound like?
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All sounds, S1, S2, S3, S4
Da Lub Dub Dub |
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Pneumonic to remember where to auscultate the heart and which valve you are over?
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APE To Man
A - Aortic P - Pulmonic E - Erb's Point T - Tricuspid M - Mitral |
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Over what valves is S1 > S2
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Tricuspid and Mitral
BOTTOM of heart |
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Over what valves is S1< S2
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Aortic and Pulmonic
Base (TOP) of heart |
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How do you check to distinguish between S1 and S2?
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S1 is in line with the carotid pulse
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Fluid in the peritoneal cavity =
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Ascites
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When do you hear S3 and S4 sounds?
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When blood enters the ventricles when it shouldn't
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What is the normal size of the apical pulse? What can a larger pulse size indicate?
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less than 2 cm
enlarged heart |
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Funny heart sounds at valves =
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Ejection clips and opening snaps
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Where are bruits located? Murmurs?
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Bruits - Outside of the heart (Trachea)
Murmurs - Inside the heart |
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What does a murmur sound like?
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Whishing
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What causes a murmur?
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Turbulent blood flow caused by a narrowed/defective valve
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What does a systole AV valve murmur sound like?
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Lub Shhh Dub
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What does a systole semilunar murmur sound like?
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Lub Dub Shh
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Table:
Systolic Diastolic AV SL |
Regurg Stenosis
Stenosis Regurg |
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For what sounds do you use the bell?
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Low Pitch
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For what sounds do you use the diaphragm?
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High Pitch
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What valve is closed during S1
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AV
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What valve is closed during S2
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Semi Lunar
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How do you hear S3 and S4 sounds?
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Bell, light pressure, do backwards Z
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Are S3 and S4 diastolic or systolic sounds?
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diastolic
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In general what happens during R sided heart failure?
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Fluid backs up in the BODY
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In general what happens during L sided heart failure?
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Fluid back up in the LUNGS
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What are some signs/symptoms of R sided heart failure?
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Pedal edema
ascites (fluit in abdominal space) Enlarged liver/spleen JVD Fatigue Dependent edema |
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What is one treatment for r sided heart failure?
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Perisintisis - drain fluid out of abdominal cavity - Liters come out!
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What are some sign and symptoms of L sided heart failure?
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Cyanosis
Proximal nocturnal dyspnea Fluid/wheeze/crackles in lungs pulmonary congestion Tripod cough tachypnea frothy and pink sputum altered dizzy DOE Pitting edema discoloration of skin edema |
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What do you inspect for on the apical pulse?
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Retraction
Life Heave |
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What do you palpate for on the heart?
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2ICS, sternal border, diagonal under breast, feel for pulse
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When does angina occur?
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When the heart's own blood supply cannot keep up with metabolic demand
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Difficulty breathing while laying down =
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Orthopnea
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Carotid sinus hypersensitivity
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Pressure over carotid tissue leads to decreased heart rate, BP, and cerebral ischemia with syncope
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What does a bruit indicate?
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Turbulence due to a narrowing
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What is a thrill?
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A palpable vitbation - feels like the throat of a purring cat. Indicated turbulent blood flow
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What are some of the reasons for cardiac enlargement
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increased ventricular volume or wall thickness
Hypertension CAP Heart Failure Cardiomyopathy |
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Is a fixed split a problem?
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No, it is always there - unaffected by respiration
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What is a paradoxical split?
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Sounds fuse on inspiration and split on expiration
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A diastolic murmur always indicates ___
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Heart disease
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A systolic murmur indicates
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a normal heart OR heart disease
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S3 is associated with __ ___
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Heart Failure OVER age 35
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Patent Ductus Arteriosus
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Left Pulmonary Artery to aorta
Closes at birth If not closed: BP has a wide pulse pressure, thrill palpable. Continuous murmur in systole and diastore (machinery murmur) |
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Machine murmur
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Continuous murmur heard at diastole and systole
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Atrial septal defect congenital
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Abnormal opening in the atrial septum - left to right shunt and large increase in pulmonary blood flow
Symptoms are mild fatigue and DOE Murmur caused by increased blood flow through pulmonic valve |
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Ventricular septal defect congenital
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Abnormal opening in septum between ventricles
Small defect is asymptomatic Poor growth/weight gain - pale thin delicate DOE, frequent respiratory infections - heart failure if severe. Loud harsh murmur - increase blood flow through mitral valve |
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Tetralogy of Fallot
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Right ventricular outflow stenosis, VSD, Right ventricular hypertrophy, overriding aorta
Shunts a lot of venous blood directly to aorta - blood never get O2 Severe cyanosis, DOE, slowed growth Thrill, systolic Murmur is LOUD |
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Coarctation of the Aorta
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Severe narrowing of descending aorta
Heart failure develops Diagnosis due to BP findings Upper extremity hypertension - diminished femoral pulse. Systolic murmur |
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Aortic stenosis
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Restricts the flow of blood during systole
Fatigue DOE palpitation, dizziness, fainting, anginal pian. Pallor, slow diminished radial pulse, low BP. Apical pulse weak. Murmur - harsh loud, mydsystolic |
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Pulmonic stenosis
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Thrill in systole at second and third left interspace. Ejection click. Systolic murmur.
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Mitral Regurgitation
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Blood regurg back into L atrium during systole through mitral valve.
Fatigue, palpitation, orthopnea, Thrill at apex Murmur - heard at apex - loud and blowing |
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Tricuspid Regurgitation
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Backflow of blood through incompetent tricuspid valve into R atrium
Engorged pulsating neck veins, liver enlarged Murmur - soft, blowing, increases with inspiration, heard at lower border |
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Mitral stenosis
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Calcified mitral valve - will not open properly. Impedes flow of blood into L Vent during diastole - large LA and LA pressure
Fatigue, palpitations, DOE, orthopnea, pulmonary edema. Diminished arterial pulse, low pitched diastolic rumble |
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TriCuspid stenosis
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Calcification of tricuspid valve - impedes forward flow into RV during diastole
Diminished arterial pulse - Jugular pulse prominent Murmur - Diastolic rumble, louder at inspiration, heard at lower border |
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Aortic regurgitation
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Stream of blood regurgitates back through incompetent aortic valve into LV during diastole. Dilation and hypertrophy due to increased LV stroke volume.
Minor then rapid detioratio - DOE, PND, angina, dizziness. Carotid pulse is like a hammer Murmur same time as S2 Best heard when person leans forward |
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Pulmonic regurg
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Backflow of blood through incompetent pulmonic valve from pulmonary artery to RV
Hard to distinguish from aortic regurg |
