Health Assessment And Physical Examination. Cardiac Week 4

Front 1

Why do the Alan's Test?What can it tell you?

Back 1

its a test for occlusion of radial or ulnar arteries: the patient makes a tight fist so as to express the blood from the skin of the palm and fingers

Front 2

when the examiner makes digital compression on either the radial or ulnar artery. Failure of blood to return to the palm and fingers when the hand is opened indicates obstruction of the blood flow in the artery that has not been compressed. This is known as?

Back 2

Alans Test

Front 3

What does JVP measure

Back 3

measures Jugular Venous pressure

Front 4

Whats a Normal JVP measurement?

Back 4

Less than 3cm, some texts say 2cm

Front 5

What is the hearts primary function ?

Back 5

pump blood to all parts of the body

Front 6

Cardiovascular disease refers to?

Back 6

all circulatory diseases

Front 7

What is CHD?

Back 7

Coronary heart disease

Front 8

What is IHD?

Back 8

Ischaemic heart disease

Front 9

What is a Stroke or CVA

Back 9

Cerebrovascular accident

Front 10

HF

Back 10

Heart Failure

Front 11

PVD

Back 11

Peripheral vascular disease

Front 12

Heart contracts

Back 12

60-100 times per minute

Front 13

Heart pumps

Back 13

4-5 litres of blood per minute

Front 14

The heart is the size of

Back 14

a clenched fist

Front 15

The heart is located

Back 15

in the thoracic cavity between the lungs and above the diaphragm- mediastinum

Front 16

Base of the heart, left and right atria, the aorta, pulmonary arteries and the superior vena cava are in the?

Back 16

Upper most portion of the heart

Front 17

Upper most portion of the heart lies behind the

Back 17

sternum

Front 18

Hearts Apex location

Back 18

lower portion of the heart

Front 19

The heart and the great vessels lie within a sac called the

Back 19

Pericardium

Front 20

the 2 serous layers of the pericardium

Back 20

parietal and visceral

Front 21

The heart has how many chambers

Back 21

4 chambers

Front 22

The heart has how many ventricles

Back 22

2 Ventricles the left and the right

Front 23

The heart has how many valves

Back 23

4 valves--- 2 AV Atrioventricular and 2 SV Semilunar valves

Front 24

The heart itself needs a continuous supply of oxygenated blood this is supplied by the

Back 24

coronary arteries

Front 25

Gas exchange occurs in the

Back 25

Capillary beds of all body tissues

Front 26

Cardiac Assessment of the precordium: Inspection; and Palpation;

should be carried out on the following

Back 26

Aortic Area, Pulmonic Area, Midprecordial area, tricuspid area, mitral area.

Front 27

Cardiac Assessment of the precordium Auscultation should occur in which areas

Back 27

Aortic Area, Pulmonic Area, Midprecordial area, Tricuspid Area, Mitral and tricuspid area s3, Mitral and Tricuspid area s4, murmurs, Prosthetic heart valves

Front 28

When Assessing the blood vessels Inspection should include?

Back 28

JVP, Blood Vessels

Front 29

When Assessing the blood vessels you should Palpate and Auscultate?

Back 29

Arterial pulses

Front 30

When Assessing the blood vessels you should Inspect and palpate?

Back 30

Peripheral pulses, colour, clubbing, capillary refill, skin temp, oedema, ulcerations, skin texture, hair distribution

Front 31

Special assessments for cardiac include arterial and venouss blood flow such as?

Back 31

Orthostatic, hypotension assessment, Homans sign, Pallor- arterial, colour return and capillary refill.

Front 32

Advanced techniques of cardio assessments that can be done?

Back 32

Pericardial Friction Rub

&

Allen test

Front 33

You should Assess the following in the cardiac patient?

Back 33

Radiation, Quality, Associated Manifestations, Aggrevating Factors, Setting, Timing, Surgical history, Allergies, Medications, Injuries, Accidents, Alcohol Use, Tobacco Use, Drug Use, Sexual Practices, Work, Home, Hobbies, Stress.

Front 34

There are 2 components of assessing the heart and blood vessels. What are they?

Back 34

1. Assessment of the Precordium

2. Assessment of the Blood Vessels

Front 35

heart assessment- the position of the patient?

Back 35

Supine or sitting, Stand on patients Right Side, Light needs to be on the opposite side to prevent shadowing

Front 36

The 2nd intercostal space- to the right of the sternum is the?

Back 36

Aortic Area

Front 37

2nd ics to left sternum is the?

Back 37

The pulmonic Area

Front 38

3rd ics to left of sternum is the?

Back 38

Midprecordial Area, Erbs Point

Front 39

5th ics to the left of the sternum is the?

Back 39

Tricuspid Area

Front 40

5th ics at the midclavicular line is the?

Back 40

Mitral Area

Front 41

1. Observe angle of Louis

2. Look Laterally to the right side of the sternum to the rib- this is the 2nd rib

3. observe beneath 2nd rib to ICS.

Aortic Area is located in the 2nd ICS to right of sternum.

Back 41

This would be how to perform Inspection of Aortic Area Examination

Front 42

When Inspecting the Aortic Area, Pulmonic Area, Midprecordial Area, Tricuspid Area Normal Findings are?

Back 42

No pulsations should be visible

Front 43

Inspection of Aortic Area Abnormal Findings are?

Back 43

Pulsation in Aortic Area

Front 44

Inspection of Aortic Area Pathophysiology

Back 44

Pulsation may indicate an aortic root aneurysm May become bigger if patient has hypertension Rupture is most likely if the aneurysm is more than 5cm

Front 45

1. Observe the left second ICS

2.Pulmonic area is located at the 2nd ICS left of sternum

What would we do here. What kind of examination?

Back 45

Pulmonic Area Examintion

Front 46

Pulmonic Area abnormal finding

Back 46

Pulse or bulge in pulmonic area is an abnormal finding

Front 47

Pulmonary stenosis- usually congenital impedes blood flow from right ventricle into lungs causes a bulge. Right side of heart dilates and right ventricle becomes hypertrophied to accomodate the load

Back 47

Pulmonic Area Pathophysiology

Front 48

Observe left 2nd icsObserve down the left rib cage counting the 3rd rib and 3rd icslocation 3rd ics left sternal border. This area is?

Back 48

Midprecordial Area Erbs Point

Front 49

Presence of bulge or left systolic bulge in midprecordial area is not normal A retraction in area is not normal

Back 49

Midprecordial Area Erbs Point Abnormal findings

Front 50

left ventricular aneurysm can produce a midprecordial pulsation.Ventricular anuerysms can develop several weeks after a AMI. hydraulic stress of AMI on the infarcted area may cause ventricular wall to bulge and thin during systolePericardial disease

Back 50

Midprecordial Area Erbs Point Pathophysiology

Front 51

Observe left 5th icsObserve down left rib cage to 4th rib- 4th ics and the 5th rib followed by 5th icsTricuspid is located at the 5th ics left of sternal border

Back 51

Tricuspid Area

Front 52

A visible systolic pulsation in tricuspid area is abnormal

Back 52

Tricuspid Area Abnormal findings

Front 53

visible systolic pulsation can result from right ventricular enlargement secondary to an increased stroke volume. Anxiety, hyperthyroidism, fever, and pregnancy increase stroke volume

Back 53

Tricuspid Area Pathophysiology

Front 54

Observe 5th ics look laterally to midclavicular line- this is mitral landmark Large breasted patient have them lift upwards and move left breast to locate the landmark

Back 54

Mitral Area

Front 55

Normally no movement in precordium except mitral area because left ventricle lies close enough to surface it is visible during systole.Apical impulse is mitral landmark. Known as point of Maximal impulse PMI

Back 55

Mitral Valve Normal Findings

Front 56

PMI

Back 56

Point of Maximal pulse occurs with carotid pulse.

Front 57

What should we palpate the heart for?

Back 57

Thrills aka vibrations- purring cat

Heaves- lifting of cardiac area- in supine position for this

Front 58

the mediastinum contains the?

Back 58

heart, great vessles, trachea, oesophagus, and lymph vessels

Front 59

Place the diaphragm of the stethoscope on the aortic landmark and listen for s2 remember 2nd ics right to sternum this is how to what?

Back 59

Auscultate Aortic Area

Front 60

Place diapraghm of the stethoscope on the chest wall at the pulmonic landmark and listen for s2 remember 2nd ics left to sternum this is how to what?

Back 60

Auscultate pulmonic area

Front 61

Both aortic and pulmonic murmurs can be heard here 3rd ics left sternal border this is known as doing what to which area?

Back 61

Auscultating Midprecordial area aka erbs point

Front 62

Place the diaphragm of the stethoscope on the chest wall at the tricuspid landmark listen fors1 5th ics left of sternal border This is doing what to which area?

Back 62

Auscultating the Tricuspid Area

Front 63

stethoscope over mitral area left 5th ics midclavicular line distinguis s1 from s2. If you cant then palpate the carotid artery while auscultating the landmark. S1 will be heard with each carotid pulse. This is known as?

Back 63

Auscultating Mitral Area

Front 64

The hearts muscles is known as the muscular pump. What type of muscle is the heart?

Back 64

Cardiac Muscle

Front 65

CARDIOVASCULAR system consists of the?

Back 65

Blood vessels and the Heart

Front 66

The heart has two circuits

Back 66

 Systemic circuit Pulmonic circuit

Front 67

The great vessels are?

Back 67

 Aorta Pulmonary Veins Pulmonary Artery Vena Cava

Front 68

The Chambers are

Back 68

 Atria Ventricles

Front 69

Atrioventricular Valves are the?

Back 69

 Tricuspid valve Bicuspid (Mitral) valve

Front 70

Semilunar valves are the?

Back 70

 Aortic Pulmonic

Front 71

Valves Assist in

Back 71

Preventing regurgitation

Maintaining flow/pressure gradients

Front 72

Arteries are?

Back 72

they Carry Oxygenatedblood to theperipheries (systemic) Capillary beds Dense, elastic walls Smooth muscle Autonomic Located deeply Pulsatile (palpation)

Front 73

Veins are?

Back 73

 Parallel to Arteries Carry deoxygenatedblood (systemic) Thin walled Contain valves Consider gravity Skeletal muscle pump Pulsatile (inspection)

Front 74

Veins flow is only?

Back 74

20/10mmHg

Front 75

Afterload is?

Back 75

 Ability of left ventricle to push open Aortic valve andpump blood into systemic circulation

Front 76

Preload is?

Back 76

 Dependant on venous return ‘Frank-starlings’ principle

Front 77

 Cardiac Output CO=

Back 77

HR x SV

Heart Rate x Stroke Volume

Front 78

Heart Rate is related to?

Back 78

 Autonomicinnervation Venous return Hormones Conduction Fever

Front 79

Stroke Volume is related to?

Back 79

 Preload Afterload Contractility Autonomicinnervation Drugs

Front 80

 When the heart pumps, blood is pushed out of theheart to the body to provide oxygen, heat andnutrients to all body tissues Generally conduction, filling, pumping andresting of the heart are perfectly timed andcontrolled to maintain cardiac output. Multiple Homeostatic mechanism

Back 80

CIRCULATION PHYSIOLOGY

Front 81

Right Side of Heart provides the?

Back 81

 Venous system Right Atrium Tricuspid Valve (S1) Right Ventricle Pulmonic Valve (S2) Pulmonary Artery Lungs

Front 82

Left Side of Heart provides the?

Back 82

 Pulmonary Veins Left Atrium Bicuspid valve (S1) Left Ventricle Aortic Valve (S2) Head and Bod

Front 83

Back 83

Jugular veins

Front 84

Back 84

Carotid Artery Located in groovebetween supra sternalnotch andsternocleidomastoidmuscle Bilateral pulse Be mindful of Vagusnerve

Front 85

Back 85

Precordium - anterior thorax directly overlying Heart andgreat vessels

Front 86

What to look for when inspecting the precordium?

Back 86

Any visible pulsations? (Apical Pulse) Condition of skin

Front 87

what does the Jugular veins do?

Back 87

drain blood from head into Superior vena cava  Indicative of volumestatus and pumpefficiency

Front 88

When Palpating Carotid Artery?

Back 88

 One side at a time!  Be mindful of the Vagus nerve!  Grading of 2+, bilaterally

Front 89

where to Palpate Apical Pulse

Back 89

medial to left mid-clavicular line in 4th-5th intercostal space

Front 90

Palpating the precordium can determine what?

Back 90

It can determine the presence of thrills

Front 91

Why is it difficult to percuss the heart

Back 91

Difficult due its anatomical location

Front 92

Predominant note when percussing is

Back 92

Predominant note: Dullness

Front 93

Back 93

Normal heart

Front 94

Back 94

Enlarged heart

Front 95

Important toauscultate global andlocalised heart sounds such as?

Back 95

 R) 2nd ICS = Aortic

 L) 2nd ICS = pulmonic

 L) 5th ICS/SB = Tricuspid

 L) 5th ICS/MCL = bicuspid

Front 96

Placing your stethoscope over these dots mean your listening to?

Back 96

RED DOT- aortic valve sounds

BLUE DOT- pulmonic valve sounds

GREEN DOT- Erbs point (where aortic and pulmonic valve sounds radiate)

YELLOW DOT- Tricuspid valve sounds

PURPLE DOT- Mitral valve sounds

Front 97

S1 Known as Lub is the closure of which valves

Back 97

AV valves

Front 98

Closure of AV valves is an indication of

Back 98

beginning ofSystole Coincides withCarotid pulse

Front 99

S2 Known as (Dub) is the closure of which valves

Back 99

Closure of SL valves

Front 100

Closure of SL Valves indicate?

Back 100

Indicates end ofSystole (markingbeginning of Diastole)

Front 101

Turbulence offlow due to incompetentvalves or Stenosis Congenital or diseaserelated. Could be a?

Back 101

Murmur

Front 102

A murmur can impact what?

Back 102

Cardiac Output

Front 103

Split S2 is

Back 103

 Normal phenomenon Impact of ↑ intrathoracicpressure on pulmonicvalve

Front 104

 Abnormal in adults Indicates decreasedcompliance ofventricles Eg. Heart failure Valve incompetence Described as dull/lowpitched

Back 104

Pathophysiology of S3

Front 105

 Rare Indicates decreasedcompliance ofventricles Eg. Ventricular failure Soft/low pitched

Back 105

Pathophysiology of S4

Front 106

Murmur, Split S2, S3, S4, Pericardial Rub, Bruit are what sound?

Back 106

Adventitous

Front 107

 Caused byinflammation Eg. Pericardititis High pitched/scratchy Sit patient forward

Back 107

Pathophysiology of Pericardial Rub

Front 108

PERIPHERAL VASCULARASSESSMENT includes

Back 108

InspectionPalpation(Auscultation)

Front 109

Back 109

Temporal

Front 110

Back 110

Brachial and Radial

Front 111

Back 111

Femoral

Front 112

Consider pulse grading

Back 112

Arterial pulses

Front 113

Vebous Flow is Facilitated by

Back 113

 Skeletal muscle pump Intrathoracic gradients Intraluminal valves

Front 114

Lymphatic system drains what?

Back 114

Lymph Fluid from tissues back into blood

Front 115

Lymph nodes Contain

Back 115

lymphocytes

Front 116

ASSESSING PERIPHERAL VASCULARSYSTEM- subjective data

Back 116

 Subjective data Phx Sensation/pain issues in legs/arms Swelling Medications Skin changes

Front 117

Back 117

Varicose Veins

Front 118

The further away apulse site is fromthe heart the morediminished theamplitude this could mean that

Back 118

Hypotensive patientsmay have absentperipheral pulses insome areas.

Front 119

With hypotensive patients you should consider using a What to find certain pulses

Back 119

 Consider use ofDoppler

Front 120

If you have trouble finding pulses you should

Back 120

 Determine capillaryreturn Consider oedema

Front 121

Grade pulses like this?

Back 121

 0 Absent 1+ weak 2+ normal 3+ bounding Bilateral?

Front 122

Checking both sides of your patient for temp is known as

Back 122

Bilateral Temperature

Front 123

What is not directly assessed in peripheral vascular assessment

Back 123

percussion

Front 124

When Auscultating you should check the following arteries for bruits.

Back 124

 Femoral Arteries Abdominal Aorta Renal Arteries

Front 125

. Describe three mechanisms that help venous blood return to the heart

Back 125

1. Contracting skeletal muscles that milk the blood proximally, back towards the heart

2. Pressure gradient caused by breathing

3. one-way (intraluminal valves) ensure unidirectional flow

Front 126

Describe the function f the lymphatic system

Back 126

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) absorb lipids from the intestinal tractWithout lymphatic drainage, fluid would build up in the interstitial spaces and produce oedema

Front 127

Describe the function of the lymph nodes

Back 127

Filter fluid before it is returned to the bloodstream and filter out pathogens

Front 128

Name the related organs in the lymphatic system

Back 128

spleen-tonsils-thymus

Front 129

Gradin scale for pitting odema

Back 129

1+: slight pitting/2 mm, disappears rapidly,

2+: somwehat deeper pit/4 mm, disappears in 10-15 sec

3+: deep pit/6 mm, may last > 1 minute; dep extremity swollen

4+: very deep pit/8 mm, lasts 2-5 min, dep extremity grossly distorted

Front 130

One of the leg's deep veins is the:

Back 130

Popliteal

Front 131

Arteriosclerosis refers to

Back 131

Thickening and loss of elasticity of the artery walls

Front 132

Lymph nodes are palpable in:

Back 132

1) Children with infections2) Adults with infectionsc) Healthy children

Front 133

Lymphoedema is

Back 133

the swelling of an extremity caused by an obstructed lymph channel

Front 134

A function of the venous system

Back 134

to hold more blood when blood volume increase

Front 135

A pulse with an amplitude of 3+ would be considered:

Back 135

Increased

Front 136

How is capillary return (refill) assessed? What is a normal response?

Back 136

time it takes for color to return to an external capillary bed after pressure is applied 2 sec