Interventions 2 Module 5

Front 1

xanthelasma

Back 1

hyperlipidemia sign

yellow cholesterol deposits, normally near inner canthus, near bridge of nose

lipid rich deposits

possibly atherosclerosis

Front 2

jugular veins show function of

Back 2

the right side of the heart

the amount they are visible tells us the pressure in the right side of the atria.

visible above clavicles and adjacent to sternocleidomastoid muscle

visible when patient is lying down because they become engorged

Front 3

assess for JVD- jugular veinous distention

Back 3

put in supine position to become engorged and then slowly raise head of bed to 45 degree angle. you should not be able to see it at this point, if you can, it means congestive heart failure, fluid overload etc.

Front 4

assess precordium

Back 4

precordium is chest wall above heart cavity

some movements might be very vague, might not be able to see them if looking down, look across and use light tangentally

looking for: pulsations (not normal, except at area of apical pulse),

lifts (chest cavity on that side is appearing to lift up, seen at left ventricular hypertrophy),

thrills (cat purring, rushing, vibrating, means valve disease. has to be extensive to see it, normally palpated first)

Front 5

palpating heart

Back 5

make sure they are supine and head slightly elevated

3 hand movements, entire palm of hand along apex of heart (fifth rib, below nipple) for 5-10 seconds, feel for pulsations, lifts, thrills. then lift hand up and place along left sternal border. then lift and place around base of heart (second intercostal space). palpate for apical pulse. only pulse that is readily palpable- reflects ventricular recoil. should be at midclavicular line. should be gentle and brief. if not, it is a lift. if forceful and sustained- increased cardiac output or left ventricular hypertrophy

Front 6

projection of sound

Back 6

2nd intercostal space- aortic valve will be heard best. not directly under this space though because sound is projected upwards

semilunar valve heard best at base of heart because being projected downwards.

Front 7

5 landmarks

Back 7

aortic area (S2 should be louder, aortic valve is heard best, right sternal border, below second rib), pulmonic area (S2 should be louder, opposite, second intercostal space, left sternal border), Erb's point (valves are equal, not associated with a valve. 3rd intercostal space, left intercostal space, frequently hear murmurs), tricuspid area (S1 is louder, tricuspid space, 4th intercostal space, left sternal border), mitral area (S1 louder, fifth intercostal space, apical pulse, mitral valve, midclavicular line)

s2 is closure of semilunar (aortic and pulmonary)

s1 closure of AV- tricuspid and mitral valve

Front 8

three positions to have patient in to auscultate

Back 8

patient leaning slightly forward and listen with the diaphragm of stethoscope at all 5 landmarks- aortic murmurs can be heard

patient lying supine- listen with diaphragm at all 5 areas

roll patient to left lateral position- listen with the bell at all 5 areas- mitral murmurs can be heard best.

need to make sure patient is warm to hear better. low frequency sounds, need to have quiet environment

Front 9

auscultate carotid arteries

Back 9

use bell of stethoscope

listening for bruit- blowing/ rushing sound, turbulant blood flow because of aneurysm making boggy wall of artery,

can hear heart sounds sometimes.

afterwards you palpate carotid artery. easily palpated. useful for evaluating heart because close to it. note symmetry of strength. palpate carotid while auscultating apical pulse, should be synchronous

should not hear anything at all

Front 10

murmur

Back 10

disruption of blood flow through heart

valves not functioning, valves are not sufficient to open enough for blood, rate of blood flow is too high (pregnancy, anemia, thyrotoxicosis)

Front 11

stenosis

Back 11

valve opening problems, stiff and non compliant, don't open enough to accomodate amount of blood flow

quiver when put under pressure

Front 12

insufficiency or regurgitation

Back 12

function of valve to close is problematic

valves walls are floppy

Front 13

murmur grading

Back 13

grade 1 is barely audible with stethoscope and grade 6 is so loud you can hear it standing next to someone

most murmurs are graded.

Front 14

peripheral vascular assessment

Back 14

look at arms and legs for color, hair distribution (terminal hair on arms and legs should be present, arterial vascular issues leads to absent hair growth), texture/ moisture (lichanification- thickening and roughening of area of skin), edema (pitting or nonpitting), venous patterns (varicose veins, dilated/swollen, incompetant walls or valves in veins), lesions (scars, nonhealing open wounds, tells you if they are nonhealing)

palpate for temperature and pulses for symmetry, strength, rate, patency. test capillary refill

Front 15

peripheral arterial disease

Back 15

insufficient tissue perfusion, not enough oxygen getting to cells. can be acute (DVT), or chronic (atherosclerosis). if chronic, rarely isolated condition and there is probably buildup of plaque somewhere else.

s/s: shiny pale skin, dependent rubor, cool skin, prolonged capillary refil, weak pulses, no hair, necrosis possible, sharp stabbing pain, clubbed fingers, thick nails (not getting adequate oxygen), claudication (sharp stabbing pain when walking) relieved by rest is CLASSIC sign, nonhealing wounds

Front 16

peripheral venous disease

Back 16

varicosities, chronic venous insufficiencies (pooling of blood, edema)

getting oxygen to cells, but not returning it

s/s: pruritis, brown skin, warm skin, strong pulses, hair is present as is edema, aching/ crampy pain

prone to skin tears, fragile skin. prone to STASIS ULCERS. exacerbated by standing for long periods of time

Front 17

electrocardiograms

Back 17

measures heart electrical activity.

things that cause electrical disturbance- ischemia, infarction, rhythm/ conduction problems, drug toxicity, electrolyte imbalances, structural defects.

Front 18

how to get accurate EKG

Back 18

need to place leads properly, poor placement can result in inaccurate reading

make them comfortable, skin is warm/ dry, don't let feet touch foot board, wires are lettered and color coded, don't make cold/ shivering, don't let them to talk

Front 19

12 lead EKG

Back 19

lead 1: V1- 4th intercostal space right sternal border

lead 2: V2- other side, 4th intercostal space left sternal border

Lead 3: between V2 and V4

Lead 4: V4- 5th intercostal space midclavicular line

lead 5: V5- 5th intercostal space left anterior axilary line

lead 6: V6- 5th intercostal space left mid axilary line

Front 20

3 lead

Back 20

leads are color coded.

right arm (white), left arm (black (below left clavicle), left leg (red) (lower chest above and left of umbilicus)

use 5 lead EKG and only place 3 leads

not going to be placing green or brown lead

Front 21

5 lead EKG

Back 21

same as 3 lead plus right leg (green- lower chest above and to the right of umbilicus), and brown which is one of the 6 precordial leads (V1-V6 placements) (normally placed at 4th inner costal space right sternal border)