10.2 Flashcards
What specific questions who you ask someone coming in with chest pain?
- what factors influence the pain?
- does the pain radiate?
- is there position related relief?
- any dizziness/ cyanosis?
- any use of nitroglycerin?
- cough, dyspnea, syncope, leg pain/cramps, severe HA, swollen ankles
What pertinent FMHx are you looking for with chest pain?
- DM
- heart disease
- hyperlipidemia
- hypertension
- obesity
- congenital heart defects
- sudden death
What are some associated sx to look out for with chest pain?
- Anxiety
- Dyspnea
- Diaphoresis
- Dizziness
- Nausea
- Vomiting
SoHx to consider with chest pain
- employment risks
- tobacco
- alcohol
- diet
- exercise
- stress
- drug use
Who are at greater risk for cardiac problems?
- Pregnant women
- Elderly
What are the 4 components of a heart examination?
- Inspection
- Palpation
- Percussion
- Auscultation
What are you inspecting the chest wall, carotid arteries and jugular veins for?
- pulsations
- lifts
- heaves
- thrusts
- symmetry
What are you inspecting the skin for?
- cyanosis of the nailbeds
- capillary refill
Where can you palpate the apical pulse?
Midclavicular line, 5th intercostal
What are the 6 places you palpate?
- the base
- left sternal border
- right sternal border
- apex
- epigastrium
- left axillae
What positions should you have the patient in for auscultation?
- Sitting
- Supine
- Left lateral recumbent
What are you describing while auscultating?
- rate
- rhythm
- duration of cycle
- timing
- intensity
- frequency
- splitting
- murmurs
- quality
What are you auscultating the carotid arteries for?
- bruits
- murmurs
What basic heart sounds are you listening for?
- S1
- S2
What valves are closed during S1?
What valves are open during S1?
Closed: (M)itral and (T)ricuspid
Open: (A)ortic and (P)ulmonic
What valves are closed during S2?
What valves are open during S2?
Closed: (A)ortic and (P)ulmonic
Open: (M)itral and (T)ricuspid
What is a normal resting HR for an adult?
60 - 90bpm
In a slender person the heart is more…
vertical and central
In a stocky person the heart lies
horizontally and to the left
Wide apical pulsation may indicate what?
Left ventricular hypertrophy
Loss of palpable apical pulsation may indicated what?
fluid, air, or displacement
Thrills are associated with what pathology?
- failure of semilunar valve to close
- aortic/pulmonary stenosis
- atrial septal defect
Loud S1 could suggest what?
Increased blood velocity
mitral stenosis
heart block
hypertension
calcification of mitral valve
Loud S2 suggests?
hypertension
valve disorder
stenosis
fluid
Frictional rubs can be caused by?
what do they sound like?
pericardial sac inflammation
grating, machine-like rubbing
What should you be inspecting for in the veins?
- JVD
- varicose veins
Inspect extremities for findings of arterial and venous insufficiencies, what are you looking for?
- edema
- erythema
- absence of hair
- cyanosis
- pallor
- ulcers
- cool skin
What 8 arteries are we palpating?
- Temporal
- Carotid
- Brachial
- Radial
- Femoral
- Popliteal
- Posterior tibialis
- Dorsalis pedis
What are you comparing while palpating pulses?
Contralateral pulses
lower and upper extremities
What is pulse pressure?
the difference between systolic and diastolic pressures.
What 4 variables contribute to the characteristics of the pulse?
1) Volume of blood ejected (stroke volume)
2) Distension of the aorta and large arteries
3) Viscosity of the blood
4) Peripheral arteriolar resistance
What are bruits?
turbulent blood flow
Inspect the chest wall, carotid arteries and jugular veins for
- pulsations
- lifts
- heaves
- thrills
- symmetry
Inspect extremities for…
- color
- hair distribution
- venous distention
Inspect the nailbeds for
cyanosis
capillary refill
What is the scale for amplitude of pulse?
4= Bounding, aneurysmal
3= Full, increased
2= Expected
1= Diminished
0=Absent
What is the scale for pitting edema?
1+ Slight pit (2-3mm)
2+ Somewhat deep pit (10-15sec or 4-5mm)
3+ Noticeable deep pit (longer than 1min or 6-7mm)
4+ Very deep pit (2-5min or 8-9mm)
Palpate and assess for thrombosis
- Redness, thickness of the vein, tenderness along superficial vein, and warmth
- Can be indicated through taking a good history and exam
- Homan’s sign (discomfort behind the knee upon forced dorsiflexion of the foot)
- Use Doppler for confirmation of diagnosis
What is the way we test for varicose veins?
Have the patient do 10 calf raises
What are normal findings on an adult?
no visible pulsations, or heaving of chest
pulses symmetric
bilat 2+
extremities warm and pink with hair present
Systolic: 100-140 Diastolic: 60-90
What happens to your BP when you stand up?
Systolic pressure drops, diastolic pressure rises
Jugular distention <9cm suggests
ventricular failure
Positive Homan’s sign indicates
venous thrombosis
Fluid always reflects what color on an ultrasound?
BLACK
Tissue is always what color on an ultrasound?
GRAY
What color will bone appear on an ultrasound?
WHITE
What operating mode is a two-dimensional image
is generated that portrays moving reflectors in color simultaneously with images.
Color Flow Doppler
What regulates the amplification (brightness) of returning echoes to compensate for loss of transmitted sound caused by absorption and reflection?
Gain
What is a relative term that refers to the echoes returned from a
structure?
Hyperechoic
What refers to structures that contain fewer or weaker echoes
than surrounding tissues.
Hypoechoic
What is the ability to distinguish between two adjacent structures
(interfaces)?
Resolution
What is an electromechanical device that is part of an ultrasound
system, that contacts the patient and converts electrical energy into mechanical energy and vice versa?
Transducer
What Color represents TOWARD the probe?
Red
What color indicates flow going AWAY from the probe?
Blue
What are the 3 main types of ultrasound probes?
- Curvilinear probe
- Linear probe
- Phased array probe
Which probe is used for abdominal and obstetric imaging?
Curvilinear probe
Which probe is used for soft tissue and small parts imaging?
Linear probes
Which probe is used to “bend” the US beam from flat, small footprint to a wider pie-shaped wedge distally.
Phased array probes
