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nursing > 2410<3assess (exam1) > Flashcards

2410<3assess (exam1) Flashcards

1
Q

the __ is the area on the anterior chest that overlies the great vessel

A

prechordium

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2
Q

the __occupies most of the anterior cardiac surface

A

(R) ventricle

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3
Q

the __ of the heart refers to the proximal surface of the heart at the right & left 2nd ICS close to sternum

A

base

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4
Q

the __forms the left lateral margin of the heart

A

(L) ventricle

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5
Q

its tapered tip is referred to as the__ and produces the apical impulse AKA point of maximal intensity

A

apex

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6
Q

the __ & __ return o2 poor venous blood to the (R) side of <3

A

superior & inferior vena cava

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7
Q

the blood flows through the right __ through the __ & into the __

A

atrium, tricusid valve, (R) ventricle

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8
Q

the __ blood leaves the right ventricle through __ & carries the venous blood to the __

A

unoxygenated blood, pulmonic valve, pulmonic artery

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9
Q

the __ returns o2 rich blood to the __ through the __ into the __

A

pulmonic vein, (L) atrium, mitral valve, (L) ventricle

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10
Q

it is delivered to the body through the __ and into the __

A

aortic valve, aorta

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11
Q

position of <3

A

extends from 2 ICS to 5 ICS from (R) border of the sternum to LMCL

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12
Q 
describe position of:
cardiac valves
tricuspid
mitral
aortic
pulmonic
A

separates RA from RV
separates LA from LV
btw LV & aorta
btw RV & pulmonary artery

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13
Q

describe diastole

  1. valve
  2. pressure
  3. 1st & last phase
  4. end
  5. associated sound
A

ventricular relax

  1. AV valves are open
  2. atrial pressure > ventricular pressure
  3. 1st: early/protodiastolic filling
    last: atrial systole or presystole (atrial kick)
  4. end: atria contract pushing remainder of blood into ventricles
  5. normally silent
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14
Q

describe systole

  1. valve
  2. pressure
  3. 2 phases
A

ventricular contract

  1. (AV) mitral & tricuspid valve closed
  2. ventricular pressure> atrial pressure
  3. S1 phase S2 phase:
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15
Q

what are AV valves

A

(atrioventricular) mitral & tricuspid

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16
Q

what are SL valves

A

(semilunar) aortic & pulmonic

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17
Q

describe two phases of systole where best heard

A

S1 phase: CLOSURE OF AV valves signal sysole and -pressure in ventricles rise SL (aortic & pulmonic) valves open (heard @ apex)

S2 phase: @ end of systole, ventricular pressure decrease and SL valves close, CLOSURE OF SL valves signals end of systole ( heard @ base)

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18
Q

effects of respiraton on <3 & what is it called

A

moRe right Less left
decrease in intrathroacic pressure -> increase venous blood on (R) side of delays closure of pulmonic valve
less volume on (L) -> aortic valve closes early
SPLIT S2

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19
Q

Describe S3

  1. what happens
  2. when it happens
  3. valves
  4. best heard
A

protodiastolic phase (early diastole)

  • rapid filling
  • immediately after s2
  • AV valves opened-> blood rushing in ventricles
  • left lateral position apex
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20
Q

when will you hear S3

A
  • in people with heart failure or high cardiac output state or filling overlaod
  • can hear in young ppl w/ compliant vessels
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21
Q

Describe s4

  1. when
  2. aka
  3. whats happening
A

presystolic phase

  • occurs before s1, at end of diastole
  • presystole
  • ventricles are resistant to filling & atria push blood into noncompliant ventricles
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22
Q

define murmur & conditions that cause it

A

gentle blowing swishing sound
increase velocity, viscosity in blood
defects in valves
dilated chamber

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23
Q

developmental changes in infants & children

A

<3 is more horizontal
apex is higher (4th ICS MCL)
adult position by 7 yo

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24
Q

developmental changes in preg. women

A

blood volume increase by 30-40%
HR increase
BP low due to peripheral vasodilation

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25
Q

developmental changes in aging adult

A

increase BP
increase HR
arrythmia increase
increase incidence in <3dz

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26
Q

define angina & describe symptoms

A

chest pain

diaphroresis, pallor, palpitations, dyspnea, nausea, trachy<3

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27
Q

define DOE & PND

A

Dyspnea on exertion

paroxysmal nocturnal dyspnea (occurs with <3 fail)

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28
Q

what happens in PND

A

Pt lies down-> increase of volume of intrathoracic blood to weak <3 cant accomodate increase of blood, pt wakes up SOB

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29
Q

define hemoptysis

when is cardiac fatigue the worst

A

blood in sputum

evening

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30
Q

where are carotids palpated

where are carotids auscultated

A

base of neck

angle of jaw, mid cervicle, base of neck

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31
Q

why do we inspect JVP

A

Jugular venous pressure

  1. can reflect central venous pressure
  2. no cardiac valves separate the superior vena cava from RA
  3. JVP gives good info about (R) side of <3
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32
Q

position of PT to assess JVP

A
  1. 30-45 degrees
  2. remove pillow
  3. turn head slightly to (L)
  4. look for pulsation in IJV EJV
33
Q

how to estimate the JVP

A
  1. use the angle of louis
  2. with ruler on angle of louis align with pulsations
  3. normal is = or < 2cm
34
Q

hepatojugular reflex

A

holding hand in RUQ, push, which empties blood from liver into venous sysem, if heart can’t pump JVP will rise will occur with <3 failure

35
Q

w/ deep inspiration this <3 sound will sound like 2 distinct sounds

A

split s2

36
Q

heard best with Diaphragm

A

s1 s2 split s2

37
Q

tennes se

A

s4

38
Q

heard every 4th beat

A

split s2

39
Q 
S3
what phase
what part of steth is used 
where is it best heard
best PT position
does it vary with resp
found normally in
what kind of gallop 
which state is it associated with
A 
early diastolic
low pitched (bell)
apex
left lateral position
no
children, young people
ventricular
ken tucky
40
Q

corresponds with carotid

A

s1

41
Q 
S4
what causes this sound
when do you hear it
what kind of sound
when is it normally heard
kind of gallop
best heard where & PT position
state association
A 
ventricular filling
heard before S1
soft low pitch (bell)
adults after exercising
atrial gallop
@ apex left lateral position
Tennes se
42
Q

heard best at pulmonic valve area, what ICS

A

s2, split s2, 2nd LICS

43
Q

occurs b/c of noncompliance

A

s3 s4

44
Q

mitral valve precedes tricuspid but heard as one sound

A

s1

45
Q

atrial gallop

A

s4

46
Q

best heard at left lateral position

A

s3 s4

47
Q

heard in young children and young adults

A

split s2 s3

48
Q

often heard with fluid overload

A

s3

49
Q

difference between split s2 & s3

A

split s2 every 4th but s3 every beat

50
Q

how to assess prechordium and what are you checking for

A

using palmar/ulnar surface of hand, palplate apex and LSB base of heart, checking for thrills (palpable vibrations)

51
Q

what causes heaves or lifts and where seen

A

thrusting of the ventricles during systole, happens with ventricular hypertrophy
RV heave: sternal border
LV heave: apex

52
Q

norm position of apical impulse, abnorm and what does it indicate

A

norm: 4th or 5th ICS LMCL
abnorm: lower & lateral to LMCL ->LV hypertrophy

53
Q 
auscultation of <3, where are most murmurs heard
2nd RICS
2nd LICS
3rd LICS
5th LICS
5th LICS MCL
A

3rd LICS Erb’s point

  1. aortic
  2. pulmonic
  3. erb’s point
  4. tricuspid
  5. mitral
54
Q

systolic murmur

A

heard btw s1 & s2

55
Q

diastolic murmur

A

heard btw s2 & s1

56
Q

pan-systolic or holo-systolic

A

heard throughout

57
Q

3 loudness grades

A

I: barely audible
IV: associated with thrill
VI: loud with stethoscope slightly off chest

58
Q

3 patterns of murmurs

A

crescendo: grows louder
decrescendo: tapers
diamond: crescendo & decrescendo

59
Q

3 quality of murmurs

A

musical
blowing
harsh rumbling

60
Q

where can murmur radiate (4 areas)

A

precordium
neck
back
axillae

61
Q

7 characteristics of innocent murmur

A 
no pathology
soft grade 2 or more
midsystolic
musical
heard @ 2-3LICS
decreases when sitting
heard in children
62
Q

characteristic of functional murmur

A

turbulence of blood in heart
Occurs secondary to increased blood flow (anemia, fever, pregnancy, hyperthyroidism)
Disappears when condition is corrected

63
Q

order of exam for <3 & neck vessels

A

HR & BP
Neck Vessels
Precordium
extremities (periph vasc assessment)

64
Q

difference btw murmur & bruits

A

murmur: turbulence in blood flow in <3
bruits: turbulence of blood flow in atery

65
Q 
S1 
1 axn of valves 
2 sound produced
3 best heard (where & with what)
4 signals
A
  1. Closure of the atrioventricular valves
    Tricuspid and Mitral (AV valves)
  2. “Lub” of the lub-dub
  3. Best heard at the apex & with the diaphragm
    4 Signals beginning of systole
66
Q 
s2
1 axn of valves 
2 sound produced
3 best heard (where & with what)
4 signals
A
  1. Closure of the semilunar valves & Aortic and pulmonic
  2. “Dub” of the lub-dub
  3. Best heard at the base with the diaphragm
    4 Signals the end of systole
67
Q

define Protodiastolic

A

Early diastole is the passive filling phase of diastole

68
Q

Atrial systole or Atrial kick

A

End of diastole -> atria contract and push last amount of blood into ventricles

69
Q

Effects of respiration on S2

A

During inspiration, intrathoracic pressure is decreased. This increases venous blood return to the right side of the heart which increases the right ventricular stroke volume. The increased volume prolongs right ventricular systole and DELAYS closure of the pulmonic valve. Left side has less blood, thus aortic valve closes earlier than pulmonic valve. Can hear two components separately. Referred to as a split S2.

70
Q

When is S3 normal & abnormal (3)

A

norm: children
abnorm: Fluid overload, decreased compliance of the ventricle
Can occur with high output states

71
Q

When can you hear an S4

A

Normal after exercise

Abnormal: decreased compliance of the ventricles, hypertension

72
Q

norm jvp

A

2 cm or less with pt. at 30 degrees

73
Q

abnorm jvp

A

3 cm or more with pt. at 30 degrees

74
Q

If you note an elevated JVP reading, you should perform_______________

A

hepatojuglar reflex

75
Q

Heave or lift

A

Forceful thrusting seen on the chest wall.
L ventricular lift -> apex
Right ventricular lift -> sternal border

76
Q

Diaphragm of the stethoscope (3 sounds)

A

Normal heart sounds, split S2, aortic or pulmonic valve murmurs

77
Q

Bell of the stethoscope (3 sounds)

A

S3, S4 (also called diastolic sounds), mitral and tricuspid valve murmurs

78
Q

How do you evaluate a murmur? (8)

A 
Timing: diastolic or systolic
Loudness: grade I through VI
Pitch: high, medium or low
Pattern: crescendo, decrescendo, diamond-shaped
Quality: musical, blowing, harsh, rumbling
Location
Radiation
Posture

nursing (15 decks)

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