Assessment: CV & PV Flashcards
Name 4 activities we ask about in a person’s personal history that could affect heart disease.
Smoking/tobacco use, alcohol use, diet, exercise
What is syncope?
Fainting; transient loss of consciousness
What is dyspnea?
Difficulty breathing
What is diaphoresis?
Excessive sweating
What is paroxysmal nocturnal dyspnea?
A sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position
What is orthopnea?
The sensation of breathlessness in the recumbent position, relieved by sitting or standing.
What is likely happening when we see numbness or pain in the extremities?
Blood can’t get to extremities or can’t return to heart.
Name 6 possible causes of chest pain
➢ Cardiac
➢ Musculoskeletal
➢ Pleural
➢ Gastrointestinal
➢ Pulmonary
➢ Psychoneurotic
With pulmonary chest pain, what are 2 possibilities of what could be happening?
Clot, ulcer
What might be a cause of psychoneurotic chest pain?
Hyperventilation from anxiety attack
True or false: Chest pain in children and adolescents is seldom due to a cardiac problem
True, often respiratory in nature
What should you assume the underlying issue is with chest pain in adults?
Cardiac until proven otherwise
Name the four valves of the heart.
- Pulmonary Valve
- Tricuspid Valve
- Mitral Valve
- Aortic Valve
Name the 5 main vessels of the heart.
- Superior Vena Cava
- Inferior Vena Cava
- Pulmonary Artery
- Pulmonary Vein
- Aorta
Which valve separates the left atrium from the left
ventricle?
Mitral
Which valve separates the right atrium from the right
ventricle?
Tricuspid
The apex is the bottom/top of the heart and the base is the bottom/top of the heart.
Apex is bottom, base is top
What heart sound is systole (pumping)?
S1
What heart sound is diastole (filling)?
S2
Where is S1 the loudest?
Apex
Where is S2 the loudest?
Base
When the first heart sound, “lub” occurs, the _______________ close.
atrioventricular
When the second heart sound, “lup” occurs, the _______________ close.
semilunar
The sound of S1 = closure of ______ and ______ valves
tricuspid and mitral
*increase in intraventricular pressure during contraction exceeds the pressure within the atria, causing a sudden closing of the tricuspid and mitral valves
The sound of S2 = closure of ______ and ______ valves
aortic and pulmonic
*At the end of systole, the ventricles begin to relax,
the pressures within the heart become less than that in the aorta and pulmonary artery, and the pulmonary and aortic valves snap shut.
What bpm reading would be considered tachycardia?
>100 bpm in an adult
What bpm reading would be considered bradycardia?
< 60 bpm
What is the order of the cardiovascular assessment?
Inspection, palpation, auscultation
Where is the suprasternal notch?
A large, visible dip in between the neck in humans, between the clavicles, and above the manubrium of the sternum.
Where is the angle of Louis (also called the Manubriosternal angle)?
Also called the sternal angle, this is the synarthrotic joint formed by the articulation of the manubrium and the body of the sternum.
What are intercostal spaces?
Spaces between the ribs that are largely occupied by muscles
What are some things to assess for during inspection?
Scars, lifts and heaves, pulsations, skin discoloration, chest wall deformities
What are thrills?
These are vibratory sensations felt on the skin overlying the heart, which indicates turbulence; this can be felt in loud murmurs.
Where does one palpate for the point of maximal impulse?
Mid-clavicular line, 5th intercostal space, palpate PMI with one finger (located under breast tissue in women)
What are some things to assess for during cardiac palpation?
Note any thrills, palpate the Point of Maximal Impulse
Can you feel the PMI in everyone?
No, about 50% of people
What are two things that will help you if you are trying to palpate the PMI?
Have the patient hold their breath or lay on their left side. These both push heart closer to the surface.
What is the mailing address of the heart?
2245 APT. M
Heart Blvd
What the eff does the 2245 stand for?
second ICS R of sternum
second ICS L of sternum
fourth ICS L of sternum
fifth ICS mid clavicular
What does APT M stand for?
Aortic area, pulmonary area, tricuspid area, mitral area
When we are auscultating heart sounds, where do we begin?
Start at the supra-sternal notch to the Angle of Louis, 2nd intercostal space
The third intercostal space, left sternal border is called what?
Erb’s point
What is the name for a high-pitched, scratchy sound caused by pericardial inflammation?
Cardiac rub (two pieces of oily salami is normal)
Where is a cardiac rub best heard?
Along the lower left sternal border using the diaphragm of the stethoscope with the patient sitting up, leaning forward, and briefly holding the breath.
How do you listen for murmurs?
Listen for murmurs in the same auscultatory sites: APTM.
What is the murmur grading system?
I - VI
What are two types of murmurs?
Regurgitation murmur - mitral valve insufficiency (bubbly murmur, a leak)
Ejection murmur – aortic stenosis
What are we checking in a peripheral vascular assessment?
- Skin temp
- Color
- Pulses
- Capillary refill
- Edema
What are the big kahuna vessels of the neck?
Carotid arteries and jugular veins
What is a bruit?
Blowing or swishing sound
What do we do when assessing the carotid arteries?
- Inspection (identify them)
- Palpate (pulse symmetry)—one at a time
- Auscultate for bruit (blowing or swishing sound)
What do we do when assessing the jugular veins?
Inspect bilaterally for distention
What is generally the most difficult pulse to find?
Popliteal
What is the name of the pulse point on the top of the foot?
Dorsalis pedis
What is the name of the pulse point on the back of the ankle, near the medial malleus?
Posterior tibeal
How do we grade pulses?
0-3+, 4+ in some places.
What does a 0 mean in pulse grading?
Absent
What does a 1+ mean in pulse grading?
Weak/thready
What does a 2+ mean in pulse grading?
Normal
What does a 3+ mean in pulse grading?
Increased, strong. Bounding.
If you are taking a CRT using a finger, where should the hand be?
Level with the heart
What is the edema grading system?
Grade if pitting present (1+ to 4+)
What is another way to assess edema?
Weight the patient
What is 1+ edema?
Disappears rapidly, “slight” (2mm)
What is 2+ edema?
Increased, disappears within 10-15 seconds (4mm)
What is 3+ edema?
Deeper, more obvious in extremetis, looks swollen, lasts 1 min (6mm)
What is 4+ edema?
Severe, looks edemous, can look deformed, lasts 2-3 minutes (8mm)
What is erythema?
Redness
Four things to assess for with a DVT
➢ Unilateral edema
➢ Pain or achiness
➢ Erythema
➢ Warmth
Should you move a patient with a suspected DVT or keep them still?
Do not move, could dislodge clot
Name whether this is a symptom related to a possible arterial vs. venous disorder: Pain after exercise.
Arterial
Name whether this is a symptom related to a possible arterial vs. venous disorder: Sharp, stabbing pain.
Arterial
Name whether this is a symptom related to a possible arterial vs. venous disorder: Pain with prolonged sitting or standing.
Venous
Name whether this is a symptom related to a possible arterial vs. venous disorder: Pain that is reduced with activity.
Venous
Name whether this is a symptom related to a possible arterial vs. venous disorder: Pain is described as aching, heavy.
Venous
Name whether this is a symptom related to a possible arterial vs. venous disorder: Lowering feet reduces pain.
Arterial
Which disorder is described by oxygenated blood being unable to get where it needs to be, type of atherosclerosis, affects legs more than arms, “can’t get the stuff out.” Arterial or venous disorder?
Arterial
Which disorder is described as a pump issue, “can’t get the stuff in.” Arterial or venous disorder?
Venous
Arterial or venous disorder?
Skin is:
Cool or cold
Hairless
Shiny
Arterial
Arterial or venous disorder?
Skin is:
Warm Thickened Mottled
Brown pigmented areas
Venous
Arterial or venous disorder?
Skin shows pallor on elevation and
rubor on dangling
Arterial
*Rubor is flushed
Arterial or venous disorder?
Pulses are often absent
Arterial
Arterial or venous disorder?
Pulses are usually present
Venous
Arterial or venous disorder?
Edema is frequent
Venous
Arterial or venous disorder?
Edema is infrequent
Arterial
What are the 6 P’s of acute arterial occlusion?
- Pain
- Poikilothermia (“coldness”)
- Parasthesia (burning or prickling sensation)
- Paralysis
- Pallor
- Pulselessness
What is poikilothermia?
Coldness
