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cardiac Flashcards

1
Q

Focused cardiac health history includes_

A

activity level, lifestyle choices, chest pain, palpitations, SOB, edema

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2
Q

T/F Palpitations are a subjective finding?

A

TRUE! They are a subjective finding b/c it’s what the pt feels; nurse cannot see or feel papitation, more of an irregular pulse and fast heart beat sound

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3
Q

pertinent activity level info is_

A

current activity level, amt of exercise:dly, wkly, mthly, lack or exercise:preference vs inability, pain c exercise, suddne onset of change in tolerable activity level: sudden onset or alwas been this way

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4
Q

pertinent lifestyle info includes_

A

smoking or tobacco use(pack use), caffeine intake (amt of coffee, tea, or energy drinks per day (energy drinks can affect heart rhythm palpitations), alcohol use(#of drinks/day, how many oz of hard alcohol *important to quantify), rx or illicit drug use(vicodin #1 drug addiction in US)

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5
Q

what is included in chest pain focused hx

A

chronic or acute onset(how long does it last/when does it come on), onset & duration, aggravating/relieving factors(exercise, deep breathing), quality (pressing, viselike-gripping pain, severe, ripping, where do you feel it), radiation to shoulder, jaw, back, neck–> women typically complain of upper back pain rather than chest pain (gender difference in complaints)

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6
Q

what is included in focused palpitations hx

A

description(skipping, racing, fluttering, pouding, is it due to anxiety, acute or chronic, any associated symptoms(cough, SOB, or nausea c chest pain), are there aggravating/alleviating factors

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7
Q

what do we want to know about SOB hx

A

dyspnea, orthopnea, paroxysmal nocturnal, dyspnea, cough

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8
Q

what is dyspnea

A

difficulty c inspiration or expiration; sudden onset may be due to PE, pneumothorax, anxiety, or recent surgery

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9
Q

what is orthopnea

A

difficulty breathing when lying down; may be due to CHF; mostly seen in elderly pts

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10
Q

what is paroxysmal nocturnal dyspnea

A

difficulty breathing & awakening during sleep; sleeping and wake up c difficulty breathing; may be due to HF, asthma, or COPD

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11
Q

what can a cough indicate

A

productive or nonproductive c chest pain may indicate CHF or coexisting pulmonary infection

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12
Q

what do we want to know about hx of edema

A

dependent edema-located in feet or ankles, periorbital edema - edema in tissues surrounding eyes

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13
Q

T/F Periorbital edema is a normal finding

A

FALSE! It is rarely a normal finding! May be due to severe pre-eclampsia, renal/liver failure *NORMAL in newborns but not after this point

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14
Q

T/F Pedal edema in pregnant women is normal

A

TRUE! It is only normal in pregnant women! ABNORMAL finding in elderly pts and can be indicative of CHF or vascular insufficiency

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15
Q

Dependent edema includes_

A

presence of sores that don_t heal on lower extremeties–>vascular or circulatory insufficiency, darkening of skin in ankles on darker individuals

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16
Q

what is involved in assessing the heart

A

eyes, neck, chest, peripheral aterial pulses, peripheral venous system, BP, HR, pulse pressure

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17
Q

what does an eye exam for assess of heart consist of

A

direct visualization of vasculature for pathology; vascular changes occur with HTN and other healthcare problems

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18
Q

what does a neck exam for heart assess consist of

A

observe rt jugular vein pressure to estimate central venous pressure

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19
Q

what does a chest exam for heart assess consist of

A

inspection of chest wall, auscultation of sounds, palpation for PMI, and/or thrills

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20
Q

why are peripheral arterial pulses assessed

A

indicates degree of perfusion, apical pulse and radial pulse comparison

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21
Q

why is the peripheral venous system assessed

A

it inicates degree of return of flow to heart

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22
Q

why are vitals signs assessed for the heart

A

they are an essential component of heart assessment

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23
Q

what is important in the vascular anatomy of the neck

A

palpation of carotid artery, assessment of juglar vein, assessment of jugular vain pressure

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24
Q

what is involved in the exam of the neck

A

carotid pulse-assessment of circulation to head and neck; bruits may be detected by listening with stethoscope

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25
what is jugular venous pressure part of
examination of the neck! An assessment of: rt arterial pressure, central venous pressure, rt ventricular pressure
26
T/F Detection of a bruits in the carotid is a normal finding
FALSE! This is an ABNORMAL finding
27
changes in JVP indicate
fluctuations in volume status, rt and lt ventricular function, tricuspid & pulmonic patency, pericardial pressures, arrhythmias
28
low JVP indicate
hypovolemia(decrease in blood volume) possibly due to hemorrhage or trauma
29
what does an elevated JVP indicate
HF, pulmonary HTN, tricuspid stenosis, pericardial compression-->mostly important if there is suspicion that pt has CHF
30
usually JVP is abnormal when it is
elevated
31
JVP exam procedure
HOB 30*, view rt side of neck, place cm ruler upright at sternal angle, identify highest point of pulsation of jugular vein, place horizontal plane from top of pulsation to ruler making a right angle, measure distance above sternal angle, 3-4cm is normal
32
what are the surface landmarks of the chest
midsternal line, midclavicular line(mcl), anterior axillary line(aal), midaxillary line(mal)
33
what is the blood flow through the heart
right to left; blood flow into RA to RV, out of pulmonary artery to the lungs, then back through LA to LV, and finally out of aorta to rest of body
34
what is S1
systole! Ventricles contract, pulmonic and aortic valves open
35
what is S2
diastole! Ventricles relax, tricuspid and mitral valves open
36
assessment of the chest wall includes_
inspection, palpation, auscultation
37
inspection for chest wall is of
chest wall shape
38
where do we palpate the chest and why
point of maximal impulse (PMI), useful in assessing murmurs for thrills
39
what is PMI
where the apex of the heart taps against the chest wall during systole
40
what do we listen for in auscultation of chest wall
rate & rhythm, quailty & timing of valve closure, extra sounds, turbulence
41
what is a thrill
sound vibrations from blood turbulence in the heart as it rushes past valves or within the heart chambers
42
what is a murmur
extra sounds in the heart that are not S1 or S2 and are longer than either of these heart sounds
43
T/F a murmur can be palpated only
FALSE! Murmurs are audible only but can be so loud that they are heard with the stethoscope off of the chest wall; the palpable component of a murmur is the thrill BUT not all murmurs have thrills
44
what is a bruit
Bruits are murmurs that are audible in the large vessels such as the jugular. It is the sound of turbulence in large vessels that can be NORMAL in kids but ABNORMAL in adults
45
where is PMI palpable
5th ICS, MCL, or left ventricular apex
46
if a murmur is found upon palpation it is always going to be_
a grade 3 or higher
47
S1 is_
the closure of the AV or mitral an tricuspid valves marking the onset of ventricular contraction
48
S2 is_
the closure of the semilunar, aortic, and pulmonic valves marking onset of ventricular relaxation
49
when does splitting occur
only in S2; may occur if aortic and pulmonic valves do not close simultaneously--> may be due to pulmonary stenosis or pulmonary HTN
50
what is S3
low frequency sound occurring early in diastole as a result of turbulence created by atrial emptying against the lt ventricular wall; NOT NORMAL
51
what is S4
low frequency sound occurring late in ventricular diastole as a result of turbulence; NOT NORMAL
52
what are ejection sounds
high frequency, sharp, clicking sounds, occurring during ventricular systole due to stenotic semilunar valve closure
53
what are the locations of cardiac valve auscultation
aortic-only heard on rt side along sternal border, pulmonic-2nd lt ICS along sternal border, Tricuspid-4th or 5th lt ICS along sternal border(xyphiod process), Mitral-4th or 5th ICS at MCL
54
what is needed when describing murmurs
timing and duration; timing-is it systolic or diastolic, can palpate carotid pulse to determine timing, if murmur coincides with cardiac upstroke it's a systolic tumor; duration-early, middle, or late systolic/diastolic
55
grade 1 of murmur is_
faint, may not be heard c each heart contraction
56
grade 2 of murmur is
quiet and may be heard easily
57
grade 3 of murmur is_
moderately loud and heard easily
58
grade 4 of murmur is_
loud with palpable thrill
59
grade 5 of murmur is_
very loud with thrill, may be heard when steth is partly off chest wall
60
grade 6 of murmur is_
very loud with thrill, may be heard with steth entirely off the chest
61
focused health hx questions for peripheral vascular system include_
common or concerning questions such as: pain or cramping in arms/legs, intermittent claudation(discomfort in lower extremity), cold/numbness/pallor in legs (raynauds disease), swelling in calves, legs, or feet, color change in fingertips or toes in cold weather, swelling with redness or tenderness in extremities, sores on legs or feet that don't heal (peripheral insufficiency)
62
what do you want to check for in arms
size/symmetry/skin color, radial pulse & brachial pulse, epitrochlear lymph nodes
63
what do you want to check for in legs
size/symmetry/skin color, femoral pulse & inguinal lymph nodes, popliteal/dorsal pedis/posterior tibial pulses, peripheral edema
64
what arterial pulses are close to body surface
radial, brachial, femoral, carotid
65
which arterial pulses are most commonly palpated in adults
radial and dorsalis pedis
66
T/F Veins have a pulse
FALSE! Only arteries have a pulse; veins have valves to aid in the flow of blood
67
where can pulses be palpated
femoral, popliteal, dosalis pedis, posterior tibial pulse
68
grading pulses
0=absent, unable to palpate;1+=diminished, weaker than expected;2+=brisk, expected(normal);3+=bounding
69
abnormal assessment of veins are_
redness, tenderness, edema, distension, increased warmth
70
how do you assess for edema
compare one foot and leg with the other(note size and prominence of veins, tendons, and bones), check for pitting edema(severity graded on 0-4 point scale), observe for skin darkening at ankle region--> the higher the edema on the LE the more severe it is
71
where are lymph nodes most easily assessed
the neck
72
where are lymph nodes easily assessed in children
under chin
73
T/F a single enlarged lymph is an abnormal finding
TRUE
74
which lymph node is the only exception to a single node enlargement
posterior auricular; seen in pts with otitis media

Health Assessment (7 decks)

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