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Health Assessment > cardiac > Flashcards

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
Q

what is jugular venous pressure part of

A

examination of the neck! An assessment of: rt arterial pressure, central venous pressure, rt ventricular pressure

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26
Q

T/F Detection of a bruits in the carotid is a normal finding

A

FALSE! This is an ABNORMAL finding

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27
Q

changes in JVP indicate

A

fluctuations in volume status, rt and lt ventricular function, tricuspid & pulmonic patency, pericardial pressures, arrhythmias

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28
Q

low JVP indicate

A

hypovolemia(decrease in blood volume) possibly due to hemorrhage or trauma

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29
Q

what does an elevated JVP indicate

A

HF, pulmonary HTN, tricuspid stenosis, pericardial compression–>mostly important if there is suspicion that pt has CHF

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30
Q

usually JVP is abnormal when it is

A

elevated

31
Q

JVP exam procedure

A

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
Q

what are the surface landmarks of the chest

A

midsternal line, midclavicular line(mcl), anterior axillary line(aal), midaxillary line(mal)

33
Q

what is the blood flow through the heart

A

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
Q

what is S1

A

systole! Ventricles contract, pulmonic and aortic valves open

35
Q

what is S2

A

diastole! Ventricles relax, tricuspid and mitral valves open

36
Q

assessment of the chest wall includes_

A

inspection, palpation, auscultation

37
Q

inspection for chest wall is of

A

chest wall shape

38
Q

where do we palpate the chest and why

A

point of maximal impulse (PMI), useful in assessing murmurs for thrills

39
Q

what is PMI

A

where the apex of the heart taps against the chest wall during systole

40
Q

what do we listen for in auscultation of chest wall

A

rate & rhythm, quailty & timing of valve closure, extra sounds, turbulence

41
Q

what is a thrill

A

sound vibrations from blood turbulence in the heart as it rushes past valves or within the heart chambers

42
Q

what is a murmur

A

extra sounds in the heart that are not S1 or S2 and are longer than either of these heart sounds

43
Q

T/F a murmur can be palpated only

A

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
Q

what is a bruit

A

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
Q

where is PMI palpable

A

5th ICS, MCL, or left ventricular apex

46
Q

if a murmur is found upon palpation it is always going to be_

A

a grade 3 or higher

47
Q

S1 is_

A

the closure of the AV or mitral an tricuspid valves marking the onset of ventricular contraction

48
Q

S2 is_

A

the closure of the semilunar, aortic, and pulmonic valves marking onset of ventricular relaxation

49
Q

when does splitting occur

A

only in S2; may occur if aortic and pulmonic valves do not close simultaneously–> may be due to pulmonary stenosis or pulmonary HTN

50
Q

what is S3

A

low frequency sound occurring early in diastole as a result of turbulence created by atrial emptying against the lt ventricular wall; NOT NORMAL

51
Q

what is S4

A

low frequency sound occurring late in ventricular diastole as a result of turbulence; NOT NORMAL

52
Q

what are ejection sounds

A

high frequency, sharp, clicking sounds, occurring during ventricular systole due to stenotic semilunar valve closure

53
Q

what are the locations of cardiac valve auscultation

A

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
Q

what is needed when describing murmurs

A

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
Q

grade 1 of murmur is_

A

faint, may not be heard c each heart contraction

56
Q

grade 2 of murmur is

A

quiet and may be heard easily

57
Q

grade 3 of murmur is_

A

moderately loud and heard easily

58
Q

grade 4 of murmur is_

A

loud with palpable thrill

59
Q

grade 5 of murmur is_

A

very loud with thrill, may be heard when steth is partly off chest wall

60
Q

grade 6 of murmur is_

A

very loud with thrill, may be heard with steth entirely off the chest

61
Q

focused health hx questions for peripheral vascular system include_

A

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
Q

what do you want to check for in arms

A

size/symmetry/skin color, radial pulse & brachial pulse, epitrochlear lymph nodes

63
Q

what do you want to check for in legs

A

size/symmetry/skin color, femoral pulse & inguinal lymph nodes, popliteal/dorsal pedis/posterior tibial pulses, peripheral edema

64
Q

what arterial pulses are close to body surface

A

radial, brachial, femoral, carotid

65
Q

which arterial pulses are most commonly palpated in adults

A

radial and dorsalis pedis

66
Q

T/F Veins have a pulse

A

FALSE! Only arteries have a pulse; veins have valves to aid in the flow of blood

67
Q

where can pulses be palpated

A

femoral, popliteal, dosalis pedis, posterior tibial pulse

68
Q

grading pulses

A

0=absent, unable to palpate;1+=diminished, weaker than expected;2+=brisk, expected(normal);3+=bounding

69
Q

abnormal assessment of veins are_

A

redness, tenderness, edema, distension, increased warmth

70
Q

how do you assess for edema

A

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
Q

where are lymph nodes most easily assessed

A

the neck

72
Q

where are lymph nodes easily assessed in children

A

under chin

73
Q

T/F a single enlarged lymph is an abnormal finding

A

TRUE

74
Q

which lymph node is the only exception to a single node enlargement

A

posterior auricular; seen in pts with otitis media

Health Assessment (7 decks)

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