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health assessment > cardiac assessment > Flashcards

cardiac assessment Flashcards

1
Q

What does the heaves or lifts indicate on precordium inspection?

A

Hyperdynamic precordium or left ventricular hypertrophy (LVH).

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2
Q

What is a thrill?

A

A palpable vibration that feels like a purring cat or vibrating phone, indicating turbulent blood flow and usually accompanying a loud murmur.

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3
Q

Where is the Point of Maximal Impulse (PMI) located?

A

At the 5th intercostal space, midclavicular line.

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4
Q

Why is percussion not done during cardiovascular physical assessment?

A

Due to more effective imaging techniques like chest radiography (CXR).

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5
Q

Where do you auscultate the aortic area?

A

Right sternal border, second intercostal space.

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6
Q

Where do you auscultate the pulmonic area?

A

Left sternal border, second intercostal space.

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7
Q

Where is Erb’s point located and what is heard there?

A

Left sternal border, third intercostal space; where heart sounds coalesce.

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8
Q

Where do you auscultate the tricuspid valve?

A

Left sternal border, fourth intercostal space.

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9
Q

Where is the mitral valve (PMI) auscultated?

A

At the midclavicular line, 5th intercostal space.

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10
Q

What position should the patient be in for auscultation of heart sounds?

A

Sitting, supine, then left side-lying.

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11
Q

What part of the stethoscope do you use first in auscultation?

A

Diaphragm first, then the bell.

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12
Q

What are normal heart sounds?

A

S1 and S2, “lub-dub.”

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13
Q

What are signs of abnormal heart sounds?

A

Murmurs (whooshing sounds), S3 or S4 (clicking sounds), irregularity, or palpitations.

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14
Q

What does a pericardial friction rub sound like?

A

Scratchy, like sandpaper or walking in snow, heard best at the left lower sternal border or apex.

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15
Q

How do you auscultate for a pericardial friction rub?

A

Have the patient lean forward, sit, and hold their breath in expiration, using the diaphragm.

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16
Q

What does Jugular Venous Distension (JVD) indicate?

A

Increased Central Venous Pressure (CVP) and potentially heart failure.

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17
Q

Where is Jugular Venous Distension most visible?

A

On the right side of the neck.

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18
Q

How are arterial pulses graded?

A

0 = absent, 1+ = weak, 2+ = normal, 3+ = increased, 4+ = bounding.

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19
Q

What are key pulses to palpate in the upper body?

A

Radial and brachial.

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20
Q

What are key pulses to palpate in the lower body?

A

Dorsalis pedis, posterior tibial, popliteal, and femoral.

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21
Q

What are signs of edema?

A

Pitting or non-pitting swelling of extremities.

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22
Q

How is edema graded?

A

1+ = mild, 2+ = moderate, 3+ = deep, 4+ = very deep.

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23
Q

What cardiovascular changes are common in pregnancy?

A

Increased heart rate and blood volume, edema, varicosities, blood pressure fluctuations, and possible pregnancy-induced hypertension (PIH).

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24
Q

What cardiovascular changes are common in the elderly?

A

Increased systolic blood pressure, higher incidence of arrhythmias, and decreased pulses due to arteriosclerosis.

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25
Q

What are common cardiovascular findings in infants?

A

Initial murmurs, patent ductus arteriosus (PDA), and patent foramen ovale (PFO).

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26
Q

How long should you auscultate an infant’s heart rate?

A

For one full minute.

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27
Q

What is an Allen test?

A

A test to check radial and ulnar artery patency.

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28
Q

What is a Homan’s test used for?

A

To check for deep vein thrombosis (DVT).

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29
Q

What are key diagnostic tests for cardiovascular assessment?

A

EKG/ECG, Holter monitor, orthostatic BP, exercise stress test, echocardiogram, and cardiac enzyme labs (e.g., troponins).

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30
Q

What past medical history should you ask about in a cardiovascular assessment?

A

History of cardiac disease or surgery.

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31
Q

What family history should be considered for cardiovascular risk?

A

History of cardiovascular disease (CVD) or coronary artery disease (CAD), noting who in the family had it and at what age.

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32
Q

What social habits are risk factors for cardiovascular disease?

A

Smoking and alcohol use.

33
Q

What medications are important to ask about?

A

Ask if the patient is taking any cardiac or antihypertensive medications or any medications with cardiovascular side effects.

34
Q

What is PQRST used for in cardiovascular assessment?

A

It stands for Palliative and provocative, Quality, Region and radiation, Severity, and Timing, used to assess symptoms like chest pain.

35
Q

What are common symptoms of cardiovascular issues?

A

Chest pain, palpitations, dyspnea, orthopnea (ask how many pillows they use), cough, fatigue, edema, and nocturia.

36
Q

What are the risk factors for coronary artery disease (CAD) in women?

A

CAD is rare in menstruating women, but after menopause, the risk of CAD equals that of men. Women may also not exhibit classic signs of myocardial infarction (MI).

37
Q

What are the atypical symptoms of MI in women?

A

Shoulder, jaw, upper back pain, nausea, fatigue, and dyspnea.

38
Q

What questions should be asked if a positive finding is identified in cardiovascular assessment?

A

Follow up with PQRST: Palliative and provocative factors, Quality of pain, Region and radiation, Severity, and Timing.

39
Q

What are key questions for peripheral vascular assessment?

A

Ask about leg pain or cramps with rest or activity, especially intermittent claudication (pain in calves with activity), and check for skin or hair loss, which can indicate poor circulation.

40
Q

What are the key risk factors for coronary artery disease (CAD)?

A

Family history, smoking, diabetes, high cholesterol (over 200), hypertension, lack of aerobic physical exercise, and a diet high in fat, cholesterol, and sodium.

41
Q

Where is the aortic auscultation point located?

A

Right sternal border, second intercostal space.

42
Q

Where is the pulmonic auscultation point located?

A

Left sternal border, second intercostal space.

43
Q

Where is Erb’s point located?

A

Left sternal border, third intercostal space, where all heart sounds coalesce.

44
Q

Where is the tricuspid auscultation point located?

A

Left sternal border, fourth intercostal space.

45
Q

Where is the mitral (PMI) auscultation point located?

A

Fifth intercostal space, midclavicular line.

46
Q

What is S1 heart sound?

A

The first heart sound (“lub”), caused by the closing of AV valves and marks the beginning of systole. Loudest at the apex but can be heard all over the precordium.

47
Q

What is S2 heart sound?

A

The second heart sound (“dub”), caused by the closure of semilunar valves and marks the end of systole. Loudest at the base but can be heard all over the precordium.

48
Q

What are S3 and S4 heart sounds?

A

Both are abnormal extra heart sounds. S3 (Kentucky) occurs after S2, due to rapid ventricular filling. S4 (Tennessee) occurs before S1 and is associated with coronary artery disease.

49
Q

What causes a murmur?

A

A swooshing sound due to turbulent blood flow, caused by increased blood velocity, decreased blood viscosity, or structural heart defects like prolapse, stenosis, or regurgitation.

50
Q

What are the characteristics of heart sounds?

A

Frequency (pitch), intensity (loudness), duration (short for heart sounds), and timing (systole or diastole).

51
Q

What is the P wave in the PQRST ECG?

A

Depolarization of the atria, leading to atrial contraction.

52
Q

What is the P-R interval in the PQRST ECG?

A

Time from the beginning of the P wave to the beginning of the QRS complex, indicating the time for atrial depolarization and impulse travel to the ventricles.

53
Q

What is the QRS complex in the PQRST ECG?

A

Depolarization of the ventricles, leading to ventricular contraction.

54
Q

What is the T wave in the PQRST ECG?

A

Repolarization of the ventricles, leading to ventricular relaxation.

55
Q

What is a bruit?

A

An abnormal buzzing or humming sound, often heard over the carotid artery, and usually benign but can indicate turbulent blood flow.

56
Q

What is an AV fistula?

A

An arteriovenous fistula is a connection between an artery and a vein, used for dialysis access.

57
Q

What safety precautions should be taken with an AV fistula?

A

Do NOT take BP, perform IV/phlebotomy sticks, or tie anything on the arm with an AV fistula.

58
Q

How do you assess an AV fistula?

A

Auscultate for a bruit (buzzing/humming sound) and palpate for a thrill (vibration).

59
Q

What is the location and assessment method for the radial pulse?

A

Located on the thumb side of the wrist; palpate by placing fingers on the radial artery just below the thumb.

60
Q

What is the location and assessment method for the brachial pulse?

A

Located on the inside of the elbow (antecubital fossa); palpate by placing fingers on the brachial artery between the biceps and triceps.

61
Q

What is the location and assessment method for the carotid pulse?

A

Located on either side of the neck, near the trachea; palpate gently with two fingers (one side at a time).

62
Q

What is the location and assessment method for the femoral pulse?

A

Located in the groin area, midway between the pubic bone and the hip; palpate deeply in this region.

63
Q

What is the location and assessment method for the popliteal pulse?

A

Located behind the knee; palpate by bending the knee slightly and placing fingers in the popliteal fossa.

64
Q

What is the location and assessment method for the dorsalis pedis pulse?

A

Located on the top of the foot, near the big toe; palpate by placing fingers gently over the artery on the dorsum of the foot.

65
Q

What is the location and assessment method for the posterior tibial pulse?

A

Located just behind the inner ankle bone (medial malleolus); palpate by pressing fingers behind the bony prominence on the inside of the ankle.

66
Q

What does the P wave represent in a normal sinus rhythm?

A

Atrial depolarization (atrial contraction).

67
Q

What does a normal sinus rhythm (NSR) show on an ECG?

A

P waves on all heartbeats with a rate of 60-100 beats per minute.

68
Q

What is sinus tachycardia?

A

A heart rate above 100 beats per minute with normal P waves.

69
Q

What is sinus bradycardia?

A

A heart rate below 60 beats per minute with normal P waves.

70
Q

What is atrial fibrillation (A-Fib)?

A

An irregular heart rhythm with no P waves, leading to shortness of breath, weakness, and an increased risk for strokes and pulmonary embolisms.

71
Q

What is the procedure for assessing the carotid artery?

A

Ask the patient to hold their breath, pick their neck up, and turn their head to the side. Use the bell of the stethoscope to listen for sounds. Assess if the pulse is steady, strong, weak, regular, or irregular.

72
Q

What is an Abdominal Aortic Aneurysm (AAA)?

A

A bulging or weakened area in the abdominal aorta, which can be assessed by auscultating for bruits and do not palpate.

73
Q

What are the subjective risk factors for an Abdominal Aortic Aneurysm (AAA)?

A

Family history of AAA, smoking, hypertension, and high cholesterol.

74
Q

What are the objective findings of an Abdominal Aortic Aneurysm (AAA)?

A

Tenderness over the abdomen, pain in the back or flank, and a pulsating mass in the abdomen.

75
Q

What could severe pain in a patient with AAA indicate?

A

A possible rupture, which is a medical emergency that can lead to hypovolemic shock.

76
Q

What is Jugular Venous Distention (JVD)?

A

A visible bulging of the jugular vein, indicating increased pressure in the superior vena cava, often due to heart failure.

77
Q

What causes Jugular Venous Distention (JVD)?

A

Heart failure or blockage leading to increased central venous pressure (CVP).

78
Q

How is Jugular Venous Distention (JVD) assessed?

A

Look for bulging veins, especially on the right side, and measure the height to estimate central venous pressure (CVP). Increased JVD indicates heart failure.

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