Cardiac Assessment

Question 1

Factors that affect blood pressure

Answer 1

• acute pain
• hyper/hypothermia
• disease process (hypertension)
• circulating blood volume (hypovolemic)

Question 2

Factors that affect the pulse

Answer 2

• exercise
• anxiety
• adrenaline
• medications
• pain

Question 3

When assessing a patients health history you should always….

Answer 3

Ask the patient questions!

Question 4

Questions to ask a patient when collecting health history…

Answer 4

• History of chest pain, palpitations, or dizziness
• Number of pillows used to sleep
• Type and amount of medications taken daily
• History of heart defect, rheumatic fever, or chest or heart surgery
• Personal and family history of hypertension (high blood pressure), myocardial infarction (heart attack), coronary artery disease, high blood cholesterol levels, or diabetes mellitus
• History of smoking (how long, how many packs/day)
• History of alcohol use
• Type and amount of exercise
• Usual foods eaten each day
• Changes in color or temperature of the extremities
• History of pain in the legs when sleeping or pain that is worsened by walking
• History of blood clots or sores on the legs that do not heal
• Swelling in the ankles and feet

Question 5

When inspecting the neck and precordium, you should check for visible…

Answer 5

pulsations.

Question 6

Pulsations usually are ______ except for the ________, located at about the fourth or fifth intercostal space at the left midclavicular line.

Answer 6

absent, apical impulse.

Question 7

Where is the Apical Impulse located?

Answer 7

about the fourth or fifth intercostal space at the left midclavicular line.

Question 8

Inspect the epigastric area at the tip of the sternum for…

Answer 8

pulsation of the abdominal aorta.

Question 9

Findings of neck vein distention (indicating heart disease) or visible pulsations in precordial areas other than the apical impulse (which may result from abnormalities of the ventricle) are considered…

Answer 9

abnormal.

Question 10

What does neck vein distension indicate?

Answer 10

heart disease

Question 11

How do we palpate the carotid artery?

Answer 11

medial to the sternomastoid muscle in the neck between the jaw and the clavicle.

Question 12

To avoid obstruction of carotid arteries, we palpate them…

Answer 12

one at a time.

Question 13

Abnormal findings may include…

Answer 13

absent, weak, thready pulse (which may indicate a decreased cardiac output), a forceful or bounding pulse

Question 14

Auscultation is used to…

Answer 14

determine the heart sounds caused by closure of the heart valves

Question 15

When auscultating heart sounds, ask the patient to breathe…

Answer 15

normally.

Question 16

How do we use systematic auscultation?

Answer 16

aortic area → pulmonic area → Erb’s point → tricuspid area → mitral area

Question 17

Use the diaphragm of the stethoscope first to listen to…

Answer 17

high-pitched sounds

Question 18

Use the bell to listen to…

Answer 18

low-pitched sounds

Question 19

Focus on the overall _______ + _______ of the heart and the normal heart sounds

Answer 19

rate + Rhythm

Question 20

Abnormal findings include…

Answer 20

extra heart sounds at any of the cardiac landmarks and abnormal rate or rhythm.

Question 21

Extra heart sounds are often heard when…

Answer 21

the patient has anemia or heart disease.

Question 22

A wide variety of conditions may alter the normal heart rate or rhythm, including…

Answer 22

serious infections, diseases of the heart muscle or conducting system, dehydration or overhydration, endocrine disorders, respiratory disorders, and head trauma.

Question 23

Extra heart sounds may be… S3, S4, murmurs, or bruits.

Answer 23

S3, S4, murmurs, or bruits.