Cardiac Assessment Flashcards
What sound can be heard during early diastole at the 3rd or 4th left interspacr at sternum border?
Opening snap, just after S2
= stenosis, increased higher atrial pressure
What is the sound associated between S1 and S2, and what does it indicate?
Midsystolic (Mitral) clock is associated with mitral valve prolapse.
During cardiac stress, tachycardia occurs. What sound is associated with this condition?
Summation sound = diastolic filling time shortens, S3 and S4 superimpose in mid-diastole
If an S2 Split is heard in both expirations and inhalation’s, but is wider during inspiration, it is called and indicates:
Wide split = right ventricle has delayed electrical activation
- R bundle branch block
What sound occurs mid- to late systole and is short and high pitched with a click quality?
Midsytolic (Mitral) Click = mitral valve prolapse
What does a lift (heave) indicate?
- R ventricular hypertrophy
- Pulmonic valve disease
- Pulmonic HTN
- Chronic lung disease
What sound is high pitched and scratchy and with breath held in expiration?
Pericardial Friction Rub
What are late diastole murmurs?
- Fourth heart sound (S4)
2. Pacemaker-induced sound
If a patient presents with varying intensity of S1, what could that be indicative of?
Atrial fibrillation
Complete heart block with changing PR interval
What could cause an accentuated S2?
- Higher closing pressure (systemic hypertension)
- Increased pressure in aorta (exercise or excitement)
- Pulmonary hypertension (mitral stenosis or heart failure)
- SL valves calcified but mobile (aortic or pulmonic stenosis)
If S3 persists when patient is sitting up, what is the sound called?
Ventricular gallop
What sound occurs due to volume overload, such as mitral/aortic/tricuspid regurgitation or high cardiac output?
S3
What nursing interventions prevent stasis of pulmonary secretions?
- Changing pt position every 2 hrs
- Increase fluids
- Chest physio (percussion and positioning)
What sound can be heard at both base and apex, just after S1 during early systole?
Aortic ejection click
What sound is heard best with the bell of the stethoscope at the apex and sounds soft and low pitched, like “distant thunder”?
S3 = ventricular filling
If a patient has delayed right ventricular electrical activation, what sound would be heard?
Wide S2 Split
What nursing interventions help reduce orthostatic hypotension?
- Early mobilization
2. Changing position slowly and gradually
Blood is detoured through _________ from the pulmonary artery to aorta
Ductus arteriosus - to bypass fetus’ lungs
What two sounds are heard during early systolic?
- Aortic ejection click at apex and base. Heard just after S1.
- Pulmonic ejection click. Heard just after S1, loud on expirations, at base only.
What heart sounds might a nurse expect if a patient has mitral stenosis?
Loud S1
Loud S2
What does a thrill in the 2nd and 3rd RIGHT interspaces indicate?
Aortic stenosis and systemic hypertension
What nursing interventions help prevent thrombus formation?
- Identify at risk patients
- Leg exercises
- Fluid intake
- Position changes
- Intermittent pneumatic compression (IPC)
- Sequential compression devices (SCDs)
- Prophylaxis (heparin)
What is it called when mitral and tricuspid components are heard separately?
Split S1, normal but uncommon
If a patient presents with faint (diminished) S1, what could that be indicative of?
First-degree heart block
Mitral insufficiency
Severe hypertension
If a patient has a loud (accentuated) S1, what could that indicate?
Increased blood velocity, due to exercise, fever, anemia, or hyperthyroidism. Possible mitral stenosis.
If a patient has ductus arteriosus, what sound would be heard?
Paradoxical S2 Split
A gentle, blowing, swooshing sound that can be heard through the chest wall
Murmur
What sounds are hear at Mid-Diastole?
S3 and summation sound
What sound can be heard with increased afterload?
Atrial gallop
These sounds can be heard during diastole
S3 and S4
Opening in the atrial septum
Foramen ovale
What does an apical impulse indicate?
Pressure overload = aortic stenosis or systemic HTN
What nursing interventions reduce cardiac workload?
- Encourage breathing while moving
2. Increase mobility
If a nurse hears a split S2 on expiration and inhalation, she knows this could indicate:
- Atrial septal defect
2. R ventricular failure
What could cause a diminished S2?
- Decreased valve strength due to decreased BP (shock)
2. SL valves thickened and calcified (aortic or pulmonic stenosis)
What are muring interventions that promote expansion of the chest and lungs?
- changing pt position every two hours
- deep breathing and coughs every 2 hrs
- incentive spirometer every hour
- removing abdominal binders every 2 hrs for deep breathing
If a Split S2 is only heard during expirations, it indicates:
Paradoxical Split = delays valve closure
- Aortic stenosis
- L bundle branch block
- Patent ductus arteriosus
What does a thrill in the 2nd and 3rd LEFT interspaces indicate?
Pulmonic stenosis and pulmonic hypertension
Patent Ductus Arteriosus
What are early diastole murmurs?
- Opening snap
2. Mitral prosthetic valve sound
What are the three conditions that result in a murmur?
- Increased velocity of blood flow
- Decreased viscosity if blood (thinner blood)
- Structural valve deficits or unusual openings in the chambers
What are the three systolic murmurs?
- Ejection clicks (aortic and pulmonic)
- Aortic prosthetic valve sound
- Midsystolic (Mitral) click
What are nursing interventions to maintain a patent airway?
- Deep breathes and cough every 2 hrs
- Reduce mucus plugs (chest physio)
- Nasotracheal or orotracheal suction techniques
If a patient has aortic stenosis and systemic hypertension, what sound would you expect to hear?
S4
What sound can be heard during mid-diastole that is prolonged and often louder than S1 and S2?
Summation sound (S3 and S4)
If a patient presents with a split S1, what could that be indicative of?
Normal but uncommon
Mitral and tricuspid components heard separately
What sound is heard just after S1, at base only, and is louder on expirations?
Pulmonic ejection click
If a patient has decreased compliance if the ventricles, what sound is heard?
S3
A murmur heard after S1 and before S2 is classified as
Systolic murmur
