Cardiovascular 2 Flashcards
focused health history
Chest pain; Palpitations, syncope, edema, fatigue, vascular changes in extremities; Risk factors for CAD; Allergies; Family; Psychosocial—activity, stress, diet, habits; Review of Systems
risk factors for CAD
obesity, smoking, high cholesterol
inspect Precordium
Aortic area—2nd ICS RSB; Pulmonic area—2nd ICS LSB; Anterior precordium—lower half of sternum at LSB & RSB; Apex—5th ICS LMCL (PMI/apical impulse; Epigastric area
inspecting neck vessels
Carotid Artery - Bruits; Jugular Veins - Jugular Vein distention (JVD)
inspect carotid arteries
look at intemaljugular veins to see how full they are, if prominent then have black flow; then palpate one at a time; feel for up stroke of pulse; note consistency and rhythm
Carotid Arteries Alterations
Pulse is Bounding; Diminished either unilaterally or bilaterally; Diminished or thready; Bruits (heard during auscultation)
ausculate carotid artery
w/ bell (lower pitched sound) have pt hold breath and listen for “swooshing” bruits; ausculate on both sides
5 areas for auscultation
Aortic (2nd ICS RSB); Pulmonic (2nd ICS LSB); Erb’s point (3rd ICS LSB) sometimes called 2nd pulmonic area; Tricuspid (4th ICS LSB or left lower sternal border SB); Mitral (5th ICS LMCL)
heart sounds
S1 (lub) closure of AV valves; S2 (dub) closure of Semilunar valves; Physiological split S1 and S2
s3
(early diastole) rapid ventricular filling; S3 may hear normally in children and young adults
s4
(late diastole) non-compliant ventricle
decrease in pulse
reduced fluid volume so decrease cardiac output
Characteristics of Murmurs
Intensity—graded 1 through 6; Placement in the cardiac cycle—systolic or diastolic; Location—best heard; Quality—blowing, harsh, musical; Pitch (frequency)—high, low
diastolic murmurs
Mitral stenosis- stiffness of value; Aortic regurgitation - floppy value
systolic murmurs
Aortic stenosis - high pitch blowing; Mitral regurgitation - floppy value
s1 s2 s3
slooshing in lub dub da; fluid building up , indicates heart failure
s4 s1 s2
a stiff wall; atrical contraction before s1, if ventricle non-compliant causes fluttering of valve; s4 indicates MI
Friction Rubs—
pericarditis, pleural effusion; grading of harsh sounds
clicks and snaps
usually stenosis of valveor mitral valve prolapse; or mechanical valve replacement have to stay on coumadin
angina pectoris
chest pain from myocardial ischemia
Congestive Heart Failure (CHF)
heart does not pump sufficiently to meet demands of body/cells
Coronary Artery Disease (CAD)
narrowing of coronary arteries R/T atherosclerosis
Pericarditis
Inflammation of pericardial sac
listen to rushing of blood flow
usually graded 1 - 6 ; 1 - usually soft and hard to hear; 6 - very loud, harsh; location base A,P; apex M,T
normal JVD measurement normal
less than 3 cm
Peripheral Vascular
Inspection, Palpation, Auscultation; Clubbing of nail beds; Capillary refill < 3 sec; Grading of Pulses (+1 to +4); Homan’s sign; Allen’s test
Pitting Edema
1+ mild (2mm depression)—disappears rapidly, no distortion; 2+ moderate (4mm depression)—disappears in 10-15 seconds, no distortion; 3+ deep (6mm depression)—last > minute, extremity looks swollen; 4+ frank/severe (8mm depression)—last 2-3
pulse amplitude
0 absent, no palpable + 1 Weak, Thready; + 2 Normal; + 3 full, increased; + 4 Bounding
Arterial insufficiency
Return to color taking longer or persistent-dependent rubor (redness); Ankle-brachial Index (ABI); Systolic Ankle pressure/Systolic brachial pressure = _____ %; Results > 1.0 or greater is normal; Results < .90 or less = Arterial insufficiency
age related considerations
Arterial Circulation; Cardiac Function; Blood pressure changes; Activity Change (DVT, Venous stasis
holostolic
occurring during all systole
holodistolic
occurring during all diastole
crescendo
increasing in intensity
descendo
decreasing in intensity
plateau
remain constant
continuous murmur
begin in systole and continue through s2
tricuspid stenosis
loudest in mid-distole; increase with inspirations; has a rumbling quality
