Cardiovascular and Peripheral Vascular Assessment

Question 1

precordium

Answer 1

area of the chest overlying the heart

Question 2

inspect, palpate, and ausculate

Answer 2

no percussing, chest x-ray is more reliable to identify the borders of the heart

Question 3

Angle of Louis

Answer 3

sternal angle, used to identify 2nd intercostal space

Question 4

Aortic area

Answer 4

2nd intercostal space, right sternal boarder

Question 5

pulmonic area

Answer 5

2nd intercostal space on the left sternal border

Question 6

Erb’s point

Answer 6

3rd intercostal space on the left sternal border

Question 7

Tricuspid area (right ventricular area)

Answer 7

4th or 5th intercostal space to the left sternal border

Question 8

Mitral area (apical area)

Answer 8

5th intercostal space, medial to the midclavicular live

Question 9

epigastric area

Answer 9

area overlying the xiphoid process

Question 10

lift

Answer 10

a slight movement

Question 11

heave

Answer 11

more vigorous movement; may see at the sternal border and a left ventricular heave at the apex

Question 12

apical pulse

Answer 12

a normal pulsation located over the apex of the heart, at the 5th intercostal space medial to the midclavicular line

Question 13

dependent edema

Answer 13

found in dependent areas such as feet and sacrum

Question 14

peripheral edema

Answer 14

feet and hands

Question 15

generalized edema (anasarca)

Answer 15

all over the body; massive edema

Question 16

pulmonary edema

Answer 16

fluid accumulation in the lungs due to imbalanced capillary dynamics

Question 17

cerebral edema

Answer 17

fluid in the brain

Question 18

pitting edema

Answer 18

press your finger into edematous area for 2-3 seconds and note the depth of indentation

Question 19

grades of pitting edema

Answer 19

1+: slight pit, normal contour
2+: deeper pit, fairly normal contour
3+: puffy, appearance of deeper pit
4+: extremely deep pit, definitely swollen

Question 20

thrills

Answer 20

palpable cardiac murmur; feels like the throat of the purring cat and is considered abnormal. signifies turbulent blood flow and accompanies loud murmurs

Question 21

pulses

Answer 21

palpate all pulses bilaterally
temporal arteries
carotide arteries
radial, ulnar, brachial arteries
apical impulse
femoral, popliteal, posterior tibialis, dorsalis pedis arteries

Question 22

skin temp

Answer 22

use dorsum or back of hand

normal=warm

Question 23

skin turgor

Answer 23

indicates hydration status
assessed by pitching the skin and releasing it
best tested on the sternum or forehead
skin goes back within 3 seconds

Question 24

capillary refill

Answer 24

normal should be 2 seconds or less
3-4 seconds= sluggish
>4= abnormal

Question 25

auscultation of heart

Answer 25

auscultate all pericardial areas first with diaphragm and then bell

diaphragm for loud/high pitched sounds

bell for low pitched sounds

breath through nose

rate and rhythm

Question 26

First heart sound (S1)

Answer 26

closure of mitral and tricuspid valves
apex of the heart
using diaphragm of the stethoscope

Question 27

Second heart sound (S2)

Answer 27

closure of aortic and pulmonic valves
base of the heart
using diaphragm of the stethoscope

Question 28

Extra heart sounds (S3)

Answer 28

Also known as ventricular gallop
Heard in the mitral/apical area with the bell of the stethoscope
Immediately after S2 (diastole)
Normal in children and young adults 
Never normal in people over 30
Left lateral (side lying) position 
Kentucky sound

Question 29

Extra Heart sound (S4)

Answer 29

Also known as atrial gallop
Heard in the mitral area using the bell of the stethoscope
Abnormal in most adults
happens before S1
Due to increased resistance to ventricular filling
Tennessee
ischemia, coronary artery disease, aortic stenosis

Question 30

Split S1

Answer 30

mitral and tricuspid heart valves not closing together
high pitched sound heard best in the tricuspid area using the diaphragm
assoc with right bundle branch block

Question 31

Split S2

Answer 31

aortic and pulmonic valve not closing together
more common in children
heard best in the pulmonic area with the diaphragm

Question 32

ejection click

Answer 32

click sound produced by movement of stiffly deformed valve

best heard with diaphragm

Question 33

Midsystolic

Answer 33

indicates mitral valve prolapse. Part of the mitral valve balloons into left atrium

Question 34

Murmurs

Answer 34

harsh, rumbling, blowing sound caused by blood flow across a defective valve, or the shunting of blood through an abnormal passage

assessed for timing, location, radiation, pitch, quality, intensity

Question 35

intensity of heart murmur grade

Answer 35

grade i: very faint
grade ii: quiet but audible
grade iii: moderately loud
grade iv: loud, associated with a palpable thrill
grade v: very loud
grade vi: loudest. may be audible with the stethoscope lifted off the chest wall

Question 36

Bruits

Answer 36

blowing or “purring” sound that indicates a distortion of a blood vessel that could interfere with blood flow

auscultated with the bell

Question 37

carotid arteries bruits

Answer 37

begin at base towards chin. ask patient to hold breath

Question 38

thyroid gland bruits

Answer 38

if gland feels enlarged. occurs because of accelerated blood flow through gland

Question 39

assess the non cardiac parameter of cardiac function

Answer 39

clouded sensorium
suddenly decreased visual acuity
suddenly decreasing hearing
sudden and progressive difficulty in locomotion
diminished reflexes

Question 40

signs and symptoms of poor perfusion

Answer 40

oliguria: scanty urine production
anorexia/constipation: results from marginal perfusion of the GI tract
hepatic engorgement: produced by weakened hearts inability to receive and pump venous blood
air hunger: from impaired perfusion of oxygenated blood to the lungs