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NUR350 Midterm > Cardiovascular and Peripheral Vascular Assessment > Flashcards

Cardiovascular and Peripheral Vascular Assessment Flashcards

1
Q

What does the peripheral vascular system consist of

A
  • Arteries
  • Veins
  • Lymphatic vessels
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2
Q

Arteries

A
  • Carry oxygenated blood away from heart
  • High pressure system
  • Vessel wall thicker and more tough; elastic and muscle fibres
  • Mediate BP
  • Have a ‘pump’ to keep blood moving; the heart, created pulse
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3
Q

Veins

A
  • Carry deoxygenated blood back to the heart
  • Low pressure system; moves slower
  • Have less number than arteries present in the body
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4
Q

What mechanisms do veins rely on to keep blood moving?

A

1) Contracting skeletal muscles
2) Pressure gradients; thoracic pressure decreases when you breathe in, abdominal pressure increases
3) Intraluminal valves; prevent back flow

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5
Q

Arteries accessible during examination

A
  • temporal
  • carotid
  • brachial
  • radial
  • ulnar
  • femoral
  • popliteal
  • dorsalis pedis
  • posterior tibial
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6
Q

Veins accessible during examination

A
  • external jugular
  • internal jugular
  • superficial arm
  • deep arm
  • femoral
  • popliteal
  • great saphenous
  • small saphenous
  • perforators
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7
Q

Venous pooling

A

Back up of blood on the venous side

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8
Q

Important arteries in the arms

A
  • Ulnar; located along pinky side running up arm
  • Radial; located on thumb side running up arm
  • Brachial; middle of upper arm
  • Pulse sites; either side or wrist, elbow pit
  • In children and infants you can palpate in between bicep and tricep
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9
Q

Important arteries in the legs

A
  • Femoral artery; major artery that supplies leg, runs alongside femur
  • Popliteal artery; located behind knee
  • Posterior tibial artery; along calf
  • Dorsalis pedis artery; on top of foot
  • Pulse sites; inner upper thigh, behind knee, top of foot on big toe side
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10
Q

Important veins in the legs

A
  • Great saphenous vein; runs all along the back of the leg

- Small saphenous vein; along the lower back of leg, smaller

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11
Q

Functions of the lymphatic system

A
  • Returns fluid back to the venous system
  • Forms a major part of the immune system
  • Absorbs lipids from the intestinal tract – helps with the transport of the fat soluble vitamins
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12
Q

What trunks do lymph vessels drain into?

A
  • Right lymphatic duct; upper right side of body

* Thoracic duct; upper left side of body and whole lower body

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13
Q

What is lymph flow propelled by

A
  • Contracting skeletal muscles
  • Pressure changes during breathing
  • Contraction of the vessels themselves
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14
Q

What lymph nodes are possibly palpable during examinations

A
  • Cervical nodes – can be palpated, the rest shouldn’t be
  • Axillary nodes
  • Epitrochlear node
  • Inguinal nodes
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15
Q

What are we looking for when assessing lymph nodes

A
  • Tender (likely infection)

* Palpable and fixed – may be cancerous

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16
Q

Infant and children considerations when assessing vascular system

A
  • Larger lymph nodes; they grow faster than the rest of the body
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17
Q

Pregnant persons considerations when peripheral assessing vascular system

A
  • Drop in BP – changes in the body result in vasodilation, starts in the second trimester
  • Edema in the lower extremities, varicose veins, hemorrhoids – due to the growing fetus
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18
Q

Older persons considerations when assessing peripheral vascular system

A
  • Arteriosclerosis – happens naturally as we age (regardless of lifestyle factors), blood vessels become more rigid, less compliant blood vessels; greater pressure from the heart is needed to push that blood out through them; increase in BP
  • Enlargement of the calf veins – more at risk of venous pooling
  • Loss of lymphatic tissue – atrophy
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19
Q

Subjective assessment of peripheral vascular system

A
  • Leg pain or cramps
  • Skin changes on arms or legs
  • Swelling in the arms or legs
  • Bilateral may indicate systemic issue
  • Unilateral may be a result of local issue
  • Lymph node enlargement
  • Medications
  • History of vascular problems?
  • Diabetes, cardiac issues, history of obesity; both in the client and family history
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20
Q

Inspecting and palpating the arms

A
  • Colour, temperature, texture, turgor, lesions, scars, edema, clubbing
  • Capillary refill – colour should return <2secs; can do fingers and toes
  • Symmetry – swelling and edema
  • Pulses – with cardiac patient want to assess in all 4 places; ensure proper circulation
  • Radial
  • Ulnar
  • Brachial
  • Epitrochlear lymph node
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21
Q

Grading a Pulse on a 4-point scale

A 
3+= increased, bounding
2+= normal
1+= weak, thread (see in someone going into shock)
0= absent
22
Q

Inspecting and palpating the legs

A
  • Skin colour, hair distribution, venous pattern, size (both lying down and standing), symmetry, skin lesions, ulcers
  • Palpate for temperature
  • Palpate inguinal lymph nodes
  • Pulses
  • Femoral
  • Popliteal
  • Dorsalis pedis
  • Posterior tibial
  • Asses for edema – if present we want to grade it
23
Q

Deep Vein Thrombosis (DVT)

A
  • Clot in a vein, usually in the leg
  • Swelling and inflammation below the blockage site
  • Swollen, red, feels really hot
  • Anyone who has prolonged immobility is at risk of DVT; older age, anyone who has altered blood coagulation, prone to clots, or any damage to the main clot itself (post-surgery)
24
Q

Peripheral Arterial Disease (PAD)

A
  • Build-up of fatty substances on the walls of the artery
  • Blockage in a peripheral artery
  • Buildup of plaque in the artery wall itself; blood is trying to come down but can’t
  • Paler, cooler, difficult to find pulse, capillary refill >2secs
  • Decreased circulation leads to non-healing injuries on the foots; especially in areas of pressure (i.e. on the ties)
  • If untreated can lead to gangrene and needs to be amputates; tissue not getting oxygen
25
Q

Where is the heart located

A
  • Heart located on the chest from the 2-5th intercostal space
  • Does extend over to the right sternal boarder over to the left midclavicular line
  • The top of the heart called the base, bottom of the heart called the apex
  • Apex lies at the 5th intercostal space at the midclavicular line; at that point we can feel the PMI
26
Q

Precordium

A

• Area on the chest where the heart would sit is called the precordium

27
Q

Pulmonary vs Systemic Circulation

A

Pulmonary

  • Right ventricle into pulmonary arteries (deoxygenated blood)
  • Blood gets oxygenated in lungs
  • Pulmonary veins carry oxygenated blood back to heart into left ventricle

Systemic

  • Left ventricle pumps oxygenated blood into systemic arteries
  • Lose oxygen in systemic circulation
  • Systemic veins carry deoxygenated blood back to heart into right ventricle
28
Q

Pericardium

A

Sac that holds the heart

29
Q

Myocardium

A

Muscles surrounding the heart

30
Q

Endocardium

A

Tissue that surrounds the inner structure of the heart

31
Q

Valves of the heart

A

Aortic valve
Pulmonic valve
Mitral (AV) valve
Tricuspid (AV) valve

32
Q

The cardiac cycle

A

Diastole
• Protodiastolic filling (passive filling)
• Presystole/Atrial systole/Atrial kick (active filling)

Systole
• Av vales close; creates the first heart sound
• For a moment, all 4 valves in the heart is closed and pressure is building
• The pressure gets to a certain point, then the semi-lunar valves
• When the semi-lunar valves close it is the second heart sound

Diastole Again

33
Q

Expected heart sounds

A

S1 (“Lup”)
• Occurs with closure of the AV valves
• Loudest at the apex

S2 (“Dup”)
• Occurs with closure of the SL valves
• Loudest at the base

Split S2 (“Lup-T-Dup”) – the aortic valve closes just before the pulmonic valve

34
Q

Extra heart sounds: S3

A
  • Heard during diastole (protodiastole) – normally a silent phase; the ventricles are resistant to filling, results in vibrations or turbulence in blood which results in an extra beat
  • Occurs just after S2
  • Physiologic – children and pregnant people; but will go away when they sit up
  • Pathologic (ventricular gallop) – gallop you hear when a horse is galloping; early sign of heart failure
35
Q

Extra heart sounds: S4

A
  • Heard at the end of diastole during presystole – ventricles that are resistant to filling; create extra vibration that is heard as a beat
  • Occurs just before S1
  • Physiologic – older person after exercise; not heard at rest
  • Pathologic (atrial gallop) – present all the time; cardiomyopathy, issues with the heart muscles
36
Q

Extra heart sounds: murmurs

A
  • A blowing or swooshing sound
  • Signals turbulent blood flow
  • Conditions that may result in a murmur:
  • Increased velocity of the blood – i.e. flow murmur in exercise
  • Decreased viscosity of the blood – i.e. anemic person
  • Structural defects in the valves or unusual openings in the chambers
  • Turbulent blood flow in a great vessel = a bruit (usually from an artheroslortic plaque)
37
Q

Conduction of the heart

A

• Automaticity – contract by itself independent of other signals

Route: 
• SA node (internal pacemaker)
• AV node
• Bundle of His
• Right and Left Bundle Branches
38
Q

Cardiac Output

A

The amount of blood being pumped by the heart per minute

• CO= SV x rate

39
Q

Stroke Volume

A

The amount of blood ejected from the heart (in one cycle)

40
Q

Preload vs Afterload

A
  • Preload = the length the ventricle must stretch just before contraction
  • Afterload = the pressure the ventricles must generate in order to open the valves and eject the blood
  • Exercise we increase the amount of blood returned to the heart; preload is slightly greater
  • If an individual has a cardiomyopathy muscles, ,ay not generate enough afterload to eject blood to the system
  • Medications that affect pre and afterload
41
Q

Infant and children considerations for CV assessment

A

• Foramen ovale – blood reroutes in utero; hole between the two atriums; shunted through that hole into the systemic circulation. Closes first hour in life
• Ductus arteriosus – blood shunted into pulmonary artery into aorta into
pulmonary circulation; takes 10-15 hours of life to close.
• Position of the heart in infants is higher and more horizontal until age 7 (at 4th intercostal space as opposed to 5th)

42
Q

Pregnant persons considerations for CV assessment

A
  • Blood volume increases – 30-40%, to support both pregnant person and fetus
  • Pulse rate increases – by about 10-15bpm
  • BP drops slightly
43
Q

Older persons considerations for CV assessment

A
  • Systolic BP increases – harder to push blood out against less elastic vessels
  • Left ventricle wall thickens – because the muscle grows bigger as it starts to work harder
  • Increased prevalence of arrhythmias – irregular heart rhythms
  • Increased incidence of cardiovascular disease, hypertension and heart failure – lifestyle habits as well as genetics
44
Q

Subjective assessment of the CV system

A
  • Chest pain – or tightness; not necessarily a presenting sign, especially in women
  • Dyspnea – shortness of breath
  • Orthopnea – need to assume a more upright position in order to feel like you can breathe
  • Cough
  • Fatigue
  • Cyanosis/pallor – ask the patient about colour changes
  • Edema
  • Nocturia – urgent need to get up and go pee in the night; can develop in person with congestive heart failure
  • Current/past cardiac history
  • Family cardiac history
  • Personal habits – nutrition smoking/alcohol/substances, stress, sleep, etc.
45
Q

Assessing neck vessels: CV system

A
  • Palpate the carotid artery – one side at a time
  • Pulse strength – ideally around a 2+
  • Equal bilaterally
  • Auscultate the carotid artery – pick 3 spots down the artery and listen; we should hear nothing
  • Bruit? – hearing the turbulent blood blow; breath sounds can interfere, tell them to hold breath for 5 seconds while you assess
46
Q

Inspecting the precordium

A

Anterior chest
• Apical impulse – may not see in an adult
• 5th intercostal space at the midclavicular line; lighting can help

47
Q

Palpating the precordium

A
  • Apical impulse – helpful to tell them to take a breath in, exhale, then hold it (no chest rising and falling) – may not be palpable in all people
  • Palpate across the precordium
  • Thrill – someone who has a very loud murmur – palpable vibration that is not at the apical impulse
48
Q

Percussion of the precordium

A
  • Place finger on the 5th intercostal space on the left chest at the axillary line, percuss inwards
  • Hollow sounds of lungs; midclavicular line you get dull thud of heart
  • Hollow sound vs. full sound
  • To detect heart enlargement; difficult to do – usually sent for tests instead
49
Q

Auscultation of the precordium

A
  • Note the rate and rhythm – consistency
  • Identify S1 and S2 – identify them separately (S1 louder at apex and at same time as the Cartoid pulse), S2 louder at the base)
  • Assess S1 and S2 separately
  • Listen for extra heart sounds
  • Listen for murmurs
  • Listen in a ‘Z’ pattern – point on the precordium where you can hear the valves best
  • Use diaphragm and bell – bell will pick up S3, S4 and murmur best
50
Q

‘Z’ Pattern

A
  • 5 spots on the precordium where you can hear the valves the best

1) Mitral valve; S1 loudest
2) Tricuspid valve
3) Erb’s point; S1 and S2 equal volume
4) Pulmonic valve
5) Aortic area; S2 loudest

51
Q

Cardiac Murmurs

A
  • Timing – between S1 and S2 or outside of them
  • Loudness
  • Pitch
  • Pattern
  • Quality – musical murmur
  • Location – hear it best in one specific area
  • Radiation – can we hear it in other places on the chest, up into the neck
  • Posture – can sometimes disappear when a person sits up, or our ability to hear a murmur can be enhances in certain postural changes
52
Q

Rating loudness of murmurs

A
  • Grade 1 = barely audible, only in a faint room and then with difficulty
  • Grade 2 = clearly audible, but faint
  • Grade 3 = moderately loud, easy to hear
  • Grade 4 = loud, associated with a thrill
  • Grade 5 = very loud, heard with one corner of stethoscope lifted off chest wall
  • Grade 6 = loudest, heard with entire stethoscope lifted just off the chest wall

NUR350 Midterm (11 decks)

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