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Health Assessment > Cardiovascular Assessment > Flashcards

Cardiovascular Assessment Flashcards

1
Q

In the cardiac cycle we have what phases ?

A

A filling phase and a pumping phase.

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2
Q

When you listen to heartbeat you are really hearing what ?

A

The closing of the valves

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3
Q

In the heart, you have two components that make it work?

A

The plumbing and the electricity

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4
Q

What is the SA node?

A

A collection of specialized cells that is designed to initiate an electric impulse that starts the sequence of the mechanical action of the cardiac cycle

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5
Q

What is the ECG ? (also EKG)

A

The electrocardiogram - we can trace the electricity of the heart with the ECG. Electrical impulses slightly precede the mechanical events

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6
Q

If SA node fails, what is the backup pacemaker?

A

The AV node- but the problem is that it can’t get the rate high enough

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7
Q

What does the P wave in the ECG describe?

A

The initial impulse at the SA node

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8
Q

QRS wave indicates what ?

A

The contraction of the ventricles

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9
Q

T wave indicates the

A

recharge

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10
Q

The semilunar valves (the aortic and the pulmonic valve) close at the _________

A

T wave

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11
Q

When do the coronary arteries get perfused ?

A

During relaxation

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12
Q

When do you check for orthostatic hypotension ?

A

Complaint of dizziness Elder who has fallen Known or suspected syncope (temporary loss of consciousness caused by a loss in blood pressure) Suspected hypovolemia (low blood volume)

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13
Q

Other signs of poor perfusion

A

Skin color, skin temp, papillary refill, peripheral pulses

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14
Q

Can you have cardiac disease without chest pain?

A

Absolutely- happens all the times Elderly Diabetics Alcoholics and drug abusers Previous Mediastinal or thoracic surgery

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15
Q

Cardiac Landmarks

A

Aortic (right of the sternum, 2nd ICS), Pulmonic (left of the sternum, 2nd ICS), Tricuspid (left of the sternum, 4-5th ICS), Mitral (5th ICS, left MCL)

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16
Q

The left main coronary artery is also known as

A

the widow maker, because having a heart attack in this vessel is most often fatal

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17
Q

What is heart disease?

A

a blanket term that speaks to disorders of the heart we need to be more specific to find out the particular disorders

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18
Q

Subjective data: ROS & history

A

Chest pain Dyspnea Orthopnea Cough Fatigue Cyanosis or Pallor Edema Nocturia Past Cardiac history Past Cardiac History HTN, hypercholesterolemia, murmur, anemia Family Cardiac History Risk Factors Smoking Alcohol Exercise Nutrition Drugs OLDCART all symptoms

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19
Q

major risk factors for heart disease & stroke

A

previous cardiovascular disease diabetes/metabolic syndrome family history, especially young high blood pressure elevated cholesterol levels smoking obesity

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20
Q

Objective data: chest inspection and palpation

A

Apical impulse heaves or lifts thrills

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21
Q

What is a thrill?

A

When assessing the pulse, this is more springy and has the rhythm of a cricket. it refers to an abnormality

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22
Q

S1 normal heart sounds

A

LUBB best heard at apex with diaphragm mitral and tricuspid closing

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23
Q

Systolic murmurs occur between

A

S1 and S1 S1 M S2

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24
Q

Diastolic murmurs occur when

A

after S1 and S2 S1 S2 M

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25
Q

MR. PASS

A

Mitral Regurgitation and Pulmonic or Aortic STenosis cause Systolic Murmurs

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26
Q

WHat is stenosis?

A

Problem with valve not opening fully

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27
Q

What is regurgitation ?

A

Problem with valve not staying closed completely

28
Q

MS. ARD

A

Mitral Stenosis and Aortic Regurgitation cause Diastolic Murmurs

29
Q

What is cyanosis ?

A

Bluish color caused by loss of oxygen

30
Q

What is claudication ?

A

Pain when walking - we see this occuring in those with peripheral vascular issues.

31
Q

Ischemic ulcer

A

Very clean hole punched wound

32
Q

Rubor

A

Very, very red…

33
Q

S3 heart sounds

A

Ventricular Gallop- occurs early in diastole S1 S2 S3 “Ken tuc ky” This sound may be heard in children and young adults, however, if present after age 30 usually represents pathology (i.e. Ischemic heart disease, ventricular dysfunction, CHF, cardiomyopathy).

34
Q

S4 heart sounds

A

Atrial Gallop Occurs late diastole/presystolic An extra heart sound, associated with late diastolic filling and atrial contraction, best heard at mitral and tricuspid areas. The sound occurs just before S1 and is often called presystolic or atrial gallop. S4 is often heard in conditions resulting in decreased ventricular compliance (I.e. CHF, MI ) or systolic overload (HTN) S4 S1 S2 “Tenn es see” heard in those with Hypertension and Coronary Artery Disease

35
Q

What is a heart murmur ?

A

A blowing, swooshing sound that occurs with turbulent blood flow in the heart or great vessels. they are abnormal a systolic murmur may occur with a normal heart or with heart disease; a diastolic murmur always indicates heart disease

36
Q

What characteristics are used when assessing a murmur?

A

Timing, Loudness (grades i- vi), pitch (high, medium or low) , pattern , quality (musical, blowing, harsh or rumbling) , location (where it is best heard), radiation (is it transmitted downstream in the direction of blood flow in the neck, back, axila)

37
Q

What causes diastolic murmurs ?

A

MS. ARD = Mitral Stenosis and Aortic Regurgitation cause Diastolic murmurs

38
Q

What causes systolic murmurs ?

A

MR. PASS = Mitral Regurgitation and Pulmonic or Aortic Stenosis cause Systolic murmurs

39
Q

What is stenosis??

A

A problem with a valve not opening fully

40
Q

What is regurgitation ?

A

Problem with valve not staying closed completely

41
Q

The carotid arteries and jugular veins are important in assessing because

A

we are given keys to the hearts efficiency through them. The jugular veins drain directly into the superior vena cava and so reflect any filling pressure or volume changes. Volume and pressure increase when the right side of the heart fails to pump efficiently, the jugular veins expose this.

42
Q

What is a bruit?

A

A bruit is a blowing, swishing sound indicating blood flow turbulence due to a local vascular cause such as atherosclerotic narrowing.

43
Q

What does the term lumen mean?

A

This refers to the inside space of an artery.

44
Q

When is a carotid bruit audible?

A

When the lumen is occluded by 1/2 to 2/3.

45
Q

How do you measure the jugular venous pressure ?

A

Observe jugular venous pulse with patient reclined at 45 degree angle (appears as three waves, more prominent when recumbent), using a centimeter ruler measure the vertical distance between the manubriosternal joint and the highest level of jugular vein pulsation on both sides Indicates volume and pressure in the right side of the heart Normal: 2 cm or less.

46
Q

What is the normal jugular venous pressure ?

A

Normal jugular venous pulsation is 2 cm or below the sternal angle.

47
Q

For those with heart failure, what will the jugular venous pulsation be at ?

A

More than 3 cm above the sternal angle while at 45 degrees

48
Q

For the peripheral vascular assessment, what can you objectively assess in the upper extremities? Bilaterally

A

Capillary Refill Radial and Brachial pulses Clubbing Edema Color Temperature Palpate epitrochlear nodes

49
Q

Lower extremities peripheral vascular assessment

A

Color Temperature Hair distribution Venous pattern Size (calf, ankle, knee and thigh circumference at widest point of larger leg and same location on smaller leg) Ulcers or lesions-size and exact location Pulses (femoral, popliteal, posterior tibial, dorsalis pedis) Edema (note pitting edema grade if present)

50
Q

What is cyanosis ?

A

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

51
Q

What is the name of the main artery of the foot?

A

The dorsalis pedis

52
Q

What is the 3 point amplitude scale for grading pulses ? What else should be noted ?

A

3+ = Full, bounding 2+ = Normal 1+ = Weak, thready 0 = Absent The rate and rhythm should also be noted

53
Q

Pitting Edema can be indicative of

A

Venous stasis Pregnancy, Obesity DVT/ VTE Long periods of sitting or standing Heart failure Liver failure Renal failure with fluid overload Poor lymphatic drainage

54
Q

What is the edema grading scale ?

A

1+ Mild pitting, slight indentation 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, indentation lasts for a long time, leg looks swollen 4+ Very deep pitting, indentation lasts for a long time, leg looks very swollen.

55
Q

What is claudication ?

A

Claudication is pain and/or cramping in the lower leg due to inadequate blood flow to the muscles.

56
Q

What are signs of arterial insufficiency?

A

Ischemic Ulcer (Generally located at toes, well defined wound edges, deep pale base +/-necrosis) Hairlessness Cool to touch Diminished pulses Claudication Pain relieved with rest and dependency

57
Q

Elevational pallor indicates

A

arterial insufficiency

58
Q

Dependent rubor

A

occurs with severe arterial insufficiency

59
Q

Chronic venous insufficiency results from ………..

A

failure of the valves in deep or superficial veins. A damaged valve with bi-directional blood flow can allow blood to flow back from the deep venous system into the superficial venous system. Over time, the weight of this column of blood causes fluid and protein to exude into surrounding tissues where it leaks and pools in the legs and feet. Chronic venous insufficiency can cause discoloration of the skin of the ankles and may lead to tissue breakdown, and ulceration. Venous ulcers are most commonly found around the ankle. They have irregular borders and are more likely to have copious drainage than other ulcer types.

60
Q

What is stasis dermatitis ?

A

Skin inflammation in the lower legs caused by fluid buildup. There is skin discoloration and thickening

61
Q

What is DVT ? what are symptoms

A

deep vein thrombosis -a deep vein is occluded by a thrombus causing inflammation, blocked venous return, cyanosis and edema.

62
Q

What are some cardiac or extracardiac signs that may indicate heart disease?

A

Poor weight gain Developmental delay Persistent tachycardia Tachypnea Cyanosis Clubbing

63
Q

What are some geriatric developmental considerations regarding the cardiovascular assessment ?

A

Increased range of heart rate 40-100 Ectopic beats more common S4 more common in older adults secondary to decreased LV compliance Murmurs may be present secondary to sclerotic changes in the aorta Peripheral pulses may be diminished, veins may appear more tortuous

64
Q

Nursing diagnoses after cardiac assessment

A

Activity intolerance r/t chest pain Altered tissue perfusion r/t decreased cardiac output Sensory/perceptual alteration – tactile r/t impaired circulation Impaired healing – foot ulcers r/t decreased circulation

65
Q

Congestive heart failure symptoms

A

Health Assessment (11 decks)

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