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Health Across the Lifespan 2 > Cardiovascular/Circulatory Assessment > Flashcards

Cardiovascular/Circulatory Assessment Flashcards

1
Q

What are the steps in assessing the heart and central vessels?

A
  1. introduction, explanation, consent, privacy, comfort, hand hygiene
  2. health history relating to complaint
  3. inspect and palpate the precordium for abnormal pulsations, lifts or heaves (pulmonic, aortic, tricuspid, apical, epigastric areas)
  4. auscultate the heart at the pulmonic, aortic, tricuspid and apical sites using both the diaphragm and bell of the stethoscope
  5. palpate the carotid arteries bilaterally (never at the same time)
  6. auscultate the carotid arteries
  7. inspect the jugular veins while in semi-Fowlers, looking for distension
  8. document findings, report abnormalities to doctor, perform followup as indicated
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2
Q

What are the steps in assessing the peripheral vascular system?

A
  1. introduction, explanation, consent, privacy, comfort, hand hygiene
  2. health history relating to complaint
  3. palpate peripheral pulses bilaterally
  4. inspect limbs when elevated and when dependent for superficial veins
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3
Q

Where is the heart positioned?

A
  • posterior and to the left of the sternum
  • both atria (the base) are posterior to both ventricles (the apex)
  • precordium = chest area overlaying heart
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4
Q

Factors relating to cardiac function

A
  • Cardiac output (CO) = amount of blood ejected from the heart each minute (CO = SVxHR)
  • Stroke volume (SV) = amount of blood ejected from the heart with each beat
  • Heart rate (HR) = beats per minute
  • Contractility = Inotrophic state of the myocardium, the strength of contraction
  • Preload = left ventricular end diastolic volume, the stretch of the myocardium
  • Afterload - resistance against which the heart must pump
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5
Q

What are the great vessels?

A
  • vena cava (superior and inferior)
  • aorta
  • pulmonary arteries
  • carotid arteries
  • jugular veins
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6
Q

What is the health assessment interview for a cardiovascular assessment?

A
  • explore chief complaint
  • assess history and family history of cardiovascular disorders (inc hypotension)
  • review personal habits, lifestyle choices and nutrition (smoking, sedentariness, etc)
  • consider psychosocial factors that affect stress
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7
Q

Where are the auscultatory areas of the heart?

A
  • aortic area (2nd right intercostal space, near the sternum)
  • pulmonic area (opposite aortic)
  • tricuspid area (5th left intercostal space, near the sternum, below aortic)
  • apical (mitral) area (5th left intercostal space, lateral to tricuspid, PMI, where the heart touches the chest wall, right fifth intercostal space)
  • epigastric
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8
Q

What 3 assessment techniques are used for cardiovascular assessment?

A
  • inspection
  • palpation
  • auscultation
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9
Q

What do you inspect for when conducting a cardiovascular assessment?

A
  • pulsations (50% of people have pulsations over the PMI, but should have nil pulsations elsewhere. Bounding abdominal pulsations are a sign of aortic aneurysm)
  • dramatic lifts/heaves (indicates enlarged heart or overactive heart)
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10
Q

Briefly, how do you conduct a basic cardiovascular assessment?

A
  • collect health history
  • inspect precordium for pulsations, lifts or heaves
  • auscultate using both diaphragm and bell - aortic, pulmonic, tricuspid, apical, epigastric areas
  • auscultate carotid arteries
  • palpate carotid arteries (individually)
  • inspect jugular veins for distension
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11
Q

What is the relationship of heart sounds to the systole and diastole?

A

S1 = mitral and tricuspid valves close = systole
S2 = aortic and pulmonic valves close = diastole
Systole is shorter than diastole
known as lub-dub

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12
Q

What are S3 and S4?

A

extra heart sounds during diastole.

  • S3 (after S2) is normal in children/young adults. May indicate heart failure in older adults.
  • S4 (just before S1) rarely heard in young adults. Often in older adults, a sign of hypertension
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13
Q

What diagnostic tests are conducted for cardiovascular assessment?

A
  • lipids
  • ECG (electrocardiogram)
  • chest xray/MRI/CT/PET/echocardiogram/cardiac catheterisation
  • stress/exercise tests
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14
Q

What are the lifespan considerations for an infant in relation to cardiovascular assessment?

A
  • differing heart sounds - may be normal or abnormal

- not uncommon to have cardiac arrhythmias (esp with expiration) - can be normal, but should be investigated

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15
Q

What are the lifespan considerations for a child in relation to cardiovascular assessment?

A
  • the apical impulse is located higher and more medial than in adults until about 8 years of age
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16
Q

What are the lifespan considerations for older adults in relation to cardiovascular assessment?

A
  • cardiac contractions weaker
  • cardiac output decreases (lower exercise tolerance)
  • pacemaker cells decrease (less impulse firing)
  • S4 heart sounds commonly present
  • emotional or physical stress may cause arrhythmias
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17
Q

What sound may be heard when auscultating the carotid?

A
  • bruit (a blowing or swishing sound) from turbulence in blood flow
  • if a bruit is heard, palpate for a thrill (a vibrating sensation like the purring of a cat)
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18
Q

What are the names of the blood vessels in the peripheral vascular system?

A 
Arteries
Arterioles
Capillaries
Venules
Veins
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19
Q

What are the structural difference between arteries and veins?

A
  • veins have valves to prevent backflow

- arteries have narrower lumen and wider, more elatic Tunica media

20
Q

What are the layers of the blood vessel, from outer to inner?

A
  • tunica adventis
  • tunica media
  • tunica intima:
    • internal elastic lamina
    • subendothelial layer
    • endothelium
  • lumen
21
Q

How do you calculate blood flow rate?

A

pressure difference (arterial pressure - venous pressure) / vascular resistance

22
Q

ow do you calculate capillary fluid exchange?

A

hydrostatic (blood pressure) / osmotic pressure (proteins)

23
Q

What are the three main factors that that increase peripheral vascular resistance?

A
  • blood viscosity
    • contraceptive pill
    • smoking
    • various medications
  • length of the blood vessel
  • diameter of the blood vessel
24
Q

Organs of the lymphatic system

A 
Lymph nodes
spleen
thymus
tonsils
peyer's patches in the small intestine
lymphatic collecting vessels
25
Q

regional lymph nodes

A

cervical nodes
axillary nodes
inguinal nodes

26
Q

What are the elements of a peripheral vascular health assessment interview?

A
  • explore chief complaint
  • assess history of cardiovascular disorders
  • review personal habits, lifestyle choice, nutritional history
  • consider psychosocial factors that affect stress.
27
Q

Assessing peripheral vascular system

A
  • bilateral arterial pulses simultaneously (except carotid) - rate, rhythm, equality, strength
  • tingling or numbness
  • presence of oedema
  • if concerned about peripheral vascular system, apical-radial pulse difference
  • looking for distension, pallor, cyanosis, unhealing wounds, thromosed veins, oedema, swelling, erythema,
28
Q

What is a Homan’s sign?

A
  • forcing dorsiflex upwards. if patient feels pain in the calf or popliteal area
  • indicative of DVT
29
Q

Clinical manifestations of peripheral arterial disorders

A
  • intermittent claudication (mild exercise results in cramping pain as not enough O2)
  • pulses diminished or absent
  • nil/minimal oedema
  • skin changes - cold, dry, shiny, hairless, thick opaque toe nails
  • pallor when elevated
  • red when dangling (dependent rubor)
  • ulcers present at tips of extremities - painful, deep, circular, pale to black base or dry gangrene
30
Q

Clinical manifestations of peripheral vascular disorders

A
  • pain - aching to cramp like, relieved by activity/elevation
  • pulses usually present
  • oedema present, increases as end of day
  • skin changes: warm thick, tough, darkened, dermatitis
  • ulcers - medial malleolus, pain variable, superficial, irregular border, granulation base
31
Q

Some causes of peripheral oedema

A
  • congestive heart failure
  • kidney disease
  • liver disorder
  • blood clots and tumors
  • long term bed rest
32
Q

two types of oedema

A

dependent (gravity-induced) - lower limbs or sacrum if bed bound
- pitting

33
Q

effects of oedema

A
  • poorer blood circulation
  • increased local pressure
  • loss of vessel elasticity
  • painful swelling
  • problems with constricting clothes/shoes
  • difficulty walking
34
Q

diagnostic tests of the peripheral vascular system

A
  • blood test (D-Dimer)
  • Dopplers to detect weak pulses
  • venogram / phlebogram / ultrasonography (to diagnose DVT)
  • ankle brachial index
35
Q

What is the ankle brachial index (ABI)?

A

A measurement that helps determine arterial perfusion in feet.

  • measure the BP using a) brachial pulse and b) dorsalis pedis or posterior tibialis
  • divide systolic of dp/pt by brachial
  • result should be between 0.9 and 1.4
  • results under 0.9 indicate peripheral artery disease
36
Q

What peripheral vascular system lifespan considerations of children

A

bruises, petechiae / oedema may indicate serious systematic disease (leukemia, meningococcal disease, lympoma

37
Q

What peripheral vascular system lifespan considerations of older adults

A

many changes even if no disease present
arterial and venous supply both deteriorate
- changes in symmetry of assessment results could be significant
- varicose veins common

38
Q

mechanisms causing oedema

A
  • increased capillary hydrostatic pressure
  • decreased plasma oncotic pressure
  • increased capillary permiability
39
Q

mechanisms causing oedema

A
  • increased capillary hydrostatic pressure
  • decreased plasma oncotic pressure
  • increased capillary permeability
40
Q

Non-modifiable risk factors for coronary heart disease

A
  • heredity
  • age
  • gender
  • ethnicity
41
Q

Non-modifiable risk factors for coronary heart disease

A
  • heredity
  • age
  • gender (women at less risk, especially before menopause)
  • ethnicity
42
Q

modifiable risk factors for coronary heart disease

A
  • elevated serum lipid levels (healthy eating patterns, low saturated and trans fatty acid intake)
  • hypertension
  • tobacco smoking
  • physical inactivity
43
Q

Conditions that may precipitate heart failure

A
  • hypervolaemia
  • disease of the heart valve (eg rheumatic heart disease)
  • congenital defects
  • hypertension
  • diabetes
  • obesity
  • myocardial infarction
  • cardiomyopathy
  • coronary artery disease
  • disease of the heart miscle
44
Q

Conditions that may precipitate heart failure

A
  • hypervolaemia
  • disease of the heart valve (eg rheumatic heart disease)
  • congenital defects
  • hypertension
  • diabetes
  • obesity
  • myocardial infarction
  • cardiomyopathy
  • coronary artery disease
  • disease of the heart muscle
45
Q

What does OLDCART mean?

A

Chest pain assessment

  • Onset
  • Location
  • Duration
  • Characteristics
  • Associated Symptoms
  • Relieving factors
  • Treatment

Health Across the Lifespan 2 (12 decks)

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