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Health Assessment > Ch 17 Heart and neck vessels assessment > Flashcards

Ch 17 Heart and neck vessels assessment Flashcards

1
Q

Give the two locations of the heart

One including intercostal spaces

Second including structures

A
  1. Left mid clavicular between the 2nd and 5th ICS

2. In the precordium, in mediastinum, between lungs, above diaphragm, posterior sternum, anterior vertebrae

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2
Q

What is the typical size of a heart and what are characteristics of a woman’s heart

A

Size of a heart is a clenched fist

Women’s heart are smaller
And weight less



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3
Q

Where is the base of the heart
(Include ICS and sternal border)

Where is the apex of the heart
(Include ICS)

Where can the apical pulse be seen and palpated
-give its 2 other names

A

Base: top of heart at 2ns ICS, and sternal border from left to right

Apex: bottom of heart 5th ICS

Apical pulse: left MCL At the fifth intercostal space

Aka: Point of maximal impulse “mitral”



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4
Q

Name the arterial (sounds red) great vessels,

Where arterial vessels originate from and what direction do the turning

A

Arterial great vessels: to body

-carotids: to brain

-aorta
-Pulmonary veins
• flow oxygenated blood

Arterial great vessels originate from base of heart and turn to supply the body

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5
Q

What is the exact location of the carotids

A

Between the sternocleidomastoid and the trachea

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6
Q

Name the Venus great vessels and what blood they carry

(Name the two jugulars)

A
  1. Jugulars
    - internal: not visible
    - external: visible with depression mid clavicle
  2. Superior vena cava
    3. Inferior vena cava
  3. Pulmonary arteries

-Venus great vessels carry deoxygenated blood

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7
Q

Name the 2 chambers and what separates them and what their actions are

A

Atrias: Collects and pumps blood

Ventricles: pumps to lung

The septum separates the right and left side of the heart

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8
Q

Name the major differences between the right and left side of the heart

Circulation
Types of walls
Size


A

Right

  • circulates blood from lower pulmonary system
  • thinner walled
  • Smaller

Left

  • circulates blood to entire body v HIGHER PRESS
  • Muscular
  • Larger
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9
Q

What are the four valves named after

A

The four valves are named after the vessels they fill

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10
Q

Name the two divisions of valves and their subdivisions include side of heart and ICS

Name the sound each division of valves make

Name the locations of the semi lunar valves

A
  1. Atrioventricular (32)
    - Tricuspid R side 4th ICS
    -Mittal L side 5th ICS
    •S1 “lub” MT close
  2. Semi lunar valves
    -pulmonic valve: between right ventricle and pulmonary artery
    L side 2nd ICS

-aortic valve: bwtween left ventricle and aorta
R side 2nd ICS
•S2 “dub” AP close

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11
Q

Name your Atrioventricular valves

A

MT

  • mitral
  • Tri cuspid
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12
Q

Name your semi lunar valves

A

 AP

Aortic
Pulmonic

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13
Q

What is the acronym for the heart landmarks

Give the landmarks of the heart in relation to the side and intercostal spaces for auscultation

A

All physicians eventually take money

A-ortic: R second intercostal

P-ulmonic:L second intercostal

E-rbs point: left third intercostal

T-richspid: left fourth
intercostal

M-itral (PMI) (apical) : left mid clavicular fifth intercostal

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14
Q

Give the three layers of the heart, the type of tissue and where they are in relation to the heart

A

Three layers of heart

  1. Endocardium: innermost
    • thin walled,lines chambers
  2. Myocardium: middle
    • thick walled, muscular for pumping
  3. Epicardium: outer most
    • thin
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15
Q

What are characteristics of the pericardium

A

The pericardium is tough, Fibrous and encloses the heart

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16
Q

What is cardiac Tampanode and upon auscultation of someone with cardiac tapenade what are you gonna hear and why

How do you resolve cardiac Tampanode

How does cardiac Tampanode occur

A

Cardiac tamponade is the accumulation of blood in the pericardium

In someone with cardiac tampanode you’re gonna hear muffled heart sounds because of decreased ventricular filling

You resolve cardiac tamponode by draining the fluid going into the xiphoid process and into the heart

Cardiac tapanode occurs due to trauma

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17
Q

Where do the coronary arteries and veins arise from and go to in relation to the heart

A

Coronary Arteries and veins arise from base of heart and brunch to Apex

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18
Q

What side of the heart has a greater blood supply

What are the two main arteries in a blood supply

A

The left side of the heart has greater blood supply

Did you main arteries in the left sided heart blood supply are the:
-left coronary
-circumflex arteries


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19
Q

Where do cardiac veins empty deoxygenated blood

A

Cardiac veins of the deoxygenated blood into the coronary sinus

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20
Q

Where does the hearts ability to beat start

What chamber does this ability arise from

A

In the Sino atrial (SA node)

The SA note located in the right atrium

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21
Q

What is the function of the SA node

A

the SA Node is known as the pacemaker of the heart

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22
Q

What is meant by the conduction system of the heart

A

A group of specialized muscle Cells and fibers that initiate the normal cardiac cycle and cause construction

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23
Q

What is meant by depolarization & (Re)polarization in relation to the conduction system

A

Depolarization: activation of heart muscle contraction

(Re) polarization: refers to muscle cells returning to rest

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24
Q

How many times per minute does the electrical stimuli from the SAnode occur

Now AV node

Now Purkinje fibers

A

The electrical stimuli from the SA node occurs at 60–100 times per minute

Electrical stimuli from AV node occurs at 40- 60 bpm

Electrical simila from Perkinji fibers occurs at 25 –40 bpm

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25
Q

Give DEE steps of the conduction system for the heart from depolarization to repolarization

A
  1. Pulse leaves SA note signaling atria DEpolarization (contraction)

2 impulse travels down internal nodal pathway to AV note =gate keeper (which is still in atria)

  1. AV node functions as a slight delay allowing for blood from atria to empty into ventricle
  2. Inpulse Then goes to the bundle of His that branches out to the right and left branches
  3. That then goes to the Purkinje fibers and causes ventricular contraction
  4. Post DEpolarization of ventricles, ventricles return to resting REpolarization
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26
Q

What does the SA NODE Initiate (cause)

Say the type of polarization

A

The SA node causes atrial contraction (DE polarization)

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27
Q

What is the SA node represented by on an EKG

What does the contraction of The ventricles represent on EKG

What do ventricle relaxations represent on an EKG

A

SA- atrial contraction= P

Ventricular contraction= QRS

ventricular relaxation=T

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28
Q

What kind of pump system is the cardiovascular system known as and why

A

The cardiovascular system is known as a double pump system because of the division between the pulmonary and systemic circulation

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29
Q

Give the two basic steps of pulmonary and systemic circulation

A
  1. Blood enters right side of heart circulates to lungs

2. Blood enters left at heart circulates To rest of body

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30
Q

When is Systole and what happens during Systole

When is diastole and what happens during diastole

A

Systole: is during contraction: the squeezing of the ventricles and blood out of the body

Diastole: during relaxation: filling of ventricles

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31
Q

Give all related information for the first heart sound

What S is it?
What does it start?
What closes?

A

“LUB” =S1

  • known as the beginning of Systole
  • MT close
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32
Q

Give all related information for the second heart sound

What S is it?
What does it start?
What closes?

A

DUB= S2

  • end of Systole, beginning diastole
  • AP close
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33
Q

Name the three parts to the cardiac output in relation to “loads” andvwhat they mean 

A

Cardiac output includes

  • preload: amount at beginning of heart contraction (that will be ejected from ventricle)
  • Contractility: as amount of blood increases force of contractility increases
  • Afterload: amount of pressure post her contraction 
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34
Q

What is afterload also known as

A

Afterload also known as the resistance of pushing blood out

Pressure in Great vessel = after load

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35
Q

During S2 what is happening within the ventricles

How big is S2 in relation to S1

A

During S2 ventricles Phil

S2 is two times greater than S1

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36
Q

Give The formula for cardiac output

What does cardiac output mean

What is normal cardiac output in relation to liters

What is normal cardiac output in relation to milliliters per beat

A

CO = HR X SV

Cardiac output is the amount of blood pumped per minute (aka each cardiac cycle ) 

Normal cardiac output in liters is 6 – 8 L per minute

Normal cardiac output in ML is  55 to 80 ML per beat

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37
Q

Define stroke volume

A

The volume of blood ejected from the heart per minute

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38
Q

What decreases cardiac output

A

Heart failure

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39
Q

Name a few things that will increase HR/SV/CO

A
  • stress
  • anxiety
  • trauma
  • exercise
  • nor/epinephrine
40
Q

What two factors (system) control the heart rate

A

The heart rate is controlled by the sympathetic and parasympathetic nervous system

41
Q

What is sympathetic system also known as

What does the sympathetic nervous system do to the heart rate

What is released during the sympathetic nervous system and give the chain reaction

A

Sympathetic narcissistm: “fight V flight”

The sympathetic nervous system increases heart rate

Nor/Epping Efron released during sympathetic nervous system increasing contractility increasing cardiac output

42
Q

As part of the sympathetic nervous system what do the baroreceptors do

What do the chemo receptors do and where are they found

A

Barrow receptors regulate heart rate and stretch

Chemo receptors Increase heart rate after sensing a decrease in pH, oh to an increase in CO2
-Found in aortic arch and parotid sinuses

43
Q

What is the parasympathetic nervous system known as

What is it’s action on heart rate and how does it do this

A

Parasympathetic nervous system = rest in digest

PNS decreases her rate by simulating Vegas nerve innervating SA node slowing heart rate contractions

44
Q

What does an ECG give in relation to the myocardium And what does it record

(Think of the meaning of ECG and where is tall happens)

A

And ECG gives us a picture and information of the electrical conduction of the myocardium

ECG records cardiac electrical changes as specific waves/intervals

45
Q

 Give the portions of an ECG and what do you mean

+PR

A

P: contraction of atrium

QRS: contraction of ventricle

T: relaxed state

PR: Time of firing of SA Note to begin construction


46
Q

What are arrhythmias and give a numerical value for them

What do you wanna find out with an ECG about an arrhythmia
Origin

A

Arrhythmias are Irregularpulses

Below 60 or above 100

ECG done on arrhythmia to determine (origin)
-whats happening, and cause

47
Q

What is atrial fibrillation

A

A fib is an irregularly irregular heart rhythm

48
Q

What do the JVD Venus neck vessels reflect

What side is JVD best noted on

A

JVD Venous neck vessels reflect pressure in the right atrium

 JD best noted on right side

49
Q

What are findings you’re going to see in CHF patients

A 
-Extreme JVD pulasations
-edema
-dyspnea
-rails

50
Q

Give lifespan considerations for older adults in relation to heart and neck

Left atrium
Ejection fraction (%, walls, intolerance)
 heart rate
Response

A

Enlarged left atrium
-mitral valve closes slower

Decreased ejection fraction at 45%

  • should be 53 to 73%
  • decreased because left ventricular wall thickens
  • causes exercise intolerance

decrease heart rate variability

decrease heart rate

Decrease response to sympathetic nervous system

51
Q

What does an ejection fraction of 45 %indicate

A

Ejection fraction of 45% indicate cardiac issues

52
Q

Give cultural considerations for coronary heart disease in relation to cause of death and countries

A

Coronary heart disease is the leading cause of death in high income countries because of fast food availability

53
Q

What cultural group has a greater percentage of obesity

A

Mexicans have a greater percentage the Caucasians to be obese

54
Q

What does hypertension increase among African-Americans

A

Hypertension in African-Americans increases deaths due to heart disease

55
Q

What are pregnant women more likely to have an increase of

Give numerical values

What occurs and why does this occur

What is a tip to help with this issue

A

Pregnant women likely to have an increase in blood volume

About 40 to 60% more (1500 ml ⬆️ norm

Increase blood volume increasing cardiac output due to increase in stroke volume

A tip is to sleep on the left side to increase cardiac output

56
Q

What happens when a pregnant woman lays supine and why

A

Laying supine while pregnant decreases cardiac output making her to circulate blood due uterus impeding venous return

57
Q

What are men most likely to experience from heart issues

What are women least likely to experience from heart issues but what do they get stuck with

A

Men likely to die from heart issues

Women have lower morbidity rates due to heart issues but have worse outcomes
-heart conditions



58
Q

Give signs and symptoms a woman would experience during an M I and when she would experiences

A

Women with MI

  • increased fatigue
  • difficulty sleeping
  • dyspnea

Women are most likely to experience these symptoms post MI

59
Q

Define cardiac emergencies by giving six examples

A
  1. Unstable arrhythmias
  2. Cardiogenic shock
    - heart suddenly doesn’t pump enough blood
  3. systemic/pulmonary embolisms
    - full or partial blockages
  4. aortic dissection‘s
    - tear in inner layer of large blood vessel (aorta)
  5. CHF
  6. hypertensive crisis
60
Q

What do you do before conducting interventions during a cardiac emergency

A

Conduct a rapid assessment before interventions during credit emergencies as patient may deny pain

61
Q

What are things you want to collect during your initial assessment which is meant to be a quick exploration of presenting symptoms

A

During an initial assessment you wanna get

  • onset
  • duration
  • severity
  • precipitating factors ( causes) 
62
Q

What is the number one rule when It comes to the symptom of chest pain

A

ALWAYS RULE OUT MI

-ask if oain radiating to left arm, neck, jaw

63
Q

Give a few symptoms of MI

A

Chest pain, SOB, abnormal BP, palpitations, diaphoresis

64
Q

What do you wanna get during the focus physical exam for any cardiac respiratory situations

A

Get ECG, cardiac enzymes, x-ray, CKMB, troponins

65
Q

If a patient presents with an arrhythmia what do you want to get And why

A

If a patient presents with arrhythmias get an ECG for determining because

66
Q

What can fluid overload lead to an result in

A

Food overload can lead to pulmonary edema resulting in decompensated (unresolved) heart failure

67
Q

In relation to urgent assessments for the heart and vessels what do you always want to get especially with fluid volume overload

(2things, one is a description)

A

get extent of edema using edema scale

And get an accurate description of pain plus alleviating and aggravating factors

68
Q

When collecting subjective data what are risk factors you wanna assess for

A

biographical info
-age, gender, ethnicity, occupation

Past medical history
-HTN, DM, CAD

Meds

Family history
- Hx Of am I, HTN, DM, CA DEE, any family members passing in their age

69
Q

What is a quick statistic about people who smoke

A

People who smoke show to have sudden deaths

70
Q

What is the most important teaching for risk factors for your patient

Name a few other risk factor
-puff puff
Any dis?

A

1 teach risk factors the patient wants to  modify first

  • smoking
  • HTN
  • activity level
  • DM
  • overweight
71
Q

What are our three cardiovascular health goals

Decrease death
Increase/report
Control what

A
  1. Reduce coronary heart disease death and disease
  2. Increase number of in my patience who receive timely defibrillation and thrombolytics
    - have patient no signs and symptoms and report on time to be treated

3 increase number of adults with HTN that control HTN
-EDU! , Med, exercise

72
Q

What is vital for patients to know about an MI And why

A

It’s vital for patients to know sudden symptoms of an MI to know when to
Seek treatment in time

73
Q

What is blood pressure considered as and mostly linked with in rekation to MI

A

Blood pressure is the most controllable respector and mostly length with the development of coronary artery disease

74
Q

What are three things that we can do for patients to reduce the risk of MI and heart disease

Ask everytime
Control of dis
Glucose

A

-smoking cessation (always ask pt about intrest is quitting!)

-Control blood pressure/cholesterol
diet, weight

- DM control of glucose!!!



75
Q

For someone at risk for heart disease what is the diet they should follow

A

Low
-sodium, fat, sugar, calories (1200)

High
-fresh fruits/veggies

76
Q

What do you want to assume about chest pain

A

All chest pain is cardiac chest pain until proven otherwise by asking about radiation

77
Q

Give common subjective cardiovascular symptoms

A
  • chest pain
  • dyspnea
  • cough
  • fatigue
  • edema
  • nocturia
  • palpitations
  • syncope
  • dizziness
78
Q

What are age related changes you see in older adults

Activity
 A& 0
Failure

A
  • decreased activity tolerance
  • syncope
  • Arrhythmias
79
Q

When checking for JVD How high do you elevate the bed, would you put under the patient’s head

What are normal findings for JVD

What are abnormal findings for JVD and what do they mean

How do you diagnose abnormal JVD

A

When checking for JVD elevate the head of bed to 30– 45° and put pillow under head

Normal JVD findings are less than 3 cm

Abnormal JBD findings are greater than 3 cm indicating bright ventricular failure

Abnormal JVD classified by position above sternal angle for more than 15 seconds

80
Q

What is the dissension associated with and why

A

Vein distention is associated with heart failure due to fluid volume overload

81
Q

When inspecting and assessing the carotid what 2 specific things are tou assessing for

what does a thrill feel like and what does a Broui sound like and indicate

A

Any thrills or bruits

Thrill : rushing vibration

Broui: whooshing sound indicating turbulent blood flow

82
Q

What does JvD reflect In relation to the right atrium

A

JVD reflects the pressure of the right atrium

83
Q

Upon inspecting and palpating in the precordium what do you wanna search for if the patient has a lump

What are you looking for within your heart landmarks

A

 upon inspecting in palpating precordium if you discover a lump you want ti asses if it is a pacemaker

We’re looking at heart landmarks you’re looking for any
thrills
heaves : vigerous movement
lifts: slight movement

84
Q

What is the most important cardiovascular technique and how do you carry it out

A

Most important credit technique is auscultation done with the diaphragm and bell

85
Q

How do you Asses the hepato-jugular reflux

And what classifies a positive result, what does it mean

A
  1. Press on the patient’s liver for 10 sec
    - to increase Venus return making JVD prominent for 
  2. Check for increase in possession of jugular vein

Positive equals above 3 cm from more than 15 seconds means fluid overload or right ventricular/tricuspid stenosis


86
Q

Why do extra Heartsounds occur

When is S3 heard what does it sound like Where is it located

When is S4 heard what does it sound like and when is it common

A

Extra Heartsounds occur from vibrations of rapid ventricular filling

S3: Heard early diastolic post s2

  • Kentucky
  • left second intercostal space

S4: Late diastolic right before S1

  • Tennessee
  • common and left ventricular complaints
87
Q

What do you hear when auscultating cardiac Tampanode

What are orher abnorm heart sounds

A

Cardiac tampanode created muffled heart sounds

OTHER:

  • systolic ejection click
  • snap
  • Pericardial friction rub
88
Q

Define systolic ejection click

A

Systolic ejection click: sudden bulging of abnormal aortic/pulmonic valve or sudden dissension associated with great arteries

89
Q

Define snap

A

Snap: opening early diastolic sounds with mitral stenosis

90
Q

Define pericardial friction rub

A

Pericardial friction rub a.k.a. acute pericarditis: increased pitch scratching/greeting sound in left lower sternal border

91
Q

What are laboratory test used to assess myocardial damage specific to intracellular myocardium

What are these two laboratory test used for (specific to MI)

A

CKMB “creatinine kinase”
Norm: 0–5 mg/mL

Troponin
Norm: less than 0.2

Laboratory test used to rule out MI

OTHER: x ray: to see heart size , ecg 

92
Q

Give what an injection fracture measures

Give norm

A

Ejection fraction measures percent of blood leaving heart each contraction

Norm: 55 to 75%

93
Q

Give nursing outcomes Related to heart and neck vessels

A

Demonstrates adequate circulation

Maintains fluid balance

94
Q

Give nursing diagnosis related to heart and neck vessels

A

Decreased cardiac output

Impaired tissue perfusion related to create an excess full volume

95
Q

Give nursing interventions related to Heart and neck vessels

A

Teach patients sign of cardiac Eskimia and when to call 911

Assess for chest pain, shortness of breath, Adema document arrhythmias

Way patient daily maintain accurate I&O

96
Q

what does CP mean

Chest pain

A

Health Assessment (20 decks)

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