Ch 17 Heart and neck vessels assessment Flashcards
Give the two locations of the heart
One including intercostal spaces
Second including structures
- Left mid clavicular between the 2nd and 5th ICS
2. In the precordium, in mediastinum, between lungs, above diaphragm, posterior sternum, anterior vertebrae
What is the typical size of a heart and what are characteristics of a woman’s heart
Size of a heart is a clenched fist
Women’s heart are smaller
And weight less

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
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”

Name the arterial (sounds red) great vessels,
Where arterial vessels originate from and what direction do the turning
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
What is the exact location of the carotids
Between the sternocleidomastoid and the trachea
Name the Venus great vessels and what blood they carry
(Name the two jugulars)
- Jugulars
- internal: not visible
- external: visible with depression mid clavicle - Superior vena cava
3. Inferior vena cava - Pulmonary arteries
-Venus great vessels carry deoxygenated blood
Name the 2 chambers and what separates them and what their actions are
Atrias: Collects and pumps blood
Ventricles: pumps to lung
The septum separates the right and left side of the heart
Name the major differences between the right and left side of the heart
Circulation
Types of walls
Size

Right
- circulates blood from lower pulmonary system
- thinner walled
- Smaller
Left
- circulates blood to entire body v HIGHER PRESS
- Muscular
- Larger
What are the four valves named after
The four valves are named after the vessels they fill
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
- Atrioventricular (32)
- Tricuspid R side 4th ICS
-Mittal L side 5th ICS
•S1 “lub” MT close - 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
Name your Atrioventricular valves
MT
- mitral
- Tri cuspid
Name your semi lunar valves
 AP
Aortic
Pulmonic
What is the acronym for the heart landmarks
Give the landmarks of the heart in relation to the side and intercostal spaces for auscultation
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
Give the three layers of the heart, the type of tissue and where they are in relation to the heart
Three layers of heart
- Endocardium: innermost
- thin walled,lines chambers
- Myocardium: middle
- thick walled, muscular for pumping
- Epicardium: outer most
- thin
What are characteristics of the pericardium
The pericardium is tough, Fibrous and encloses the heart
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
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
Where do the coronary arteries and veins arise from and go to in relation to the heart
Coronary Arteries and veins arise from base of heart and brunch to Apex
What side of the heart has a greater blood supply
What are the two main arteries in a blood supply
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

Where do cardiac veins empty deoxygenated blood
Cardiac veins of the deoxygenated blood into the coronary sinus
Where does the hearts ability to beat start
What chamber does this ability arise from
In the Sino atrial (SA node)
The SA note located in the right atrium
What is the function of the SA node
the SA Node is known as the pacemaker of the heart
What is meant by the conduction system of the heart
A group of specialized muscle Cells and fibers that initiate the normal cardiac cycle and cause construction
What is meant by depolarization & (Re)polarization in relation to the conduction system
Depolarization: activation of heart muscle contraction
(Re) polarization: refers to muscle cells returning to rest
How many times per minute does the electrical stimuli from the SAnode occur
Now AV node
Now Purkinje fibers
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
Give DEE steps of the conduction system for the heart from depolarization to repolarization
- 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)
- AV node functions as a slight delay allowing for blood from atria to empty into ventricle
- Inpulse Then goes to the bundle of His that branches out to the right and left branches
- That then goes to the Purkinje fibers and causes ventricular contraction
- Post DEpolarization of ventricles, ventricles return to resting REpolarization
What does the SA NODE Initiate (cause)
Say the type of polarization
The SA node causes atrial contraction (DE polarization)
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
SA- atrial contraction= P
Ventricular contraction= QRS
ventricular relaxation=T
What kind of pump system is the cardiovascular system known as and why
The cardiovascular system is known as a double pump system because of the division between the pulmonary and systemic circulation
Give the two basic steps of pulmonary and systemic circulation
- Blood enters right side of heart circulates to lungs
2. Blood enters left at heart circulates To rest of body
When is Systole and what happens during Systole
When is diastole and what happens during diastole
Systole: is during contraction: the squeezing of the ventricles and blood out of the body
Diastole: during relaxation: filling of ventricles
Give all related information for the first heart sound
What S is it?
What does it start?
What closes?
“LUB” =S1
- known as the beginning of Systole
- MT close
Give all related information for the second heart sound
What S is it?
What does it start?
What closes?
DUB= S2
- end of Systole, beginning diastole
- AP close
Name the three parts to the cardiac output in relation to “loads” andvwhat they mean 
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 
What is afterload also known as
Afterload also known as the resistance of pushing blood out
Pressure in Great vessel = after load
During S2 what is happening within the ventricles
How big is S2 in relation to S1
During S2 ventricles Phil
S2 is two times greater than S1
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
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
Define stroke volume
The volume of blood ejected from the heart per minute
What decreases cardiac output
Heart failure
Name a few things that will increase HR/SV/CO
- stress
- anxiety
- trauma
- exercise
- nor/epinephrine
What two factors (system) control the heart rate
The heart rate is controlled by the sympathetic and parasympathetic nervous system
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
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
As part of the sympathetic nervous system what do the baroreceptors do
What do the chemo receptors do and where are they found
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
What is the parasympathetic nervous system known as
What is it’s action on heart rate and how does it do this
Parasympathetic nervous system = rest in digest
PNS decreases her rate by simulating Vegas nerve innervating SA node slowing heart rate contractions
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)
And ECG gives us a picture and information of the electrical conduction of the myocardium
ECG records cardiac electrical changes as specific waves/intervals
 Give the portions of an ECG and what do you mean
+PR
P: contraction of atrium
QRS: contraction of ventricle
T: relaxed state
PR: Time of firing of SA Note to begin construction

What are arrhythmias and give a numerical value for them
What do you wanna find out with an ECG about an arrhythmia
Origin
Arrhythmias are Irregularpulses
Below 60 or above 100
ECG done on arrhythmia to determine (origin)
-whats happening, and cause
What is atrial fibrillation
A fib is an irregularly irregular heart rhythm
What do the JVD Venus neck vessels reflect
What side is JVD best noted on
JVD Venous neck vessels reflect pressure in the right atrium
 JD best noted on right side
What are findings you’re going to see in CHF patients
-Extreme JVD pulasations -edema -dyspnea -rails 
Give lifespan considerations for older adults in relation to heart and neck
Left atrium
Ejection fraction (%, walls, intolerance)
 heart rate
Response
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
What does an ejection fraction of 45 %indicate
Ejection fraction of 45% indicate cardiac issues
Give cultural considerations for coronary heart disease in relation to cause of death and countries
Coronary heart disease is the leading cause of death in high income countries because of fast food availability
What cultural group has a greater percentage of obesity
Mexicans have a greater percentage the Caucasians to be obese
What does hypertension increase among African-Americans
Hypertension in African-Americans increases deaths due to heart disease
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
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
What happens when a pregnant woman lays supine and why
Laying supine while pregnant decreases cardiac output making her to circulate blood due uterus impeding venous return
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
Men likely to die from heart issues
Women have lower morbidity rates due to heart issues but have worse outcomes
-heart conditions

Give signs and symptoms a woman would experience during an M I and when she would experiences
Women with MI
- increased fatigue
- difficulty sleeping
- dyspnea
Women are most likely to experience these symptoms post MI
Define cardiac emergencies by giving six examples
- Unstable arrhythmias
- Cardiogenic shock
- heart suddenly doesn’t pump enough blood - systemic/pulmonary embolisms
- full or partial blockages - aortic dissection‘s
- tear in inner layer of large blood vessel (aorta) - CHF
- hypertensive crisis
What do you do before conducting interventions during a cardiac emergency
Conduct a rapid assessment before interventions during credit emergencies as patient may deny pain
What are things you want to collect during your initial assessment which is meant to be a quick exploration of presenting symptoms
During an initial assessment you wanna get
- onset
- duration
- severity
- precipitating factors ( causes) 
What is the number one rule when It comes to the symptom of chest pain
ALWAYS RULE OUT MI
-ask if oain radiating to left arm, neck, jaw
Give a few symptoms of MI
Chest pain, SOB, abnormal BP, palpitations, diaphoresis
What do you wanna get during the focus physical exam for any cardiac respiratory situations
Get ECG, cardiac enzymes, x-ray, CKMB, troponins
If a patient presents with an arrhythmia what do you want to get And why
If a patient presents with arrhythmias get an ECG for determining because
What can fluid overload lead to an result in
Food overload can lead to pulmonary edema resulting in decompensated (unresolved) heart failure
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)
get extent of edema using edema scale
And get an accurate description of pain plus alleviating and aggravating factors
When collecting subjective data what are risk factors you wanna assess for
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
What is a quick statistic about people who smoke
People who smoke show to have sudden deaths
What is the most important teaching for risk factors for your patient
Name a few other risk factor
-puff puff
Any dis?
1 teach risk factors the patient wants to  modify first
- smoking
- HTN
- activity level
- DM
- overweight
What are our three cardiovascular health goals
Decrease death
Increase/report
Control what
- Reduce coronary heart disease death and disease
- 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
What is vital for patients to know about an MI And why
It’s vital for patients to know sudden symptoms of an MI to know when to
Seek treatment in time
What is blood pressure considered as and mostly linked with in rekation to MI
Blood pressure is the most controllable respector and mostly length with the development of coronary artery disease
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
-smoking cessation (always ask pt about intrest is quitting!)
-Control blood pressure/cholesterol
diet, weight
- DM control of glucose!!!

For someone at risk for heart disease what is the diet they should follow
Low
-sodium, fat, sugar, calories (1200)
High
-fresh fruits/veggies
What do you want to assume about chest pain
All chest pain is cardiac chest pain until proven otherwise by asking about radiation
Give common subjective cardiovascular symptoms
- chest pain
- dyspnea
- cough
- fatigue
- edema
- nocturia
- palpitations
- syncope
- dizziness
What are age related changes you see in older adults
Activity
 A& 0
Failure
- decreased activity tolerance
- syncope
- Arrhythmias
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
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
What is the dissension associated with and why
Vein distention is associated with heart failure due to fluid volume overload
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
Any thrills or bruits
Thrill : rushing vibration
Broui: whooshing sound indicating turbulent blood flow
What does JvD reflect In relation to the right atrium
JVD reflects the pressure of the right atrium
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
 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
What is the most important cardiovascular technique and how do you carry it out
Most important credit technique is auscultation done with the diaphragm and bell
How do you Asses the hepato-jugular reflux
And what classifies a positive result, what does it mean
- Press on the patient’s liver for 10 sec
- to increase Venus return making JVD prominent for  - 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

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
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
What do you hear when auscultating cardiac Tampanode
What are orher abnorm heart sounds
Cardiac tampanode created muffled heart sounds
OTHER:
- systolic ejection click
- snap
- Pericardial friction rub
Define systolic ejection click
Systolic ejection click: sudden bulging of abnormal aortic/pulmonic valve or sudden dissension associated with great arteries
Define snap
Snap: opening early diastolic sounds with mitral stenosis
Define pericardial friction rub
Pericardial friction rub a.k.a. acute pericarditis: increased pitch scratching/greeting sound in left lower sternal border
What are laboratory test used to assess myocardial damage specific to intracellular myocardium
What are these two laboratory test used for (specific to MI)
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 
Give what an injection fracture measures
Give norm
Ejection fraction measures percent of blood leaving heart each contraction
Norm: 55 to 75%
Give nursing outcomes Related to heart and neck vessels
Demonstrates adequate circulation
Maintains fluid balance
Give nursing diagnosis related to heart and neck vessels
Decreased cardiac output
Impaired tissue perfusion related to create an excess full volume
Give nursing interventions related to Heart and neck vessels
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
what does CP mean
Chest pain
