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HealthAss#3 > Ch 19Heart&Vessels > Flashcards

Ch 19Heart&Vessels Flashcards

1
Q

What happens to blood volume during pregnancy

A

increase to 30-40% with rapid expansion occurring during second trimester

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2
Q

What happens to pulse rate during pregnacy

A

increase pulse rate rises 10-15 beats/min

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3
Q

fetal heart function begins to beat at

A

3 weeks gestation

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4
Q

for about the first 2/3 of pregnancy the fetal heart is

A

shunted through an opening in the atrial septum, the forarmen, in to the left side of the heart where it pumped through the aorta

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5
Q

for about the last 1/3 of pregnancy the fetal heart

A

oxygenated blood is pumped by the right side of the heart out through the pulmonary artery, but detoured through the ductus arterosis to the aorta

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6
Q

how are the left and right ventricles during the last 1/3 of pregnancy for the infacnt

A

they are equal and weight and muscle thickness because they are both pumping into the systemic circulation

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7
Q

When does the ductus arteriosis normally clsoe

A

10-15 hours after birth

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8
Q

at what age does the mass of the left ventricle reach adult ratio of 2:!

A

at age 1 yo

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9
Q

We know that what lifestyle modifies the developments of CV disease;

A

smoking, diet, alcohol, exercise, stress

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10
Q

with what happens to Diastolic and Systolic with agin

A

systolic increases, diastolic may decreases (in the 6th decade)

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11
Q

Why does systolic BP increase

A

thickening and stiffening of the large arteries, collagen and calcium deposits, and loss of elastic fibers.

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12
Q

Does resting heart change with aging

A

No

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13
Q

Does cardiac output at rest in change with aging

A

does not change with agin

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14
Q

which dyrhythmias increase with aging

A

supraventricular and ventricular dysrhythmias increase

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15
Q

are ectopic beats common in aging

A

yes

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16
Q

Age related change in ECG

A

prolong P-R
prolong Q-T
Left axis deviation from age-related mild LV hypertrophy and fibrosis in the left bundle branch
increased incidence of bundle branch block

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17
Q

what is the leading cause of death in 65

A

CVD

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18
Q

what is stage 1 hypertension

A

systolic >140 and/or diastolic>90

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19
Q

9 modifiable factors of CVD

A

lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, inadequate consumption of fruits and vegetables, alcohol use and lack of physical activity.

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20
Q

hypertension is _ to _ times more common among women taking OC

A

2-3

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21
Q

leading cause of preventable disease

A

smoking

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22
Q

What does the nicotine increase the risk for

A

MI/stoke by causing the following: increase in oxygen demand with a concomitant decrease in oxygen supply and activation of platelets, fibrinogens and adverse change in the lipid profile

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23
Q

Americans over the age of 20 and older obesity percentage

A

73% of men and 64% of women

blacks 80%

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24
Q

within a first year of heart attack _ of women _ age and older will die compared to _ percentage of men

A

26%, 45, 19%

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25
Q

men report a heart attack as ___

women report heart attack as ____

A

men: sharp and crushing
women: dull and ache

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26
Q

The largest cluster of acute prodromal symptoms was reported

A

by smoking, younger obese, diabetic black women with history of heart disease.

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27
Q

Subjective data for heart and neck vessels:

A

1) chest pain
2) dyspnea
3) orthopnea
4) cough
5) fatigue
6) cyanosis or pallor
7) edema
8) nocturia
9) past cardiac history
10) family cardiac history `
11) pt centered car

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28
Q

SD: Chest pain

A

angina?
When did it start?
How long have you had it this time?
Is pain relieved by rest or nitroglycerin?

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29
Q

SD: Dyspnea

A

Which type of activity bring this on??
What about the last six months?
Position?
Constant/come and go?

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30
Q

characteristic sign of angina

A

squeezing “clenched fist”
diaphoreses, cold sweats, pallor, grayness, palpitation, dyspnea, nausea, tachycardia, fatigue.
* differentiate pain of cardiac versus non-cardiac

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31
Q

:DOE

A

need to quantify exactly
Paroxysmal?
Constant or interemittent?

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32
Q

PND

A

paroxysmal nocturnal dyspnea occurs with HF. Typically the person awakens after 2 hours of sleep with the perception of needing air

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33
Q

SD: Cough

A 
Do you have a cough? 
Duration?
Frequency? 
Type? 
Mucus?
Associated factors?
Relieved by medication?
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34
Q

SD: Fatigue

A

Do you tire easily? When did fatigue start? And RECENT changes occurred in energy level? Is it related to tiem of day?

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35
Q

Unusual fatigue in women suspect what?

A

MI

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36
Q

SD: Orthopenea?

A

How many pillows?

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37
Q

SD: Cyanosis or Pallor?

A

Ever noted your facial skin turning blue or ashen? Cyanosis or Pallor occurs with MI or low cardiac output state as a result of decreased tissue perfusion.

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38
Q

SD: Edema

A

Any swelling of your feet and legs?

Onset? Change? How much swelling? Does SOB occur before or after leg swelling?

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39
Q

SD: Nocturia

A

Do you awaken at night with an urgent need to urinate? How long has this been occurring? Changing?

40
Q

SD: Past Cardiac History

A

Any history or hypertension, elevated cholesterol, or triglycerides, heart murmur, congenital heart disease? Last ECG, stress ECG, serum cholesterol measurement, other heart?

41
Q

SD: Family cardiac

A

Any family history of hypertension, obesity, diabetes, CAD, sudden death at younger age.

42
Q

SD: patient centered care (cardiac risk factors)

A

Nutrition? Smoking? Alcohol? Exercise? Drugs?

43
Q

Additional History for Infants?

A

how was the mothers health during infancy? Any unexplained fever, rubella first trimester, other infection, hypertension or drugs? Cyanosis while nursing, crying? Is the baby able to eat nurse or finish bottle? Growth? Activity?

44
Q

Additional History for Children?

A

Is growth as expected? Does the child have normal activity? Chest pain? Frequent respiratory infection? Family history?

45
Q

Additional history for the pregnant women?

A

High BP during this or earlier pregnancy? Treatment? Associated factors? Weight gains, feet swelling? Have you had any faintness or dizziness with pregnancy?

46
Q

Additional history for the aging adult?

A

Do you have any known heart or lung disease: hypertension, CAD, chronic emphysema or bronchitis? Efforts to treat? Does your home have nay stairs. Does this have any effect on ADL. Have you stopped taking meds? Finances?

47
Q

Auscultate the Carotid Artery:

A

present of bruit? Use bell of stethoscope to auscultate the carotid artery at three levels 1) angle of jaw 2) midcervical area 3) base of neck

48
Q

Inspect the Jugular Venous Pulse (CVP)

A

may use either external or internal
position the person supine anywhere from a 30-45 angle, wherever you can best see the top of the vein or pulse
Note sternomastoid muscle

49
Q

Bruit is audible when the lumen is occluded by

A

1/2-2/3

50
Q

Full distended external jugular veins above 45 degrees signify increased

A

CVP as seen with heart failure.

51
Q

Estimate the jugular venous Pressure Steps

A

If you cannot find internal jug use ex jug.
difficult and not reliable
ruler at angle of louis
ruler from jug distention should be >3cm
IF ESTIMATED JUG VENOUR PRESS IS PRESENT or you suspect HG do abdominojular test— hf is present if the jugular veins will elevate more than 4cm and stay elevated as long as you push.

52
Q

Inspect anterior chest

A

is apical pulse present?
A heave or lift is a sustained forceful thrusting of the ventricle during systole. IT occurs with ventricular hypertrophy as a result of increase workload

53
Q

Palpate the Apical Impulse

A 
ask the person to exhale and hold
use one finger pad. 
you feel best at then end of expiration
NOTE-
Location
Size
Amplitude
Duration
54
Q

Palpate Across the Precordium

A

Use palmar aspect of your four finger to gently palpate apex, the left sternal border and the base, searching for pulsation.
If present note the timing.

55
Q

What is a thrill?

A

turbulent blood flow
helps id location/origin of murmur
does not rule our murmur

56
Q

Auscultation does not

A

note the actual anatomic location of the valves

57
Q

The valve areas to auscultate for aortic, pulmonic, tricuspid, and mitral valve are

A

Aortic-second right intercostal
Pulmonic-second left intercostal
Tricuspid valve- left lower sternal border
Mitral valve- fifth interspace at around left midclavicular line

58
Q

When auscultating begin with

A

diaphragm end piece and use the following routine

1) note the rate and rhythm
2) identify S1 and S2
3) assess S1 and S2 separately
4) listen for extra heart sounds
5) listen for murmurs

59
Q

Premature beat

A

an isolated beat is early or a pattern occurs in which every third or fourth bear sounds early

60
Q

Irregulary irregular

A

no pattern to the sound; beat comes rapidly and at random intervals as in atrial fibrillation

61
Q

A pulse deficit

A

signals a weak contraction of ventricle; occurs with atrial fibrillation and premature beats and heart failure

62
Q

S1 is louder than S2 at the

A

apex

63
Q

S2 is louder than S1

A

at the base

64
Q

S1 coincides with the

A

carotid artery and the R wave

65
Q

First heart sound is ___ caused by ___ and heard over__

A

S1 cause by closure of AV valve and heard over the entire precordium

66
Q

A split S1

A

is normal but occurs rarely and means you are hearing the mitral and tricuspid components separately.

67
Q

S2 is associate with ______ and is heard over ______ and loudest at ______

A

closure of semilunar valves heard over precordium

68
Q

A fixed split is

A

is unaffected by respiration; the split is always there

69
Q

a paradoxical split

A

is the opposite of what you would expect the sounds fuse on inspiration and split on expiration

70
Q

A pathological S3 may occur

A

with heart failure and volume overload

71
Q

A pathological S4 may occur with

A

CAD

72
Q

A systolic murmur may occur with ___ or ____; a diastolic murmur always indicates ____

A

healthy heart, heart disease; heart disease

73
Q

It is crucial to define what in a murmurs/

A

heart sounds by; Timing, loudness, pitch, pattern, quality, location, radiation, posture.

74
Q

A murmur of mitral stenosis is ______ and _____

Where as aortic stenosis is _____

A

low pitched and rumbling

harsh

75
Q

ECG and ECHO can establish

A

an innocent murmur from a pathological one

76
Q

S3 and S4 and the murmur of mitral stenosis sometimes may be heard only when

A

on the left side.

77
Q

A soft diastolic regurgitation may be heard only when the person is

A

leaning forward in the sitting psostion

78
Q

Aging adult

A

Rise is systolic is common with aging
Diastolic generally stays constant.
Some may experience orthohypo
ap diameter increases making it more difficult to hear the splitting of S2
systolic murmurs occur in 50% of aging people
S3 is associated with hf and it ALWAYS abnormal after age 35
ectopic beats may be normal and do not necessarily indicate underlying heart disease

79
Q

Inferior vena cave brings venous blood up from

A

the liver to the right atrium

80
Q

Superior vena cava brings venous blood down from the

A

head and upper extremities to the right atrium

81
Q

venous blood flow from the

A
  • right atrium to through tricuspid valve to right ventricle
  • from right ventricle through pulmonic valve to pulmonary artery
  • from pulmonary artery to lungs,
82
Q

Oxygenation blood flow through

A
  • pulmonary veins to left atrium
  • From left atrium through mitral valve to left ventricle
  • From left ventricle, through aortic valve into aorta
  • Aorta delivers oxygenated blood to the body
83
Q

Cardiac Cycle two cycles include

A

diastole (ventricles relax, fill with blood) and systole (heart contracts, blood pumped from ventricles & fills pulmonary and systemic arteries).

84
Q

S1
S2
S3
S4

A
  • S1 (normal) – can be heard all over pericordium, loudest at apex
  • S2(normal) – can be heart all over pericordium, loudest at base
  • S3 ( normal or abnormal)- can be heard at apex or left lower sternal border
  • S4 (could occur in adults older than 40 without cardiovascular disease, especially after exercise.
85
Q

Auscultate over

A

precordium from base of heart to apex in zig zag formation over four valve areas ( Aortic, pulmonic, tricuspid, mitral)

86
Q

Characteristic sounds

A

Frequency, intensity, duration timing

87
Q

How many liters does the heart pump throughout the body per minute

A

3-6 liters

88
Q

Major cause of stroke is

A

carotid artery stenosis

89
Q

Hemorrhagic stroke often related to

A

hypertension

90
Q

Ischemic stroke ofter related to

A

atherosclerosis

91
Q

Jugular vein empties

A

deoxygenated blood into the superior vena cave

92
Q

If heart failure is present, pressure in the jugular

A

be elevated more than 3 cm above the sternal angle while patient is at 45 degree angle.

93
Q

Aging Adult

A

-Difficult to isolate aging process
-Lifestyle modifies development of cardiovascular disease
-Aging adult have increase in systolic blood pressure
-No change in resting heart rate
-Dysrhythmias increase with age
Smoking, chronic alcohol use, obesity, lack of exercise, unhealthy eating.

94
Q

Hypertension; men versus women

A
  • Stage I – 140/90 or currently taking antihypertensive medication
  • Two to three times more common in women taking oral contraceptives
  • More men than women until age 45
  • From age 45 – 64 the same amount of men and women
  • From age 64 more women than men
95
Q

when assessing dyspnea on exertion

A

quantify (after walking? How far? Does it interfere with ADL’s?)

HealthAss#3 (4 decks)

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