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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
men report a heart attack as ___ | women report heart attack as ____
men: sharp and crushing women: dull and ache
26
The largest cluster of acute prodromal symptoms was reported
by smoking, younger obese, diabetic black women with history of heart disease.
27
Subjective data for heart and neck vessels:
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
28
SD: Chest pain
angina? When did it start? How long have you had it this time? Is pain relieved by rest or nitroglycerin?
29
SD: Dyspnea
Which type of activity bring this on?? What about the last six months? Position? Constant/come and go?
30
characteristic sign of angina
squeezing "clenched fist" diaphoreses, cold sweats, pallor, grayness, palpitation, dyspnea, nausea, tachycardia, fatigue. * differentiate pain of cardiac versus non-cardiac
31
:DOE
need to quantify exactly Paroxysmal? Constant or interemittent?
32
PND
paroxysmal nocturnal dyspnea occurs with HF. Typically the person awakens after 2 hours of sleep with the perception of needing air
33
SD: Cough
``` Do you have a cough? Duration? Frequency? Type? Mucus? Associated factors? Relieved by medication? ```
34
SD: Fatigue
Do you tire easily? When did fatigue start? And RECENT changes occurred in energy level? Is it related to tiem of day?
35
Unusual fatigue in women suspect what?
MI
36
SD: Orthopenea?
How many pillows?
37
SD: Cyanosis or Pallor?
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.
38
SD: Edema
Any swelling of your feet and legs? | Onset? Change? How much swelling? Does SOB occur before or after leg swelling?
39
SD: Nocturia
Do you awaken at night with an urgent need to urinate? How long has this been occurring? Changing?
40
SD: Past Cardiac History
Any history or hypertension, elevated cholesterol, or triglycerides, heart murmur, congenital heart disease? Last ECG, stress ECG, serum cholesterol measurement, other heart?
41
SD: Family cardiac
Any family history of hypertension, obesity, diabetes, CAD, sudden death at younger age.
42
SD: patient centered care (cardiac risk factors)
Nutrition? Smoking? Alcohol? Exercise? Drugs?
43
Additional History for Infants?
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
Additional History for Children?
Is growth as expected? Does the child have normal activity? Chest pain? Frequent respiratory infection? Family history?
45
Additional history for the pregnant women?
High BP during this or earlier pregnancy? Treatment? Associated factors? Weight gains, feet swelling? Have you had any faintness or dizziness with pregnancy?
46
Additional history for the aging adult?
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
Auscultate the Carotid Artery:
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
Inspect the Jugular Venous Pulse (CVP)
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
Bruit is audible when the lumen is occluded by
1/2-2/3
50
Full distended external jugular veins above 45 degrees signify increased
CVP as seen with heart failure.
51
Estimate the jugular venous Pressure Steps
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
Inspect anterior chest
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
Palpate the Apical Impulse
``` 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
Palpate Across the Precordium
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
What is a thrill?
turbulent blood flow helps id location/origin of murmur does not rule our murmur
56
Auscultation does not
note the actual anatomic location of the valves
57
The valve areas to auscultate for aortic, pulmonic, tricuspid, and mitral valve are
Aortic-second right intercostal Pulmonic-second left intercostal Tricuspid valve- left lower sternal border Mitral valve- fifth interspace at around left midclavicular line
58
When auscultating begin with
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
Premature beat
an isolated beat is early or a pattern occurs in which every third or fourth bear sounds early
60
Irregulary irregular
no pattern to the sound; beat comes rapidly and at random intervals as in atrial fibrillation
61
A pulse deficit
signals a weak contraction of ventricle; occurs with atrial fibrillation and premature beats and heart failure
62
S1 is louder than S2 at the
apex
63
S2 is louder than S1
at the base
64
S1 coincides with the
carotid artery and the R wave
65
First heart sound is ___ caused by ___ and heard over__
S1 cause by closure of AV valve and heard over the entire precordium
66
A split S1
is normal but occurs rarely and means you are hearing the mitral and tricuspid components separately.
67
S2 is associate with ______ and is heard over ______ and loudest at ______
closure of semilunar valves heard over precordium
68
A fixed split is
is unaffected by respiration; the split is always there
69
a paradoxical split
is the opposite of what you would expect the sounds fuse on inspiration and split on expiration
70
A pathological S3 may occur
with heart failure and volume overload
71
A pathological S4 may occur with
CAD
72
A systolic murmur may occur with ___ or ____; a diastolic murmur always indicates ____
healthy heart, heart disease; heart disease
73
It is crucial to define what in a murmurs/
heart sounds by; Timing, loudness, pitch, pattern, quality, location, radiation, posture.
74
A murmur of mitral stenosis is ______ and _____ | Where as aortic stenosis is _____
low pitched and rumbling | harsh
75
ECG and ECHO can establish
an innocent murmur from a pathological one
76
S3 and S4 and the murmur of mitral stenosis sometimes may be heard only when
on the left side.
77
A soft diastolic regurgitation may be heard only when the person is
leaning forward in the sitting psostion
78
Aging adult
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
Inferior vena cave brings venous blood up from
the liver to the right atrium
80
Superior vena cava brings venous blood down from the
head and upper extremities to the right atrium
81
venous blood flow from the
* right atrium to through tricuspid valve to right ventricle * from right ventricle through pulmonic valve to pulmonary artery * from pulmonary artery to lungs,
82
Oxygenation blood flow through
* 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
Cardiac Cycle two cycles include
diastole (ventricles relax, fill with blood) and systole (heart contracts, blood pumped from ventricles & fills pulmonary and systemic arteries).
84
S1 S2 S3 S4
* 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
Auscultate over
precordium from base of heart to apex in zig zag formation over four valve areas ( Aortic, pulmonic, tricuspid, mitral)
86
Characteristic sounds
Frequency, intensity, duration timing
87
How many liters does the heart pump throughout the body per minute
3-6 liters
88
Major cause of stroke is
carotid artery stenosis
89
Hemorrhagic stroke often related to
hypertension
90
Ischemic stroke ofter related to
atherosclerosis
91
Jugular vein empties
deoxygenated blood into the superior vena cave
92
If heart failure is present, pressure in the jugular
be elevated more than 3 cm above the sternal angle while patient is at 45 degree angle.
93
Aging Adult
-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
Hypertension; men versus women
- 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
when assessing dyspnea on exertion
quantify (after walking? How far? Does it interfere with ADL’s?)

HealthAss#3 (4 decks)

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