Ch. 20- Cardiovascular and Neck Vessels Assesment

Question 1

The heart chambers are separated by valves, whose main purpose is what?

Answer 1

To prevent backflow of blood

Question 2

Valves are unidirectional meaning what?

Answer 2

They can only open one way.

Question 3

How many valves are in the heart?

Answer 3

4

Question 4

What are the 4 valves in the heart?

Answer 4

• Two antrioventricular (AV) valves known as tricuspid (R) and mitral (L)
• Two semilunar (SL) valves known as aortic (L) and pulmonic (R)

Question 5

The AV valves separate what?

Answer 5

Atria and ventricles.

Question 6

AV valves open during what?

Answer 6

Diastole to allow ventricular refill

Question 7

AV valves close during what?

Answer 7

Systole to prevent backflow

Question 8

What is S1?

Answer 8

first heart sound (AV valve closing: systole)

Question 9

SL valves are set between what?

Answer 9

Ventricles and arteries.

Question 10

SL valves open during what?

Answer 10

Systole to allow ventricular ejection.

Question 11

SL valves close during what?

Answer 11

Diastole to allow ventricular filling.

Question 12

What is S2?

Answer 12

Second heart sound (SL valves closing: diastole)

Question 13

Where can S1 be heard?

Answer 13

Over all pericardium, but loudest at apex

Question 14

Where can S2 be heard?

Answer 14

Over all pericardium, but loudest at base

Question 15

What are two extra heart sounds?

Answer 15

S3 and S4

Question 16

When is S3 heard?

Answer 16

When ventricles resistant to filling during early rapid filling phase.

Question 17

Ventricular filling causes what?

Answer 17

Vibrations

Question 18

What does S3 sound like?

Answer 18

“lub, dub, a” (Kentucky)

Question 19

When does S4 occur?

Answer 19

At the end of diastole, when ventricle is resistant to filling
(Just before S1)

Question 20

What do the atria do during S4?

Answer 20

Atria contract and push blood into noncompliant ventricle

this creates vibrations heard as S4

Question 21

What does S4 sound like?

Answer 21

“dah, lub, dub” (Tennessee)

Question 22

What are murmurs created by?

Answer 22

Conditions that cause turbulent blood flow and collision currents

Question 23

What do murmurs sound like?

Answer 23

Gentle, blowing, swooshing sounds (lower frequency, use bell)

Question 24

What are causes of a murmur?

Answer 24

• Increased blood velocity-flow murmur
• increased blood viscosity
• structural defects in valves

Question 25

What is regurgitation?

Answer 25

A backflow of blood caused by failure of the heart's mitral valve to close tightly.

Question 26

What is Stenosis?

Answer 26

Narrowing of the valve in the large blood vessel branching off the heart (aorta).

Question 27

How do you grade murmurs?

Answer 27

``` 1- barely audible 2- clearly audible, but faint 3- moderately loud, easy to hear 4- loud, associated with palpable thrill 5- very loud, part of stethoscope off of chest, thrill 6- can hear without stethoscope ```

Question 28

Explain thrill:

Answer 28

palpable vibration

Question 29

How do you document a murmur?

Answer 29

Example: 2/6 best heard over RSB

Question 30

What are all heart sounds described by?

Answer 30

- Pitch - Loudness - Quality - Duration - Timing

Question 31

Explain Pitch:

Answer 31

described as high pitched or low pitch

Question 32

Explain Loudness:

Answer 32

loud or soft

Question 33

Explain Quality:

Answer 33

blowing, harsh

Question 34

Explain Duration:

Answer 34

very short for heart sounds; silent periods are longer

Question 35

Explain Timing:

Answer 35

Systole or diastole

Question 36

The carotid artery is what type of artery?

Answer 36

Central artery

Question 37

Timing of the carotid artery closely coincides with what?

Answer 37

ventricular systole (S1)

Question 38

Where is the carotid artery located?

Answer 38

In the groove between trachea and medial to the sternomastoid muscle

Question 39

Jugular veins empty what? and where?

Answer 39

unoxygenated blood directly into superior vena cava

Question 40

There are two jugular veins present where?

Answer 40

In each side of the neck

Question 41

Where does the internal jugular lie?

Answer 41

Medial to sternomastoid muscle- usually not visible

Question 42

When may internal jugular pulsations be noted?

Answer 42

When supine in suprasternal notch

Question 43

Where does the external jugular vein lie?

Answer 43

Lateral to sternomastoid muscle, above clavicle

Question 44

What objective data assessment techniques do we use in a cardiovascular assessment?

Answer 44

- Palpation - Auscultation - Bruit - Inspection

Question 45

During palpation of the carotid artery what should be done?

Answer 45

- Palpate only one carotid artery at a time to avoid cutting off circulation - feel amplitude of pulse (ex: normal strength bilaterally)

Question 46

During auscultation of the carotid artery what should be done?

Answer 46

- Assess for presence of carotid bruit - Avoid compressing the artery which can create an artificial bruit - Ask client to exhale and hold breath while examiner listens

Question 47

What is a Bruit?

Answer 47

Narrowing; indicates turbulent blood flow (Ex: Carotids 2+ with no bruit noted bilaterally) - Bruits are vascular sounds resembling heart murmurs. Sometimes they're described as blowing sounds - If bruits are present, you'll typically hear them over the aorta, renal arteries, iliac arteries, and femoral arteries.

Question 48

When performing inspection of jugular venous pulse, it is best viewed from which patients side?

Answer 48

right side of neck

Question 49

What position should the patient be in when inspecting the jugular venous pulse?

Answer 49

Supine at 30-45 degree angle, pillow removed, and pt. head slightly turned away from examiner

Question 50

When inspecting the jugular venous pulse what equipment should be used?

Answer 50

A pen light

Question 51

What areas are you observing when inspecting the jugular venous pulse?

Answer 51

- Suprasternal notch (internal jugular) | - lateral to sternocleidomastoid (external jugular)

Question 52

What are normal findings when inspecting the jugular venous pulse?

Answer 52

- In some these veins aren't visible, in others they are full in supine positions - should disappears person sits up around 45 degrees (document no JVD at 45 degrees)

Question 53

Patient can be supine when inspecting the anterior chest for what?

Answer 53

- Apical impulse at apex of heart, 5th intercostal space/mid calvicular line - PMI- point of maximum impulse

Question 54

When palpating anterior chest localize apical pulse precisely by what?

Answer 54

- using one finger pad and asking person to exhale and then hold it - if sitting lean forward, or ask pt. to lie in ? position to palpate

Question 55

How do you palpate the anterior chest in a cardiovascular assessment?

Answer 55

Using palmar aspect of four finger, gently palpate sex, left sternal border, and base, searching for any other pulsations or thrills

Question 56

When auscultating the heart it is important to know what about the valves areas?

Answer 56

Valve areas are not over actual anatomic locations of valves but sites in chest wall where sounds produced by valves are best heard

Question 57

Where is the pulmonic valve area?

Answer 57

2nd ICS left sternal border

Question 58

Where is the aortic area?

Answer 58

2nd ICS right sternal border

Question 59

Where is herbs point?

Answer 59

3rd-4th ICS left sternal border

Question 60

Where is the tricuspid area?

Answer 60

left lower sternal border

Question 61

Where is the mitral area?

Answer 61

5th ICS left mid clavicular line

Question 62

What should you note when performing auscultation of the heart?

Answer 62

- Rate and rhythm - Identify S1 and S2 - Listen for extra heart sounds - Listen for murmurs - Assess all five areas with diaphragm and bell

Question 63

What are additional heart sounds?

Answer 63

- Mitral prosthetic valve sound - Pericardial friction rub - Aortic prosthetic valve sounds - Ejection murmurs-aortic stenosis - Regurgitation murmurs