Ch 20 - PPT notes

Question 1

what is a split S2?

Answer 1

-during inspiration there is a pressure change
- more blood comes in the right than the left
- the aortic valve closes before the pulmonary
- this causes a split S2 sound

Question 2

when is S3 heard? what is happening?

Answer 2

-immediately after S2
-ventricles are resistant to filling at the beginning of diastole

Question 3

when is S4 heard? what is happening?

Answer 3

• right before S1
• ventricles resistant to filling at the end of diastole

Question 4

what does a murmur sound like?

Answer 4

gentle, whooshing, blowing

Question 5

what is pulse pressure?

Answer 5

the difference between systolic and diastolic pressure

Question 6

what are three hemodynamic changes with aging?

Answer 6

• increased systolic blood pressure
• increased pulse pressure
• no change in HR or CO during rest

Question 7

what are there increased rates of in the elderly?

Answer 7

• CAD
• heart failure
• hypertension

Question 8

what is the most common underlying cause of death globally?

Answer 8

CVD

Question 9

what does HTN accelerate?

Answer 9

atherosclerosis

Question 10

how does smoking and tobacco use impact heart disease?

Answer 10

it impacts oxygenation

Question 11

how does elevated cholesterol contribute to heart disease?

Answer 11

LDL adds to plaque formation

Question 12

what do you need to control in T2 diabetes?

Answer 12

glycemic control

Question 13

what disease is the number 1 killer of women?

Answer 13

heart disease

Question 14

why do women usually have delayed diagnosis of heart disease?

Answer 14

women usually have different symptoms than the typical chest pain that men feel

Question 15

what are the eleven types of subjective data to gather during an assessment of CV health ?

Answer 15

chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis, edema, pallor, nocturia, past cardiac history, past family history, personal habits

Question 16

what position should the patient be for you to asses carotid artery?

Answer 16

patient should be sitting

Question 17

what position should the patient be in for you to asses the precordium and jugular vein?

Answer 17

patient should be supine with chest and head slightly elevated

Question 18

what are you looking for when inspecting the neck?

Answer 18

• jugular/carotid artery pulsations
• jugular distention

Question 19

what are you looking for when inspecting the chest wall? where should it be seen? in whom is it easier to see the apical pulse?

Answer 19

• the apical pulse
• in the fourth or fifth intercostal space
• it is easier to see the apical pulse in children or those with thinner chest walls

Question 20

what can you ask to help you find the apical pulse?

Answer 20

• “exhale and hold it”

Question 21

what regions do you palpate across the precordium? what should you expect?

Answer 21

• the apex, left sternal border and base
• no pulsations

Question 22

where is the aortic valve found for auscultation?

Answer 22

2nd right intercostal space

Question 23

where is the pulmonic valve found for auscultation?

Answer 23

2nd left intercostal space

Question 24

where is the tricuspid valve found for auscultation?

Answer 24

lower left sternal border on the fourth intercostal space

Question 25

where is the mitral valve found for auscultation?

Answer 25

left fifth intercostal space, medial to midclavicular line

Question 26

where is Erb’s point found?

Answer 26

3rd left intercostal space

Question 27

summary checklist: heart and neck vessel examination – precordium asucultation

Answer 27

Auscultation
Identify anatomic areas noting rate and rhythm
Listen in systole and diastole for murmurs
Repeat with bell
Listen at apex and base

Question 28

summary checklist: heart and neck vessel examination - precordium inspection and palpation

Answer 28

Describe location of apical pulse
Note any heave (lift) or thrill

Question 29

summary checklist: heart and neck vessel examination - neck

Answer 29

Carotid pulse – observe and palpate
Observe jugular venous pulse