Chapter 12: Heart Flashcards

Question

A third heart sound is created by: Atrial contraction Ventricular contraction Diastolic filling Regurgitation between the right and left ventricles

Answer 1

ANS: C Rationale: Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria and the filling sometimes produces a third heart sound, S3.

Answer 2

ANS: D Rationale: Mitral regurgitation has symptoms of decompensated congestive heart failure, including shortness of breath, pulmonary edema, and orthopnea. Objective data include a high-pitched pansystolic murmur radiating to the axilla and possibly a third heart sound.

Answer 3

ANS: C Rationale: A thrill is a fine, palpable, rushing vibration; it is a palpable murmur.

Answer 4

ANS: B Rationale: Congestive heart failure can leave the patient feeling fatigued. Decreased energy levels and unintended weight loss are also indicative of congestive heart failure because the heart is using extra energy to pump blood to the body.

Answer 5

ANS: B Rationale: FRAIL stands for fatigue, resistance, ambulation, illness, and loss of weight. The ability to climb one flight of stairs is a criteria of the FRAIL scale.

Answer 6

ANS: A Rationale: In the elderly, the anteroposterior diameter of the chest can increase thus making it difficult to assess heart sounds.

Answer 7

Name the organs located in the thoracic cavity and identify the normal physiologic processes for these organs. ANS: The chest, or thorax, is a structure of bone, cartilage, and muscle capable of movement as the lungs expand. It consists anteriorly of the sternum, manubrium, xiphoid process, and costal cartilages; laterally, of the 12 pairs of ribs; and posteriorly, of the 12 thoracic vertebrae. The primary muscles of respiration are the diaphragm and the intercostal muscles. The diaphragm is the dominant muscle. It contracts and moves downward during inspiration, lowering the abdominal contents to increase the intrathoracic space. The pleural cavities include the right and left lungs. Respirations with the lungs keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide. Respiration involves the movement of air back and forth from the alveoli in the lungs to the outside environment, gas exchange across the alveolar-pulmonary capillary membranes, and circulatory system transport of oxygen to and carbon dioxide from the peripheral tissues. The heart is positioned behind the sternum and the contiguous parts of the third to the sixth costal cartilages. Its function is to circulate oxygenated blood to the body and nonoxygenated blood to the lungs. The heart is further divided into the right and left sides of the heart as well as into four chambers with four valves, which normally permit flow of blood in one direction only. The closing of the valves makes the “heart sounds.” Portions of the great vessels include the aorta, superior and inferior venae cavae, pulmonary arteries, and pulmonary veins. The aorta carries oxygenated blood out of the left ventricle to the body. The pulmonary artery, which leaves the right ventricle and divides almost immediately into right and left branches, carries deoxygenated blood to the lungs. The superior and inferior venae cavae carry deoxygenated blood from the upper and lower body, respectively, to the right atrium. The pulmonary veins return oxygenated blood from the lungs to the left atrium.

Answer 8

ANS: Students should clinically reason to determine if findings in other body systems are related to the chief complaint of “chest pain.” Onset and duration of pain: sudden, gradual, vague, length, related to physical exertion, rest, coughing, cold temperature, does it awaken him at night, and so on Character: aching, sharp, tingling, burning, pressure Location: radiates down the arms to the neck, jaws, teeth, and scapula; relief with rest or position Severity: interferes with activity; needs to stop all activity until subsides; severity of 7 on a scale of 0 to 10 Associated symptoms, treatment, and medications used

Answer 9

The following information is obtained during the history portion of his admission: White man, age 65 years, with a 10-year history of hypertension that is controlled with Bystolic 20 mg every morning. He smoked 2 packs of cigarettes per day for 40 years but no longer smokes. He rarely consumes alcoholic beverages. He does drink 6 to 8 cups of caffeinated coffee every day. His height is 74 inches with a weight of 195 pounds. His father died from an acute myocardial infarction. His mother had a long history of hypertension and died from a hemorrhagic stroke. ANS: Pain while walking only a short distance that is resolved with rest.

Answer 10

ANS: Hypertension, smoking history, caffeinated coffee consumption, and family history of myocardial infarction.

Answer 11

Inspection: note visibility and palpable impulses, cyanotic skin, nail beds for cyanosis and capillary refill, and jugular venous distention. Palpation: feel and identify the apical impulse and its location, which should be at the point of maximal impulse (PMI); determine if there is a presence of a heave or lift, which could represent left ventricular hypertrophy. Feel for a thrill: a fine palpable rushing vibration that could represent cardiovascular valve murmurs. Percussion: recognize that it does have a limited use but could potentially be used to determine heart size. Auscultation: auscultate heart sounds in the five cardiac areas. Listen for the basic heart sounds of S1 and S2. Listen to the rhythm, paying particular attention to the potential of splitting heart sounds, presence of an irregular heart rate, presence of bruit, and cardiac rate. Objective findings related to Mr. Davis’ concern of “angina” as supported by vital signs of P = 120, R = 30, B/P = 160/89, and T = 99. Skin is warm and dry but was diaphoretic while Mr. Davis complained of “chest pain.” Pulse was irregularly, irregular.