Chapter 19 &20 HA Flashcards
How long should the patient rest before performing a ankle-brachial index test?
5-10 minutes
What device do you use detect a weak peripheral pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity.
Doppler probe
A highly specific, noninvasive and readily available way to determine the extent of peripheral arterial disease
Doppler stethoscope
Which way are you going to measure a doppler probe?
counterclockwise
An ABI between 0.91 and 1 is…..
borderline cardiovascular risk
ABI Scores:
- 90-0.71
- 70-0.41
- 40-0.30
A)Mild PAD
B) Moderate PAD
C) Severe PAD, usually with rest pain except in the presence of diabetic neuropathy
An ABI less than 30 means……
Ischemia, with impending loss of tissue
This valve is located in the 2nd right interspace
Aortic Valve
What valve is located in the 2nd left interspace?
Pulmonic valve area
What valve is located in the left lower sternal border?
Tricuspid valve area
Fifth interspace at around left midclavicular line is located where?
Mitral valve area
What pattern should you inch your stethoscope
Z pattern, from the base of the heart across and down and over to the apex
What does a normal heart rate range from…….
50-95
The rhythm varies with the person’s breathing, increasing at the peak of inspiration and slowing with expiration
Sinus arrhythmias
When you notice any irregularities in rate or rhythm what should you check?
Pulse deficit by auscultating apical beat while palpating the radial pulse
Start of systole and thus serves as the reference point for the timing of all other cardiac sounds.
S1
Signals a weak contraction of the ventricles; it occurs with afib, premature beats, and heart failure
pulse deficit
Congenital cyanotic heart disease can cause what finding when examining the patients nails?
Clubbing
Clubbing of fingers and toes usually does not appear until when, if with severe cyanotic defects.
late in the first year
Palpate the apical impulse in the fourth interspace to the left of the midclavicular line until what age?
4 years old
4th interspace at midclavicular space (4-6)
5th interspace to right of midclavicular line (7)
A precordial bulge to the left of the sternum with a hyperdynamic precordium signals
Cardiac enlargement
What congenital defects does cyanosis occur in?
tetralogy of Fallots or transposition of the great arteries
When palpating the apical impulse what should the nurse ask the patient to do?
Exhale and hold their breath
How do you localize the apical impulse precisely?
by using one finger pad
What might you have the patient do to find the apical impulse
roll the person midway to the left
A sustained forceful thrusting of the ventricle during systole. Occurs with ventricular hypertrophy as a result of increased workload.
heave or lift
Increased force and duration but no change in location occurs with left ventricular hypertrophy and no dialtion
sustained impulse
Not palpable with ______ ______ because of overriding lungs.
pulmonary emphysema
Where can you feel apical impulse best?
at the end of expiration
What states the apical impulse increases in amplitude and duration
high cardiac output (anxiety, fever, hyperthyroidism, anemia)
Which lymphatic duct empties into the left subclavian vein?
Thoracic Duct (drains rest of body)
Which lymphatic duct empties into the right subclavian vein?
Right lymphatic duct (drains right side of body)
How does lymph flow?
contractions of the skeletal muscles
Filters the fluid before it is returned to the bloodstream and filter out microorgansims that could be harmful to the body.
Lymph nodes
Destroys RBC to produce antibodies, store RBC and to filter microorganisms from the blood
spleen
Located at the entrance to the respiratory and GI tracts and respond to local inflammation
tonsils
Is important in developing the L lymphocytes of the immune system in children, and located in the superior mediastinum behind the sternum and in front of the aorta
Thymus
Where is the SA node?
near the superior vena cava
Specialized cells in SA node near the superior vena cava initiate an……
electrical impulse
What is another name for the SA node
pacemaker
How many L of blood per minute does the heart normally pump?
4-6L
What position should the patient be in to listen to the S3 and S4 heart sounds?
Left lateral
What position should the patient be in to to listen to a soft diastolic murmur of aortic regurgitation
leaning forward in the sitting position
When doing a pulse assessment on a patient with anxiety, how might you characterize your findings?
+3
What force of pulse occurs with shock and peripheral artery disease?
weak, “thready”, pulse
Which test has replaced percussion to outline the borders of the heart?
chest xray or echocardiogram
What are chest xray’s and echoes are more accurate at detecting…..
heart enlargement
What non-invasive test is performed to check for valvular incompetency?
Doppler ultrasound
A split S2 sound is heard only in the _______ valve area
pulmonic (2nd left interspace)
A split S2 is a normal phenomenon that occurs towards……
then end of inspiration in some people
When S2 splits, what sound will you hear?
T-DUP
During _______, synchrony returns and the aortic and pulmonic components fuse together.
Expiration
Unaffected by respiration; the split is always there
fixed split
The opposite of what you would expect; the sounds fuse on inspiration and split on expiration.
Paradoxical split
During systole, happens during mitral valve prolapse, and is the most common extra sounds.
midsystolic click
This is the muscle wall of the heart?
Myocardium
A tough, fibrous, double-walled sac that surrounds and protects the hear
pericardium
Thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves.
endocardium
A thin-walled reservoir for holding blood, and the thick walled ventricles is the muscular pumping chamber.
Atrium
What is the main purpose of valves?
to prevent backflow of blood
Semilunar valves are the pulmonic valves in the _____ side of the hear
Right
When do the semilunar valves open?
During systole
Deficiency in which vitamin may increase the risk of cardiovascular disease?
Vitamin D
Encourage men ages 45 to 79 years and women age 55 to 79 years to use what if potential benefit of preventing MI outweighs the potential risk of GI bleeding?
Aspirin
Vitamin D deficiency can be associated with what medical conditions?
HTN, diabetes, metabolic syndrome, left ventricular hypertrophy, and chronic vascular inflammation
To screen for heart disease in infant, what should we observe?
fatigue during feeding
Which node is in the antecubital fossa and drains the hand and lower arm?
Epitrochlear Node
In the groin drain most of the lymph of the lower extremity, the external genitalia, and the anterior abdominal wall.
Inguinal nodes
How do you check the epitrochlear nodes?
shake the patient’s hand and reach your other hand under their elbow to the groove between the biceps and triceps muscles
Epitrochlear node occurs in what condition?
generalized lymphadenopathy
When auscultating the carotid artery, you hear a blowing, swishing sound. What is this called?
Bruit
Bruit increases risk of…..
transient ischemic attack and ischemic stroke
Radiate tot he neck and must be distinguished from a local bruit
aortic valve murmurs (aortic stenosis)
A bruit indicates turbulence from a local vascular cause and is a marker for…..
atherosclerotic disease
A carotid bruit is audible when the lumen is occluded by
1/2 to 2/3
Auscultate the Carotid Artery using the ____ of the stethoscope.
bell
Where is S1 heard the loudest at?
the apex
Occurs with closure of the semilunar valves and signals the end of systole.
S2
Where is S2 is loudest over?
Base of the heart
The QRS complex occurs during which part of the cardiac cycle?
Depolarization of the ventricle
The P wave occurs during which part of the cardiac cycle
Depolarization of the atria
the time necessary for atrial depolarization plus time for the impulse to travel through the AV node to the ventricles
PR inerval
A thrill in the 2nd and 3rd RIGHT interspaces occurs with what condition?
Aortic stenosis and systemic hypertension
A thrill in the 2nd and 3rd LEFT interspaces occurs with what condition?
pulmonic stenosis, pulmonic hypertension
Pressure overload is found in what conditions?
aortic stenosis or systemic hypertension
Which artery travels behind the medial malleolus and forms the plantar arteries?
posterior tibial artery
Major artery of the leg, passes under the inguinal ligament. Travels down the thigh.
Femoral artery
Deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel
Ischemia
Below the knees what artery is divided
popliteal artery
Travels down the front of the leg on the dorsum of the foot, where it becomes the dorsalis pedis
anterior tibial artery
What cardiac sound is best characterized as sounding like sandpaper?
Pericardial friction rub
What position is the patient in to best hear pericardial friction rub.
sitting up and leaning forward and the breath held in expiration.
What is claudification?
Pain when walking
The number of blocks walked or stairs climbed to produce pain.
Claudification distance
What type of occlusion is associated with erectile dysfunction (Leriche Syndrome)
Aortoiliac occlusion
Risk factors for Peripheral Vascular Disease (PVD)
Diabetes and smoking
PND is short for what condition?
Paraoxsmal Nocturnal Disorder
What does PND occur with?
Heart failure
A pulmonary disorder but also occurs with mitral stenosis
Hemoptysis
What increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically the person awakens after 2 hours of sleep with the perception of needing fresh air
Lying down
Arteries carry freshly oxygenated blood to all body tissues
High pressure system
Veins drain the deoxygenated blood with its waste products from the tissues and return it to the heart
Low pressure system
Engorged pulsating neck veins and liver enlargement can be seen with what cardiac condition?
Tricuspid regurgitation
Stream of blood regurgitates back into LA during systole through incompetent mitral valve. Fatigue, palpitation, orthopnea, PND. Thrill in systole at apex.
Mitral Regurgitation
Calcification of pulmonic valve restricts forward flow of blood. Thrill in systole at 2nd and 3rd left interspace
Pulmonic Stenosis
What are the names of the semilunar valves?
Aortic and Pulmonic
Sudden sharp and stabbing pain relieved often by sitting or leaning forward and worsens by lying down or with inspiration
Pericarditis
Sharp or stabbing pain worsening with deep breaths.
Pulmonary embolism
Occurs early in systole at the start of ejection because it results from opening of the SL valves. Open silently, but in the presence of stenosis
Ejection Click
Severe narrowing of teh descending aorta, usually at the junction of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery.
Coarctation of the Aorta
Occurs with occlusion of a deep ven. Occurs with lympatic obstruction.
Unilateral edema
Occurs with arterial deficit, especially……
diabetes
Episodes of abrupt, progressive tricolor change of the fingers in response to cold, vibration, or stress
Raynaud Phenomenon
Buildup of fatty plaques on intima (atherosclerosis) plus hardening, calcification of arterial wall (arteriosclerosis).
Arterial (Ischemic) Ulcer
After acute DVT or chronic incompetent valves in deep veins. Account for 80% of lower leg ulcers.
Venous (Stasis) Ulcer
Normal leg veins have dilated as a result of chronic increased venous pressure (obesity, multiple pregnancies) and incompetent valves that permit reflux of blood back toward leg instead of forward toward heart.
Superficial Varicose Veins
