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NURS 307 > Chapter 19: Heart and Neck Vessels > Flashcards

Chapter 19: Heart and Neck Vessels Flashcards

1
Q

Heart is located

A

between 2nd and 5th intercostal space, R border of sternum to L midclavicular line

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2
Q

Precordium

A

area on anterior chest overlying the heart and great vessels

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3
Q

Great vessels lie where?

A

bunched above the base of the heart

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4
Q

Pericardium

A

tough, fibrous, double walled sac that surrounds and protects the heart

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5
Q

Myocardium

A

muscular wall of the heart, does the pumping

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6
Q

Endocardium

A

thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

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7
Q

During diastole, AV valves

A

open during the hearts filling phase

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8
Q

During systole, AV valves

A

close to prevent regurgitation of blood back up into the atria

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9
Q

S1

A

occurs with the closure of AV valves and thus signals the beginning of systole.

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10
Q

S2

A

occurs with closure of the semilunar valves and signals the end of systole.

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11
Q

Where can you hear S1 heart sounds?

A

usually loudest at the apex, but heard throughout the precordium

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12
Q

Where can you hear S2 heart sounds?

A

loudest at the base, but heard throughout the pericordium

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13
Q

Extra heart sounds include

A

S3, S4, Murmurs

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14
Q

S3

A

some conditions create vibrations during ventricular filling, the vibrations are S3

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15
Q

S4

A

atria contract and push blood into a noncompliant ventricle which creates vibration that are heard as S4

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16
Q

Murmurs

A
  • turbulent blood flow and collision currents against cardiac chambers and/or valves.
  • gentle, blowing, swooshing sound that can be auscultated on the chest wall.
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17
Q

Cardiac output

A

equals the volume of blood in each systole (SV) times the number of beats per minute (rate)

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18
Q

Preload

A

blood filling in the ventricles

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19
Q

Afterload

A

push against force to contract

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20
Q

Neck Vessels include

A

carotid artery and external jugular

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21
Q

carotid artery

A

located between the trachea and sternomastoid muscle

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22
Q

jugular veins

A

internal and external jugular

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23
Q

internal jugular

A

lies deep and medial to the sternomastoid muscle

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24
Q

external jugular

A

superficial, lateral to the sternomastoid muscle, above the clavicle

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25
Q

Cultural and Genetic Considerations for Heart disease

A

increased incidence in African American population

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26
Q

Cultural and Genetic Considerations for HTN

A

African Americans highest incidence, also they develop HTN earlier in life and their average B/P’s are much higher.

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27
Q

Cultural and Genetic Considerations for Smoking

A

nicotine increases the risk of myocardial infarction and stroke by increasing the oxygen demand, but having a decrease in oxygen supply, changing lipid profiles and activating platelets and fibrinogen which are clot forming agents.

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28
Q

Cultural and Genetic Considerations for Cholesterol

A

whites, mexican americans and african americans - both male and female - highest groups of elevated LDLs which gradually contributes to thrombus formation in arteries and leads to MI’s and strokes

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29
Q

Cultural and Genetic Considerations for Obesity

A

epidemic in US, highest incidence in Whites, African Americans, and Mexican Americans.

30
Q

Cultural and Genetic Considerations for Diabetes (Type 2)

A

risk of cardiovascular disease is 2x greater among people with diabetes

31
Q

Cultural and Genetic Considerations for Males/Females

A

heart disease is a leading cause of death for both males and females; however, presenting symptoms vary greatly.

32
Q

Cardiovascular History (Subjective)

A 
A.	Chest pain/chest tightness
B.	Dyspnea, SOB
C.	Orthopnea
D.	Cough
E.	Fatigue
F.	Cyanosis or pallor
G.	Edema
H.	Nocturia
I.	Past Cardiac Hx
J.	Family Cardiac Hx 
K.	Self-Care/Personal Habits
33
Q

Orthopnea

A

difficulty breathing during sleep or lying down

34
Q

Edema

A

any swelling in the lower extremities

35
Q

Nocturia

A

awaken at night with an urgent need to urinate

36
Q

Past Cardiac Hx

A

HTN, elevated blood cholesterol, elevated triglycerides, heart murmur, congenital heart disease, rheumatic fever

37
Q

Family Cardiac Hx

A

HTN, obesity, diabetes, coronary artery disease, sudden death

38
Q

Self-Care/Personal Habits

A
  1. Nutrition/Diet - (in regards to fat, cholesterol & salt intake)
  2. Smoking
  3. Alcohol
  4. Exercise
  5. Medications (prescribed, OTC, street drugs)
39
Q

Physical Exam/Assessment (Objective)

A
  1. Palpitation
  2. Auscultation
  3. Inspection
40
Q

Cardiac Palpitation

A
  1. Palpate carotid artery bilaterally
  2. Palpate the apical impulse
  3. Palpate precordium - note any other pulsations or thrills, normally none
41
Q

Cardiac Inspection

A
  1. Inspect for jugular venous distension.

2. Inspect the anterior chest.

42
Q

Cardiac Auscultation

A
  1. Auscultate the carotid artery
  2. Auscultation of anterior chest.
  3. Auscultation of apical heart rate
43
Q

Inspect jugular venous distension

A
  • position pt supine w/ head/neck elevated approx. 30-45 degree angle.
  • instruct pt to turn head away from examiner and observe for distension.
44
Q

Inspect anterior chest

A

you may or may not see the apical impulse.

note other pulsations, heaves or lifts.

45
Q

Heaves or lifts

A

forceful thrusting

46
Q

Auscultate the carotid artery

A

for the presence of a bruit with the bell of the stethoscope (a bruit is abnormal)

47
Q

Auscultate the anterior chest

A
  • Z pattern or 5 traditional valve areas.
  • Identify S1 and S2
  • Listen for possible S3 and/or S4.
  • Listen for murmurs
48
Q

5 Traditional Valve Areas:

A
  1. Aortic (R 2nd interspace)
  2. Pulmonic (L 2nd interspace)
  3. Erb’s Point (L 3rd interspace)
  4. Tricuspid (L lower sternal border, 4-5 interspace)
  5. Mitral (5th interspace, L midclavicular line)
49
Q

If a murmur is auscultated describe intensity in terms of the following:

A
  1. Grade I/VI
  2. Grade II/VI
  3. Grade III/VI
  4. Grade IV/VI
  5. Grade V/VI
  6. Grade VI/VI
50
Q

Grade I/VI

A

barely audible, heard with difficulty

51
Q

Grade II/VI

A

clearly audible, but faint

52
Q

Grade III/VI

A

moderately loud, easy to hear

53
Q

Grade IV/VI

A

loud, associated with a thrill palpable on the chest wall

54
Q

Grade V/VI

A

loud, heard with 1 corner of the stethoscope lifted off the chest wall, palpable thrill

55
Q

Grade VI/VI

A

very loud, still heard with entire stethoscope lifted off the chest wall, palpable thrill

56
Q

Auscultate apical heart rate

A

note rate and rhythm

57
Q

Common Cardiac Abnormalities

A 
A. Patent Ductus Arteriosus (PDA)
B. Atrial Septal Defect (ASD)
C. Ventricular Septal Defect (VSD)
D. Tetralogy of Fallot
E. Coarctation of the Aorta
F. Mitral Regurgitation
G. Murmurs
H. Congestive Heart Failure (CHF)
58
Q

Patent Ductus Arteriosus (PDA)

A

normal in fetus, spontaneously closes within hours of birth

59
Q

Atrial Septal Defect (ASD)

A

Abnormal opening of the atrial septum resulting usually in L to R shunt and causing large increase in pulmonary blood flow

60
Q

Ventricular Septal Defect (VSD)

A

Abnormal opening in septum between ventricles (usually sub aortic area)

61
Q

Tetralogy of Fallot

A

4 components: shunts a lot of venous blood directly into aorta away from pulmonary system so blood never gets oxygenated

62
Q

4 Components of Tetralogy of Fallot

A
  1. R ventricular outflow stenosis
  2. VSD
  3. R ventricular hypertrophy
  4. Overriding aorta
63
Q

Coarctation of the Aorta

A

severe narrowing of descending aorta, increased workload on L ventricle

64
Q

Mitral Regurgitation

A
  • stream of blood regurgitates back into L atria during systole through incompetent mitral valve
  • in diastole, blood passes back into L ventricle again along with new flow
65
Q

When assessing murmurs

A

determine grade, differentiate systolic vs. diastolic, note location

66
Q

Congestive Heart Failure (CHF)

A
  • the heart’s inability to pump enough blood to meet the metabolic demands of the body.
  • the kidney’s compensatory mechanisms of abnormal retention of Na and H2O to compensate for the decreased CO2
67
Q

S3

A

(ventricular gallop) occurs with heart failure and volume overload

68
Q

S4

A

(atrial gallop) occurs with CAD

69
Q

fixed split

A

unaffected by respiration; the split is always there

70
Q

paradoxical split

A

opposite of what you would expect; the sounds fuse on inspiration and split on expiration

71
Q

the murmur of mitral stenosis is

A

low

72
Q

the murmur of aortic stenosis is

A

harsh

NURS 307 (29 decks)

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