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Health Assessment > Chapter 20-Heart and Neck Vessels > Flashcards

Chapter 20-Heart and Neck Vessels Flashcards

1
Q

position and surface landmarks

A

-precordium
-mediastinum
-apex & base of heart
-right and left cardiac borders
-great vessels

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2
Q

heart layers

A

-pericardium (sac)
-myocardium (muscle)
-endocardium (valves & chambers)

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3
Q

chambers

A

-atria: right and left
-ventricles: right and left

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4
Q

valves

A

atrioventricular
-tricuspid
-mitral (bicuspid valve)

semilunar
-pulmonic
-aortic

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5
Q

cardiac cycle

A

-systole (s1 & s2)
-diastole (blood fills; don’t usually hear sounds)
-events in the right and left sides

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6
Q

direction of blood flow

A
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7
Q

heart sounds

A

-second heart sounds
-second heart sound
-effect of respiration

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8
Q

heart sounds review

A

first heart sound (s1)
-occurs with closure of av valves (mitral/tricuspid): signals beginning of systole (heard best near apex)

second heart sound (s2)
-occurs with closure of semilunar valves (aortic/pulmonic) signals end of systole (s2 loudest at base)

effect of respiration
-volume of right and left ventricular systole is just about equal but can be affected by respiration
-consider phrase: more to the right heart; less to the left

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9
Q

electrocardiograph (ecg)

A

-ECG waves arbitrarily labeled PQRST, which stand for
-P wave: depolarization of atria
-P-R interval: from beginning of P wave to beginning of
-QRS complex (time necessary for atrial depolarization plus time for impulse to travel through AV node to ventricles)
-QRS complex: depolarization of ventricles
-electrical events slightly precede mechanical events in heart

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10
Q

extra heart sounds

A

-third heart sound (s3): during diastole; heard after s2; usually signifies HF; ventricle gallop

-fourth heart sound (s4): very soft; end of diastole; hear just before s1

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11
Q

murmurs

A

usually a valve problem (stenosis vs regurgitation)

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12
Q

characteristics of sound

A

-frequency (pitch)
-intensity (loudness)
-duration
-timing

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13
Q

conduction

A

-sa, av, bundle, pernicke fibers

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14
Q

pumping ability

A

-cardiac output (how much blood)
-preload (before systole)
-afterload (after systole)

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15
Q

neck vessels

A

-carotid artery (look for bruits; carotid artery stenosis; atherosclerosis)

-jugular veins
-internal (much deeper)
-external
-venous pulse and pressure (if distended usually right sided heart failure)

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16
Q

subjective data: health history questions

A

-chest pain (does it get worse with deep breath? y=lungs n=heart)
-dyspnea
-orthopnea
-cough
-fatigue (related to decreased cardiac output)
-cyanosis (can be normal in dark skin) or pallor

17
Q

health history questions

A

-edema
-nocturia (urination at night)
-cardiac history
-family cardiac history
-personal habits (cardiac risk factors): smoking, exercise, diet

18
Q

objective data: the physical exam

A

preparation
-position and draping
-room preparation
-order of examination

equipment needed
-marking pen
-small centimeter ruler
-stethoscope with diaphragm and bell endpieces
-alcohol swab

19
Q

carotid arteries

A

no percussion
bell, hold breath
-palpate (palpate separate, don’t massage)
-auscultate for bruit (could be carotid artery stenosis-obstruction)

20
Q

jugular veins

A

-inspect the jugular venous pulse (bulging; pulsation) (30-45 degrees have bed)
-estimate the jugular venous pressure
-palpate for hepatojugular reflux

21
Q

objective data

A

precordium
-inspect the anterior chest
-palpate the apical impulse
-palpate across the precordium (lumps/masses; tenderness) (subcutaneous air crepitus)
-percuss to outline the cardiac borders

22
Q

objective data: auscultation

A

-auscultate the heart sounds
-identify auscultatory areas
-note the rate and rhythm
-sinus arrhythmia
-pulse deficit
-identify s1 and s2
-s1 is louder than s2 at the apex
-s1 coincides with carotid artery pulse
-s1 coincides with r wave on electrocardiogram
-listen to s1 and s2 separately
-listen for extra heart sounds (s3 & s4)
-listen for murmurs

23
Q

characteristics of normal heart sounds

A

-first heart sound
-second heart sound
-splitting of second heart sound

24
Q

extra heart sounds

A

-mid systolic click (metal valve=click)
-third heart sound
-fourth heart sound
^^3rd & 4th tilt pt. to left lateral position

25
Q

murmurs

A

-timing
-loudness
-pitch
-pattern
-quality
-location
-radiation
-posture

26
Q

abnormal findings systolic extra sounds

A

-ejection click
-aortic prosthetic valve sounds
-midsystolic click

27
Q

abnormal findings diastolic extra sounds

A

-opening snap
-mitral prosthetic valve sound
-third heart sound
-fourth heart sound
-summation sound
-pericardial friction rub (infection is precursor)

28
Q

abnormal findings abnormal pulsations on the precordium

A

-thrill at the base
-lift (heave) at the sternal border
-volume overload at the apex
-pressure overload at the apex

29
Q

abnormal findings congenital heart defects

A

-patent ductus arteriosus
-atrial septal defect
-ventricular septal defect
-tetralogy of fallof
-coarctation of the aorta

30
Q

Abnormal findings murmurs caused by valvular defects

A

-midsystolic ejection
-diastolic rumbles of atrioventricular valves
-pansystolic regurgitant murmurs
-early diastolic murmurs

31
Q

mid systolic ejection (what you would hear)

A

-aortic stenosis
-pulmonic stenosis

32
Q

diastolic rumbles of atrioventricular valves

A

-mitral stenosis
-tricuspid stenosis

33
Q

pan systolic regurgitant murmurs

A

-mitral regurgitation
-tricuspid regurgitation

34
Q

early diastolic murmurs

A

-aortic regurgitation
-pulmonic regurgitation

35
Q

summary checklist: heart and neck vessels examination

A

-neck
-precordium

36
Q

summary checklist: neck

A

-carotid pulse: observe and palpate
-observe jugular venous pulse
-estimate jugular venous pressure

37
Q

summary checklist: precordium

A

inspection & palpation
-describe location of apical pulse
-note any heave (lift) or thrill

auscultation
-identify anatomic areas noting rate and rhythm
-listen in systole and diastole for murmurs
-repeat with bell
-listen at apex with person in left lateral position
-listen at base with person in sitting position

Health Assessment (11 decks)

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