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Nursing 171 > Circulation + Perfusion chp 38 Physical Assessment > Flashcards

Circulation + Perfusion chp 38 Physical Assessment Flashcards

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1
Q

Circulation

A

flow of blood throughout the heart and blood vessels

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2
Q

Perfusion

A

describes blood flow to a capillary bed to provide nutrients and oxygen to tissues and organs

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3
Q

Cardiac Cycle

A

simultaneous contraction of the two atria, followed by a fraction of a second later the simultaneous contraction of the ventricles

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4
Q

Electrical Conduction

A

electrical activity that initiates contraction of the myocardium

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5
Q

Sinoatrial (SA) Node

A

pacemaker of the heart

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6
Q

Atrioventricular (AV) Node

A

electrical activity passes through the AV node into the left and right bundles of HIS and into Purkinje Fibers to the ventricles

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7
Q

Arteries

A

oxygenated blood to tissues

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8
Q

Veins + Venules

A

deoxygenated blood back to heart/ lungs

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9
Q

Hemoglobin

A

carries oxygen

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10
Q

4 Chambers of the Heart

A

Two Atria: act as reservoir, receives blood returning via veins from body + lungs
Two Ventricles: larger, thicker
-pumps blood to lungs + body

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11
Q

4 Valves of the Heart

A

Two Atrioventricular Valves:
1. Tricuspid
2. Mitral
Two Semilunar Valves:
1. Pulmonic (separates right ventricle from pulmonary artery)
2. Aortic (separates left ventricle from aortic artery)

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12
Q

Apical Pulse

A

PMI

  • apex of the heart
  • at the bottom of heart
  • where left ventricle almost touches chest
  • left ventricle contracts and forms apical pulse
  • PMI (point of maximal impulse)
  • PMI located at 5th ICS left midclavicular line
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13
Q

Characteristics of Normal Heart Sounds

A 
>Lub
-first heart sound
-S1
-Mitral + Tricuspid Valves
>Dub 
-2nd heart sound
-S2
-Aortic + Pulmonic Valves
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14
Q

Correct Order of Auscultation

A

All Physicians Take Money
A= Aortic Valve
P= Pulmonic Valve
(S2 DUB)

T= Tricuspid Valve
M= Mitral Valve
(S1 LUB)

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15
Q

Coronary Arteries

A
  • heart has its own blood supply to the heart
  • fill during diastole
  • from the coronary sinus, blood flows into the two main coronary arteries, which branch into several sections to supply the heart muscle with blood
  • the coronary arteries are the only arteries in the body that fill during diastole
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16
Q

Autonomic Nervous System

A
  • sympathetic fibers
  • parasympathetic fibers

> heart: regulate heart rate + contractility
Vascular system: maintain vascular tone

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17
Q

Factors that Influence Cardiac function

A
  • developmental stage
  • environment
  • stress
  • allergic reactions + air quality
  • heat + cold
  • medications
  • lifestyle
  • nutrition
  • exercise
  • obesity
  • heredity
  • tobacco use
  • substance abuse
  • pregnancy
  • pathophysiological conditions
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18
Q

Factors that Influence Cardiac Function in Older Adults

A
  • thicker, more rigid valves
  • decreased myocardial strength
  • lower exercise tolerance
  • health problems
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19
Q

Heart Failure

A

Pathophysiological condition

  • occurs when the heart becomes an inefficient pump and is unable to meet the body’s demands
  • blood is oxygenated when it passes through the lungs, but is not well circulated to the organs + tissues
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20
Q

Cardiomyopathy

A

Pathophysiological condition

-heart muscle disorder that results in heart enlargement and impaired cardiac contractility

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21
Q

Cardiac Ischemia

A

Pathophysiological Condition
-occurs when oxygen requirements of the heart are unmet
-prolonged ischemia leads to myocardial infarction (MI) as parts of the heart necroses (die) from inadequate oxygen
-angina pectoris is transient pain in chest due to MI
(tissue becomes injured but does not necrose)

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22
Q

Coronary Artery Disease

A

leading cause of cardiac ischemia
-condition in which plague builds up inside the coronary arteries
-plague narrows the arteries reducing blood flow to the heart muscle
(more likely clots will form and block the arteries)

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23
Q

Dysrhythmias

A

alterations in heart rhythm

-can lower cardiac output and decrease tissue oxygenation

24
Q

Heart Valve Abnormalities

A

create turbulent flow, leading to a decrease in cardiac output and compromised tissue oxygenation

  • often audible murmur
  • mitral + aortic valves mostly affected
25
Q

Non-modifiable Risk Factors of Heart Disease

A
  • family history
  • gender
  • race, ethnicity
  • age
26
Q

Modifiable Risk Factors of Heart Disease

A
  • hyperlipidemia (high concentration of fats or lipids)
  • smoking
  • drug or alcohol use
  • diabetes
  • obesity
  • sedentary lifestyle
  • stress
  • high fat diet
  • left ventricular hypertrophy
  • use of oral contraceptives
27
Q

Health History Questions Used

A
  • chief complaint?
  • history of chest pain, pressure, heaviness?
  • leg pain, swelling in ankles, feet or hands?
  • cyanosis or pallor in extremities?
  • fatigue, shortness of breath?
  • precipitating or alleviating factors?
  • palpitations, dizziness?
  • family history of hypertension, heart failure, MI?
28
Q

Effective Cardiac Pump Looks Like?

A
  • systolic and diastolic BP in expected range
  • activity is tolerated
  • peripheral pulses are palpable
  • skin color is normal for individual
  • urinary output is in the expected range
  • cognitive status WNL
29
Q

Effective Cardiac Pump NOT Look Like?

A
  • neck veins are distended
  • dysrhythmia is present
  • peripheral edema is present
  • profuse diaphoresis
  • c/o nausea fatigue and pain
  • difficulty breathing
  • weight gain
30
Q

Peripheral Arterial Disease

A
  • found in legs + feet
  • occurs when tissues do not receive enough blood flow to keep up with the demand for oxygen
  • caused by build up of fatty deposits and plague within the arteries (atherosclerosis)
31
Q

Intermittent Claudication

A

when arteries that supply blood to the legs are narrowed

-leg pain occurs especially with walking

32
Q

What Happens When Blood Flow Becomes More Restricted In Legs?

A

as blood flow becomes more restricted, pain occurs at rest, as well as numbness or a cold feeling to the leg or foot, especially on one side

  • weak pulse
  • change in color
  • hair loss or shiny skin on leg
  • sores that wont heal
33
Q

Why is Peripheral Vascular Assessment Important?

A

reveal arterial and venous disorders

  • history
  • inspection
  • palpation
34
Q

Peripheral Vascular History

A

does the patient have:

  • intermittent claudication? (pain on walking that disappears at rest)
  • leg cramps
  • varicose veins
  • leg ulcers
  • edema of feet or legs
  • blood clots
  • pallor of fingertips
35
Q

Peripheral Vascular Inspection

A

compare side to side

  • size
  • symmetry
  • skin/color
  • nail beds/ capillary refill
  • venous pattern
  • hair growth
36
Q

Peripheral Vascular Palpation

A
  • temperature
  • capillary refill
  • edema (pitting or non-pitting)
  • pulses

Capillary refill:

  • performed on fingers + toes
  • squeeze patients finger or toes nails
  • may use tips of fingers or toes
  • normal capillary refill immediate or < 3 seconds
37
Q

Assessment of Pulse

A
  • Rate: 60 to 100 beats/ min
  • Rhythm: regular or irregular
  • Strength: amplitude and quality i.e. weak + thready or strong + binding
  • Equality: equal on both sides of the body
38
Q

Pulse Amplitude Descriptions and Numbers

A 
0= absent
1+= diminished, weak
2+= normal
3+= bounding
(may indicate hypertension or too much circulating blood volume)
39
Q

Indicators of Normal Peripheral Tissue Perfusion

A
  • BP WNL
  • peripheral pulses 2+ and equal
  • sensation normal
  • skin color + temperature normal
  • no edema, variscosities, lesions noted
  • equal hair growth
40
Q

What do Arterial Changes look like?

A
  • Color= pale, brownish discoloration, bluish red color if insufficiency is severe
  • Temperature= cool
  • Pulse= decreased or absent
  • Skin Changes= thin, shiny, decreased hair growth, thickened nails
  • Edema= absent or mild
  • Sensory loss
41
Q

Venous Insufficiency Look Like?

A

-Color= normal, reddened or cyanotic or brown pigment
-Temperature= normal or warm
-Pulse= normal
-Edema= present or marked
may also indicate an obstruction of the lymphatic system
-pain more severe standing, relieved with elevation

42
Q

2 Most Common Venous Problems

A
  • varicose veins

- thrombophlebitis

43
Q

Varicose Veins

A

occur when the heart valves are incompetent

44
Q

Erythema

A

reddened area

45
Q

Pitting Edema

A

4+ Edema

usually associated with fluid retention and heart failure

46
Q

Thrombophlebitis

A
  • a difference in the size of the leg may indicate a blood clot
  • symmetry is an observation we expect to find; if there is asymmetry anywhere it usually indicates a problem and should be noted
47
Q

Arterial Insufficiency

A

narrowing of the arteries

-commonly pelvis + legs

48
Q

Arterial Insufficiency Clinical Symptoms

A

PAD–> Peripheral arterial disease

  • cramping
  • pain
  • tired legs or hip muscles that worsens during walking/ activity and subsides with rest
49
Q

Venous Insufficiency

A

inadequate return of venous blood from legs to heart

50
Q

Clinical Symptoms of Venous Insufficiency

A

PVD–> peripheral venous disease

  • tired/heavy, achy cramping in legs
  • pain worsens when standing and improves with leg elevation and activity
51
Q

Arterial Ulcers

A
  • intermittent claudication pain
  • no edema
  • no pulse or weak pulse
  • no drainage
  • round smooth sores
  • black eschar
  • location of sores: toes + feet
52
Q

Venous Ulcers

A
  • dull, achy pain
  • lower leg edema
  • pulse present
  • drainage
  • sores with irregular borders
  • yellow slough or ruddy skin
  • location of sores: ankles
53
Q

Basic Assessment: Cardiovascular

A

-heart + blood vessles
Heart: muscle that pumps blood throughout the body
-size of a clenched fist
Blood Vessels: make up the vascular system
-2 Main networks:
>pulmonary circulation
>systemic circulation

54
Q

Basic Assessment: Heart

A 
-Heart Sounds
Location:
>aortic, pulmonic, tricuspid, mitral
-S1, S2, S3, S4
murmurs
-Inspection
>PMI
>Heaves/ Lifts
-Palpation
>thrill
55
Q

Basic Assessment: Vessels

A 
Central Vessels (provide circulation to brain)
>carotid arteries
-palpate pulsations
-auscultate for bruit
>jugular veins
Peripheral Vessels (supply blood to all body cells)
-BP
-peripheral pulses
-signs of inadequate oxygenation
-variscosities

Nursing 171 (38 decks)

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