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SRNAHealthAssessment > EXAM -2 CV/Peripheral Ass > Flashcards

EXAM -2 CV/Peripheral Ass Flashcards

1
Q

**A heave or lift =

A

sustained forceful thrusting of ventricle in systole secondary to **↑ **WORKLOAD

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2
Q

Left Vent. Heave seen where?

A

@ Apex

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3
Q

Right Vent. Heave seen where?

A

@ Sternal Border

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4
Q

Precordium palpate - If displaced down & to left =

A

Left Vent. Dilation = volume overload

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5
Q

PRECORDIUm palpate If ↑ force & duration but No change in location =

A

Left Vent. Hypertrophy = pressure overload

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6
Q

Thrill (palpable vibration), if present =

often accompanied by______

A

turbulent flow

• Often accompanied by murmur

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7
Q

Percuss -

A

to detect heart enlargement

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8
Q

Normal

A

Left border cardiac dullness @ 5 interspace mid-clavicular line

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9
Q

Dullness slopes up medially toward

A

sternum to **2nd interspace L. sternal border

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10
Q

• Right border matches

A

R. sternal border

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11
Q

Precordium Enlargement indicates_____ or _______

4 conditions

A

↑ Vent. volume or wall thickness

• HTN, CAD, HF, Cardiomyopathy

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12
Q

S3 = ____gallop 2 conditions

A

ventricular gallop• HF & Volume Overload

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13
Q

S4 =________ 1 condition

A

atrial gallop

Ex: CAD

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14
Q

Negative intra-thoracic pressure =

A

↑ venous return to Right heart

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15
Q

• A2 closes first,

A

then P2 – happens on inspiration
increase venous return to right heart
More to the RIGHT, Less to the LEFT (LL)

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16
Q

• MoRe to_____, Less to the______

A

theRight; Left

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17
Q

Neck Vessels

A

Reflect efficiency of cardiac function

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18
Q

**Carotids

A
  • Btw. Trachea & sternomastoid m.

* Pressure wave coincides w/ systole

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19
Q

**Jugular veins

A

Reflects Right side Heart activity
•*** Filling Pressure
• **Volume Changes

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20
Q

Carotid Normal pulse =
• Diminished =______
• Increased = ______states such as

A

2+ bilaterally
↓ SV
hyperkinetic such as • (exercise, anxiety, fever, etc.)

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21
Q

Auscultate carotid artery for ____

A

Bruits

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22
Q

3 listening positions: (BAM)

A
  • 1 – angle of jaw
  • 2 – mid-cervical area
  • 3 – base of neck
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23
Q

Avoid compressing may lead to

A

false bruits

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24
Q
  • Up to 2/3 =______bruit, 2/3+ =

* Total occlusion =

A

loud ; diminished sound

no sound

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25
Q

Internal Jugular Vein Valve where?

A

• Only valve btwn. Vena Cava & Brain

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26
Q

JVD indicates ______

A

Right Sided HF
• Vol. & Pressure increase
• Jugular veins become distended = JVD

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27
Q

Think of Jugular Veins as a

A

CVP manometer
Allows “reading” of CVP
• Reference point @ Sternal Angle
• Compare w/ highest point of venous pulsation

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28
Q

What is a normal JVP?

A

Normal = 2cm or less above Sternal angle

29
Q

Hepatojugular Reflux Test Perform if 2 reasons

A
  • venous pressure elevated

* Suspect CHF

30
Q

Hepatojugular Reflux Techniques

A
  • Pt. Supine
  • Your R. hand @ RUQ over Liver
  • Push w/ firm sustained pressure 30 sec.
  • Watch jugular veins
31
Q

***Normal heart hepatojugular Reflux vs CHF

A
  • ***With Normal Heart – veins rise few sec.s, then recede

* *** With CHF – veins stay elevated as long as you push

32
Q

Clubbing use

Normal clubbing angle is

A

Profile sign
• Clubbing - use profile sign
• Normal nailbed angle = 160 degrees

33
Q

Nailbed greater than 180

A

• 180+ = cyanotic heart ds, cor pulmonale, subacute BE

34
Q

Normal Capillary fill time is

A

Normal: 1-2 sec.

35
Q

• 3+ Capillary refill associated with

A

vasoconstriction or ↓ C.O.

• (hypovolemia, HF, Shock)

36
Q

Grade Force w/ 4 point scale
4+______
3+_______
Both indicates ____

A

bounding
Increased

HYPERKINETIC STATES

37
Q

Grade Force w/ 4 point scale
1+_______
0______
Both indicates

A

weak
absent

“Thready” Shock or PAD

38
Q

Allen Test determines what ?

A

Determines patency of Radial & Ulnar Arteries

39
Q

)))Allen test techniques

A 
Compress radial artery with thumb
• Ask pt. close fist several times
• Continue to compress & ask pt. to open hand
• Palm should turn pink ***IMMEDIATELY
• If not, ulnar artery occluded
• Repeat w/ Ulnar artery
40
Q

Modified Allen Test – tests what________
• Occlude_________
• Normal color return =

A

collateral circulation
BOTH arteries
3 – 5 sec.

41
Q

Leg Inspect
• Measure calf size – s/b equal bilaterally
• Diffuse bilateral edema =________

A

systemic illness

42
Q

Leg Unilateral swelling =

A

acute local problem

43
Q

• Asymmetry of calves

A
  • **1cm or more refer for poss. DVT
  • ***• (+) Homans’ sign (~35%)
  • ->Flex knee; anteriorly compress gastroc. M., if pain = (+)
44
Q

Lymphedema 1-3cm =

A

mild

45
Q

Lymphedema 3-5cm

A

moderate

46
Q

Lymphedema:5+cm =

A

severe

47
Q

Leg • Brown discoloration

A

Hemosiderin = venous insufficiency/stasis

48
Q

Venous stasis ulcers

A
  • Above medial malleolus

* Shallow, poorly defined edges

49
Q

Arterial ulcers

A
  • @ or below lateral malleolus, foot/toes
  • Deeper, well defined edge
  • “punched out” appearance
50
Q

Palpate & Inspect Legs
• Use_________
• Assess temperature changes/differences
• Note ___________
• If you suspect arterial deficit, raise legs ~12”, ask pt. to flex feet_______
• Then have pt. sit up, legs over side of bed
• Normal color return =

A

back of hand

iff gradual or abrupt
• Skin color now reflects only arterial blood contribution

< 10 sec.

51
Q

Arterial deficit seen with

A

Unilateral cool leg or foot w/ abrupt temp. drop as you move down

52
Q

what does Dependent rubor indicates =

A

severe arterial insufficiency

53
Q

Palpate popliteal

A 
Popliteal
• Difficult to feel
• Use both hands
Press deep into popliteal fossa
• Often felt just lateral to medial tendon
54
Q

Palpate DP (location)

A

DP (dorsalis pedis)

• Dorsum, btwn. 1st & 2nd Metatarsal

55
Q

Palpate PT (posterior tibial)

A

• Posterior to medial malleolus

56
Q

Also palpate leg and check for __________

A

Check for pre-tibial edema

57
Q

Bilateral dependent pitting edema indicates (2)

A

HF or Cirrhosis

58
Q

Manual Compression Test – tests valve competence

What does competent valve prevent?

A
  • Pt. standing
  • Compress vericose vein distally
  • With other hand 20cm higher, compress vein moving down the leg
  • Competent valves prevent wave transmission
59
Q

___________= normal valves

A

• No wave felt

60
Q

During manual compression test if Wave felt =

A

incompetent valves

61
Q

What does the vascular doppler check for?

A

• Tests for diminished peripheral flow

62
Q

ABI is used for

A

Ankle-Brachial Index
• Non-invasive test to determine extent of PVD
• Measures pressures @ arm and ankle

63
Q

In ABI, which pressure is normally higher?

A

Normal ankle pressure slightly higher

64
Q

Normal ABI usually =

A

1.0 to 1.2

65
Q

ABI that indicates PVD

A

0.9

66
Q

ABI that indicates Mild PVD

A

0.7-0.9

67
Q

ABI that indicates moderate PVD

A

0.7 – 0.4

68
Q

ABI that indicates SEVERE PVD

A

• 0.4 – 0.3

69
Q

PVD ABI ______ indicate extreme ischemia impending _________

A

< 0.3 ; limb loss

SRNAHealthAssessment (20 decks)

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