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Health Assessment > EXAM 2 PART 1 > Flashcards

EXAM 2 PART 1 Flashcards

1
Q

what is hemoptysis?

A

coughing up blood

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2
Q

how long does acute cough last?

A

less than 2-3 weeks

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3
Q

how long does chronic cough last?

A

over 2 months

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4
Q

a continuous cough throughout the day is indication of a:

A

acute illness such as respiratory infection

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5
Q

a cough in the afternoon/evening is an indication of:

A

exposure to irritants

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6
Q

a cough a night could be due to:

A

postnasal drip, sinusitis

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7
Q

a cough in the early morning could be due to:

A

chronic bronchial inflammation of smokers

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8
Q

white or clear mucoid sputum is a sign of:

A

colds, bronchitis, viral infections

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9
Q

yellow or green sputum is a sign of:

A

bacterial infections

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10
Q

rusted color sputum is sign of:

A

TB, pnemonoccal pneumonia

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11
Q

pink frothy sputum is a sign of:

A

pulmonary edema or sympathomimetic medications

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12
Q

How is the thoracic cage defined?

A

by the sternum, 12 pairs of ribs and 12 thoracic vertebrae

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13
Q

The first 7 ribs attach directly to the _____

A

sternum via costal cartilage

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14
Q

Ribs 11 and 12 are considered ______

A

floating ribs

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15
Q

The _____ is the point at which the ribs join their cartilages

A

costochondral junctions

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16
Q

T/F costochondral junctions are not palpable

A

True

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17
Q

The suprasternal notch can be felt as a:

A

hollow U-shaped depression above the sternum, between the clavicles

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18
Q

This structure has 3 parts: the manubrium, the body, and the xiphoid process

A

sternum

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19
Q

Sternum is also considered as the _________

A

breastbone

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20
Q

This is often called the angle of louis and is the articulation of the manubrium and body of the sternum

A

sternal angle

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21
Q

The sternal angle is continous with the:

A

2nd rib

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22
Q

You can easily palpate down to the:

A

10th ribs

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23
Q

_________ marks the site of tracheal bifurcation into the right and left main bronchi

A

angle of louis

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24
Q

The ______ is the right and left coastal margins from an angle where they meet at the xiphoid process

A

costal angle

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25
Q

The costal angle increases when:

A

the rib cage is chronically overinflated as in emphysema

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26
Q

When counting ribs and intercoastal spaces on the back start with the:

A

vertebra prominens and feel for the most prominent bony spur protruding at base of neck (this will be spinous process of c7; if two seem most prominent then the upper one is c7 and lower one is t1

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27
Q

Where is the scapulae located?

A

symmetrically in each hemithorax

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28
Q

Why do we use reference lines?

A

to pinpoint a finding vertically on the chest

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29
Q

Midspinal is another name for:

A

vertebral

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30
Q

The lateral chest is divided by 3 lines:

A

anterior axillary, posterior axillary and midaxillary

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31
Q

________ is the middle section of the thoracic cavity and contains the esophagus, tracheae, heart and great vessels

A

mediastinum

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32
Q

Pleural cavities contain which organ:

A

the lungs

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33
Q

The ______ is the highest point of lung tissue and the ______ is also called the lower border:

A

apex; base

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34
Q

How many lobes does the right lung have and the left lung have?

A

3; 2

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35
Q

Lobes of the lung are separated by:

A

fissures that rub obliquely through the chest

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36
Q

The posterior chest is almost all:

A

lower lobe

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37
Q

______ is serous membranes that form an envelope between the lungs and the chest wall

A

Pleurae

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38
Q

________ lines the outside of the lungs and dips down into the fissures

A

visceral pleura

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39
Q

________ lines the inside of the chest wall and diaphragm and is continous with the visceral pleura

A

parietal

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40
Q

pleural cavity is filled with lubricating fluid and has ________ which holds lungs tightly against chest wall

A

negative pressure

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41
Q

Pleurase extend approx. 3 cm below the level of the lungs forming:

A

the costodiaphragmatic recess

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42
Q

What does the costodiaphragmatic recess do:

A

is a potential space that compromises lung expansion when abnormally filled with air or fluid

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43
Q

The _______ begins at the cricoid cartilage in the neck and branches just below the sternal angle into the right and left bronchi and lies anterior to the esophagus and is 10-11 cm long in the adult:

A

trachea

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44
Q

Which bronchus is shorter, wider and more vertical?

A

the right main bronchus

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45
Q

The _______ and _______ transport gases between the environment and the lung parenchyma

A

trachea and bronchi

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46
Q

What is the dead space?

A

space filled with air but is not available for gasesous exchange

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47
Q

What structures constitute the dead space?

A

trachea and bronchi

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48
Q

What protects alveoli from small particulate matter in the inhaled air?

A

the bronchial tree

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49
Q

What kind of cells is the bronchi lined with?

A

goblet cells

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50
Q

_________ secrete mucus that entraps the particles and cilia which sweep particles upward where they can be swallowed and expelled; lined in the bronchi

A

goblet cells

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51
Q

________ is a functional respiratory unit that consist of the bronchioles, alveolar ducts, alveolar sacs and the alveoli

A

acinus

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52
Q

Where does gasesous exchange occur?

A

across the respiratory membrane

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53
Q

Why are alveoli clustered like grapes around each alveolar duct?

A

to create millions of interalveolar septa walls that increase the working space available for gas exchange (surface area)

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54
Q

What are the major functions of the respiratory system?

A

supplying o2 to the body for energy production, removing co2 as a waste product of energy reactions, maintaining homeostasis (acid-base balance) of arterial blood and maintaining heat exchange (less important in humans)

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55
Q

How does respiration maintain the pH or the acid-base balance of the blood?

A

by supplying o2 to the blood and eliminating excess co2

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56
Q

The lungs help to maintain pH balance by:

A

adjusting the levels of co2 through respiration

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57
Q

What does hypoventilation cause?

A

co2 to build up in the blood

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58
Q

What does hyperventilation cause?

A

co2 to be blown off

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59
Q

Our breathing pattern changes without awareness due to:

A

cellular demands

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60
Q

What mediates the involuntary control of respirations?

A

the pons and medulla (respiratory center in the brainstem)

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61
Q

What is humoral regulation?

A

change in co2 and o2 levels in the blood and the hydrogen ion level (less important)

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62
Q

What is the normal stimilus to breathe?

A

hypercapnia

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63
Q

What is hypercapnia?

A

an increase of co2 in the blood

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64
Q

What is hypoxemia?

A

decrease of 02 in the blood

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65
Q

______ increases respirations but is less effective then hypercapnia

A

hypoxemia

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66
Q

Inspiration occurs when:

A

air rushes into the lungs as the chest size increases

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67
Q

Expiration occurs when:

A

co2 is expelled from the lungs as the chest recoils

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68
Q

Mechanical expansion and contraction of chest cavity alters the size of the thoracic container in 2 dimensions:

A

the vertical diameter lengthens or shortens or the anteroposterior diameter increases or decreases

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69
Q

How is the lengthening of the vertical diameter accomplished?

A

by downward or upward movement of the diaphragm

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70
Q

How is the anteroposterior diameter increased or decreased?

A

by elevation or depression of the ribs

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71
Q

In ______ increasing the size of thoracic container creates a slightly negative pressure in relation to the atmosphere, therfore air rushes in to fill the partial vacuum

A

inspiration

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72
Q

Expiration is primarily:

A

passive

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73
Q

Expiration causes the diaphragm to:

A

relax

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74
Q

During expiration, the squeezing from the relaxtion of the diaphragm creates a:

A

relatively positive pressure within the alveoli, allowing air to flow out

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75
Q

Forced inspiration requires the use of:

A

accessory neck muscles to heave up the sternum and rib cage

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76
Q

In the aging adult, the costal cartilages become _______, making the thorax less mobile

A

calcified

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77
Q

Respiratory muscle strength _______ after 50 and continues decreasing into the 70s

A

declines

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78
Q

In the aging adult, there is a decrease in elastic properties within the lungs which makes them less:

A

distensible and lessens their tendency to collapse and recoil

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79
Q

The aging lung is a more:

A

rigid structure that is harder to inflate

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80
Q

Older adults experience a increase in small airway closures which yields _______

A

decreased vital capacity and increased residual volume

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81
Q

What is decreased vital capacity?

A

Maximum amount of air that can be expelled from the lungs after first filling the lungs to maximum

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82
Q

What is increased residual volume?

A

the amount of air remaining in the lungs even after the most forceful expiration

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83
Q

With aging, less _______ is available for gas exchange due to ________

A

surface area; histolic changes

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84
Q

Why do the lung bases in the aging population become less ventilated?

A

Due to the closing off of a number of airways

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85
Q

A older person is at a greater risk for:

A

dyspnea and postoperative pulmonary complications such as post-op atelectasis and infection from a decreased abillity to cough, a loss of protective airways refleces and increased secretions (due to histologic changes)

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86
Q

_______ is the 2nd most common diagnosis cancer in men and women and the leading cause of cancer death in the U.S and is primarily caused by _________

A

lung cancer; smoking

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87
Q

Smoking causes:

A

a high mutational burden in the DNA genome

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88
Q

Due to complexity of high mutational rates in smokers, finding a _______ against lung cancer is difficult

A

targeted drug treatment

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89
Q

______ is a airbone lung disease that has infected 1/3 of the worlds population

A

TB

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90
Q

TB is termed as a ______ due to increased globilazation and air travel

A

social and migratory disease

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91
Q

TB incidence is stable among US born:

A

whites and asians

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92
Q

Who are at greater risk for contracting TB?

A

those with HIV, the homeless, those in shelters, prisons and LTC

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93
Q

Those most at risk for asthma are those living below:

A

the poverty level

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94
Q

mycoplasma pneumonia has a ______ cough

A

hacking

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95
Q

early heart failure has a ______ cough

A

dry

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96
Q

what is croup?

A

infection of the upper airway

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97
Q

croup has a ______ cough:

A

barking

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98
Q

colds, bronchitis and pneumonia have a ______ cough

A

congested

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99
Q

______ is a common burdensome symptom and a predictor of negative outcomes

A

dyspnea

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100
Q

chronic dyspnea is SOB lasting > 1 month and may have what origin?

A

neurogenic, respiratory or cardiac

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101
Q

chronic dyspnea can occur with:

A

anemia, anxiety and deconditioning

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102
Q

what is orthopnea?

A

Difficulty breathing when supine (state # of pillows needed for comfort)

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103
Q

what is paroxysmal nocturnal dyspnea?

A

awakening from sleep with SOB and needing to be upright for relief

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104
Q

cyanosis signals:

A

hypoxia

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105
Q

when may asthma attacks occur?

A

with a specific allergen, extreme cold or anxiety

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106
Q

how is asthma described?

A

as chest tightness

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107
Q

for people with a smoking history, dyspnea and cough what tool can you use to identify who should be assessed with spirometry for COPD?

A

5-item lung function

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108
Q

when does chest pain of the thoracic origin occur?

A

with muscle soreness from coughing or inflammation of pleura overlying pneumonia

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109
Q

When collecting smoking history, you should:

A

Assess smoking behavior, ways to modify daily smoking habits, identify triggers and how to manage withdrawal

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110
Q

What increases the risk for allergic rhinitis and asthma?

A

Traffic related air pollution

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111
Q

What symptoms do carbon monoxide cause?

A

Dizziness
Headache
Fatigue

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112
Q

What symptoms do sulfur dioxide cause?

A

Cough

Congestion

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113
Q

The CDC recommends the flu vaccine for everyone:

A

6 months or olders

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114
Q

Older adults have decreased _________ and less _______ for gas exchange.

A

vital capacity; surface area

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115
Q

Because older adults have less efficient respiratory systems, they have less tolerance for:

A

Activity

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116
Q

What may older adults have due to pulmonary function deficits?

A

reduced exercise capacity

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117
Q

Who is at a greater risk for respiratory dysfunction?

A

sedentary or bedridden people

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118
Q

Why may an older adults activity levels decrease?

A

Because of increasing SOB or pain

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119
Q

Some older adults feel _______ pain less intensely than young adults

A

pleuritic

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120
Q

In an older adult with precisely localized sharp pain, you should consider:

A

fractured ribs or muscle injury

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121
Q

When should you begin the respiratory examination?

A

after palpating the thyroid gland

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122
Q

On the posterior, lateral thorax, and anterior you should go in what order of examination?

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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123
Q

Anteroposterior diameter should be less than the _____ at 1: 2.

A

transverse diameter

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124
Q

AP to transverse diameter increases with:

A

age

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125
Q

When AP is equal to transverse diameter, the patient is:

A

barrel chested

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126
Q

What does it mean to be barrel chested?

A

the ribs are horizontal and the chest appears as if held in continuous inspiration

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127
Q

Who is more likely to experience a barrel chest?

A

those with COPD due to hyperinflation of the lungs

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128
Q

Why are neck muscles hypertrophied in those with COPD?

A

from aiding in forced respirations across the obstructed airways

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129
Q

Why do those with COPD sit in a tripod position?

A

for leverage so the abdominal, intercostal and neck muscles all can aid in expiration

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130
Q

When does cyanosis occur?

A

with hypoxia

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131
Q

When does unequal chest expansion occur?

A
  • marked atelectasis
  • lobar pneumonia
  • pleural effusion
  • thoracic trauma
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132
Q

What is tactile fremitus?

A

a palpable vibration generated by the larynx and transmitted via patent bronchi and the lung parenchyma to the chest wall

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133
Q

What factors affect the intensity of tactile fremitus?

A
  • location: it is most prominent between the scapulae and around the sternum where major bronchi are closest to chest wall
  • thin chest wall: thick tissue damps the vibration
  • voice: a loud, low pitched voice generates more fremitus than a soft high pitched one
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134
Q

What conditions make for a better conducting medium for sound vibrations and increase tactile fremitus?

A

those that increase the density of lung tissue

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135
Q

When does decreased fremitus occur?

A

any barrier that comes between the sound and your palpating hand; obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema

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136
Q

When does crepitus occur?

A

in subcutaneous emphysema when air escapes from the lungs and enters subcutaneous tissue

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137
Q

What does a dull note signal?

A

abnormal density in the lungs (pneumonia, pleural effusion, atelectasis or tumor)

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138
Q

If a patient has a hairy chest, how can you minimize extraneous noises?

A

by pressing harder on the chest or wetting the hairs with a damp cloth

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139
Q

What are the 3 types of normal breath sounds?

A
  • bronchial
  • bronchovesicular
  • vesicular
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140
Q

This normal breath sound characteristic is high pitched with a loud amplitude and a harsh hollow tubular quality. It is found in the trachea and larynx

A

bronchial

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141
Q

This normal breath sound characteristic is moderate pitched with a moderate amplitude and a mixed quality that is found over major bronchi where fewer alveoli are located

A

bronchovesicular

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142
Q

This normal breath sound characteristic is low pitched with a soft amplitude and a rusting quality. It is located over peripheral lung fields where air flows through smaller bronchioles and alveoli

A

vesicular

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143
Q

When do decreased or absent breath sounds occur?

A
  • when the bronchial tree is obstructed
  • in emphysema
  • when theres obstruction of sound between the stethoscope and the lungs
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144
Q

What are increased breath sounds, how do they sound and when do they occur?

A

sounds are louder than they should be and they are high pitched, tubular quality with prolonged expiratory phase and a pause between inspiration and expiration. they occur when consolidation or compression yields a dense lung area that enhances transmission of sound from the bronchi

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145
Q

Discontinuous popping sounds heard over inspiration. Inspiratory = inhaled air colliding with previously deflated airways and expiratory = sudden airway closing

A

What are crackles?

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146
Q

Continuous musical sounds heard over expiration normally as a result of acute asthma (high pitched) or chronic emphysema (high pitched) or bronchitis (low pitched)

A

What are wheezes?

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147
Q

these are non-pathologic sounds that are short, popping crackling sounds lasting only a few breaths

A

atelectatic crackles

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148
Q

Where are atelectatic crackles heard?

A

in the periphery of the lung

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149
Q

Where can voice sounds be heard and describe normal voice transmission?

A

over the chest wall and it is soft, muffled and indistinct

150
Q

When are voice sounds listened to?

A

when you suspect lung pathology; you are testing for the presence of bronchophony (99), egophony (eeeeee) and whispered pectoriloquy (1-2-3)

151
Q

This condition has horizontal ribs and a costal angle of >90 degrees

A

barrel chest

152
Q

When does hypertrophy of abdominal muscles occur?

A

in chronic emphysema

153
Q

Tense, strained tired facies and purse-lipped breathing accompany what condition?

A

COPD

154
Q

Cerebral hypoxia may be reflected by:

A

excessive drowsiness or anxiety, restlessness and irritability

155
Q

Clubbing of distal phalanx occurs with ______. Why?

A

COPD because of growth of vascular connective tissue

156
Q

Cutaneous angiomas (spider nevi) is associated with ________ and may be evident where?

A

liver disease or portal hypertension; on the chest

157
Q

Name the accessory neck muscles and explain when they are used

A
  • scalene
  • sternomastoid
  • trapezius
    Used in acute airway obstruction and massive atelectasis
158
Q

What does retraction suggest?

A

obstruction of respiratory tract, when increased inspiratory effort is needed (atelectasis)

159
Q

What muscles are used to force expiration in COPD?

A
  • rectus abdominis

- internal intercostal muscles

160
Q

What conditions result in a lag in expansion?

A
  • atelectasis
  • pneumonia
  • post-op guarding
161
Q

How should you auscultate the lung fields?

A

over the anterior chest from the apices in the supraclavicular areas down to the 6th rib

162
Q

What is determined by the number of seconds it takes for the person to exhale from total lung capacity to residual volume; its a screening measure for airflow obstruction

A

forced expiratory time

163
Q

What does a handheld spirometer measure?

A

lung health in chronic conditions such as asthma

164
Q

_______ is the total volume of air exhaled

A

forced vital capacity

165
Q

A normal FEV1/FVC ratio outcome is:

A

75% or greater meaning no significant obstruction of airflow is present

166
Q

When does a forced expiration of 6 seconds or more occur?

A

with obstructive lung disease

167
Q

An FEV1/FVC ratio of 60% - 70% is a:

A

mild obstruction of airflow

168
Q

An FEV1/FVC ratio of 50% - 60% is a:

A

moderate obstruction of airflow

169
Q

An FEV1/FVC ratio of <50% is a:

A

severe obstruction of airflow

170
Q

SpO2 results must be evaluated in the context of:

A
  • hemoglobin levels
  • acid base balance
  • ventilatory status
171
Q

What is a safer, simple, inexpensive clinical measure of functional status in aging adults?

A

6 minute walk test; they are equipped with a POX

172
Q

A person who walks >300 meters during a 6 MWT is:

A

more likely to engage in ADLs

173
Q

When should the person discontinue the 6 MWT?

A

If SpO2 is less than 88% or if extreme breathlessness occurs

174
Q

In older adults, the chest cage commonly shows a increased _______ giving a round barrel shape and kyphosis

A

AP diameter

175
Q

In an older person, you may palpate _______ due to decreased subcutaneous fats

A

marked bony prominences

176
Q

What may be decreased but symmetric with an older person?

A

chest expansion

177
Q

What results in less mobile thorax in an older adult?

A

costal cartilages becoming calcified

178
Q

If a older adult becomes dizzy or feels faint during auscultation, what should you do?

A

Tell them to hold their breath for a few seconds to restore equilibrium

179
Q

How should you examine the thorax of an acutely ill person?

A

have a second examiner hold the persons arm and support him in the upright position. If your alone, roll the person from side to side, examining the uppermost half of the thorax (prevents bilateral comparison)

180
Q

What is the difference between side stream smoke and mainstream smoke?

A

side stream is the smoke seen from the burning end of a cigarette and mainstream smoke is smoke exhaled from the person smoking

181
Q

Nonsmokers exposed to SHS increase risk for ______ and ______

A

heart disease; stroke

182
Q

What condition is associated with normal aging, chronic emphysema and asthma as a result of hyperinflation of lungs?

A

barrel chest

183
Q

This condition is a markedly sunken sternum and adjacent cartilages that is more noticeable on inspiration. It is congenital, usually not symptomatic and may cause embarrassment or negative self-concept; surgery may be indicated

A

pectus excavatum

184
Q

This condition is a forward protrusion of the sternum with the ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast). It is less common, requires no treatment but if severe, surgery may be indicated.

A

pectus carinatum

185
Q

This condition is a lateral S-shaped curvature of the spine that is more prevalent during childhood and in girls. If severe (>45 degree), lung volume may be reduced and cardiopulmonary function may be impaired.

A

scoliosis

186
Q

This condition is a exaggerated posterior curvature of the spine that causes significant back pain and limited mobility. It can impair cardiopulmonary function and cause hyperextension of the head to maintain level of vision. It is associated with aging.

A

kyphosis

187
Q

Postmenopausal osteoporotic women are likely to get

A

kyphosis

188
Q

Rapid shallow breathing, >24 per minute and is a normal response to fever, fear or exercise

A

tachypnea

189
Q

This increases in both rate and depth and occurs with extreme exertion, fear or anxiety as well as diabetic ketoacidosis, hepatic coma, salicylate overdose lesions of the midbrain, and alteration in blood gas concentration

A

hyperventilation

190
Q

Hyperventilation blows off ______ causing ________

A

CO2; a decreased level in the blood (alkalosis)

191
Q

This is slow breathing <10, as in drug induced depression in the medulla, increased intracranial pressure and diabetic coma

A

Bradypnea

192
Q

This is irregular shallow pattern caused by an OD of narcotics or anesthetics but may also occur with pro-longed bed rest or splinting of the chest to avoid respiratory pain

A

Hypoventilation

193
Q

This is a cycle where respirations gradually wax and wane in a regular pattern increasing in rate and depth and then decreasing. Breathing period last 30-45 seconds with periods of apnea alternating the cycle

A

Cheyne-stokes respiration

194
Q

What are some causes of Cheyne-stokes respiration?

A
  • severe heart failure (most common)
  • renal failure
  • meningitis
  • OD
  • increased intracranial pressure
    (occurs in older adults during sleep)
195
Q

This condition is similar to Cheyne-stokes respiration but the pattern is irregular and a series of normal respirations are followed by a period of apnea. Cycle can last anywhere from 10 seconds to a minute

A

biot respiration

196
Q

This condition causes normal inspiration and prolonged expiration to overcome increased airway resistance

A

chronic obstructive breathing

197
Q

Atelectatic crackles develop in:

A
  • aging adults
  • bedridden
  • persons just aroused from sleep
198
Q

This is a high-pitched, monophonic, inspiratory crowing sound that is louder in the back and originates from the larynx or trachea

A

stridor

199
Q

These conditions result in what kind of breathing?

  • croup
  • acute epiglottis
A

stridor

200
Q

What condition results in the follow?

  • airway obstruction
  • compression of the lung
  • lack of surfactant
A

Atelectasis

201
Q

Pneumonia is conditioned by:

A

swollen alveolar with RBCs and WBCs passing from blood to the alveoli

202
Q

infection of the trachea and larger bronchi characterized by cough lasting up to 3 weeks…..what condition is this?

A

Acute bronchitis

203
Q

proliferation of mucus glands in passageways resulting in excessive mucus secretions….what condition is this?

A

Chronic bronchitis

204
Q

destruction of pulmonary connective tissue and characterized by permanent enlargement of air sacs…what condition is this?

A

Emphysema

205
Q

free air in pleural space causing partial or complete lung collapse. can be spontaneous, traumatic, or tension…..what condition is this?

A

Pnemothorax

206
Q

associated with aids; cysts containing organism and macrophages form in alveolar spaces causing it to thicken and the disease to spread….what condition is this?

A

Pnemocystis jiroveci pneumonia

207
Q

inhalation of tubercle bacili into the alveolar wall….what condition is this?

A

TB

208
Q

an acute pulmonary insult that damages alveolar capillary membranes leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema….what condition is this?

A

Acute respiratory distress syndrome (ARDS)

209
Q

What does the CV system consist of?

A

The heart (muscular pump) and blood vessels

210
Q

What area on the anterior chest directly overlies the heart and great vessels?

A

precordium

211
Q

What is the mediastinum?

A

where the heart and great vessels are located between the lungs in the middle third of the thoracic cage

212
Q

The top of the heart is called the ______ and the bottom of the heart is the ______

A

base; apex

213
Q

What continuous loops are the blood vessels arranged in?

A

pulmonary and systemic circulation

214
Q

When is an apical impulse produced?

A

during contraction when the apex beats against the chest wall

215
Q

Where is the apical pulse palpable?

A

at the 5th intercostal space 7-9 cm from the mid-sternal line

216
Q

What is the function of the superior and inferior vena cava?

A

they return unoxygenated venous blood to the right side of the heart

217
Q

What is the function of the pulmonary artery?

A

it leaves the right ventricle, bifurcates and carries the venous blood to the lungs

218
Q

What is the function of the pulmonary veins?

A

they return freshly oxygenated blood to the left side of the heart

219
Q

What is the function of the aorta?

A

to carry oxygenated blood out to the body

220
Q

Describe the pericardium

A

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

221
Q

What ensures smooth, friction free movement of the heart muscles?

A

pericardial fluid

222
Q

What is the muscular wall of the heart and its function?

A

myocardium; it does the pumping

223
Q

What is the thin layer of endothelial tissue that lines the inner surface of the heart chamber and valves?

A

endocardium

224
Q

Which side of the heart pumps blood into the lungs?

A

right side

225
Q

Which side of the heart pumps blood into the body?

A

left side

226
Q

What is the atrium?

A

a thin walled reservoir for holding blood

227
Q

What is the ventricle?

A

the muscular pumping chamber

228
Q

What separates the chambers of the heart?

A

valves

229
Q

What is the main purpose of valves?

A

prevent the back flow of blood

230
Q

Valves are _______ and can open only ________

A

Unidirectional; one way

231
Q

What is the right AV valve called?

A

tricuspid

232
Q

What is the left AV valve called?

A

bicuspid; mitral

233
Q

How many valves are in the heart?

A

4

234
Q

Which valves separate the atria and the ventricles?

A

atrioventricular valves

235
Q

What is chordae tendineae?

A

collagen fibers that anchor the AV valves to papillary muscles embedded in the ventricle floor

236
Q

When do the AV valves open?

A

during the hearts filling phase (diastole) to allow ventricles to fill with blood

237
Q

When do the AV valves close?

A

during the pumping phase (systole) to prevent regurgitation of blood back to atria

238
Q

These valves are set between the ventricles and the arteries and are considered the pulmonic valve in the right side of the heart and the aortic valve in the left side of the heart

A

semilunar valve

239
Q

When do semilunar valves open?

A

during systole when blood ejects from the heart

240
Q

What gives a person symptoms of pulmonary congestion?

A

abnormally high pressure in the left side of the heart

241
Q

What occurs with high pressure on the right side of the heart?

A

the neck veins and abdomen distend

242
Q

What is the cardiac cycle?

A

rhythmic movement of blood through the heart

243
Q

Explain the two phases of the cardiac cycle?

A

In diastole the ventricles relax and fill with blood and in systole the heart contracts and blood is pumped from the ventricles and fills the pulmonary and systemic arteries

244
Q

What does presystole/atrial systole (atrial kick) cause?

A

a small rise in the left ventricular pressure

245
Q

What contributes to the first heart sound and what does it signal?

A

closure of the AV valves; the beginning of systole

246
Q

When contraction against a closed system works to build pressure inside the ventricles to a high level, what has occurred?

A

isometric contraction

247
Q

What contributes to the second heart sound and what does it signal?

A

closure of the SL valves; the end of systole

248
Q

What is isometric or isovolumic relaxation?

A

when the 4 valves are closed and the ventricles are relaxed

249
Q

Why is pressure on the right side of the heart lower than the left side?

A

because less pressure is needed to pump blood to its destination, the pulmonary circulation

250
Q

Events occur slightly later in the ______ of the heart because of myocardial depolarization

A

right side

251
Q

Where is S1 loudest and where is S2 loudest?

A

apex; base

252
Q

What is split S2?

A

when the aortic valves close earlier than the pulmonic valve

253
Q

When does S3 occur?

A

when the ventricles are resistant to filling during the early rapid filling phase

254
Q

When does S4 occur?

A

at the end of diastole at presystole when ventricle is resistant to filling resulting in decreased compliance of the ventricle and systolic overload

255
Q

What is a murmur?

A

a gentle, blowing, swooshing sound

256
Q

What causes a murmur?

A
  • congenital and acquired valvular defects *
  • velocity of blood increase
  • viscosity of blood decreases
  • structural defects in the valves or unusual openings occur in the chambers
257
Q

What initiate an electrical impulse?

A

specialized cells in the SA near the superior vena cava

258
Q

What does the ECG waves stand for (PQRST)

A
  • P wave - depolarization of the atria
  • PR interval - from beginning of P wave to the beginning of the QRS complex
  • QRS complex - depolarization of the ventricles
  • T wave - repolarization of the ventricles
259
Q

In a healthy resting adult, what does the heart normally pump?

A

4-6 L of blood per minute throughout the body

260
Q

Formula for cardiac output?

A

CO = SV x R

261
Q

What is preload?

A

volume; of the venous return that builds during diastole; it is a stretch beyond normal resting state

262
Q

What does the frank starling law state?

A

the greater the stretch the stronger is the contraction of the heart. this increases contractility results in an increased volume of blood ejected

263
Q

What is afterload?

A

pressure; its the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure

264
Q

CV assessment includes what vascular structures in the neck?

A

carotid artery and jugular veins

265
Q

What do the carotid artery and jugular veins reflect?

A

Efficiency of cardiac function

266
Q

Describe the jugular vein

A

empty unoxygenated blood directly into the superior vena cava. they give information about activity on the right side of the heart and reflect filling pressure and volume changes (i.e when the heart fails to pump efficiently).

267
Q

______ is caused by a forward propulsion of blood

A

arterial pulse

268
Q

_______ results from a backwash, a waveform moving backward caused by events upstream

A

jugular pulse

269
Q

What happens to the BP in the aging and what causes the change in BP?

A

there is an increase in systolic BP (isolated systolic HTN); caused by thickening and stiffening of the large arteries (arteriosclerosis) which is caused by collagen and calcium deposits in vessel walls and loss of elastic fibers

270
Q

______ creates an increase in pulse wave velocity because the less compliant arteries cant store the volume ejected

A

arteriosclerosis

271
Q

What characteristics or functions of the heart do NOT change with aging

A
  • the heart does not increase in size
  • no change in the resting heart rate
  • cardiac output at rest is not changed
272
Q

What part of the heart does increase with age? Why or why not

A

left ventricular wall thickness; it accommodates the vascular stiffening

273
Q

What increases the pulse pressure in the aging?

A

a decreasing diastolic pressure and increasing systolic pressure

274
Q

What happens to the heart of an aging person during exercise?

A

decreased ability to augment cardiac output shown by a decreased max. heart rate with exercise and diminished sympathetic response

275
Q

What type of exercise modifies many of the aging changes in CV function?

A

aerobic exercise

276
Q

The presence of ______ and ________ increase with age

A

supraventricular; ventricular dysrhythmias

277
Q

What is common but usually asymptotic in health older people?

A

ectopic beats

278
Q

What may ectopic beats compromise in sickly older people?

A

cardiac output and BP

279
Q

Why may tachydysrhythmias not be tolerated well in older people?

A

the myocardium is thicker and less compliant and early diastolic filling is impaired at rest and the diastole is also shortened

280
Q

What changes in ECG may occur in older adults?

A
  • prolonged P-R interval and Q-T interbal (QRS interval unchanged)
  • left axis deviation
  • increased incidence of bundle branch block
281
Q

What disease increases with age?

A

CVD is the leading COD in those 65+ (vitamin D deficiency increases risk)

282
Q

What can older adults do to decrease their chances of getting CVD or respiratory illnesses?

A
  • increasing physical activity (30/min 5/days)
283
Q

There was an increase in CVD mortality among adults ages:

A

35-64

284
Q

What adds to the lipid core of plaque formation in coronary and carotid arteries? What does this result in?

A

high levels of LDL (bad cholesterol); MI and stoke

285
Q

What factors does physical activity have good effects on?

A
  • HDL (good cholesterol)
  • vitamin D
  • apolipoprotein B
  • hemoglobin A1c
286
Q

What is the leading COD in women and why?

A

CVD because women tend to have smaller coronary arteries compared to men

287
Q

What are the most common symptoms (and prodromal symptoms) linked to ACS/MI?

A
  • fatigue
  • discomfort in the jaw or teeth
  • unusual fatigue
  • arm pain
  • SOB
288
Q

Chest pain could have origins where else in the body?

A
  • pulmonary
  • musculoskeletal
  • GI
289
Q

When does paroxysmal nocturnal dyspnea occur?

A

with heart failure, normally as the person is lying down and the volume of intrathoracic blood increases. the person typically awakens 2 hours after sleeping with the perception of needing fresh air

290
Q

______ is the need to assume a more upright position to breathe

A

orthopnea

291
Q

When is fatigue worse for those with decreased CO?

A

in the evening

292
Q

When is fatigue worse for those with anxiety or depression?

A

all day or in the morning

293
Q

_____ is dependent when caused by heart failure. When is this worse and better?

A

edema; in the evening and its better in the morning after elevating legs all night

294
Q

Cardiac edema is bilateral. Unilateral swelling has a ________ cause

A

local vein

295
Q

_______ is recumbency at night promoting fluid resorption and excretion

A

nocturia

296
Q

When does nocturia occur?

A

with heart failure in those ambulatory during the day

297
Q

Usage of what medicine could prevent MI?

A
  • aspirin

- vitamin D

298
Q

What increases the risk for CVD?

A
  • vitamin D deficiency

- advancing age

299
Q

What is carotid sinus hypersensitivity?

A

when pressure over the carotid sinus leads to a decreased heart rate, BP and cerebral ischemia with syncope

300
Q

Who is carotid sinus hypersensitivity more likely to occur in?

A

older adults with HTN or occlusion of the carotid artery

301
Q

What is a bruit?

A

a blowing, swishing sound that indicates blood flow turbulence. it is marked by atherosclerotic diseases

302
Q

what does a bruit increase the risk for?

A

transient ischemic attack (TIA) and ischemic stroke

303
Q

What part of the stethoscope is used to listen to the carotid artery and where is the placement levels on the neck?

A

the bell

  • the angle of the jaw
  • midcervical area
  • base of the neck
  • ask the person to take a breath, exhale and hold it briefly*
304
Q

What is unilateral distention of external jugular veins caused by?

A

local causes such as kinking or an aneurysm

305
Q

What is a heave or lift and when does it occur?

A

a sustained forceful thrusting of the ventricle during systole it occurs with ventricular hypertrophy from increased workload (PVD, pulmonic HTN, chronic lung disease)

306
Q

Where is a right ventricle heave seen?

A

at the sternal border

307
Q

Where is a left ventricle heave seen?

A

at the apex

308
Q

What is the size, amplitude and duration of a apical impulse?

A

1x2 cm, short gentle tap and short duration normally occupying the first 1/2 of systole

309
Q

Where or who is the apical impulse not palpable in?

A
  • obese people
  • those with thick chest walls
  • those with pulmonary emphysema
310
Q

Left ventricular dilation occurs with:

A

heart failure and cardiomyopathy

311
Q

What is a trill?

A

a palpable vibration that feels like the throat if a purring cat

312
Q

What do trills signify?

A

turbulent blood flow and helps you locate loud murmurs (but absence of thrills do not rule out the presence of a murmur)

313
Q

The valve areas are:

A
  • second right interspace = aortic valve area
  • second left interspace = pulmonic valve area
  • left lower sternal space border = tricuspid valve area
  • fifth interspace at around left midclavicular line = mitral valve area
314
Q

______ occurs normally in young adults and children and the rhythm varies with the persons breathing, increasing at the peak of inspiration and slowing with expiration

A

sinus arrhythmia

315
Q

What does a pulse deficit signal and when does it occur?

A

it signals a weak contraction of the ventricles and occurs with A Fib, premature bears and heart failure

316
Q

When may heart sounds be diminished?

A

in conditions that place an increased amount of tissue b/w the heart and stethoscope ( emphysema, obesity, pericardial fluid)

317
Q

What is the most common extra sound during systole?

A

midsystolic click which is associated with mitral valve prolapse

318
Q

When does S3 (ventricular gallop) occur?

A

with heart failure and volume overload (mitral/aortic regurgitation and L-R shunts)

319
Q

When does S4 (atrial gallop) occur?

A

with CAD

320
Q

A systolic murmurs may occur with ______ or ______. But a diastolic murmurs always indicates _______

A
  • healthy heart; heart disease

- disease

321
Q

Grades of a murmur:

A

1 - barely audible
2- clearly audible but faint
3 - moderately loud and easy to hear
4 - loud; associated with thrills
5 - very loud; associated thrill; one corner os stethoscope lifted off chest wall
6 - loudest; can hear with entire stethoscope off chest wall

322
Q

A crescendo pattern is:

A

growing louder

323
Q

A decrescendo pattern is:

A

tapering off

324
Q

A crescendo-decrescendo or diamond shaper:

A

increases to a peak and then decreases

325
Q

The murmur of mitral stenosis is:

A

low pitched and rumbling

326
Q

The murmur of aortic stenosis is:

A

harsh

327
Q

S3 and S4 and the murmur of mitral stenosis may be heard only when on:

A

the left side

328
Q

When may the aortic regurgitation be heard?

A

when the person is leaning forward in the sitting position

329
Q

What is hypertrophic cardiomyopath?

A

inherited thickening of the myocardium; men and women equally effected

330
Q

In older adults, there is a gradual rise in SBP and DBP remains fairly constant resulting in a:

A

widened pulse pressure

331
Q

What happens to the chest with aging?

A

it increases in anteroposterior diameter making it difficult to palpate the apical impulse and hear splitting of S2

332
Q

What is common in the aging?

A
  • orthostatic hypotension
  • S4 esp. after exercise
  • systolic murmurs
  • premature ectopic beats
333
Q

A heart healthy diet includes:

A
  • an increase in fruits and vegetables

- avoidance of trans fat and too much salt

334
Q

This condition can result in pressurelike pain lasting for 3-5 minutes after activity, often resolving with rest. Pain can radiate to the jaw, neck or both arms and usually results in sweating, nausea, vomiting, SOB and fatigue

A

Angina pectoris

335
Q

This condition can result in pressurelike discomfort at rest and can radiate to the jaw, neck, left arm or shoulder resulting in palpitations or syncope

A

Prinzmetal or variant angina

336
Q

This condition can result in heaviness or crushing pain or pressure that is poorly localized, lasting for 20-30 minutes to hours with no resolve. Pain radiates to the teeth, jaw, neck one or both arms/shoulders but there may be no pain. Symptoms include indigestion, dizziness, flushing, perspiration, etc.

A

Acute coronary syndrome (MI)

337
Q

This condition has sudden sharp and stabbing pain relieved by sitting or leaning forward but worsens when lying down or inspiration. It can radiate to the trapezius muscle region and symptoms include dry cough, muscle/joint aches and fever

A

Pericarditis

338
Q

This condition has sharp pain not associated with activity and chest pain w/o radiation. Symptoms include fatigue, light headedness, SOB, irregular heart beat, palpitations and exercise intolerance

A

mitral valve prolapse

339
Q

This condition has sudden severe pain with no change in location or tearing sensation lasting for hours. Pain is in the anterior chest with radiation to the neck, jaw, or intrascapular region of the back. Symptoms include mental status changes, limb pain and weakness and SOB

A

aortic dissection

340
Q

This condition has cardiac like chest pain with exertion located in the chest region and symptoms of SOB, low extremity swelling and fatigue

A

pulmonary hypertension (secondary)

341
Q

This condition has a sharp, stabbing pain that worsens with deep breaths and is felt in the chest, back, shoulder or upper abdomen. Symptoms include SOB, hemoptysis, and cough

A

pulmonary embolism

342
Q

This condition has sharp, stabbing pain associated with cough and is on one side of the chest but can cause upper abdominal pain. Symptoms include cough, fever, SOB, chills, sputum, myalgia and malaise

A

Pneumonia

343
Q

This condition has acute/sudden and sharp pain in the lateral region of the chest but it can radiate to the shoulder and cause acute SOB and cough

A

Pneumothorax

344
Q

This condition has a burning sensation (angina like) with eating large meals and is worse when laying down but relieved when sitting up. It is in the retrosternal region and symptoms include cough, regurgitation of food and abdominal pain

A

gastroesophageal reflux

345
Q

This condition has crushing chest pain that is substernal and results in dysphagia, and a sensation that something is in the throat

A

Esophageal spasm

346
Q

This condition has sudden onset of pain that crescendos and last up to 20 minutes after eating fatty meals. It can be in the right upper abdomen and radiate to the right intrascpaular region, shoulder or back resulting in nausea, vomiting, anorexia and fever

A

cholecystitis

347
Q

This condition has sudden dull, boring steady pain unrelieved by lying supine but relieved by learning forward or in fetal position. It is periumbilical pain that radiates to the back and causes nausea, vomiting, anorexia and diarrhea

A

pancreatitis

348
Q

This condition has it unilateral, burning and borelike pain in the chest region resulting in tingling, itching and burning

A

herpes zoster

349
Q

This condition has sharp, pleuritic pain that worsens with deep breathing, palpation or movement and is in the area from 2nd-5th intercostal spaces; can radiate to the arm. Symptoms include chest tightness and warmth at area of pain

A

costochondritis

350
Q

This condition has sharp pain with moving, stretching or pushing movements of the arms and is located in the area around the strained muscle, sternum or ribs. Symptoms include muscle spasms, crepitation, swelling and loss of strength

A

chest wall muscle strain

351
Q

This condition has heaviness in the chest region and symptoms include fatigue, restlessness, withdrawal and weight gain or loss

A

depression

352
Q

This condition has sharp pain in the chest region and symptoms include palpations, dizziness, sweating, shaking, restlessness, fatigue and irritation

A

Anxiety

353
Q

This condition has decreased CO, dilated pupils, ascites, jugular vein distention, enlarged spleen and liver, crackles and wheezes, pale, gray or cyanotic skin, decreased BP, urine output and dependent pitting edema in the sacrum/legs

A

heart failure

354
Q

______ occurs early in systole at the start of ejection because it results from opening of the SL valve

A

ejection click

355
Q

Where is the aortic ejection click heard?

A

at the 2nd right interspace and apex where it may be loudest at the apex

356
Q

Where is the pulmonic ejection click heard?

A

at the 2nd left interspace and often grows softer with inspiration

357
Q

Where is the midsystolic click best heard?

A

with the diaphragm and the apex

358
Q

A deformed valve opens with this sharp, high pitched noise with a snapping quality that sounds after S2 and is best heard with the diaphragm in the 3rd or 4th left interspace at the sternal border

A

opening snap

359
Q

Mitral prothetic valve sounds is the:

A

ball in cage

360
Q

What is the location, respiratory variation and pitch of S3?

A
  • heard at the apex or left lower sternal border
  • does not vary in timing with respiration
  • lower pitched
361
Q

What causes friction rubs? and how do they sound?

A

inflammation of the pericardium; high pitched like sandpaper that is best heard at the apex and left lower sternal border.

362
Q

When is friction rub common?

A

During 1st week after a MI

363
Q

This condition results in calcification of aortic valve cusps, restricting forward blood flow during systole. LV hypertrophy develops

A

aortic stenosis

364
Q

This condition results in calcification of pulmonic valve restricting forward flow of blood

A

pulmonic stenosis

365
Q

This condition results in stream of blood regurgitates back into LA during systole via incompetent MV

A

mitral regurgitation

366
Q

This condition results in backflow of blood via incompetent tricuspid valve into RA

A

Tricuspid regurgitation

367
Q

_____ is caused by backward blood flow from area of high pressure to lower pressure

A

pansytolic regurgitant murmus

368
Q

_______ is caused by forward flow through SL valves

A

midsystolic ejection murmurs

369
Q

_____ is caused by emilunar valve incompetence

A

early diastolic murmurs

370
Q

________ is heard when a backflow of blood via incompetent pulmonic valve from pulmonary artery to RV

A

pulmonic regurgitation

Health Assessment (4 decks)

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