Exam 3 Flashcards
What is the precordium
area on anterior chest directly overlying heart and great vessels
What is the pericardium or pericardium sac
protective, fluid-filled sac with 2 layers that surrounds your heart and helps it function properly, helps with friction free movement of heart muscle
What is the myocardium
muscular wall of heart that does the pumping
What is the endocardium
thin layer of endothelial tissue that lines inner surface of heart chambers and valves
What is the mediastinum
heart and great vessels located between lungs in the middle third of thoracic cage
Where does the heart sit
2nd to 5th intercostal space and from right border of sternum to left midclavicular line
Where is the apex of the heart located
5th intercostal space left midclavicular line
Where is the base of the heart located
2nd intercostal space across midline of the sternum
Describe in order the circulation of heart blood flow
-vena cava
-right atrium
-tricupsid valve
-right ventricle
-pulmonic valve
-pulmonary arteries
-unoxygenated blood to lungs
-lungs oxygenate blood
-pulmonary vein
-left atrium
-mitral valve
-left ventricle
-aortic valve
-aorta
Describe how fetal circulation is different
-lungs non functioning
-blood pumped from placenta to right side of heart
-two openings shunt (bypass lungs) directly to aorta and systemic circulation
-shunts: foramen ovale and ductus arteriosus
Where is the aortic valve located
2nd intercostal space immediately to right of sternal border
Where is the pulmonic valve located
2nd intercostal space immediately to left of sternal border
Where is the tricuspid valve located
4th or 5th intercostal space immediately to left of sternal border
Where is the mitral valve located
5th intercostal space midclavicular line
What does S1 represent closure of
AV valves
-tricupsid and mitral valves
What does S2 represent closure of
semilunar valevs
-pulmonic and aortic valves
Where is S1 loudest at
apex
Where is S 2 loudest at
base
Where does S1 begin
systole
-lub sound
Where does S2 begin
diastole
-dup
How and where to get the apical pulse
5th intercostal space left midclavicular line
-palpate one finger
-have pt exhale and hold breath
What does displaced apical pulse indicate
-heave or lift
-Enlarged Heart
-Volume Overload
-CHF
What is the order of auscultation of heart sounds
aortic
pulmonic
tricuspid
mitral
What is an S3 murmur
right after S2 when AV valves open and atrial blood first pours into ventricles
-due to the vibration of ventricles that resist early, rapid filling
This is often an indicator of heart failure
What is an S4 murmur
before S1 (presystole), ventricle resistant to filling, atria contract and push blood into noncompliant ventricle
-CAD
-can be common in adults older than 40-50 and are normal
How to assess for pulse deficit
-palpate carotid artery
-auscultate apical heart rate
-compare, equal “no pulse deficit”
How to assess for carotid bruits
whooshing sound, blood flow turbulence, can indicate atherosclerotic disease
-use bell over 3 spots on carotid artery
- pt exhale and hold breath
-do bilaterally
-normal “no bruits noted”
What is heave or lift
sustained forceful thrusting of the ventricle during systole
-ventricular hypertrophy result of increased workload
-find from inspecting precordium
What is a thrill
palpable vibration
-like the throat of purring cat
-signifies turbulent blood flow
Describe the clinical portrait of heart failure
Dilated pupils, skin pale, gray or cyanotic, dyspnea, orthopnea, crackles, cough, decreased BP, N&V, ascites, pitting edema, anxiety, falling O2 sat, confusion, JVD, MI, fatigue, S3 gallop, enlarged spleen, decreased urine output, weak pulse.
What is dyspnea
difficulty breathing, shortness of breath
What is dyspnea on exertion
shortness of breath with exertion (DOE after walking two level blocks)
What is paroxysmal nocturnal dyspnea (PND)
person awakens from sleep with perception of needing fresh air
What is angina
chest pain
What is orthopnea
need to assume a more upright position to breathe. exact number of pillows used can indicate how severe the orthopnea is
What is nocturia
wake up in the night needing to pee
What is pallor
paleness
What is orthostatic hypotension
Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions
What causes jugular vein distention
right sided heart failure
What are questions we would ask when getting a cardiac history
-chest pain
-dyspnea
-orthopnea
-cough
-fatigue
-cyanosis or pallor
-edema
-nocturia
-past cardiac history
-family cardiac history
What are risk factors for cardiac troubles
-nutrition
-smoking
-alcohol
-physical activity
Which ethnic groups are at a greater risk for cardiovascular failure
-prevalence of hypertension (contributes to coronary heart disease) in black americans is highest in the world
-higher rate of stroke, death from heart disease
What is stenosis
-The area through which blood moves out of the heart to the aorta is narrowed
calcification of valve restricting forwards flow of blood
What is regurgitation
-valves dont close completely
back flow of blood
What is heart failure
a chronic condition in which the heart is unable to pump out all of the blood that it receives
How do we grade pulses
0=absent
1+= weak
2+= normal
3+= increased, full bounding
How do we assess for pretibial edema
depress skin over tibia for 5 secs and release, should leave no indentation
How do we grade pitting edema
1+, Mild pitting, slight indentation, no perceptible swelling of the leg
2+, Moderate pitting, indentation subsides rapidly
3+, Deep pitting, indentation remains for a short time, leg looks swollen
4+, Very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted
How to perform a capillary refill test
hands near level of heart, depress and blanch nail beds, release and note time of color return
-normal: <3 secs
Describe the characteristics of an artery
-heart pumps oxygenated blood through arteries to tissues
-pulse
-strong, tough, dense
-stretch and recoil
Describe the characteristics of a vein
-absorb CO2 and waste products from periphery and carry back to heart
How does venous flow occur
-moves forward by contraction of skeletal muscles and one way values not allowing blood to go backwards
What is the purpose of the lymphatic system
retrieve excess fluid and plasma protein from interstitial spaces and returns to blood stream
Name 3 functions of the lymphatic system
- conserve fluid and plasma proteins that leak out of capillaries
- form major part of immune system that defends body against disease
- absorb lipids from small intestine
What is claudication
Cramping pain in legs induced by exercise. Typically caused by artery obstruction. Assessed by number of blocks walked or stairs climbed to produce pain
What do the cervical nodes drain
head and neck
What do the axillary nodes drain
breast and upper arm
What do the epitrochlear nodes drain
hand and lower arm
What do the inguinal nodes drain
lower extremity, external genitalia, anterior abdominal wall
Where are radial pulses and what supplies them
medial to radius at wrist
-radial artery supplies blood
Where are the brachial pulses and what supplies them
above elbow crease
-brachial artery supplies blood
What is a deep vein thrombosis (DVT)
deep vein occluded by thrombus blocking venous return
-acute, unilateral painful swelling, warmth, redness, cyanosis
-causes: immobility, history blood clots, estrogen therapy (birth control), trauma, infection
Where is the femoral pulse and what supplies it (we only verbalize for assessment)
below inguinal ligament, between pubis and inferior superior iliac crest
-deep femoral artery supplies blood
Where is the popliteal pulse and what supplies it (we only verbalize for assessment)
leg extended, anchor thumbs on the knee and curl fingers around into popliteal fossa
-superficial femoral artery becomes popliteal artery and supplies blood
Where is the posterior tibial pulse and what supplies it
Between medial malleolus and the achilles tendon
-posterior tibial artery supplies blood
Where is the dorsalis pedis pulse and what suplpies it
lateral to and parallel the the extensor tendon of the big toe
-anterior tibial artery supplies blood
How do we use a doppler ultrasonic probe
detects weak peripheral pulse, magnifies pulsatile sounds from heart and blood vessels
-place drop of coupling gel on end of handheld device , use light pressure over pulse site
-swishing swooshing sounds are normal
List 8 acute arterial symptoms
-sudden onset
-throbbing
-pain
-pallor
-pulselessness
-paresthesia
-poikilothermia (coldness)
-paralysis
List 8 chronic arterial symptoms
-onset gradual
-cramp
-numbness and tingling
-feeling of cold
-low ankle brachial index
-cool pale skin
-diminished pulses
-pallor on elevation
List 3 acute venous symptoms
-sharp deep calf muscle tender to touch
-sudden onset
-red, warm, swollen leg
List 5 chronic venous symptoms
-aching, tiredness, feeling of fullness
-chronic pain, increases at end of day
-edema
-varicosities
-weeping ulcers at ankle
What is a venous stasis ulcer
After acute DVT or chronic incompetent valves in deep veins
-medial malleolus and tibia bleeding, uneven edges, develops into an open wound
-itching, brown pigments, petechiae
What is an aneurysm
sac formed by dilation in artery wall
-cause: arthrosclerosis (plaque builds up in artery)
Where is the carotid pulse and what supplies it
pulse felt on either side of the neck, over the carotid artery.
-carotid artery supplies blood
Describe the homan’s sign test
the individual’s knee should be in a flexed position. The examiner will then forcibly and abruptly dorsiflex the individual’s ankle and observe for pain behind the knee, which constitutes a positive Homan sign (presence of thrombosis).
-tests for DVT
Where is the apex of the lungs
top of lung location. anterior: 3-4cm above clavicles
Where is the base of the lungs
bottom of lung location. -anterior: rests on diaphragm
-posterior: T10: T12 with inspiration
Describe the right lung
-shorter than left (room for liver)
-3 lobes
Describe the left lung
-narrower than right (room for heart)
-2 lobes
Describe the posterior lung
almost all lower lobe
Where is the pleural cavity
either side of mediastinum (left or right)
-contains lungs !
What are the four main functions of the respiratory system
- supplies oxygen for energy production
- removes carbon dioxide (CO2)
- maintains homeostasis (acid base balance) of arterial blood
- maintains heat exchange, stabilizes body temp
How are respirations controlled
-involuntary control
-pons and medulla (part of brain stem)
Describe hypercapnia as a respiratory drive
-primary drive to breathe
-increases in CO2 levels in the blood stimulate us to breathe
Describe hypoxemia as a respiratory drive
-not as strong as hypercapnia
-COPD pt use as main drive
-decrease of O2 in the blood stimulate us to breathe
What are the normal muscles of respiration
diaphragm and intercostal muscles
What are the accessory muscles of respiration
-neck shoulders and abdomen
-sternal and intercostal retraction
-abdominal muscles contract and push diaphragm up squeezing lungs
Why do we use accessory muscles for respiration
occur as a result of forced inspiration with intense exercise or respiratory distress
What is the angle of louis and where is it located
at secondary rib
-indentation between manubrium and body of sternum
-marks tracheal bifurcation (division) into right and left main bronchi
What is the APGAR scoring system
newborns respiratory assessment at 1 min and 5 mins after birth
-scored on: heart rate, respiratory effort, muscle tone, reflex irritability, color
-2,1 or 0 score
-score of 7-10 indicated good condition, needing only suction of nose and mouth
What are we assessing for when inspecting respirations
- rate (12-20)
- depth (moderate: easy rise and fall. shallow: hardly see breaths. deep: really working for breath)
-use of accessory muscles
What are we assessing for during inspection of the thorax
-symmetry: transverse diameter should be 2:1. 1:1 indicates barrel chest, respiratory disease, lungs hyperinflated
-lesions
-scars
-hair pattern: females fine villus hair
-hair color compared to rest of body
What are we assessing for during inspection of lips and mucous membranes
-lips: pink and moist, no cyanosis
-buccal mucosa: pink and moist, no cyanosis
What are we assessing for during inspection of nails
-shape and contour: slightly convex, pink nail beds, no cyanosis
-angle: less than 160 degrees, make diamond
-capillary refill: push down nail bed, <3 secs
What are we assessing for during palpation of thorax
-anterior and posterior: no crepitations
-place hands butterfly on ribs, take deep breath, do anterior and posterior, smooth, symmetrical, and equal chest expansion anterior and posterior
How do we auscultate lungs vesicular and what are expected findings
use diaphragm
-over peripheral lung fields
-low pitch
-soft inspiration greater than expiration anterior and posterior
How do we auscultate the lungs bronchovesicular and what are expected findings
use diaphragm
-over major bronchi
-moderate pitch and amplitude
-inspiration equal to expiration anterior and posterior
How do we auscultate the lungs bronchial and what are expected findings
use diaphragm
-over trachea and larynx
-high pitch
-loud inspiration less than expiration anterior only
What do adventitious breath sounds sound like
-crackles indicating pneumonia
-wheezing indicating asthma
What does resonance in the lungs sound like and where can we expect to find it
-clear hollow sound
-low pitch
-healthy lung tissue
What does hyper resonance in the lungs sound like and where can we expect to find it
-booming sound
-lower pitch
-normal over childs lung and abnormal in adult indicating emphysema or pneumothorax
What does dullness in the lungs sound like and where can we expect to find it
-soft muffled thud
-abnormal density in lungs: pneumonia, pleural effusion, atelectasis, tumor
-can be normal in athlete with muscular chest wall or obese adults with subcutaneous fat
What id diaphragmatic excursion and what can it indicate
percussion measuring outer 5-7cm of tissue
-abnormal finding must be 2-3 cm wide
-indicates lung disease, COPD
How do we assess for tactile fremitus
-palpable vibration
-use ball of fingers and touch chest while they repeat “ninety nine” or “blue moon”
-vibrations should feel same on both sides
What is a barrel chest and where do we expect to find it
- equal anteroposterior to transverse diameter, 1:1 ratio
normal aging, chronic emphysema and asthma
Describe adventitious breath sounds: crackles (rales) and what can it indicate
-short popping sounds
-heard more on inspiration
-not cleared with coughing
-indicates pulmonary edema, pneumonia
Describe adventitious breath sounds: wheeze (rhonchi) and what can it indicate
-high pitches, musical, squeaking sounds
-inspiration or expiration as air is compressed through narrow passageways
-indicates tumors, asthma, bronchitis, emphysema
Describe adventitious breath sounds: stridor and what can it indicate
-high pitch crowing sound
-louder in neck than chest
-inspiration and/or expiration
-obstruction or swollen upper airway
-indicates epiglottitis, croup
What is a pleural friction rub
-coarse low pitched grating quality that sounds like two pieces of leather being rubbed together, crackles close to ear
-caused when pleurae become inflamed and lose normal lubrication!
What is tachypnea and what can cause it
rapid shallow respirations >20-24
-fever, exercise, respiratory distress
What is bradypnea and what can cause it
slow <10
-drug induced, increased ICP, coma
What is hyperventilation
blowing out too much CO2
-increase in depth and rate
What are kussmuals respirations and when does it occur
- increased rate, depth in attempt to compensate for acidosis
- occur in diabetic ketoacidosis
What are cheyne stokes
-waxing/waning respiration pattern
-increasing rate and depth then decreasing
-normal in infants
-increased ICP, drug overdose, meningitis, renal failure
Describe the development variations in lungs and thorax in the elderly
-calcified costal cartilages (less mobile thorax)
-decreased strength respiratory muscles
-lungs rigid, hard to inflate
-decreased ventilation of lung bases
-fewer alveoli
-kyphosis: hump in curvature of spine
What is crepitus
coarse, crackling sensation palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue, subcutaneous emphysema!
What is emphysema
-destruction of pulmonary connective tissue
-indications: barrel chest, accessory muscles used with respiration, SOB on exertion, tachypnea, respiratory distress
What is atelectasis
the collapse of part or all of a lung, is caused by a blockage of the air passages (bronchus or bronchioles) or by pressure on the lung
What are retractions
Skin pulling around the ribs or above the clavicles during inspiration, sinks in
What is chronic obstructive pulmonary disease (COPD)
airflow limitation caused by airway narrowing and/or obstruction, loss of elastic recoil, or both.
The electrical stimulus of the cardiac cycle follows which sequence
At SA node - AV node - bundle of His - bundle branches
When listening to heart sounds, the nurse knows that the S1:
Is louder than the S2 at the apex of the heart
When listening to heart sounds the nurse knows the valve closures that can be heard best at the base of the heart are
mitral and tricuspid
When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to be true
Blood can flow into the left side of the heart through an opening in the atrial septum
If the nurse hears extra heart sounds in the infant at 48 hours after birth, the nurse should:
Make sure the advanced practitioner is aware of this finding before discharge
What is tactile fremitus produced by
sounds generated from the larynx
What best describes the normal mechanism of respiration in relation to the diaphragm
During inspiration the diaphragm descends and flattens
What is the normal diaphragmatic excursion in an adult patient
3-5 centimeters
