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Health Assessment > Exam 3 > Flashcards

Exam 3 Flashcards

Heart, Peripheral Vascular, Abdominal

1
Q

Definition of pulmonary circulation

A

Right side pumps blood to lungs by removing C02 & replenishing supply

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2
Q

Definition of systemic circulation

A

Left side of the heart pumps blood to other parts of the body

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3
Q

How is deoxygenated blood traveled through the heart?

A

Blows flows into superior and inferior vena cava-> right atrium-> tricuspid valve-> R.ventricle-> pulmonary valve-> R. pulmonary artery->Lungs

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4
Q

How is oxygenated blood traveled through the heart?

A

Pulmonary veins-> L.atrium->mitral valve->L.ventricle->aortic valve->aortic arch->All parts of body

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5
Q

What valves prevents from flowing in reverse direction?

A

Pulmonic & aortic (semilunar valves)

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6
Q

Lays of the Heart & Function

A

Pericardium- Fibroserous sac that attache to great vessels & surround heart

Myocardium-Thickest layer, contracts muscle cells

Endocardium-Thin endothelial tissue & lines inner surface of heart

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7
Q

Electrical Pathways of the heart

A
  1. SA node (sinus node) generates impulses & contracts to send blood to ventricles
  2. Impulse conducted to atria to AV node
  3. AV node relays impulse to AV bundle (bundle of His)
  4. Electrical impulses travel to right and left bundle branch & purkinje fibers in myocardium to both ventricles
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8
Q

Definition of Diastole & Systole

A

Diastole-Relaxation of ventricles (filling)

Systole-Contraction of ventricles (emptying)

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9
Q

Why is systole split into two?

A

S1- Beginning of systole, closing of AV valves (tricuspid & mitral)

S2-Ventricular emptying, decreased pressure & closing of semilunar valves (aortic & pulmonic)

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10
Q

Normal Heart Sounds & Where are they heard the best

A

S1 (“lub”)-Best at apex
M1-mitral valve closure
T1-Tricupsid valve closure

S2 (“dub”)-Best at base
A2-aortic valves closure
P2-pulmonic valve closure

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11
Q

Extra Hearts Sounds

A

Diastolic filling sounds
S3-early in diastole, after S2
S4-Late in diastole, before S1

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12
Q

How to Calculate CO & Normal Output

A

SV*HR=CO
Normal: 5-6 L/min

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13
Q

What type of oxygen do carotid arteries supply and what to assess for?

A

Supply neck and head (brain) w/oxygenated blood

Assess for amplitude & contour

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14
Q

What type of oxygen do jugular venous pulse & why is it important?

A

Supply neck and head with unoxygenated blood via superior vena cava

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15
Q

Definition of Murmur

A

Blowing, swishing sounds over valve area or intercostal space

(Described as musical, harsh, or rumbling)

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16
Q

Biological (Genetic) Changes of Infants

A

Heart beat begins 3 weeks gestation

Oxygenation occurs via placenta

Formen ovale closes within first hour (Ductus arterioles closes within 10-15 hours)

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17
Q

Biological (Genetic) Changes of Pregnant Women

A

Increased blood volume 30-40%

Increased SV & CO (pulse 10-15 bpm higher)

Decreased arterial blood pressure

Decreased BP drops during 2nd trimester, then increases back to normal

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18
Q

Biological (Genetic) Changes of Older Adults

A

Systole BP (20 mm Hg) due to stiffening of large arteries

Increased LV wall thickness

Increased risk for arrhythmia & coronary artery disease

Ectopic beats (extra heart beats) are common

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19
Q

S/S of Chest Pain

A

Angina: Cardiac chest pain; severe w/sense of pressure radiates to left shoulder or jaw

Diaphoresis: Sweating

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20
Q

What does Tachycardia & Palpitations Indicate?

A

Tachycardia: Weak heart= Increased CO

Palpitations=Abnormal conduction or Increased CO

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21
Q

What cardiac diseases is dyspnea associated with?

A

MI, HF, or contrary artery disease

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22
Q

Definition of Orthopnea?

A

Sit upright to breathe due to fluid in the lungs

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23
Q

Indicates HF

A

Orthopnea

Nocturnal dyspnea

White-Pinked tinged sputum (fluid accumulation)

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24
Q

How does ARF & RHD develop?

A

Group A & B-hemolytic streptoccis

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25
Q

Mneumonic for Smoking

A

Ask, advise, Assess, Assist, Arrange

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26
Q

Normal & Abnormal Findings of Neck Vessels (Inspection)

A

Normal: jugular venous pulse not visible at 45 degrees or higher

Abnormal: Visible pulse (Increase venous pressure) indicated HF, pulmonary embolic, cardiac tamponade

Distention on one side-Kink or aneurysm

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27
Q

Positive Kussmaul Sign

A

Increased jugular venous pressure on inspiration indicates pericarditis

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28
Q

Normal & Abnormal Findings of Neck Vessels (Auscultation)

A

Use bell to auscultate carotid artery & patients holds their breath

Normal: No swishing, blowing, or other sounds

Abnormal: Bruit over artery indicates occlusive arterial disease

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29
Q

Definition of Bruit

A

Blowing/Swishing sound caused by blood passing through narrowed vessels

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30
Q

Normal & Abnormal Findings of Neck Vessels (Palpation)

A

Normal: Pulse 2+ bilaterally, contour smooth

Abnormal: 1+ (hypovolemia, shock, decreased CO)

+4 (hypervolemia, increased CO, thrills)

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31
Q

Normal & Abnormal Findings of Anterior Chest (Inspection)

A

Normal: Apical pulse may not be present (mitral area at MCL, fourth/fifth ICS)

Abnormal: Heaves/Lifts indicates enlarged ventricles

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32
Q

Definition of Heaves/Lifts

A

Abnormal outward pulsations

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33
Q

Normal & Abnormal Findings of Anterior Chest (Palpation)

A

Normal: Apical pulse in mitral area, 1-2cm, small amplitude

Abnormal: Unable to palpate (pulmonary emphysema); Large, displaced, long duration (Cardiac enlargement)

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34
Q

Normal & Abnormal Findings of Anterior Chest (Auscultation)

A

Diaphragm at apex

Normal: 60-100 bpm w/regular rhythm

Abnormal: Bradycardia/Tachycardia (Decreased CO)

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35
Q

How to auscultate pulse rate deficit

A

Palpate radial pulse & auscultate apical pulse (full minute)

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36
Q

Findings of Pulse Rate Deficit

A

Normal: Pulse identical

Abnormal: Indicates A.fib, A.flutter, blockage, or premature contractions

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37
Q

Abnormal & Normal Findings of Extra Sounds

A

Normal: No extra sounds

S3 heard at beginning of diastole pause in children, adolescents, and young adults

S4 heard at end of diastole in athletes & older adults 40-50

Abnormal: Ejection sounds or clicks indicate friction rub during systole

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38
Q

Normal & Abnormal Findings of Anterior Chest (Auscultation; Murmurs)

A

Normal: No murmurs

Abnormal: mid systolic, pansystolic, & diastolic murmurs

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39
Q

Definition of Murmurs

A

Swishing sound caused by turbulent blood flow through heart valves or great vessels

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40
Q

Definition of Arteries

A

Blood vessels that carry oxygenated, nutrient rich blood from the heart to capillaries

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41
Q

Majors Arteries of Arm & Components

A

Bronchial Artery

Radial Artery (thumb side)

Ulnar Artery (pinkie side)

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42
Q

Major Arteries of Leg & Components

A

Femoral Artery

Popliteal Artery: Artery front of thigh to back of thigh

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43
Q

Components of Popliteal artery

A

Anterior branch: Dorsalis pedis artery (Top of foot)

Posterior branch: Posterior tibial artery (behind medial malleolus of ankle)

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44
Q

Definition of Veins

A

Blood vessels that carry deoxygenated, nutrient-depleted blood from tissues to heart

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45
Q

Mechanisms of Venous Pressure

A
  1. One way valves to prevent blood from flowing backwards
  2. Skeletal muscles contract sending blood towards heart
  3. Inspiration increased abdominal pressure creating pressure gradient
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46
Q

Definition of Perfusion

A

Interstitial fluid releases water, oxygen & nutrients & picks up products (CO2)

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47
Q

Biological (Genetic) Changes of Pregnant Women

A

Occurs in 3rd Trimester

Edema-Bilateral pitting edema in lower extremities

Variocosities-Enlarged & twisted veins under skin

Hemmorrhoids-Elarged & irritated veins or blood vessels around anus/lower rectum

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48
Q

Biological (Genetic) Changes of Infants

A

Peripheral system same as adults

Developed at birth

Acrocyanosis & skin molting at birth

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49
Q

Biological (Genetic) Changes of Older Adults

A

Increase risk for atherosclerosis & arteriosclerosis

Dorsalis pedis & posterior tibial pulse become difficult to find

Trophic changes: thin, shiny skin; thick-ridged nails; loss of hair on lower legs

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50
Q

S/S of Arterial Insufficiency

A

Cold, pale (pallor), clammy skin, thin skin on extremities

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51
Q

S/S of Venous Insufficiency

A

Warm skin, edema, brown hyperpigmentation

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52
Q

Definition of Intermittent Claudification and Indicates

A

Weakness, cramping, aching or pain w/activity

Indicates arterial disease

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53
Q

S/S of Peripheral Venous Disease and Indicates

A

Heaviness of legs, aching aggravated by standing/sitting. leg edema

Associated with delayed wound healing

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54
Q

What does Erectile Dysfunction indicated in male patient?

A

Central arterial or venous disease

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55
Q

What does Peripheral Venous Disease Cause?

A

Blood clots, DVT, swelling, narrowing/blockage of vessels

56
Q

What does oral contraceptives & smoking cause in females patients?

A

Increase risk for Raynaud, Edema, HTN, or Thrombophlebitis

57
Q

Normal & Abnormal Findings of Arms (Inspection)

A

Normal: Bilaterally symmetric w/minimal difference; No edema

Abnormal: Lymphedema (Blocked or damaged lymphatic circulation)

58
Q

Normal & Abnormal Findings of Arms (Inspection)

A

Normal: Color the same bilaterally

Abnormal: Raynaud Disorder

59
Q

Definition of Raynaud Disorder

A

Vasoconstriction or vasospasm of fingers or toes; rapid color changes (pallor, cyanosis) & tingling, swelling, pain, coldness, or burning

60
Q

Normal & Abnormal Findings of Arms (Palpation)

A

Normal: Skin warm to touch bilaterally. Capillary refill less than 2 sec.

Abnormal: Cold extremities (arterial insufficiency). Capillary greater than 2 secs (vasoconstriction, shock, hypothermia, decreased CO)

61
Q

Normal & Abnormal Findings of Arms (Palpation, Pulses)

A

Normal: Radial pulse 2+ bilaterally & artery wall has resilient quality

Abnormal: 3+ or 4+ (hyperkinetic); 0+ or 1+ (arterial occlusion)

62
Q

Why would you palpate the ulnar and brachial pulses?

A

Palpate if arterial insufficiency is suspected

63
Q

What is the Allen test? Why is it ordered?

A

Test patency of radial and ulnar arteries

Essential for ABG’s or arterial line placement

64
Q

How to perform Allen test?

A

Patient makes a fist & occlude pulses. Patient releases fist and nurse removes thumb based on assessed artery

65
Q

Findings of Allen Test

A

Normal: Pink coloration in 3-5 sec

Abnormal: Pallor persists indicates arterial insufficiency

66
Q

Normal & Abnormal Findings of Legs (Inspection)

A

Normal: No changes in skin pigmentation

Abnormal: Pallor & rumor suggests arterial insufficiency. Cyanosis suggests venous

67
Q

Normal & Abnormal Findings of Legs (Palpation)

A

Normal: No edema present in legs. Warm bilaterally.

Abnormal: Pitting edema (HF, Venous stasis, hepatic cirrhosis).

Cold (Arterial insufficiency). Warmth (Superficial thrombophlebitis)

68
Q

Normal & Abnormal Findings of Legs (Palpation, Auscultated)

A

Normal: Pulse strong bilaterally. No sounds auscultated.

Abnormal: Arterial occlusion

69
Q

How to find varicosities & thrombophlebitis?

A

Inspect while patient is standing

Normal: Veins are barely visible

Abnormal: Varicose veins (distended veins)

Thrombophlebitis (Redness, thick, & tender along vein)

70
Q

What Abnormality is Common in Older Adults?

A

Varisocites are common in older adults

71
Q

What are the three special tests?

A

Position change Test

Manual Compression Test

Trendelenburg Test

72
Q

How to perform position change test?

A

Patient is supine and nurse places forearms under ankles/knee and raise the legs 12in above. Patient pumps their feet for 1 min. Patient sits up and dangles feet

73
Q

Findings of Position Change Test

A

Normal: Pink color returns in 10 sec or less

Abnormal: Pallor remains & takes greater than 10 sec (arterial insufficiency)

74
Q

How to calculate Ankle-Brachial Index (ABI)

A

Systolic ankle pressure/ Systolic brachial pressure

75
Q

Normal & Abnormal Range of ABI

A

Normal: 1.0-1.4

Abnormal: <0.9 & >1.40 (Risk for stroke or heart attack)

76
Q

What tests are used if a patient has varicose veins?

A

Manual Compression Test & Trendelenburg Test

77
Q

What is the Manual Compression Test?

A

Performed when patient has varicose veins and used to assess competence of veins.

78
Q

How to perform Manual Compression Test

A

Patient stands & nurse puts hand on lower portion of veins & other hand 6-8in above the first hand. Test for pulsations in upper hand

79
Q

What is the Trendelenburg Test?

A

Tests saphenous veins & retrograde

80
Q

How to perform Trendelenburg Test?

A

Elevate patient leg 90 degrees for 15 secs & apply tourniquet to upper thigh. Patient than stands & observe venous filling

81
Q

Findings of Trendelenburg Test

A

Normal: No pulse palpated. Saphenous veins fill less than 30 sec

Abnormal: Pulse is in upper fingers. Filling above tourniquet. Rapid filling

82
Q

What are the Court Quadrants?

A

RUQ, RLQ, LLQ, LUQ

83
Q

Three layers of abdominal Wall

A

External abdominal oblique

Internal abdominal oblique

Trasverse abdominis

84
Q

What is the linea alba?

A

White line that joins muscles fibers & aponeurosis at midline of abdomen

85
Q

What are the types of abdominal viscera?

A

Solid viscera & Hollow viscera

86
Q

Definition & Example of Solid Viscera

A

Organs that maintain their shape

Liver, pancreas, spleen, adrenal gland, kidneys, ovaries, uterus

87
Q

Definition & Example of Hollow Viscera

A

Organs that change their shape

Stomach, gallbladder, colon, small intestine, & bladder

88
Q

Biological (Genetic) Changes of Infants

A

Umbilical cord (2 arteries, 1 vein)

Bladder high than abdomen

Round contour expected

Organs easily palpable

89
Q

Biological (Genetic) Changes of Pregnant Women

A

Nausea/Vomiting

Pyrosis- Heartburn or indigestion

Hemorrhoids

Diminished bowel movements

Skins changes (melasma, linea nigra)

Decreased GI motility

90
Q

Biological (Genetic) Changes of Aging Adults

A

Accumulation of abdominal fat

Decreased musculature, salivation, liver size

Constipation

Increased risk for gallstones

91
Q

Causes of abdominal pain

A

Inflammation, infection, distention, obstruction, pressure, or trauma

92
Q

What kind of ulcer awakens a person at night?

A

Duodenal ulcer

93
Q

Gastric or Duodenal ulcer indicated by?

A

Epigastric pain w/tarry stools

94
Q

S/S of GERD

A

Heartburn, dry cough, asthma symptoms, or trouble swallowing

95
Q

What does hematemesis indication?

A

Hematemesis: Vomiting w/blood

Espohageal varices or duodenal ulcers

96
Q

Normal Bowel Movements

A

2-3x a day or 3x a week

97
Q

What does bloody or mucoid stools indicate?

A

Inflammatory disease (Crohn disease, ulcerative colitis)

98
Q

What does clay colored or fatty stools indicate?

A

Malabsorption syndrome

99
Q

What medications cause GI bleeding?

A

Aspirin, ibuprofen, & steroids

100
Q

Definition of Brain-Gut Axis

A

High stress felt in the gut

101
Q

Types of pain & their definitions

A

Visceral pain (hollow)- Dull, aching, burning, cramping in organs that are distended or forcefully contract

Parietal pain- Peritoneum becomes inflamed; severe or steady pain

Referred pain-Distant sites that experience that same pain as organ

102
Q

Organs in the RUQ

A

Liver (majority)
Right Kidney
Transverse/ascending colon
Pancreas (small portion)
Gallbladder*
Small intestines

103
Q

Organs in the LUQ

A

Live (small portion)
Spleen*
Left kidney
stomach
Transverse/Descending colon
Pancreas (Majority)
Small intestine

104
Q

Organs in the RLQ

A

Ascending colon
Small intestines
Righter urters
Appendix*
Right ovary (female)
Right fallopian tube (female)

105
Q

Organs in the LLQ

A

Descending/Sigmoid colon
Small intesine
Lefter urters
Left ovary (female)
Left fallopian (female)

106
Q

Normal & Abnormal Findings of Abdomen (Inspection)

A

Normal: Abdomen similar to skin tone. Silver, pink or blue stria. Pale olde scars. Abdomen is free of lesions or rashes.

Abnormal:
Grey Turner sign: Purple discoloration of flanks (bleeding)

Pale taunt skin (fluid in abdominal cavity)

Spider angioma: Dilated surface arterioles & capillaries w/central star

DARK blueish-pink striae (Cushing syndrome)

107
Q

What is a Cullen Sign?

A

Bluish or purple discoloration around umbilicus (periumbilical ecchymosis)

108
Q

Definition of hernia

A

Protrusion of the bowel through abdominal wall

109
Q

Normal & Abnormal Findings of Aortic pulsations

A

Normal: Slight pulsation of aortic pulse

Abnormal: Exaggerated or wide pulsations (abdominal aortic aneurysm)

110
Q

What is a Peristaltic waves?

A

Ripple like fashion from LUQ to RLQ seen with obstruction

111
Q

Normal & Abnormal Findings of Abdomen (Auscultate)

A

Normal: soft clicks or gurgles heard every 5-30/min

Abnormal: Hyperactive Bowels-Rushing, tinkling, or high-pitched

Hypoactive-diminished bowels (paralytic ileus, inflammation, or obstruction)

112
Q

What does an auscultated bruit indicate?

A

An aneurysm or renal arterial stenosis (RAS)

113
Q

Definition of Friction Rubs (Auscultate)

A

High pitched, Rough grating sound that’s created when liver or spleen rubs peritoneum

114
Q

What is the normal & abnormal percussed tone in all quadrants?

A

Normal: Generalized tympany over abdomen. Dullness over spleen and liver

Abnormal: Accentuated tympana or hyperressonace (abdominal distention)

115
Q

Definition of Hepatomegaly

A

Enlarged liver (tumor, cirrhosis, abscess, or vascular engorgement)

116
Q

What is the Scratch Test?

A

Determines the location and size of liver and spleen

117
Q

How to perform the Scratch Test?

A

Place diaphragm of stethoscope at second to last intercostal place, MCL. Slightly stroke the skin moving towards lower costal margin.

118
Q

What is the Shifting Dullness Test?

A

Used if ascites is suspected. A special percussion technique.

119
Q

What is Positive sign of Shifting Dullness Test?

A

Dull percussion around the flanks

120
Q

What is ascites?

A

Fluid in abdominal cavity, which is a sign of liver failure due to hypertension

121
Q

What is the Fluid Wave Test?

A

Another way to test for ascites

122
Q

How to Perform Fluid Wave Test?

A

Nurse places ulnar side of hand and lateral forearm on midline of abdomen. Use other hand to tap opposite side of abdomen
*Requires Assistance

123
Q

Normal & Abnormal findings of Fluid Wave Test

A

Normal: No fluid wave is felt

Abnormal: Movement of fluid against resting hand

124
Q

How to perform Rebound Tenderness?

A

Palpate deeply at 90 degrees halfway between umbilicus & anterior iliac crest (McBurney Point). Then suddenly release pressure and assess for pain

125
Q

What is a Blumberg Sign?

A

A patient with rebound tenderness experiences sharp, stabbing pain when pressure is released. Indicated peritoneal irritation (appendicitis)

126
Q

How to Perform Referred Rebound Tenderness Test?

A

Palpate deeply in LLQ & quickly release pressure

127
Q

What is a Positive Rovsing Sign?

A

Patient feels pain in RLQ during pressure in LLQ (acute appendicitis)

128
Q

What is a Psoas Sign?

A

Pain in RLQ due to irritation of the iliopsoas muscles related to appendicitis

129
Q

How to assess for Psoas Sign?

A

Lie patent in left lateral position & hyperextend patients right leg.

130
Q

What is a Obturator Sign?

A

Pain in RLQ due to irritation of obturator muscle related to appendicitis

131
Q

How to assess for Obturator Sign?

A

Support patients right knee & ankle. Flex the hip the knew & rotate the leg internally and externally

132
Q

What is the Hypersensitivity Test?

A

Pain or exaggerated sensation of RLQ related to appendicitis

133
Q

How to perform Hypersensitivity Test?

A

Stroke the RLQ with sharp object or pinch skin and release quickly.

134
Q

How to test for Cholecystitis?

A

Press fingers on liver border in RUQ & ask patient to inhale deeply

135
Q

What is a Murphy Sign?

A

Sharp pain that causes patient to hold their breath (inspiration). Associated with cholecystitis (inflammation of gallbladder)

Health Assessment (5 decks)

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