Exam 3 Bolded Terms Flashcards
First heart sound S1 signals…
beginning of systole
First heart sound S1 is loudest at…
the apex
Second heart sound S2 occurs with…
closure of semilunar valves
*aortic and pulmonic
Second heart sound S2 is loudest at…
the base
Third heart sound S3 occurs…
immediately after S2, when AV valves open and atrial blood first pours into ventricles
Third heart sound S3 is abnormal in…
-adults may indicate heart failure
-persons over age 35
what happens during the Fourth heart sound S4?
Atria contract and push blood into noncompliant ventricle
murmurs
Gentle, blowing, swooshing sound (turbulent blood flow) that can be heard on chest wall
what are the characteristics of sound?
frequency or pitch
intesity or loudness
duration
timing
frequency or pitch
described as high pitched or low pitched
intensity or loudness
loud or soft
duration
very short for heart sounds: silent periods are longer
timing
systole or diastole
what kind of artery is the carotid artery?
a central artery, closr to the heart
the carotid artery timing closely coincides with…
ventricular systole
where is the carotid artery pulse located?
in groove between trachea and sternocleidomastoid muscle
why is it difficult to isolate the “aging process” of the cardiovascular system?
because it is so closely interrelated with lifestyle, habits, and diseases
What is attributes to the aging process alone related to the cardiovascular system?
-Increase in systolic BP due to thickening and stiffening of the arteries
-No change in heart rate or cardiac output at rest
what are the caused of CVD
interaction of genetic, environmental, and lifestyle factors
Modifiable risk factors
evidence shows they contribute to majority of cardiac risk; treatment and control of these help to lessen risk
Non-modifiable risk factors
race, ethnicity, gender, socioeconomic status, and educational level carry an excess burden of CVD
Hypertension is 2 to 3 times more common among women taking
oral contraceptives
hypertension is highest in what group?
African/African American
Chest pain questions
o Any chest pain or tightness? (Onset, location, character, PQRST?)
o Any associated symptoms?
o Any shortness of breath? (Onset, duration?)
o Do you have a cough? (Duration, frequency, type?)
orthopnea question
How many pillows do you use when sleeping or lying down?
cyanosis or pallor question
have you ever noticed your facial skin turn blue or ashen?
nocturia question
do you awaken at night with an urgent need to void? How long has this been occurring?
edema question
o Do you have any swelling of your feet and legs? Onset?
cardiac history questions
o Cardiac medical history
o Cardiac family history
o Nutrition
o Smoking
o Medications/drugs
o Alcohol
o Exercise
o Environment
why do we palpate the carotid artery?
Yields important information on cardiac function
what do we auscultate for in middle/older aged people in the carotid artery?
presence of bruit
what side of the stethoscope should you use to auscultate the carotid artery?
bell
when using the bell of the stethoscope to auscultate the carotid artery what should the nurse remember?
· Avoid compressing the artery
· Ask person to take a breath, exhale, and hold
aortic valve location
2nd right intercostal space
tricuspid valve location
Left lower sternal border 4th intercostal space
pulmonic valve location
2nd left intercostal space
mitral valve location
5th intercostal space mid clavicular line
heave/lift
precordial movements that are visible and/or palpable pulsations of the chest wall
how is a heave/lift best felt
with the heel of the hand at the sternal border
thrill
vibratory sensation on your hand
arteriosclerosis
hardening of the arteries
atherlosclerosis
plaque build up in arteries
Trophic changes associated with arterial insufficiency may be seen
- Thin, shiny skin
- Thick, ridged nails
- Loss of hair on lower legs
what is the strongest risk factor associated with PAD
smoking
who does the AHA reccommend get screened for PAD
all people over the age 70 and/or who are between ages 50 and 69 who have a history of smoking or diabetes
what do you use to detect early clubbing
profile sign (viewing finger from side)
what is the normal nail bed angle
160 degrees
capillary refill is an index of
peripheral perfusion and cardiac output
normal color returns in how many seconds fro capillary refill
2-3 seconds
what conditions can skew findings for capillary refill
A cool room, decreased body temperature, cigarette smoking, peripheral edema, and anemia
Pulse grading scale
3+, increased, full, bounding
2+, normal
1+, weak
0, absent
what is the modified allen test used for
to evaluate collateral circulation prior to cannulating radial artery
if the femoral artery is weak or diminished, what should you do?
auscultate site for a bruit
the popliteal pulse is
almost impossible to palpate
where do you palpate the posterior tibial pulse
between the malleolus and Achilles tendon
how do you palpate the dorsalis pedis pulse
Requires very light touch, it is just lateral to and parallel with extensor tendon of big toe
Pitting Edema Scale
· 1+ mild pitting, slight indentation, no perceptible swelling
· 2+ moderate pitting, indentation subsides rapidly
· 3+ deep pitting, indentation remains, leg looks swollen
· 4+ very deep pitting, indentation lasts a long time, leg very swollen
arterial circulation deficit worsens with…
elevation of the legs causing pallor
dark-skinned person’s feet
are more difficult to evaluate, but soles should reveal extreme color change
what is the dopple ultrasonic probe?
a device to detect a weak peripheral pulse (measure low BP or BP in lower extremity)
Costal cartilages are calcified with aging leads to a
less mobile thorax
the aging lung is more rigid which means…
its harder to inflate
atelectasis
small airway close/collapse of alveoli
decrease in alveoli means
less surface area for gas exchange
lung base becomes less ventilated
cough questions
o Do you have a cough?
o When did is start? Gradual or sudden?
o Cough up any blood?
o Describe your cough: hacking, dry, barking, hoarse, congested, bubbling?
SOB questions
o Ever had any shortness of breath or hard-breathing spells?
o Do episodes seem to be related to food, pollen, dust, animals, season, or emotion?
chest pain with breathing questions
o Any chest pain with breathing? Please point to exact location
o Is the pain burning or stabbing?
history if respiratory infection question
o Any past history of breathing trouble or lung disease, such as bronchitis, emphysema, asthma, or pneumonia?
o Smoking history
environmental exposure question
o Are there any environmental conditions that may affect your breathing?
-Where do you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy traffic area
self-care behavior
-TB skin test, chest x-ray study
-Pneumonia or influenza immunization
Anteroposterior (AP) diameter should be ______ than transverse diameter
less
what is tactile fremitus
palpable vibration
how do you assess for tactile fremitus
o Use base of fingers or ulnar edge of one hand
- Touch person’s chest while he or she repeats the words, “ninety-nine” or “blue moon”
- Start over lung apices and palpate from one side to another
what factors affect normal intensity of tactile fremitus
- Thickness of chest wall
- Pinch and intensity
- Increase density of lung tissue make a better conducting medium for sound-increase tactile fremitus
what is most important when listening to breath sounds
side to side comparison
how do you minimize noise on a hairy chest
press harder or wet the hair with a damp cloth
whatare the normal breath sounds
o Bronchial (tracheal or tubular)
o Bronchovesicular
o Vesicular
adventitous breath sounds
o Added sounds not normally heard in the lungs
Atelectatic crackles:
adventitious sound, is not pathologic; short, popping, crackling sound like fine crackles but do not last beyond a few breaths
§ Heard the periphery only
§ Disappear after a few first breaths or after a cough
voice sounds
o Voice can be auscultated over the chest wall
o Eliciting voice sounds usually not done in routine examination
o These are supplemental maneuvers that are performed if you suspect lung pathology on basis of earlier data
Note shape and configuration of chest wall
Ribs slope down with symmetric interspaces
crepitus
o crackling, crinkling, grating feeling under the skin (rice crispies)
- Air under skin of chest wall from the neck or lung
Measurement of pulmonary function status
o Normal between 97% to 98%
o The 6-minute walk test is a safer, simpler, inexpensive, clinical measure of functional status in aging adults
