Exam 3 Cardiovascular Flashcards
What is the factor characteristics for arterial pulses?
Rate
Rhythm
Contour
Amplitude/振幅
Absent
1 = Weak
2 = Normal
3 = Increased, full, bounding
Pitting vs. non-pitting edema
Pitting?
Interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation
Movement of excess interstitial fluid, in response to pressure Usually unilateral (often DVTs)
The aortic and pulmonic valves are called __________ valves because each of their leaflets is shaped like a half moon.
semilunar
Health Promotion and Counseling
Factors
- Smoking
- Weight control
- Exercise
- HTN control
- DM management
- Limit alcohol intake
- Foot care
Myocardium
The muscular wall of the heart; it does the pumping
Function of arteries
a) Supply what?
b) What ischemia affect the body?
a) Oxygen & essential nutrients to tissues
b) Partial blockage (ischemia) creates an insufficient supply
reduced blood flow
The mitral valve, when closed, prevent blood from back flowing into the??
Left atrium
1) Blood from the body’s organs and tissues returns to the heart from the a)________
2) Then empties into the b)________ and travels through the c)________ .
Then into the d)________ which pumps it through the e)________ into the f)________
a)superior and inferior venae cava
b) right atrium
c) tricuspid valve
d) right ventricle
e) pulmonary valve
f) pulmonary artery
Physical Examination/Inspection
Apical pulse
Heaves (lift)
Outward movement of the precordium associated with heart failure
The arteries
a) Thicker or thinner?
b) More or less stretch and expand?
c) More or less pressure than the veins?
a) Thicker with a greater smooth muscle layer
b) Less ability to stretch and expand from internal pressure
c) Much more pressure than are the veins
Auscultation
Best heard in an area is the anatomic site because the sound is transmitted in the direction of?
blood flow
What is the Jugular veins at?
- Two jugular veins present in each side of neck
- Empty unoxygenated blood directly into superior vena cava
What are Murmurs?
A sound when blood volume in the heart increased or its flow altered.
Use bell of the stethscope
The __________ is the heart muscle that does the pumping
Myocardium
Assessing for Pitting Edema
Press for how many seconds?
Describe 1 to 4 stages
For 5 seconds and release
1+ Mild pitting, slight indentation
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains, leg looks swollen
4+ Very deep pitting, indentation lasts long time, leg very swollen
Blood pressure?
Pulse pressure?
Mean arterial pressure?
Force of blood pushing against side of wall
Difference between systolic and diastolic pressures
Pressure forcing blood into tissues
The veins
a) More or less sturdy?
b) Veins has valve? T or F?
a) Less sturdy and more distensible
Venous return is less forceful than blood flow through the arteries
b) T/valves to keep blood flowing in one direction
Differentiate between murmurs, bruits, heave (lift), and thrill
Thrill?
Mediastinum
The heart and great vessels are located between the lungs in the middle third of the thoracic cage
(holds the heart & the great vessels)
Venous disease, factor?
-Thrombophlebitis
-prolonged immobilization
pregnancy, obese
Inadequate venous return from the legs to the heart is
DVT
In __________, left ventricular pressure continues to drop and falls below left atrial pressure
diastole
When palpate?
Touch hard or light?
Touch lightly
Sensation decreases as you increase pressure and feel for thrills
Position auscultate heart sounds
Supine
Sitting
left lateral decubitus position
What does a pulse deficit mean?
The apex of the heart is 120bpm
The ridical heart is 98bpm
There are fewer puleses in the arteries than there are heartbeats
When forward flow is restricted in the heart is know as
Stenosis
Differentiate between murmurs, bruits, heave (lift), and thrill
Heave (lift)?
An abnormal sustained, systolic. outward movement of the precordium associated with heart failure
Murmurs
Cause high outputv demands increase the speed of blood flow
What stiuations? 4
Fever
Thyrotoxicosis
Anemia
Pregnancy
What valves are closing the first heart sound(s1)?
The mitral and tricuspid valves are sounds of S1
Deep Vein Thrombosis
a) what it causes?
b) Symptoms
c) Objective factor?
a) Thrombus(clot)
b) Sudden onset of intense
sharp, deep muscle pain
c) Increased warmth
swelling
redness
tender to palpation
Venous disease
a) Skin change
b) Ulcer
a) thick & hardened skin hemosiderin staining (brown/dark skin color)
b) near medial malleolus
irregular shaped
moderate to large drainage
What sounds can the bell detect?
Murmurs
Bruits
Extra heart sounds
where the carotid artery at?
between the trachea and sternomastoid muscle
- Palpate one carotid artery at a time
located on both sides of your neck that deliver blood to your brain and head
What is the PMI?
Point at which the apical impulse is most readily seen or felt
Using one finger pad may need to roll person midway to left to find it
What would cause one leg to be colder than the other?
Peripheral artery disease
If the legs and feet aren’t getting enough blood flow to operate correctly
4 valves of heart
Tricuspid valve
Mitral valve
Pulmonary valve
Aortic valve
DVT subjective data? 9
Leg pain or cramps
Skin changes on arms or legs
Swelling in the calves, legs, or feet
Swelling with redness or tenderness
Intermittent claudication
Cold, numbness, or pallor in the legs; hair loss
Lymph node enlargement
Medications
Smoking history
Effect on the older people
- Systolic blood pressure increase/thickening & stiffening of the arteries
- Left ventricular wall thickness
- calcification (arteriosclerosis)
- ↑ muscle fatigue
- dyspnea(difficulty brathing)
The stroke volume is 60 and the heart rate is 70.
what is the cardiac output?
4200
The cardiac impulse originates in the a)________node
Then spreads through the b)__________
Then c)__________node
Then the impulse travels to d)__________, then, e)_____and then to through f)_____
a) SA node(pacemaker)
b) Atria
c)AV node
d) Bundle of His
e) Right and left bundle branches
f) Ventricles
Area of Auscultation at the second ICS and right sternal border
Aortic
Endocardium?
The thin layer of endothelial tissue that lines the inner surface of the heart
Differentiate between murmurs, bruits, heave (lift), and thrill
Murmurs?
Just a word used to describe an abnormal sound
Sound of blood flowing through the heart
What the other names for the MITRAL VALVE?
PMI (point of maximal impulse)
Apical pulse
The pulmonary veins _________?
Carry oxygenated blood to the left atrium
Aging adult,Peripheral vessels grow more rigid
What is this called?
Arteriosclerosis
Lymphatic system
a) What is remove for?
b) What’s absorb for?
c) What’s produce for?
a) The removal of excess fluids from body tissues
b) Fatty acids and subsequent transport of fat
c) Immune cells (such as lymphocytes, monocytes, and antibody producing cells called plasma cells)
Peripheral Pulse
A pulse that can be palpated over a peripheral artery
Where are the Jugular veins at?
a) Internal jugular
b) External jugular
a) lies deep and medial to sternomastoid muscle (usually not visible),
although pulsations may be seen in sternal notch when person is supine
b) vein is more superficial
lies lateral to sternomastoid muscle, above clavicle
Vascular System
Developmental Competence
Peripheral vessels grow more rigid (arteriosclerosis)
Arterial walls lose elasticity and vasomotor tone
Calcification and plaque buildup (atherosclerosis)
Loss of lymphatic tissue ↓ in numbers & size lymph nodes
Differentiate between the carotid artery pulsation and the jugular vein pulsation
Jugular vein
Lower, more lateral, under or behind sternomastoid muscle
Two visible waves per cycle
varies with respiratio
Level of pulse drops and disappears as person sits up
Why is auscultation in the left lateral decubitus?
The left lateral decubitus position increases murmur of mitral stenosis.
Still murmurs?
In children, adolescents, and especially in young athletes have no apparent cause
Lymphatic system
a) Form a major part of the a)________
b) Conserve b)________ and b)________
c) Without lymphatic drainage, it produce c)________
a) Immune system defends/the body against diseases
b) Fluid and plasma proteins/ leak out of the capillaries
c) Edema/fluid would build up in interstitial spaces
Second heart sound?
S2 or Dub
Results from closure of SL valves- can hear S2 over all Precordium, but loudest at base
Pericardium?
is a tough, fibrous layer that surrounds and protects the heart
Pale, shiny skin and loss of hair is a consequence of?
Arterial insufficiency
Palpate the temperature of both legs and feet use with?
With the backs of your hands
What is a Pulse Deficit?
The difference between a radial & Apex of the heart pulse.
Stroke volume is the amount of blood ejected by the ventricle with each heartbeat
True or false
True
Which has thicker walls: arteries or veins?
arteries
While assessing an adult client, the nurse detects opening snaps early in diastole during auscultation of the heart. The nurse should refer the client to a physician because this is usually indicative of…
mitral valve stenosis
Heart Sounds, what are we listing for? 6
Rate
Rhythm
S1, S2
Splitting
Extra heart sounds
Murmurs
Area of auscultation located at the second ICS and left sternal border
pulmonic
The dorsalis pedis pules
Palpate the dorsum of the foot
Stenosis?
Narrow valve-forward flow is restricted
Functions of veins
Drain deoxygenated blood and its waste products from tissues and return it to heart
Drain 排出する
What is arteriosclerosis?
The build-up of fats, cholesterol, and other substances in and on the artery walls
Older people
What does pulse deficit indicate?
The volume of blood pumped from the heart may not be sufficient to meet the needs of body’s tissues
Diastole
AV valves a)_______ , ventricles b)_______ and c)_______
This process takes up d)_______ of cardiac cycle
a) Open
b) Relax
c) Fill of the blood
d) 2/3
The femoral pulse?
Press deeply below the inguinal ligament and about midway between the anterior superior iliac spine and the symphysis pubis
Regurgitation?
Incompetent valve-blood flows backward
DVT causes?
Prolonged bed rest
History of varicose veins
Trauma
Infection
Cancer
Obesity
When you auscultate the carotid arteries, what are you assessing for?
Bruits
Blowing or swinging sounds that indicate obstraction duering blood flow
During contraction, apex beats?
Against chest wall, producing an apical impulse - normally at 5th ICS to the left MCL
5th ICS -5th intercostal spac
MCL-midclavicular line
What is known as the PACEMAKER of the heart?
SA node
Which of the following is correct about the LEFT ventricle?
It pumps blood into the systemic circuitve
The direction of blood flow through the heart is best described by which of these?
Right atrium–> right ventricle –>pulmonary artery –>lungs pulmonary vein –> left atrium –>left ventricle
Types of Heart murmurs (abnormal findings)
Pansystolic
Midsystolic
Diastolic
First heart sound?
S1 OR Lub
Results from closure of AV valves
Can hear S1 over all Precordium, but loudest at apex
The heart lies in the __________ cavity in the mediastinum under the sternum and between the second and fifth intercostal spaces
Pericardial
Which layer forms the bulk of the heart and is the layer that contract?
Myocarium
Heart extends from a)_____ to a)_______intercostal cartilages
From b)_____ to c)_____
a) 2nd to 5th
b) right sternal border (RSB)
c) left midclavicular line (MCL)
Major risk factors for heart disease & stroke
HTN
Smoking
High cholesterol
Obesity
Diet
Sedentary lifestyle
Stress
DM
What is Raynaud’s Syndrome?
Fingers showing cyanosis
Differentiate between the carotid artery pulsation and the jugular vein pulsation
Carotid?
Higher and medial to muscle
Brisk, localized
One wave per cycle, palpable
No pressure change
Unaffected by position change
__________ is the period of ventricular contraction
Systole
What is the spasm?
Involuntary contractions of a muscle, typically harmless and temporary, but can be painful.
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Apical Pulse
A pulse that can be ausculated over the apex of the heart
Area of auscultation located in the apex and assessing the left ventricle, fourth to fifth ICS at the left midclavicular line
Maital
Neck Vessels: Inspection
Position
Position person supine anywhere from a 30- to a 45-degree angle
Older people/Electrical irritability enhanced
What does it mean?
Increase fibrosis and sclerosis in the heart valves
fibrosis/thickening or scarring of the tissue
sclerosis/stiffening of a tissue
Capillary refill time more than 3 seconds
What this indicate?
Arterial insufficiency
What part of the autonomic nervous system will stimulate the SA node to increase heart rate & the force of contraction?
Sympathetic
Responsible for your “fight or flight”
What is a major difference between arteries and veins?
Veins have valves
What are the Great Vessels?
Major arteries and veins connected to heart
Aorta
Pulmonary trunk
Pulmonary veins
Superior vena cava
Inferior vena cava
Characteristics of heart sounds 4
Frequency (pitch): high, medium or low
Intensity (loudness): S1 loudest at the apex, S2 loudest at the base
Duration: very short for heart sounds; silent periods are longer
Timing: systole and diastole
What is the main cause of venous ulcers?
or venous insufficiency?
The veins have one-way valves that keep blood flowing up toward the heart
When these valves become weak or the veins become scarred and blocked
Blood can flow backward and pool in the legs
Pitting vs. non-pitting edema
Non- pitting?
Lymphedema. When it is extremely difficult for lymph fluid to drain as it should, it is often due to a blockage.
cancer treatment
The P-wave phase of an ECG represents?
when the SA node creates an action potential that depolarizes the atria.
Depolarize reduce or remove the polarization of
The semilunar valves are located?
At the exit of each ventricle at the beginning of the great vessels
Which ABNORMAL conditions may affect the location of the apical impulse?
CARDIAC ENLARGEMENT
What is arterial ischemia?
An injury to the brain or spinal cord
Caused by a lack of oxygen to the area affected
Results from obstruction of blood flow by blood clots
Narrowed or damaged arteries or both
Cardiac output?
Volume of blood pumped from a heart per minute. Adult heart normally pumps between 4 to 6 L of blood throughout the body/minute.
CO = SV X HR
Which sound is louder? S1 or S2?
S2 is louder because the larger valves are the Aortic and Pulmonic
Raynaud’s syndrome?
- *White,** due to arteriospasm and resulting deficit in supply
- *Blue**, due to slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of hemoglobin
- *Red** (rubor), due to return of blood into the dilated capillary bed or reactive hyperemia
Arterial disease
a) Skin change
b) Ulcer
a) Pale, shiny, loss of hair
Diminished or absent pulses
b) Tips of toes, foot, or lateral malleolus
Rounded, smooth, looks “punched out”, minimal drainage
Due to lack of arterial blood flow supplying the area of the wound
Earliest sign of heart failure
Auscultation of S3 Heart sounds
Systole
AV valves a)_________, ventricles b)_________,
Pumps blood into c)_________ and c)_________
This takes up d)_________,of cardiac cycle
a) close
b) contract
c) pulmonary and systemic arteries
d) 1/3
Auscultate bruit with the a)_______ of stethoscope as a b)_______ pitch sound
a) bell
b) low
When listening over the carotid vessels, ask the patient to suspend breathing for a few heartbeats so that respiratory sounds do not interfere with auscultation
The difference between the systolic and diastolic pressure is
Pulse pressure
Lymphatic system
Only superficial nodes are palpable
Arterial disease factor?
-Arteriosclerosis
Arterioembolism
-Smoking
DM/Diabetes mellitus
HTN
high chol
Obesity
Lymphatic system
During circulation of the blood, more fluid leaves a)________ than b)________ can absorb.
a) capillaries
b) veins
Differentiate between murmurs, bruits, heave (lift), and thrill
Bruits?
Also called vascular murmur
Blowing vascular sounds
Where is S1 heard beset?
Apex
What are cardiac thrills?
A palpable murmur
Rushing vibration
Vibratory sensations felt on the skin
Physical Examination/palpation
Apical impulse
Heaves (lift)
Thrills
What subjective dates we want to get?
Chest pain
Dyspnea
Edema
Nocturia
Orthopnea
Cough
Fatigue
Cyanosis or pallor
Personal cardiac history
Family cardiac history
Auscultation position of heart valves
A,P,T,M
A: Second intercostal space
Right sternal border
Aortic area
P: Second intercostal space
Left sternal border
Pulmonic area
T: Third intercostal space
Left sternal border
Second pulmonic area
M: Fifth intercostal space
Left midclavicular line
Apex, Mitral area
Define claudication
Condition with cramping pain
Commonly in the legs
Caused by too little blood flow
Often indicates peripheral artery disease
- During contraction, a)__________ beats against chest wall
- Producing an b)__________
- Normally at b)_____to the b)_____
a) apex
b) apical impulse
c) fifth ICS/intercostal cartilages
c) left MCL/left midclavicular line
Systolic pressure?
Diastolic pressure?
Maximum pressure felt on artery during left ventricular contraction
Resting pressure that blood exerts constantly between each contraction
What is the major health problem resulting from a pulse deficit?
A. Bradycardia
B. Activity intolerance
C. Decreased cardiac output
D. Impaired tissue perfusion
Decreased cardiac output
Why do we get nocturia with heart failure?
-Urinating frequently at night
- A weak heart can’t pump blood efficiently, causing fluids to build up in the body
- The kidneys work to rid the body of excess fluid
- Causing large amounts of urine production and frequent urination
First–Palpate the radial pulse
Second–If cannot obtain then feel brachial pulse
What should the nurse do when a pulse deficit is suspected?
Ask another health care provider to count the radial pulse while the nurse counts the apical pulse.
What are the 7 arterial pulses?
neck (carotid artery)
the wrist (radial artery)
behind the knee (popliteal artery)
the groin (femoral artery)
inside the elbow (brachial artery)
the foot (dorsalis pedis and posterior tibial artery)
the abdomen (abdominal aorta)
