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Health Assessment > Exam 3 - Heart & Neck Vessels > Flashcards

Exam 3 - Heart & Neck Vessels Flashcards

1
Q

List subjective data

A 
Chest pain (angina)
Dyspnea (DOE/PND)
Orthopnea
Cough
Fatigue
Cyanosis/pallor
Edema - swelling in face, hands, legs (bilaterally)
Nocturia
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2
Q

Cardiac disease risk factors:

A
  • Nutrition (modifiable) - 24 hr diet recall
  • Smoking (modifiable) - pack history = multiply packs per day X years of use
  • Alcohol (modifiable) - how much, how often, how long, etc.
  • Exercise (modifiable) - What type, for how long, how often
  • Drugs (modifiable
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3
Q

How do we differentiate from BPH and Heart issues?

A

The frequency and amount or urination
Heart issues: void frequently at night with high amounts
BPH: try to void frequently at night but amount will be low

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4
Q

How should we teach our pt about chest pain?

A

Signs and symptoms for early recognition of MI

Always call 911 with chest pain

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5
Q

What do we ask about past cardiac history?

A

1 - Immediate family history (nonmodifiable)
2 - Hypertension? (Nonmodifiable) - if yes, what medication are you on and when have you taken it?
3 - Activity level? (Modifiable) - how many times/week do you exercise? How long? How long do you rest?

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6
Q

Order of assessment during physical exam

A

Pulse and BP
Extremities
Neck vessels
Precordium

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7
Q

Position pt should be in when palpating the carotid arteries

A

Sitting

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8
Q

Position pt should be in when palpating the jugular veins and precordium

A

Supine, slightly elevated (*allows blood to pool)

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9
Q

Active waves

A

Arterial

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10
Q

*What does an active wave mean?

A

Blood is actively flowing. Takes force from cardiac contraction to push the blood around

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11
Q

Which waves are passive?

A

Venous waves

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12
Q
  • What does a passive wave mean?
A

Rely on muscle to move blood up

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13
Q

What is S1 and what causes it?

A

“Lub” - the sound of the atrioventricular valves (tricuspid and mitral) closing

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14
Q

What is S2 and what causes it?

A

“Dub” sound - closing of semilunar valves (aortic and pulmonic) closing

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15
Q

Can respirations affect arterial waves?

A

No

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16
Q

Can passive venous waves be affected by respirations?

A

Yes

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17
Q

List the flow of blood through the heart

A 
1 - Superior vena cava
2 - Right atrium
3 - Right ventricle
4 - Pulmonic artery
5 - Lungs
6 - Pulmonic vein
7 - Left atrium
8 - Left ventricle
9 - Aorta
10 - Body
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18
Q

Muscle that covers the carotid arteries

A

Sternomastoid

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19
Q

How to palpate the carotid arteries

A
  • Avoid excessive pressure
  • Palpate medial to sternal muscle
  • One carotid at a time
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20
Q

What is something abnormal we would notice while palpating the carotid arteries?

A

Thrills (turbulence)

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21
Q

What is a thrill?

A

Palpable vibration in carotid arteries

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22
Q

Normal strength of pulse at carotid arteries

A

2+

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23
Q

What does a thrill feel like?

A

The throat of a purring cat

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24
Q

What does a thrill mean?

A

Signifies turbulent blood flow, and usually accompanies loud murmurs
(Absence of a thrill does not rule out presence of a murmur)

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25
Q

*Part of stethoscope used to auscultate carotids and **what should we have pt do while listening?

A

Bell with light pressure

Have pt take deep breath, exhale, and hold it

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26
Q

Patients we should listen to carotids on?

A

Middle aged and older

Pts showing symptoms of CV disease

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27
Q

Abnormal sound heard while listening to carotids, and what is it?

A

Bruit - blowing, swishing sound indicating blood flow turbulence

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28
Q

What do normal carotids sound like?

A
  • Absence of bruit
  • Normal strength 2+
  • Same bilaterally
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29
Q

Position pt should be in to inspect jugular venous pulse

A

Supine (30-45 degree angle)
Head turned to Side
Have pen light shining directly on neck

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30
Q

Normal jugular venous appearance upon inspection

A

Visible by pulsation only

Disappears when pt sits up

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31
Q

Abnormal jugular venous pulse

A

Increased CVP (central venous pressure) - heart failure

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32
Q

Location of Internal jugular pulse vs. carotid pulse

A

Internal jugular: lower, more lateral, under or behind sternomastoid muscle

Carotid: higher and medial to sternomastoid muscle

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33
Q

Quality of internal jugular pulse vs. carotid pulse:

A

Internal jugular: undulant and diffuse, two visible waves per cycle

Carotid: Brisk and localized, one wave per cycle

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34
Q

Respiration with internal jugular pulse vs. carotid pulse:

A

Internal jugular: varies with respiration

Carotid: does not vary

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35
Q

Are internal jugular pulse or carotid pulse palpable?

A

Jugular: No

Carotid: yes

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36
Q

Pressure used for internal jugular pulse vs. carotid pulse:

A

Jugular: light pressure at base of neck easily obliterates

Carotid: no change

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37
Q

Position of person when inspecting / palpating internal jugular pulse vs. carotid pulse:

A

Jugular: level of pulse drops and disappears as person is brought to sitting position

Carotid: no change

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38
Q

Where is the base of the heart?

A

At the top

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39
Q

Where is the apex of the heart?

A

At the bottom

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40
Q

What are the AV valves?

A

Tricuspid (right)

Mitral (left)

41
Q

Function of AV valves

A

Allow blood into the heart chambers

42
Q

When do AV valves open/close?

A

Open during filling (diastole)

Close during ejection (systole)

43
Q

What are the semilunar valves?

A

Pulmonic (right)

Aortic (left)

44
Q

Function of the semilunar valves

A

Allow blood to enter lungs/periphery

45
Q

When do semilunar valves open?

A

During ejection (systole)

46
Q

What happens to heart during diastole?

A

Ventricles relaxed (filling)

47
Q

What happens to heart during systole?

A

Ventricles contract (ejection)

48
Q

*** What do valves respond to?

A

Pressure gradients

49
Q

Artery that wraps around the heart (“widow maker”)

50
Q

Where does the LM artery come off of?

51
Q

Where is the precordium?

A

Center of the chest. Intercostal spaces 1-6

52
Q

What is the PMI?

A

Apical impulse

53
Q

** Where is the PMI located?

A

5th intercostal space, at or medial to left MCL

54
Q

Size of PMI (apical impulse)

A

1 cm X 2 cm (rectangle)

55
Q

Amplitude of PMI

A

Short, gentle tap

56
Q

Duration of PMI

A

Short, first half of systole

57
Q

How long do you listen to PMI?

A

Always listen for 60 seconds *this is most accurate pulse reading

58
Q

Process of palpating across precordium

A
  • Assess for other pulsations (apex, left sternal border, base)
  • Use palmar aspects of hand
59
Q

Normal finding after palpating across precordium

A

No pulsations

60
Q

Position pt should be in for cardiac auscultation

A

Supine position (30-45 degree angle)

61
Q

*** Where do we listen during cardiac auscultation?

A 
Aortic valve - 2nd right ICS
Pulmonic valve - 2nd left ICS
Erb’s point - 3rd left ICS
Tricuspid valve - left lower sternal border (4th - 5th ICS)
Mitral valve - 5th ICS, left MCL (apex)
62
Q

Part of stethoscope used during cardiac auscultation

A

First use diaphragm

63
Q
  • What do we listen to during cardiac auscultation
A

First identify S1 and S2 and then any splitting

Rate, rhythm, and count apical pulse for 60 seconds

64
Q

Where is S1 loudest?

65
Q

What does S1 coincide with?

A

Carotid artery pulse

Simultaneously feel pulse. Should hear lub at same time as pulse thumps

66
Q

Where is S2 loudest?

67
Q

What sounds to we note during cardiac auscultation?

A

S1
S2
Any splitting
Any extra sounds

68
Q

Cardiac cycle definition

A

Rhythmic flow of blood through the heart

69
Q

Two phases of cardiac cycle

A

Diastole

Systole

70
Q

Definition of diastole and **how long does it last?

A

Ventricles relax and fill with blood

2/3 of cycle

71
Q

Definition of systole and **how long does it last?

A

Heart’s contraction, blood pumped from ventricles fills pulmonary and systemic arteries
1/3 of cycle

72
Q

What occurs during diastole?

A

Relaxation or filling phase:

  • Ventricles relaxed, AV valves open
  • Pressure in atria higher than that in ventricles, so blood pours rapidly into ventricles
  • Toward end of diastole, atria contract and push last amount of blood into ventricles (atrial kick)
73
Q

When does atrial systole occur?

A

During ventricular diastole

74
Q

What is atrial kick?

A

Toward the end of diastole, atria contract and push last amount of blood into ventricles

75
Q

What occurs during systole?

A

Contraction or pumping phase:

  • Ventricular pressure becomes higher than that in atria, so AV valves close
  • Closure of AV valves contributes to first heart sound (S1) and signals beginning of systole
  • For brief moment, all 4 valves are closed and ventricular walls contract (isometric contraction)
76
Q

What is isometric contraction?

A

The very brief moment when all 4 valves are closed and ventricular walls contract, during systole

77
Q

Purpose of the cardiac valves and how do they work?

A

To prevent back flow
Unidirectional - only open one way
Passive - respond to extreme pressures to open/close

78
Q

What is stenosis?

A

Valves have things hanging from them that prevent closure

79
Q

What is regurgitation?

A

Incompetent valve that allows blood to flow back and forth

80
Q

** What causes S1?

A

Closing of the mitral and tricuspid valves (AV valves)

81
Q

Which sound marks the start of systole?

82
Q

What causes S2?

A

Closing of the semilunar valves

83
Q

Which sound signals the end of systole?

84
Q

Why does splitting occur?

A

When aortic valve closes earlier than pulmonic valve

Effect of inspiration

85
Q

How much blood does the heart pump per minute?

86
Q

How do you listen for extra sounds and what are they?

A
  • Use the bell
  • S3 and S4
  • If you suspect an extra sound, roll pt to left side to force heart against chest wall to hear better
  • Listen for any low-pitched murmurs
87
Q

What is an acute MI?

A

Sudden lack of blood flow and blocked coronary artery

88
Q

What causes an acute MI?

A

Plaque
Clot
Spasm

89
Q

How should you explain an MI to a patient?

A

Our heart is made up of two systems, electrical and plumbing
EKG looks at the electrical impulses
Plumbing is where the issue is with a MI

90
Q

Signs and symptoms of an acute MI

A 
Chest pain
SOB
Dizziness
Fatigue
Sweating
Indigestion
Nausea/vomiting
Restlessness / apprehension
91
Q

Signs and symptoms of heart failure

A 
Dilated pupils
Skin pale, gray, cyanotic, cool, moist skin
Falling O2
Fatigue
Confusion
Jugular vein distention
Dyspnea
Orthopnea
Crackles, wheeze breath sounds
Cough
Decreased blood pressure
S2 gallop, tachycardia
Weak pulse
Nausea/vomiting
Ascites (fluid in peritoneal cavity)
Enlarged spleen and liver
Decreased urine output
Dependent, pitting edema
92
Q

Palpitation

A

Bounding or racing of heart associated with normal emotions or a heart disorder

93
Q

Pericardial friction rub

A

Inflammation of pericardium gives rise to friction rub
Sounds high pitched and scratchy
Best heard at apex during systole or dyastole

94
Q

Pulse deficit

A

Radial pulse is less than ventricular rate as auscultation at apex

95
Q

What does a pulse deficit indicate?

A

Lack of peripheral perfusion for some of the heart contractions

96
Q

Pulse pressure

A

Difference between systolic and diastolic pressures

Normally 30-40 mm Hg

97
Q

Summation sound

A

When both the pathologic S3 and S4 are present, a quadruple sound is heard

98
Q

Syncope

A

Brief lapse in consciousness caused by transient cerebral hypoxia

Health Assessment (17 decks)

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