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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
*Part of stethoscope used to auscultate carotids and **what should we have pt do while listening?
Bell with light pressure | Have pt take deep breath, exhale, and hold it
26
Patients we should listen to carotids on?
Middle aged and older | Pts showing symptoms of CV disease
27
Abnormal sound heard while listening to carotids, and what is it?
Bruit - blowing, swishing sound indicating blood flow turbulence
28
What do normal carotids sound like?
- Absence of bruit - Normal strength 2+ - Same bilaterally
29
Position pt should be in to inspect jugular venous pulse
Supine (30-45 degree angle) Head turned to Side Have pen light shining directly on neck
30
Normal jugular venous appearance upon inspection
Visible by pulsation only | Disappears when pt sits up
31
Abnormal jugular venous pulse
Increased CVP (central venous pressure) - heart failure
32
Location of Internal jugular pulse vs. carotid pulse
Internal jugular: lower, more lateral, under or behind sternomastoid muscle Carotid: higher and medial to sternomastoid muscle
33
Quality of internal jugular pulse vs. carotid pulse:
Internal jugular: undulant and diffuse, two visible waves per cycle Carotid: Brisk and localized, one wave per cycle
34
Respiration with internal jugular pulse vs. carotid pulse:
Internal jugular: varies with respiration Carotid: does not vary
35
Are internal jugular pulse or carotid pulse palpable?
Jugular: No Carotid: yes
36
Pressure used for internal jugular pulse vs. carotid pulse:
Jugular: light pressure at base of neck easily obliterates Carotid: no change
37
Position of person when inspecting / palpating internal jugular pulse vs. carotid pulse:
Jugular: level of pulse drops and disappears as person is brought to sitting position Carotid: no change
38
Where is the base of the heart?
At the top
39
Where is the apex of the heart?
At the bottom
40
What are the AV valves?
Tricuspid (right) | Mitral (left)
41
Function of AV valves
Allow blood into the heart chambers
42
When do AV valves open/close?
Open during filling (diastole) | Close during ejection (systole)
43
What are the semilunar valves?
Pulmonic (right) | Aortic (left)
44
Function of the semilunar valves
Allow blood to enter lungs/periphery
45
When do semilunar valves open?
During ejection (systole)
46
What happens to heart during diastole?
Ventricles relaxed (filling)
47
What happens to heart during systole?
Ventricles contract (ejection)
48
*** What do valves respond to?
Pressure gradients
49
Artery that wraps around the heart (“widow maker”)
Left main
50
Where does the LM artery come off of?
The aorta
51
Where is the precordium?
Center of the chest. Intercostal spaces 1-6
52
What is the PMI?
Apical impulse
53
** Where is the PMI located?
5th intercostal space, at or medial to left MCL
54
Size of PMI (apical impulse)
1 cm X 2 cm (rectangle)
55
Amplitude of PMI
Short, gentle tap
56
Duration of PMI
Short, first half of systole
57
How long do you listen to PMI?
Always listen for 60 seconds *this is most accurate pulse reading
58
Process of palpating across precordium
- Assess for other pulsations (apex, left sternal border, base) - Use palmar aspects of hand
59
Normal finding after palpating across precordium
No pulsations
60
Position pt should be in for cardiac auscultation
Supine position (30-45 degree angle)
61
*** Where do we listen during cardiac auscultation?
``` 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
Part of stethoscope used during cardiac auscultation
First use diaphragm
63
* What do we listen to during cardiac auscultation
First identify S1 and S2 and then any splitting | Rate, rhythm, and count apical pulse for 60 seconds
64
Where is S1 loudest?
At apex
65
What does S1 coincide with?
Carotid artery pulse Simultaneously feel pulse. Should hear lub at same time as pulse thumps
66
Where is S2 loudest?
At base
67
What sounds to we note during cardiac auscultation?
S1 S2 Any splitting Any extra sounds
68
Cardiac cycle definition
Rhythmic flow of blood through the heart
69
Two phases of cardiac cycle
Diastole | Systole
70
Definition of diastole and **how long does it last?
Ventricles relax and fill with blood | 2/3 of cycle
71
Definition of systole and **how long does it last?
Heart’s contraction, blood pumped from ventricles fills pulmonary and systemic arteries 1/3 of cycle
72
What occurs during diastole?
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
When does atrial systole occur?
During ventricular diastole
74
What is atrial kick?
Toward the end of diastole, atria contract and push last amount of blood into ventricles
75
What occurs during systole?
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
What is isometric contraction?
The very brief moment when all 4 valves are closed and ventricular walls contract, during systole
77
Purpose of the cardiac valves and how do they work?
To prevent back flow Unidirectional - only open one way Passive - respond to extreme pressures to open/close
78
What is stenosis?
Valves have things hanging from them that prevent closure
79
What is regurgitation?
Incompetent valve that allows blood to flow back and forth
80
** What causes S1?
Closing of the mitral and tricuspid valves (AV valves)
81
Which sound marks the start of systole?
S1
82
What causes S2?
Closing of the semilunar valves
83
Which sound signals the end of systole?
S2
84
Why does splitting occur?
When aortic valve closes earlier than pulmonic valve | Effect of inspiration
85
How much blood does the heart pump per minute?
4-6 L
86
How do you listen for extra sounds and what are they?
- 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
What is an acute MI?
Sudden lack of blood flow and blocked coronary artery
88
What causes an acute MI?
Plaque Clot Spasm
89
How should you explain an MI to a patient?
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
Signs and symptoms of an acute MI
``` Chest pain SOB Dizziness Fatigue Sweating Indigestion Nausea/vomiting Restlessness / apprehension ```
91
Signs and symptoms of heart failure
``` 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
Palpitation
Bounding or racing of heart associated with normal emotions or a heart disorder
93
Pericardial friction rub
Inflammation of pericardium gives rise to friction rub Sounds high pitched and scratchy Best heard at apex during systole or dyastole
94
Pulse deficit
Radial pulse is less than ventricular rate as auscultation at apex
95
What does a pulse deficit indicate?
Lack of peripheral perfusion for some of the heart contractions
96
Pulse pressure
Difference between systolic and diastolic pressures | Normally 30-40 mm Hg
97
Summation sound
When both the pathologic S3 and S4 are present, a quadruple sound is heard
98
Syncope
Brief lapse in consciousness caused by transient cerebral hypoxia

Health Assessment (17 decks)

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