Exam 4 Flashcards
cardiac landmarks for assessment and how to assess
APE To Man, A2 (aortic), P2 (pulmonary). Erb’s point, T1 (tricuspid), M1 (mitral); assess clock wise starting with aortic (right upper quadrant)
direction of blood flow through the heart
IVC and SVC- RA- tricuspid- RV pulmonic valve- pulmonic artery-lungs -pulmonary veins- LA-bicuspid- LV -aortic valve-body and coronary arteries
diastole
ventricles relax and fill with blood
systole
heart contracts
two distinct components to each heart sound exist because
cardia depolarization occurs slightly later on the right side of the heart than on the left side
discribe conduction of the heart from SA node
conduction: cardiac impulse originates in the sinoatrial node and spreads through the atria and to the atrioventricular node, where it is delayed. Impulses travel to the bundle of His, the right and left bundle branches and then to the ventricles.
what are signs of aging that occur to the cardio vascular system
systolic increases, left ventricular wall thickens, decreased ability of the heart to augment cardiac output with exercise, increased presence of supraventricular and ventricular arrhythmias with aging
how to assess for JVD
inspect for JVD when head of exam table 45 degrees, positive indicates increased CVP and right side heart failure
how to assess carotid artery
auscultate for bruit, positive indicates narrowing of carotid artery
what is a bruit
blowing, swishing sound that indicates blood flow turbulance in a vessel
how should you assess pulse deficit?
detect irregular rhythm assess apical beat simultaneously with radial pulse, if difference in the two is detected subtract radial rate from apical rate. this is recorded as the pulse deficit
what type conditions does pulse deficit cause
present with weak contration of ventricles occuring with atrial filbrillation, premature beats, or heart failure
How should we assess point of maximal impulses PMI?
palpate where apical impulse can be best palpated, heave or lift of chest wall occurs with ventricular hypertrophy; right ventricular heave at sternal border, left ventricular heave at apex
4 guide lines for S1 vs. S2 sound
- S1 is normally first except for in trachyarrhythmias
- S1 is louder than S2 at the apex; S2 louder than S1 at base
- S1 coinsides with the carotid artery pulse
- S1 coinsides with the R wave in on ECG monitor
what is S3
third heart sound, ventricular gallop (ken-tuck-y), heard best at apexwith client lying on left side, normal in children and young adults, sign of heart failure in other adults
what is S4
fourth heart sound artial gallop (ten-nes-see), heard over tricuspid or mitral areas, occurs before S1, heard in older adults with hypertension aortic stenosis or history of myocardial infarction, listen with bell at apex with pt in left lateral position
grading scale of murmurs
i-barely audiable ii-audible but quiet and soft iii-moderately loud with no thrust or thrill iv- loud with thrill v- very loud with thrust or thrill vi- loud enough to hear before stethoscope come in contact with skin
Aortic prosthetic valve sounds
hear a ticking or clicking sound with artificial (mechanical) valve
assessing pericardial friction rub
have pt sit up, lean foward and exhale, listen with diaphragm over 3rd ICS on left side of chest, sounds like scratchy rubbing sound
what is thrill?
palpable vibration suggests valve dysfunction, feels like purring cat
what is a heave or lift?
during palpation can feel lifting of chest wall; if along left sternal borde, may be right ventricular hypertrophy and if over left ventricular area may be ventricular aneurysm
characteristics to look for of a murmur
timing, loudness, pitch, pattern, quality, location, radiation, posture
regurgitation murmur
back flow of blood bc of incompetent valve that can’t close properly so blood leaks back into previous chamber
stenosis
murmur caused by narrowing of valve opening bc calcification, fibrosis, or thickening of leaflets lead to a decreased blood flow through the valve
blood vessels with age
grow more rigid and lead to rise in systolic BP
Modified Allen Test
used to determine if there is adequate collateral circulation before cumulating the atery or performing aterial blood gases
major artery supplying the arm and leg
brachial artery and femoral artery; ulnar artery one most often not palpable
bruit over femoral artery
partial occlusion of the artery
3 stomach lobes
fundus, body and pylorus
Stomach functions:
Breakdown of food particles
Very little absorption takes place in the stomach.
Secretes hydrochloric acid and digestive enzymes to breakdown fats and proteins.
innocent murmur
indicates having no other valvular or other pathologic causes; healthy children
functional murmur
due to increased blood flow in the heart; anemia fever pregnancy hyperthyroidism
S1
closure of the av valves, loudest at apex, can be split which is rare but normal
S2
closure of semilunar valves, loudest at base, can split at end of inspiration only heard in pulmonic valve areas
preload
venous return that builds during diastole
Afterload
the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure
manual compression test of the leg
put one hand on lower part of vein and put other hand at the top and compress from the top. competent valves will prevent a wave transmission and lower fingers will feel no change
if femoral pulse is absent you would expect
all pulses below to be absent.
all pulses to assess
temporal, coronary, radial, ulnar(may not be palpable), brachial, femoral, popliteal, posterior tibial, dorsalis pedis
pitting scale for edema
1+: mild pitting, slight indent, no swelling 2+: moderate pitting indent subsides rapidly 3+: deep pitting, indent remains short time, leg looks swollen 4+: very deep pitting indent lasts long time, leg very swollen
how to obtain ankle brachial index
use arm BP cuff above ankle and assess ABP using Doppler of DP or PT and divide that by the systolic BP of the brachial arm; ABI=ankle sys BP/ brachial sys BP
ABI; what range indicates the presence of peripheral vascular disease and mild claudication
0.9- 0.7
normal is 1.06
frontal lobe
personality, emotions intellectual
parietal lobe
sensation
occipital lobe
visual
broca’s area
motor speech; frontal
basal ganglia
motor system; extrapyramidal
thalamus
relay station between the spinal cord and brain stem
hypothalamus
control center of vital functions, temp, heart rate, sleep, pituitary, ANS and emotions
cerebellum
coordination of voluntary movements, equilibrium, and muscle tone
brain stem
midbrain, pons, medulla (vital autonomic center, controls respiration heart GI nuclei for CNs 8-12 and crossing of motor fibers
spinal cord
transmits messages to and from brain to spinal nerves and it mediate reflexes
right side of brain controls
left side of body
sensory pathways transmit messages to
the thalamus
spinothalamic tract
sensations of pain temp crude or light touch
posterior column
sensations od position vibration and finely localized touch
corticospinal or pyramidal tract
motor cortex to brainstem and decussate (crossover) to opposite side of the brain; voluntary movements and writing
extrapyramidal tracts
maintain muscle tone control body movements such as walking
cerebellar system
gets information about position of muscles and provides equilibrium
upper motor neurons
located in CNS; diseases with upper neurons are stroke cerebral palsy and multiple sclerosis
lower motor neurons
located mainly in the peripheral NS; diseases include spinal cord lesions poliomyelitis and amyotrophic lateral sclerosis
neurological screening
person that seems healthy for neurological problems
the complete neurological exam
complete if any problems such as headache, neurological deficit, change level of consciousness, muscle weakness or incoordination, or seizures
neuro-recheck is used on
anyone one with an identified problem to rack the situation to see if it worsens or gets better; report neurological changes promptly
brudzinski’s and Kernig’s test
check for mono
cushings triad
opposite signs of shock, hypertension bradycardia and decrease RR
Mental status ABCT
Appearance, behavior, cognitive ability, thought process
Alert
fully aware of external and internal stimuli
lethargic
drifts off to sleep when not stimulated
obtunded
sleeping most of the time, difficult to arouse
stupor
responds only to persistent or vigorous shake or pain
coma
no response to pain, ranges from “light coma” with some reflex action to ‘deep coma’ with no motor activity
delirium
disturbance of consciousness or cognition that is acute in onset
flat affect
lack of emotional response
elation
extreme joy and optimism
euphoria
cheerfulness and optimism that is inappropriate to the situation
ambivalence
experiencing opposing emotions about a topic
lability
rapidly shifting emotions
Glasgow coma scale
highly predicts mortality; 1) eye opening 2) verbal 3)motor movement
decorticate rigidity
arms/ hands on chest
decerebrate rigidity
arms to sides with hands pointed outward
normal score for mini mental status exam
24-30
explain how to assess the cranial nerves
1-smell 2-eye chart, fields, scope 3-pupils and eyes follow object 4-normal eye movement 5-muscles of mastication light touch 6-move each eye laterally 7-face symmetry 8-hearing with tuning fork, whisper 9-gag and cough 10-gag and swallow 11- turn head shrug shoulders 12-stick tongue out
kinesthesia
big toe and finger up and down; abnormal is reported as loss of position test
tactile discrimination
fine touch, problems occur with lesions in sensory cortex or posterior column; client closes eyes for this test
graphesthesia
draw a number on hand with clients eyes closed
extinction
touch both sides of body and ask how many areas feel touched; no report of touch on opposite side of stroke
scoring reflexes
4+ hyperactive 3+ brisk 2+ normal 1+present but diminished 0 absent
four unrelated word test
ask after 5, 10 and 30 minutes; Alzheimer’s anxiety and depression can cause a score of 0 or 1
mini mental assessment includes
orientation, registration, recall, calculation, language, and graphomotor function; used to screen for cognitive loss and quality of cognitive function
set test- FACT
for mental status, asked to name 10 items in four categories or sets: fruits animals colors towns; max score is 40, less than 15 indicates possible dementia
Dysdiadochokinesia
slow clumsy response to RAM
stereognosis
recognize familiar object by feel
only test temperature discrimination when
pain sensation is absent
hypertension increases the risk for stroke and ______ have great risk for hypertension and for alzheimer’s
African Americans
Cullen’s sign
bluish umbilicus indicates intra-abd hemorrhage
turner’s sign
bruise on flank indicates retroperitoneal hemorrhage
dilated tortuous visible abdominal veins
indicates inferior vena cava obstruction
rebound tenderness
used when client has RLQ pain and may have appendicitis
Inspiratory arrest or Murphy’s sign
when palpating the liver, there is pain and when the client is asked to take a deep breath they stop breathing when there is gallbladder (cholecysitis)
iliopsoas muscle test
when thought to have appendicitis, client supine lift rt leg straight up flexed at the hip and push on thigh as client tries to keep leg up; if positive pain is felt in the RLQ
drug and alcohol abuse are more common in
native and African americans
obesity is more frequent in
Hispanics and African americans
_____ are at greater risk for gastric cancer
Japanese
lactose intolerance is greater in
non-white and jewish americans
muscle strength grading
5- full ROM against gravity/ full resistance 4- Full ROM against gravity/ some resistance 3- full ROM against gravity 2- full ROM with gravity eliminated 1- slight contraction 0- no contraction
phalen’s test
carpel tunnel test; wrist bent 90 degrees causing numbness or burning
tinel’s test
hit nerve
kyphosis
hump on back
what is ascites
fluid wave across abdomen, need two people to preform test
explain borbory gmi
hyperactive bowel sounds bc of hyper-peristalsis when a person can feel own stomach growling
ballottment test
to test for large amounts of fluid around the patella
bulge sign
small amount of fluid in knee joint, can displace fluid
McMurray’s test
rotate knee hearing click positive for meniscus tear
_____ measures angles of joint flexion
goniometer
