Examination of Cardiac Patient Flashcards
4 important aspects of chart review
- hospital course
- chief complaint
- procedures during hospitalization (resutls from tests)
- Labs
4 things to look for when looking at a patients medications
- current meds
- meds with impact on hemodynamic responses
- intravenous meds (w/ a short half life)
- timing of meds
3 things to look out for during patient interview
- level of mentation (hypoperfusion)
- anginal equivalent (recurrent pain patterns)
- baseline lvl of dyspenia
borg scale of percieved dyspenia
levels 0, 2, 5, 10 are what?
0 - no shortness of breath
2 - mild SOB
5 - strong or hard breathing
10 - SOB so bad you need to stop and rest
during the observation/evaluation of venous pressure what 4 areas should you observe?
1,2 Jugular venous distension of external and internal jugular vein
- central venous pressure
- veins of dorsum hand
what 3 factors influence arterial pulse?
- stroke volume
- ejection velocity
- systemic vascular resistance.
what is pulsus alternans?
regular alternation in force of beats - weak pulse follows a strong pulse.
produced when stroke volume increases then decreases from beat to beat
what is pulsus parodoxus?
what is the minimal systolic pressure in the radial, femoral, and carotid artery?
pulse volume decreases during inspiration and increases in exhalation
80, 70, 60 mmHg
where is the apex beat/apical impulse on the body?
what is a thrill?
most lateral and inferior point cardiac impulse can be felt on a patient (indicator of heart size)
palpable murmur
what do you do differently when auscultating the lungs versus auscultating the heart?
with the lungs you want to auscultate both anteriorly and posteriorly going side to side, while with the heart you want to use the inching method via moving from apex > sternal border > aortic area (or vice versa)
how hard do you press down on the patients skin with the diaphragm? with the bell?
diaphragm - leave slight depression in their skin
bell - gently to barely make air seal
what is a bruit?
what does a supraclavicular arterial bruit sound like?
abnormal sound in an artery where blood rushes past an obstruction.
low to medium pitch crescendo-decrescendo
what does S1 mark the sound of?
where is it heard the loudest?
Mitral M1 and triscupid T1 closure
mitral area
what does S2 mark the sound of?
how is it possible to hear A2 and P2 as separate sounds?
signals the end of ventricular systole, A2 and P2
have the patient quitely breathe
What does S3 mark the sound of? (Abnormal)
when is right ventricular S3 loudest?
How is the sound different during left ventricular S3?
ventricular gallop (rushing in) inspiration remains unchanged or decreases in loudness
what does S4 mark the sound of? (Abnormal)
when is left sided and right sided S4 loudest?
atrial gallop (stiff wall)
Left sided - louder on expiration
right sided - louder on inhalation
when does a summation gallop occur? (2) Abnormal sound
when S3 and S4 sound fuse
heart rate > 120
which patients present with a pericardial friction rub?
where is it best to auscultate to detect this condition?
patients with inflammation of the pericardial membrane or pleural sac
over the 3rd or 4th ICS at left sternal border
4 main factors in the production of heart murmers
- high rate of flow through valves
- forward flow through constricted valve
- backward flow through incompetent valve
- decreased viscosity of blood
classifications of murmurs for systolic/diastolic
early, mid, late, holosystolic (systolic only)
continuous
6 grading intensities of heart murmurs
I: audible only with concentration
II: faint, but heard immediately
III: not loud, but somwhat louder than grade II
IV: loud, but still of intermediate intensity. Associated with a palpable thrill
V: very loud, and heard with only one edge of the stethoscope against the chest wall. Palpable thrill.
VI: so loud that it can be heard with the stethoscope off the chest wall. A palpable thrill is present
which korokoff sounds are typically used to measure BP?
which in pregnant women and children
exercising patients?
1st and 5th
1st and 4th
1st, 4th, and 5th or just 1st and 4th
