FINAL Flashcards
Describe the flow of blood through the heart.
- Vena cava
- Right atrium
• Tricuspid valve - Right ventricle
- Pulmonary arteries
- Lungs
- Pulmonary veins
- Left atrium
- Mitral valve
- Left ventricle
- Aorta
- Right atrium
____________: the ventricles relax and fill with blood. Relaxation.
diastole
____________: blood is pumped from the ventricles and fills the pulmonary and systemic arteries. Contraction
systole
5 Areas where heart valve closures can be heard
- precordium
- Aortic Valve Area
- Pulmonic Valve Area
- Tricuspid Valve Area
- mitral valve area
WHICH HEART SOUND? Closure of the AV valves. Can be heard all over the precordium, loudest at the apex. “LUB” is the sound heard.
FIRST
WHICH HEART SOUND? Closure of the semilunar valves. Can be heard all over the precordium, loudest at the base. “DUP” is the sound heard.
SECOND
2 components of assessment of the carotid arteries in older patients:
- PALPATE each carotid artery medial to the sternomastoid muscle in the neck.
- AUSCULTATE each carotid artery for the presence of a bruit (blowing, swishing sound)
3 areas to AUSCULTATE on the carotid artery when checking for bruits
- angle of the jaw
- midcervical area
- base of the neck
TRUE OR FALSE? excessive pressure on the sinus area higher in the neck & excessive vagal stimulation here could slow down the heart rate.
TRUE
TRUE OR FALSE? Palpate firmly and both carotid arteries at the same time to avoid compromising blood to the brain.
FALSE - one at a time
WHAT PART OF THE STETHOSCOPE DO YOU USE AUSCULATE THE HEART?
DIAPHRAGM
WHAT PATTERN DO YOU USE TO AUSCULTATE THE HEART?
Z PATTERN STARTING AT THE BASE AND GOING TO THE APEX
Area of palpation of apical impulse
the fourth or fifth and be at the medial to the midclavicular line.
TRUE OR FALSE? APICAL IMPULSE IS PALPABLE IN EVERYBODY.
FALSE. Apical pulse is palpable in about half of adults, not palpable in obese persons or in persons with thick chest walls.
How do you estimate the Jugular venous pressure.
- Use the angle of Louis (sternal angle) as an arbitrary reference point and compare it with the highest level of venous pulsation.
- Hold a vertical ruler on the sternal angle
- Align a straight edge on the ruler like a T-Square
- Adjust the level of the horizontal straight edge to the level of pulsation
- Read the level of intersection not he vertical ruler
What is normal jugular venous pressure
2cm or less above the sternal angle
This is a palpable vibration, it feels like the throat of a purring cat.
thrill
What does a thrill signify?
signifies turbulent blood flow and accompanies loud murmurs.
TRUE OR FALSE? Absence of a thrill rules out the presence of a murmur.
FALSE
________________ is the area on the anterior chest overlying the heart and great vessels.
Precordium
9 areas are palpable for pulse?
- Dosalis Pedis
- Radial
- Ulner
- Temporal
- Carotid
- Femoral
- Bracial
- Popliteal
- Posterior Tibial
TRUE OR FALSE? It is normal to find palpable nodes that are small (1cm or less), movable, and nontender.
False.
Enlargement of these nodes could signal a possible infection as this area drains most of the lymph of the lower extremity and genitalia and the anterior abdominal wall.
Inguinal lymph nodes
Describe the lymphatic system of a healthy 3 year old child
- Well developed
- lymph nodes are relatively large and the superficial ones often are palpable even when the child is healthy.
- Lymph nodes are firm, mobile and nontender.
Typical capillary refill time
Normally the vessels refill within a fraction of a second up to 2 seconds.
What does capillary refill lasting more than 1 or 2 seconds indicate
vasoconstriction or decreased cardiac output.
This occurs in 20% of cases of deep vein thrombosis.
Positive Homan’s sign
thrombophlebitis (possible complications)
inflammation
blocked venous return
cyanosis
edema
This is also present in a variety of other conditions such as muscle injury, achilles tendonitis and plantar muscle injury.
positive Homan’s sign
What are the SUBJECTIVE signs of venous stasis?
aching pain in calf or lower leg, worse at end of the day, worse with prolonged standing or sitting.
What are the OBJECTIVE signs of venous stasis?
Firm brawny edema coarse, thickened skin pulses normal brown pigment discolouration petechiae dermatitis
This will show discoloured feet (dark colour)
venous stasis
This causes increased venous pressure, which then causes RBCs to leak out of veins and into the skin. As these RBCs break down, they leave hemosiderin (iron deposits) behind, which are the brown pigment deposits.
venous stasis
This can occur after acute deep vein thrombosis
venous stasis
Documentation for edema
- 0+=no pitting edema
- 1+: Mild pitting, slight indentation, no perceptible swelling of the leg
- 2+: Moderate pitting, indentation subsides rapidly
- 3+: Deep pitting, indentation remains for a short time, leg looks swollen
- 4+: Very deep pitting, indentation lasts a long time, leg is very swollen.
Grading of pulses (amplitude) on three point scale (0-3+)
- 0: Absent
- 1+: Weak
- 2+: Normal
- 3+: increased, full, bounding
Distended bladder assessment
- Percuss lightly in all four quadrants to determine the prevailing amount of tympani and dullness.
- tympany occurs over intestines
- dullness occurs over full bladder
A dull note forward of the midaxillary line indicates enlargement of the ___________, as occurs with mononucleosis, trauma, and infection.
spleen
The splenic dullness normally is not wider than _____ cm in the adult and should not encroach on the normal tympani over the gastric air bubble.
7
Reason for auscultation preceding percussion and palpation
- This is done because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds.
what are Borborygmi
- hyper active bowel sounds
- occur with early mechanical bowel obstruction (high pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
Possible percussion notes of abdomen
TYMPANY should predominate because air in the intestines rises to the surface when the person is supine
DULLNESS over the liver and spleen
DESCRIBE THE DEPTHS OF Light and deep palpation
light: 1 cm
deep: 5-8 cm
Objective of light palpation
Objective is not to search for organs but to form an overall impression of the skin surface and musculature
Objective of deep palpation
Palate for specific organs
- liver
- spleen
- kidneys
Assessment for abdominal aortic aneurysm
AUSCULTATE: murmur is harsh, systolic, or continuous and accentuated with systole.
If a bruit is heard, do not palpate the area for fear of rupturing!
PALPATE the aortic pulsation in the upper abdomen slightly to the left of midline - normally it is 2.5 cm to 4cm wide
Murphy’s sign (Inspiratory Arrest)
A normal response is to complete the deep breath without pain
Pain occurs with inflammation of the gallbladder. The descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway
Range of liver span
Normal liver span ranges from 6 to 12 cm
Average is 10.5 for males and 7cm for females
7 organs in Right Upper Quadrant (RUQ)
- Liver
- Gallbladder
- Duodenum
- Pancreas (head)
- Kidney & adrenal (right)
- Colon (hepatic flexure)
- Colon (part of ascending and transverse)
7 organs in Left Upper Quadrant (LUQ)
- Stomach
- Spleen
- Liver (left lobe)
- pancreas (body)
- kidney & adrenal (left)
- Colon (Splenic flexure)
- Colon (part of transverse and descending)
5 organs in Right Lower Quadrant (RLQ)
- Cecum
- Appendix
- ovary and tube (right)
- ureter (right)
- spermatic cord (right)
5 organs in Left Lower Quadrant (LLQ)
- Colon (Part of descending)
- Sigmoid colon
- ovary and tube (left)
- ureter (left)
- spermatic cord (left
3 organs found midline
- Aorta
- Uterus (if enlarged)
- Bladder (if distended)
Positive obturator test
With patient in supine, lift the right leg, flexing at the hip and 90 degrees at the knee. Hold the ankle and rotate the leg internally and externally
- Negative or normal response is no pain
- Positive response is pain.
When is the obturator test performed?
when appendicitis is suspected.
What does fecal occult blood indicate?
Occult bleeding usually indicates cancer of colon
TRUE OR FALSE? Fecal occult test may have a false positive response if the person has ingested significant amounts of red meat within 3 days of the test
True.
2 common conditions of intense itching and irritated skin in children
- Diaper rash
* Pin Worms
What causes hemmorhoids
increased portal venous pressure from:
- straining to poo
- chronic constipation
- pregnancy
- obesity
- chronic liver disease
- low fibre diet
SUBJECTIVE Symptoms of Benign prostatic hypertrophy
urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia
OBJECTIVE Symptoms of Benign prostatic hypertrophy
a symmetrical nontender enlargement, commonly occurs in males beginning in the middle years