HAPS--Cardiac Assessment Flashcards

1
Q

Apex

A

the tip of the heart located to the left of midline

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2
Q

Base

A

posterior & to the right of the midline

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3
Q

Atrioventricular valves (A/V)

A

Tricuspic

Mitral (bicuspid)

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4
Q

Semilunar valves

A

Pulmonic

Aortic

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5
Q

Systole

A

contraction of the ventricles

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6
Q

S1

A

onset of systole = closure of mitral and tricuspid valves

Louder at the Apex

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7
Q

Diastole

A

relaxation of the ventricle

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8
Q

S2

A

onset of diastole = closure of aortic and pulmonic valves

Louder at the base

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9
Q

Insufficient valve

A

“Leaky”

Does not close completely

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10
Q

Stenotic

A

“Stiff”

Does not open completely

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11
Q

Blood Flow through Heart

A
R. Atrium >
Tricuspid valve >
Right ventricle >
Pulmonic valve >
Pulmonary artery >
Lungs >
Pumonary veins >
Left atrium > 
Mitral valve > 
Left ventricle>
Aortic valve>
Aorta
> BODY
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12
Q

Coronary Arteries (3 major vessels)

A

Left Anterior Descending artery
Left Circumflex artery
Right Coronary artery

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13
Q

blood supply of coronary arteries?

A

Coronary arteries receive their blood supply from the aorta and supply blood to the myocardium.

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14
Q

Automaticity:

A

Ability of pacemaker cells to initiate an impulse spontaneously and repetitively

The conduction tissue area with the highest rate of automaticity assumes the role of pacemaker, normally the SA node

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15
Q

Contractibility

A

The ability to respond to this impulse with pump action.

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16
Q

Autonomic Nervous System

A

Sympathetic

Parasympathetic

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17
Q

Sympathetic

A

Increase heart rate, speed of conduction and vigor of contraction

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18
Q

Parasympathetic

A

Decrease rate of firing of the SA node, speed of conduction and force of contraction

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19
Q

The Cardiac Assessment

A
History
B/P Assessment
Inspection
Palpation & pulsation
Auscultation
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20
Q

Preparation for Cardiac Assessment

A

: The client should be sitting up supine at a 30-45 degree angle

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21
Q

INSPECTION

A

General appearance: chest symmetry, skin color, hair pattern (on legs)
Peripheral and Central circulation (pulses)
Aortic pulsations
Capillary Refill
Edema Assessment

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22
Q

Palpate carotid artery

neck vessels

A

Palpate only one carotid artery at a time to avoid compromising arterial blood to brain
Feel amplitude of pulse
Findings should be same bilaterally

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23
Q

Auscultate the Carotids

A

Auscultate each carotid arteries for the presence of a bruit with your bell
This swishing sound indicates turbulence therefore… none should be present
If it is present, the patient is at risk for TIA, CVA.
It is present if the lumen is occluded by ½. After the lumen is 100% occluded, the bruit will disappear.

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24
Q

Observe for JVD

A

Have the client sitting 30 degree
Have them turn face away
Shine light
Pulsations should disappear after 45 degrees or is indicative of heart failure

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25
Q

Measuring JVP

A

Place one ruler vertically at the sternal angle.
Locate the pulsation and place another ruler at the level of the pulsation.
Line up the two rulers as a T.
Measure JVP at the level where the horizontal ruler intersects the vertical ruler.
Ideally the measurement should be less than 2 cm

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26
Q

Palpation

A

Palpate over the valve areas for thrills
Thrills are vibratory sensations caused by the heart and felt on the body surface
Thrills are indicative of turbulent blood flow
Check for thrills over the apex, base, and left sternal border

27
Q

Auscultation with use of diaphragm side

A

used for high pitched sounds
S1 and S2
Murmurs

28
Q

auscultation with use of bell side

A

low pitched sounds
S3 and S4
Murmurs
Bruits

29
Q

Auscultation

A
Begin with diaphragm end piece and use following routine
Note rate and rhythm 
Identify S1 and S2 
Assess S1 and S2 separately
Listen for extra heart sounds
Listen for murmurs
30
Q

ORIGIN OF HEART SOUNDS

A

S-1 =T + M closure
S-2 = A + P closure

(lub-dub sound)

31
Q

S - 1 (lub)

A

Onset of Systole
Closure (shutting) of mitral and tricuspid valves
Loudest at apex
Indication is normal

32
Q

S -2 (dub)

A

Heard at end of systole…Onset of diastole
Closure (shutting) of aortic and pulmonic valves
Heard best at aortic area, base
Indication is normal

33
Q

Abnormal Heart Sounds

A

S 3
S 4
Murmurs = blowing or swooshing sound
Friction Rubs = inflammation of pericardium like sand paper rubbing

34
Q

S3

A

loudest at APEX additional sound “KENTUCKY”
Can be physiologic (normal) or pathologic (abnormal).
Physiologic S3 is heard in children and young adults
May last to age 40 in women.
Also called a ventricular gallop indicates decreased compliance of ventricles and indicative of heart failure

35
Q

MURMURS - TLC

A

TIMING
LOCATION
CHARACTER

36
Q

TIMING: (murmurs)

A

Systolic or Diastolic?

37
Q

LOCATION (Murmurs)

A

Heard best over which area

38
Q

CHARACTER (murmurs)

A

QUALITY
blowing, musical, harsh, rumbling
LOUDNESS
Graded on 6 point scale

39
Q

Murmurs

A

Sound produced by turbulence of abnormal blood flow through a valve
When listening for murmurs:
Determine the timing in the cardiac cycle
Do they occur in systole? (heard between S1 and S2)
Do they occur in diastole? (heard between S2 and S1)

40
Q

MURMURS- Main Causes

A

Stenotic valve
Regurgitant or insufficient valve
Abnormal passage between heart chambers

41
Q

Murmurs - Grading

A
Grade 1: very faint
Grade 2: quiet but clearly heard
Grade 3: moderately - loud no thrill
Grade 4: loud - may have thrill
Grade 5: very loud - thrill present
Grade 6: heard with stethoscope off chest with a thrill
42
Q

PERICARDIAL FRICTION RUB

A

Produced by inflammation (Pericarditis)
Heard best at apex and along left sternal border
Lean patient forward
Sounds like sand paper rubbing together

43
Q

Infants

A

Heart rate may range from 100 to 180 beats per minute immediately after birth
Infants normally have wide fluctuations with activity, from 170 bpm or more with crying or being active to 70 to 90 bpm with sleeping

44
Q

Arterial Insufficiency

A
Intermittent Claudicating
Capillary refill > 3 sec
Absent or faint pedal pulses
Thick toenails
Cool skin
Pain with ambulation
Shiny skin
Scant hair
45
Q

Venous Insufficiency

A
Swelling in legs (graded from +1-+4)
Warm skin temperature
Dependent cyanosis
Brown discoloration of the skin
Chronic leg pain when in dependent position
46
Q

The inspection for central/peripheral circulation

A

Capillary Refill: should be less than 2 seconds
Clubbing: Is it present?
Pulses: How would you grade them?

47
Q

Pulsations

A
Temporal
Carotid
PMI
Brachial
Radial
Ulnar
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
Dopplers can be utilized as well
48
Q

Pulse Assessment

A
Scale for pulse assessment
\+0 = absent or not discernible
\+1 = thready, weak, difficult to feel
\+2 = normal, detected readily
\+3 = increased
\+4 = bounding
49
Q

legs inspection for central/peripheral circulation

A
Skin color
Hair distribution
Size (swelling or atrophy)
Lesions or ulcers
Temperature
Edema
50
Q

Edema

A

unilateral or bilateral
Firmly depress skin for 5 seconds and release
Normally, your finger should leave no indentation
Scale
Present vs absent
Pitting vs non-pitting

51
Q

What does high pressure in the left side of the heart indicate?

A

symptoms of pulmonary congestion

52
Q

What does high pressure in the right side of the heart indicate?

A

distended neck veins and abdomen

53
Q

Where is the aortic valve

A

2nd right intercostal

54
Q

Where is pulmonic valve

A

2nd left intercostal space

55
Q

where is tricuspid valve

A

left lower sternal border

56
Q

where is mitral valve

A

fifth interspace at around left midclavicular line

57
Q

Where is Erb’s point

A

3rd left intercostal space under the pulmonic valve

58
Q

What happens at Erb’s point

A

This is where a murmur would be heard

59
Q

S3 (ventricular gallop)

A

-occurs with heart failure and volume overload

60
Q

S4 (atrial gallop)

A

occurs with CAD

61
Q

What does a systolic murmur indicate

A

may occur with healthy heart of with heart disease

62
Q

What does diastolic murmur indicate

A

always indicates heart disease

63
Q

S3 and S4 murmur of mitral stenosis may be only heard on what side?

A

left side