Health Assessment II Flashcards
receives venous blood from the superior and inferior vena cava and pump into the right ventricle
right atrium
serves to pump the un-oxygenated blood to the pulmonary circulation and lunges where fresh oxygen is available
right ventricle
receives oxygenated blood from the pulmonary veins and pumps this blood into the left ventricle
left atrium
pumps oxygenated blood (arterial blood) to all areas of the body to maintain tissue oxygenation
left ventricle
Heart sound locations
Aortic Pulmonic Erbs point (where murmurs are heard) Tricuspid Mitral
dull low pitch sound occurs when the mitral and tricupsid valve closes. (heard best at mitral area)
Lub (S1)
high pitch sound occurs when the aortic and pulmonic valve closes. (heard best at pulmonic area)
Dub (S2)
occurs because blood is not flowing correctly from the atrium into the ventricle so it’s basically impaired ventricular filling.
Gallop sounds
occurs during rapid ventricular filing ; common in children and young adults (kentuckY)
S3
heard during atrial contraction (may be heard in the elderly with hypertension) TENessee
S4
created by turbulent blood flow due to a defective valve, congenital defect, increased blood flow (heard best at Erb’s Point (third intercostal space))
Murmur
grating sound heard when pericardial layers rub against each other; percariditis
Percaridal Friction Rub
When assessing the abdmonial what order should you do it in?
Inspect, Auscultate, Palpate, Purcuss
look, listen, then feel
How do bowel sounds typically sound?
high pitch, gurgly type noises
one gurgle high pitch sound per minute; decreased mobility in the bowel
hypoactive , less active
one gurgle high pitch sound per 3 seconds ; increased mobility in the bowel
hyperactive ; over active
what major organs are in the right upper quadrant
liver, gallbladder, duodedum
what major organs are in the right lower quandrant
appendix
what major organs are in the left upper quadrant?
stomach, spleen, pancreas
what major organs are in the left lower quadrant ?
sigmoid colon
one gurgle high pitch sound every 5-10 seconds
normal bowel sounds
without urine output
anuric
less than 30 mL of output in an hour
oliguric
abnormal urine colors
pink-tinged, bloody (red), light brown, dark yellow, orange, blue or green
no control over urine output
incontinent urine
what is edema typically caused by?
cardiac problems
information coming from the nurse only
primary
information coming form anyone else
secondary
larger part of the stethoscope that best hears high pitch sounds
diaphragm
smaller part of the stethoscope that best hears low pith sounds
bell
Newborn 80 - 180 1 year 80 - 140 5-8 years 75 - 120 10 years 50 - 90 Teen 50 - 90 Adult 60-100 Older Adult 60 - 100
Normal Pulse Range
Newborn 30 - 80 1 year 20 - 40 5-8 years 15 - 25 10 years 15 - 25 Teen 15 - 20 Adult 12 - 20 Older Adult 15 -20
Normal Respiration Range
Newborn 50 - 80 25 -55
1 year 94 - 103 49 - 56
5-8 years 103 - 112 65 - 70
10 years 111 - 119 73 - 78
Teen 120 - 131 76 - 81
Adult <120 <80
Older Adult <120 <80
Normal Blood Pressure Range
normal is 95 - 100%
Normal Oxygen Saturatoin Level
