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Assessment (Test #2) > Heart and Neck Vessels > Flashcards

Heart and Neck Vessels Flashcards

1
Q

The “top” of the heart is the ________

A

base

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2
Q

The “bottom” of the heart is known as the _______

A

apex

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3
Q

During contraction, the apex beats against the chest wall, producing ___________

A

an apical IMPULSE

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4
Q

Of the heart’s 4 chambers, the ________ forms the greatest area of anterior cardiac surface.

A

right ventricle

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5
Q

What makes blood fall into the right atrium? (in class question)

A

Only gravity

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6
Q

The __________ leaves the right ventricle, bifurcates, and carries the venous blood to the lungs.

A

Pulmonary artery

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7
Q

The __________ return the freshly oxygenated blood to the left side of the heart, and the ________ carries it out to the body.

A

Pulmonary veins/

Aorta

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8
Q

The __________ is a tough, fibrous, double-walled sac that surrounds and protects the heart.

A

pericardium

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9
Q

___________: this ensures smooth, friction-free movement of the heart muscle.

A

pericardial fluid

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10
Q

The ________ is the muscular wall of the heart (it does the pumping).

A

myocardium

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11
Q

The __________ is the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

A

endocardium

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12
Q

The ______ side of the heart pumps blood into the lungs, and the _______ side of the heart simultaneously pumps blood into the body

A

right/

left

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13
Q

The _______ is a thin-walled reservoir for holding blood.

A

atrium

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14
Q

The thick-walled _________ is the muscular pumping chamber.

A

ventricle

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15
Q

The ______ open and close passively in response to pressure gradients in the moving blood.

A

valves

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16
Q

The right AV valve is the __________

A

tricuspid

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17
Q

The left AV valve is the __________

A

bicuspid or mitral valve

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18
Q

The AV valves open during the heart’s ___________, to allow the ventricles to fill with blood

A

the heart’s filling phase, or diastole

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19
Q

During ___________, the AV valves close to prevent regurgitation of blood back up into the atria

A

the pumping phase, or systole

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20
Q

When the valve leaflets do NOT meet and unite to form a perfect seal you have: ____________ (in class point)

A

murmurs

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21
Q

The ___________ open during pumping, or systole, to allow blood to be ejected from the heart.

A

semilunar valves

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22
Q

**There are no valves between the vena cava and the right atrium nor between the pulmonary veins and the left atrium. For this reason _______________________________________ occurs on each side. **

A

abnormally high pressure in the Left side of the heart gives a person symptoms of -pulmonary congestion-, and abnormally high pressure in the Right side of the heart shows in the -neck veins and abdomen-

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23
Q

Review direction of blood flow if needed (pg 458, fig 19-5)

A
  1. From liver to right atrium (RA) through inferior vena cava
    Superior vena cava drains venous blood from the head and upper extremities
    From RA, venous blood travels through tricuspid valve to right ventricle (RV)
  2. From RV, venous blood flows through pulmonic valve to pulmonary artery
    Pulmonary artery delivers unoxygenated blood to lungs
  3. Lungs oxygenate blood
    Pulmonary veins return fresh blood to left atrium (LA)
  4. From LA, arterial blood travels through mitral valve to left ventricle (LV)
    LV ejects blood through aortic valve into aorta
  5. Aorta delivers oxygenated blood to body
    ** Remember that the circulation is a continuous loop. The blood is kept moving along by continually shifting pressure gradients. The blood flows from an area of higher pressure to one of lower pressure.
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24
Q

The rhythmic movement of blood through the heart is the__________. It has two phases: In ________, the ventricles relax and fill with blood. This takes up two thirds of the cardiac cycle. The heart’s contraction is _________. During this phase, blood is pumped from the ventricles and fills the pulmonary and systemic arteries. This is one third of the cardiac cycle

A

cardiac cycle/
diastole/
systole

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25
Q

Toward the end of diastole, the atria contract and push the last amount of blood (about 25% of stroke volume) into the ventricles. This active filling phase is called __________, or sometimes the “atrial kick.” It causes a small rise in left ventricular pressure.

A

presystole, or atrial systole

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26
Q

The __________ contributes to the first heart sound (S1) and signals the beginning of systole.
(Note: You can hear S1 over all the precordium, but usually it is loudest at the APEX)

A

closure of the AV valves

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27
Q

This contraction against a closed system works to build pressure inside the ventricles to a high level=________

A

(isometric contraction)

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28
Q

The ___________ causes the second heart sound (S2) and signals the end of systole.
(note : Although it is heard over all the precordium, S2 is loudest at the BASE)

A

closure of the semilunar valves

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29
Q

Now all four valves are closed and the ventricles relax= _______________

A

(called isometric or isovolumic relaxation)

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30
Q

The volume of right and left ventricular systole is just about equal, but this can be affected by respiration. To learn this, consider the phrase:

A

MoRe to the Right heart,

Less to the Left

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31
Q

When the aortic valve closes significantly earlier than the pulmonic valve, you can hear the two components separately, this is is known as ___________

A

Split S2

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32
Q

Normally, diastole is a silent event. However, in some conditions, ventricular filling creates vibrations that can be heard over the chest. These vibrations are known as ___________

A

S3

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33
Q

________ occurs when the ventricles are resistant to filling during the early rapid filling phase (protodiastole).

A

S3 (This occurs immediately after S2) **S3 hugs S2

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34
Q

________ occurs at the end of diastole, at presystole, when the ventricle is resistant to filling.

A

S4

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35
Q

The atria contract and push blood into a noncompliant ventricle. This creates vibrations that are heard as S4. S4 occurs just before __________.

A

S1 (S4 holds onto S1)

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36
Q

A ___________ is a gentle, blowing, swooshing sound that can be heard on the chest wall. (usually blood circulating through normal cardiac chambers and valves usually makes no noise)

A

murmur

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37
Q

Conditions resulting in a murmur are:

A
  1. Velocity of blood increases (flow murmur) (e.g., in exercise, thyrotoxicosis)
  2. Viscosity of blood decreases (e.g., in anemia)
  3. Structural defects in the valves (narrowed valve, incompetent valve) or unusual openings occur in the chambers (dilated chamber, wall defect)
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38
Q

All heart sounds are described by:

A
  1. Frequency (pitch)—heart sounds are described as high pitched or low pitched, although these terms are relative because all are low-frequency sounds, and you need a good stethoscope to hear them
  2. Intensity (loudness)—loud or soft
  3. Duration—very short for heart sounds; silent periods are longer
  4. Timing—systole or diastole
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39
Q

The _________ has an intrinsic rhythm, it is the “pacemaker.”

A

SA node

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40
Q

In the resting adult, the heart normally pumps between __________ of blood per minute throughout the body

A

4 and 6 L

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41
Q

Cardiac output=

A

the volume of blood in each systole (called the stroke volume) X the number of beats per minute (rate) CO=SV x R

42
Q

__________ is the venous return that builds during diastole. It is the length to which the ventricular muscle is stretched at the end of diastole just before contraction

A

Preload (page 462)

43
Q

Increased contractility (from the muscle stretching, like during exercise) results= __________________

A

in an increased volume of blood ejected (increased stroke volume)

44
Q

___________ is the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. (It is the resistance against which the ventricle must pump its blood)

A

Afterload

45
Q

The __________ is located in the groove between the trachea and the sternomastoid muscle, medial to and alongside that muscle

A

carotid artery

46
Q

The ___________ empty unoxygenated blood directly into the superior vena cava

A

jugular veins

47
Q

Because no cardiac valve exists to separate the superior vena cava from the right atrium, _________ give information about activity on the right side of the heart. (exposes when the right side of the heart is not pumping correctly).

A

the jugular veins

48
Q

The larger ________ vein lies deep and medial to the sternomastoid muscle. (It is usually not visible)

A

internal jugular vein

49
Q

The _________ vein is more superficial; it lies lateral to the sternomastoid muscle, above the clavicle.

A

external jugular vein

50
Q

The jugular pulse results from: _______________________________________

A

a backwash, a waveform moving backward caused by events upstream

51
Q

Specifically,the jugular veins reflect:

A

filling pressure and volume changes of the right side of the heart

52
Q

With aging, there is an increase in systolic blood pressure (BP). This is due to:

A

stiffening of the large arteries, which in turn is due to calcification of vessel walls (arteriosclerosis)

53
Q

With age, the heart does not get larger but the ____________increases. This is an adaptive mechanism to accommodate the vascular stiffening mentioned earlier that creates an increased workload on the heart.

A

left ventricular wall thickness

54
Q

________________ increases sharply with advancing age and accounts for about half of the deaths of older people

A

Coronary artery disease

55
Q

In the United States, an estimated ____ million people (more than 1 in 3) have one or more forms of cardiovascular heart disease (CVD)

A

81 mil

56
Q

The current cutpoints for cholesterol risk in adults are the following: total cholesterol levels of _____ mg/dL are high risk; and levels from _______ mg/dL are borderline–high risk

A

≥240 mg/dL

200 to 239 mg/dL

57
Q

Subj data/questions associated with CHEST PAIN:
1. -Any chest pain or tightness?

  * Onset: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  * Location: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  * Character: \_\_\_\_\_\_\_\_\_\_\_\_\_\_
A
  • Onset: When did it start? How long have you had it this time? Had this type of pain before? How often?
  • Location: Where did the pain start? Does the pain radiate to any other spot?
  • Character: How would you describe it? Crushing, stabbing, burning, viselike? (Allow the person to offer adjectives before you suggest them.) (Note if uses clenched fist to describe pain.)
58
Q

________: is an important cardiac symptom, occurs when the heart’s own blood supply cannot keep up with metabolic demand. Chest pain also may have pulmonary, musculoskeletal, or gastrointestinal origin; it is important to differentiate.

-A squeezing “clenched fist” sign is characteristic of this, but the symptoms below may be equivalents in the absence of chest pain

A

Angina

59
Q

•Any associated symptoms with chest pain?: Sweating, ashen gray or pale skin, heart skips beat, shortness of breath, nausea or vomiting, racing of heart?

A

Diaphoresis, cold sweats, pallor, grayness.

Palpitations, dyspnea, nausea, tachycardia, fatigue.

60
Q

Goal of this question:

Pain made worse by moving the arms or neck, breathing, lying flat?

A

Trying to differentiate pain of cardiac versus noncardiac origin.

61
Q
  1. Dyspnea. (subj data)

Any shortness of breath?

  • What type of activity and how much brings on shortness of breath? How much activity brought it on 6 months ago?
    * Onset: ____________
    * Duration: ______________
    * Seem to be affected by position:lying down?
    * Awaken you from sleep at night?
     Does the shortness of breath interfere with   activities of daily living?
A

•Onset: Does the shortness of breath come
on unexpectedly?

    * Duration: Constant or does it come and go?
    * Seem to be affected by position: Lying down?
    * Awaken you from sleep at night?
62
Q

Dyspnea on exertion (DOE) you want to:

A

quantify exactly (e.g., DOE after walking two level blocks).

63
Q

________________ occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically, the person awakens after 2 hours of sleep with the perception of needing fresh air.

A

Paroxysmal nocturnal dyspnea (PND)

64
Q
  1. Orthopnea. (subj data)

What is an example question asked?

A

How many pillows do you use when sleeping or lying down?

65
Q

________ is the need to assume a more upright position to breathe. (Note the exact number of pillows used.)

A

Orthopnea

66
Q
  1. Cough.

Do you have a cough?

Example questions:

A
  • Duration: How long have you had it?
  • Frequency: Is it related to time of day?
  • Type: Dry, hacking, barky, hoarse, or congested?
  • Do you cough up mucus? Color? Any odor? Blood tinged? Note sputum production, mucoid or purulent.
  • Associated with: Activity, position (lying down), anxiety, talking?
  • Does activity make it better or worse (sit, walk, exercise)?
  • Relieved by rest or medication?
67
Q

_________ is often a pulmonary disorder but also occurs with mitral stenosis.

A

Hemoptysis (the expectoration of blood)

68
Q
  1. Fatigue. (subj data)

Do you seem to tire easily? Able to keep up with your family and co-workers?

   * Onset: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  * Fatigue related to time of day: All day, morning, evening?
A

Onset: When did fatigue start? Sudden or gradual? Has any recent change occurred in energy level?

69
Q

Fatigue from decreased cardiac output is worse in the _________, whereas fatigue from anxiety or depression occurs __________.

A

evening/

all day or is worse in the morning

70
Q
  1. Cyanosis or pallor: (subj data) example question:
A

Ever noted your facial skin turn blue or ashen?

71
Q

Cyanosis or pallor occurs with myocardial infarction or low cardiac output states as a result of ___________.

A

decreased tissue perfusion.

72
Q
  1. When asking about _______, these questions may be used:

Any swelling of your feet and legs?

  • Onset: When did you first notice this?
  • Any recent change?
A

Edema

73
Q

Edema is dependent when caused by ________

A

heart failure

74
Q

________ is worse at evening and better in morning after elevating legs all night.

A

Cardiac edema

75
Q

Cardiac edema shows __________ swelling; _________ has a local vein cause.

A

Cardiac edema is bilateral; unilateral swelling has a local vein cause.

76
Q
  1. Do you awaken at night with an urgent need to urinate? How long has this been occurring? Any recent change?
A

Nocturia

77
Q

__________: this occurs with heart failure in the person who is ambulatory during the day.

A

Nocturia

78
Q

Risk factors for CAD (coronary artery disease):

A
  • Collect data regarding elevated cholesterol
  • elevated blood pressure
  • blood sugar levels above 130 mg/dL or known diabetes mellitus
  • obesity
  • cigarette smoking
  • low activity level
  • and length of any hormone replacement therapy for postmenopausal women
79
Q

Subjective ?’s for the aging adult

A

Additional History for the Aging Adult

  1. Do you have any known heart or lung disease: Hypertension, CAD, chronic emphysema, or bronchitis?
  2. Do you take any medications for your illness such as digitalis? Aware of side effects? Have you recently stopped taking your medication? Why?
  3. Environment: Does your home have any stairs? How often do you need to climb them? Does this have any effect on activities of daily living?
80
Q

To evaluate the carotid arteries, the person can be _______. To assess the jugular veins and the precordium, the person should be ____________.

A

sitting up/

supine with the head and chest slightly elevated

81
Q

Stand on the person’s _____ side; this will facilitate your hand placement, viewing of the neck veins, and auscultation of the precordium.

A

right

82
Q

Ensure the female’s privacy by ___________.

A

keeping her breasts draped

83
Q

The room must be _______

A

warm—chilling makes the person uncomfortable, and shivering interferes with heart sounds

84
Q

When performing a regional cardiovascular assessment, use this order:

A
  1. Pulse and blood pressure
  2. Extremities (see Peripheral Vascular Assessment in Chapter 20)
  3. Neck vessels
  4. Precordium

(*The logic of this order is that you will begin observations peripherally and move in toward the heart)

85
Q

~Located central to the heart, the _______ yields important information on cardiac function

A

carotid artery

86
Q

_______________ is the condition in which pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. This may occur in older adults with hypertension or occlusion of the carotid artery.

A

Carotid sinus hypersensitivity

87
Q

Make sure to palpate the carotid artery: _______

A

gently and only one at a time

88
Q

~For persons middle-aged or older or who show symptoms or signs of cardiovascular disease, auscultate each carotid artery for the presence of a __________. This is a blowing, swishing sound indicating blood flow turbulence; normally none is present.

A

bruit

89
Q

A _________ indicates turbulence due to a local vascular cause, such as atherosclerotic narrowing

A

bruit

90
Q

When auscultating the carotid artery: Keep the neck in a neutral position. Lightly apply the bell of the stethoscope over the carotid artery at three levels: ___________, ___________, ____________

A

(1) the angle of the jaw, (2) the midcervical area, and (3) the base of the neck (see Fig. 19-17).

91
Q

Avoid compressing the artery because this could: ________________

A

create an artificial bruit and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis

92
Q

Ask the person to___________________ while you listen so that tracheal breath sounds do not mask or mimic a carotid artery bruit.

A

take a breath, exhale, and hold it briefly

93
Q

A carotid bruit is audible when the lumen is occluded by ____ to _____.

A

1/2 to 1/3

94
Q

Bruit loudness increases as the atherosclerosis worsens until the lumen is occluded by ______ . After that, bruit loudness decreases. When the lumen is completely occluded, the bruit disappears. Thus absence of a bruit does not ensure absence of a carotid lesion.

A

2/3

95
Q

A murmur sounds much the same but is caused by a __________. Some aortic valve murmurs (aortic stenosis) radiate to the neck and must be distinguished from a local bruit.

A

cardiac disorder

96
Q

~Inspect the: ___________

A

Jugular Venous Pulse

97
Q

From the jugular veins you can assess the________ and thus judge the heart’s efficiency as a pump. Stand on the person’s _____ side because the veins there have a direct route to the heart

A

central venous pressure (CVP)

right side

98
Q

You can see the top of the external jugular vein distention overlying the _________ or the pulsation of the internal jugular vein in the __________.

A

sternomastoid muscle

sternal notch

99
Q

When inspecting the Jugular Venous Pulse: Position the person ___________, wherever you can best see the top of the vein or pulsations. In general, the higher the venous pressure is, the higher the position you need. Remove the pillow to avoid flexing the neck; the head should be in the same plane as the trunk. Turn the person’s head slightly away from the examined side, and direct a strong light tangentially onto the neck to highlight pulsations and shadows.

A

supine anywhere from a 30- to a 45-degree angle

100
Q

Unilateral distention of external jugular veins is due to local cause (kinking or aneurysm).

Full distended external jugular veins above 45 degrees signify increased CVP as with: _______

A

CVP as with heart failure.

101
Q

Left-sided systolic failure signs and symptoms (mnemonic)

A

“Left Systolic Failure Can Have Dialated Heart Cause Of Pulmpnary Backflow”:

Loss of hair on legs
Skin cold and clammy
Fatigue
Crackles
High heart rate
Dyspnea
HTN
Cyanosis
Orthopnea
Pink Sputum

Assessment (Test #2) (4 decks)

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