HEART & NECK VESSELS... PERIPHERAL VASCULAR SYSTEM

Question 1

Layers of the heart wall

Answer 1

-pericardium
-myocardium
-endocardium

Question 2

2 atriums

Answer 2

holding rooms

Question 3

2 ventricles

Answer 3

muscylar pumping chamber

Question 4

2 AV valves

Answer 4

tricuspid & mitral

Question 5

Diastole

Answer 5

ventricles relaxed
AV valves open
pressure higher in atria
blood pours rapidly into ventricles
towards the end, atria contracts and pushes out the last amount of blood

Question 6

systole

Answer 6

ventricles are full of blood=higher pressure in ventricles than in atria

AV valves swing shut(S1)=beginning of systole

ventricle walls contract, builds pressure

when pressure is higher, valves open, blood is ejected rapidly

after ventricle blood leaves, valves swing shut (s2)

Question 7

heart sounds

Answer 7

S1= 1st heart sound, occurs with closure of AV valves
signals beginning of systole (loudest @ apex)

S2= second heart sound
occurs with closure of semilunar valves
signals end of systole
loudest @ base

murmurs= blood circulating normally makes no sound
–> noisy flow, gentle, blowing, swooshing sound

Question 8

carotid arteries assessment

Answer 8

palpate one at a time to avoid compromising blood flow to the brain

arteries should be normal in strength & same bilaterally

diminished pulse- cardiogenic shock
increased pulse- feels full and strong, exercise, anxiety, fever

Question 9

jugular vein assessment

Answer 9

Lets you assess Central venous
pressure/judge hearts efficiency as a
pump
* Stand on right side of patient
* Position patient supine at a 30-45 degree angle. Use pen light to see better
* Findings
* In some people you can see the jugulars, in
others you cannot
* If you can see them, they should disappear
by 45 degrees
* Full distended jugular veins above 45 degrees
signify increased CVP and heart failure

Question 10

peripheral vascular system

Answer 10

Consists of veins and arteries to
perfuse the lower part of the
body

• Arteries carry oxygenated blood
  out to the body
• Veins carry deoxygenated blood
  back to the heart
• Neck: Carotid and jugular veins

Question 11

lymphatic system

Answer 11

• Retrieves excess fluid & plasma
  proteins
• Forms part of immune system
• Absorb lipids from small
  intestine
• Lymph nodes

Question 12

quality and strength of pulses

Answer 12

0= absent
1+= weak “thready” hard to palpate, decreased cardiac output, peripheral arterial disease, aortic valve stenosis

2+= expected normal, easy to palpate strong

3+= pounds under fingertips. exercise, anxiety, fever, anemia, hyperthyroidism

Question 13

swelling/edema

Answer 13

+1 mild pitting, slight indentation,
no perception of swelling

• +2 moderate pitting, indentation
  subsides rapidly
• +3 deep pitting, indentation remains
  for a short time, legs swollen
• +4 very deep pitting, indentation
  lasts a long time, legs grossly
  swollen
• Bilateral edema - may be related to heart disease
• Unilateral edema - may be related to deep vein thrombosis

Question 14

cardiac cycle

Answer 14

the rhythmic movement of blood through the heart

Question 15

other normal heart sounds

Answer 15

third heart sounds-due to the vibration to ventricles that resist early due to early filling

Question 16

fourth heart sounds

Answer 16

due to vibration of noncompliant ventricles when the atria contract and push blood into them

Question 17

why does the heart contract?

Answer 17

response to an electrical current in its conduction system

SA NODE–> ATRIA–> AV NODE (delay)–> BUNDLE OF HIS–> R/L bundle branches–>ventricles

Question 18

ECG waves

Answer 18

labeled PQRST

measures depolarization of the atria, ventricles and repolarization of the ventricles

Question 19

cardiac output

Answer 19

stroke volume x beats per min

Question 20

preload

Answer 20

venous return that builds during diastole

Question 21

afterload

Answer 21

opposing pressure that the ventricle must generate to open the aortic valves against the higher aortic pressure

Question 22

carotid artery location

Answer 22

groove between the the trachea and the sternomastoid mm. its pulse coincides with ventricular systole

Question 23

jugular vein

Answer 23

gives info about filling pressures and volume changes in the R. side of the heart

Question 24

cardio system during pregnancy

Answer 24

blood volume increases by 30-50%, which increases the stroke volume, cardiac output and pulse rate

the foramen ovale allows oxygenated blood from the placenta to be shunted to the L side of the heart & out to the general circulation

Question 25

ductus arteriosus

Answer 25

remaining blood being directed to the lungs, is shunted into the aorta

@ birth, lung inflation closes both openings

Question 26

risk factors for heart disease & stroke

Answer 26

high blood pressure, smoking, high cholesterol, physical inactivity

Question 27

unexpected findings in the Peripheral vascular syste,

Answer 27

peripheral arterial disease
-leg cramping
-skin changes
-cool legs
-swelling in arms/leg
-lymph node enlargement
-smoking
-sparse leg hair

Peripheral venous growth
-aching, tired feeling in legs
-presence of varicositities
-lower leg edema
-brown discoloration of skin, ulcers @ ankles
-weepy pruritic dermatitis
-shallow non-healing ulcers in lower leg

deep vein thrombosis
-immobility
-localized tenderness
-sharp, deep pain, warm skin
-pitting edema in symptomatic leg
-tenderness
-cancer
-obesity
-hormones

Question 28

subjective data

Answer 28

asks questions that investigate
chest pain, dyspnea, or orthopnea: cough, fatigue, cyanosis or pallor; edema, nocturia; past history or family history of cardiac disease

Question 29

objective data

Answer 29

focus on the neck vessels 1st
palpate each carotid artery separately
auscutate each artery for bruit; inspect the jugular venous pulse

Question 30

to gather clients history of chest pain, how should the nurse begin

Answer 30

encourage the client to describe his chest discomfort

Question 31

The nurses decides to begin palpation at the base of the heart.

Where should the nurse palpate first?

Answer 31

Right sternal border, 2nd intercostal space.

Question 32

Auscultation

Answer 32

Which side of the stethoscope is the nurse using to auscultate for heart
sounds?
—Diaphragm—

After the initial auscultation what is the next step?
—Count apical pulse—

Where does the nurse identify S1 and S2?
—S1 apex, S2 base—

Which part of the stethoscope does the nurse use to listen for murmurs

–Bell–

Question 33

jugular vein distention

Answer 33

place the client in semi-flower’s position

Question 34

older adults

Answer 34

the systolic blood pressure rises and orthostatic hypotension may occur

Question 35

Blood flow through the heart

Answer 35

SVC
R.ATRIUM
tricuspid
R.ventricle
pulmonary valve
lungs
pulmonary veins
L.ATRIUM
Mitral valve
Left ventricular
AV valve
Aorta
Rest of body