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NURS 202 > Lecture 2: Cardiovascular and Peripheral Vascular > Flashcards

Lecture 2: Cardiovascular and Peripheral Vascular Flashcards

1
Q

CV: Heart Valves: Atrioventricular

A

Between the atria and the ventricles
- Tricuspid opens from RA to RV
- Mitral opens from LA to LV

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2
Q

CV: Heart Valves: Semilunar

A
  • Pulmonic valve and aortic valve
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3
Q

CV: 2 Neck Vessels

A
  1. Carotid Artery
  2. Jugular Artery
    - Internal
    - External
    - Venous pulse and pressure
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4
Q

Cardiovascular Assessment Subjective Data: Health History

A
  • Chest pain
  • Dyspnea
  • Orthopnea
  • Cough
  • Fatigue
  • Cyanosis or pallor
  • Edema
  • Nocturia
  • Past cardiac history
  • Family cardiac history
  • Personal habits (cardiac risk factors)
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5
Q

Cardiovascular Assessment Subjective Data: Cultural and Social Considerations

A
  1. Increase incidence of cardiovascular disease (CVD) in Canada among men and women
  2. Influence of socioeconomic factors
    - High blood pressure
    - Smoking
    - Serum Cholesterol
    - Obesity
    - Diabetes
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6
Q

CV: Nonmodifiable Risk Factors

A
  • Age
  • Gender
  • Genetic Factors
  • Race and Ethnicity
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7
Q

CV: Modifiable Risk Factors

A
  • High BP
  • Smoking
  • Diabetes mellitus
  • Physical inactivity
  • Obesity
  • High blood cholesterol
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8
Q

CV: Additional Health History Questions: Infants

A
  • Maternal Health
  • Feeding without tiring
  • Growth
  • Activity, milestones
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9
Q

CV: Additional Health History Questions: Children

A
  • Growth
  • Activity
  • Joint pain and fever
  • Headache and nosebleed
  • Resp disease
  • Family history
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10
Q

CV: Additional Health History Questions: Pregnant women

A
  • Hypotension
  • Hypertension
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11
Q

CV: Additional Health History Questions: Older Adults

A
  • Disease
  • Medication
  • Environment
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12
Q

CV: Women and Heart Attacks

A
  • Symptoms easily attributed as something else
  • Often ignored
  • Women minimize significance of symptoms
  • Heart disease is the leading cause of death in women older than 55 yrs of age
  • Ovaries decrease production of estrogen = increased low-density lipoprotein (LDL), blood pressure (BP), and body fat above the waist, decreased high-density lipoprotein (HDL), metabolism of sugar affected
  • Hormone replacement therapy (HRT) or no HRT?
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13
Q

CV Physical exam: Palpate and auscultate carotid artery while pt. sitting #1

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
    1. Palpate carotid arteries while cient sitting, and auscultate for bruit
    2. Assist client to supine position:
  • Inspect the anterior chest - deformities, pulsations, skin
  • Palpate the apical impulse
  • Palpate for thrills
  • Repeat in L lateral position
    3. Precordium
  • Inspect the anterior chest
  • Palpate the apical impulse
  • Palpate across the precordium
  • (Precuss to outline the cardiac borders)
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14
Q

CV: Landmarking the chest

A
  • Intercostal spaces
  • Midclavicular lines
  • Sternal border
  • Axillary lines
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15
Q

CV: Auscultation of CV and PV

A
  1. Identity auscultatory areas. Use the diaphragm of stethoscope
    - Note rhythm and rate
    - Identify S1 and S2 (S1 is louder than S2 at the apex, S1 coincides with carotid artery pulse)
    - Listen to S1 and S2 separately. Closure of valves produces sound
    - Listen for extra heart sounds, murmurs
    Where?
    - 2nd ICS, RSB (aortic)
    - 2nd ICS, LSB (pulmonic)
    - 5th ICS, LSB (tricuspid)
    - 5th ICS, LMCL (mitral)
    Auscultatory Areas: APe To Man
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16
Q

CV: What is S1?
1. What valves are closing?
2. Location
3. Cardiac cycle
4. Sound

A
  1. Tricuspid and mitral
  2. Apex
  3. Beginning of Systole
  4. LUB-dup
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17
Q

CV: What is S2?
1. What valves are closing?
2. Location
3. Cardiac cycle
4. Sound

A
  1. Pulmonic and aortic
  2. Base
  3. End of Systole
  4. Lub-DUP
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18
Q

CV: Split S2

A
  • Normal occurrence at end of inspiration
  • Inspiration -> aortic closes before pulmonic
  • DUP becomes T-DUP
  • Expiration -> aortic and pulmonic valves close together
  • Usually heard in pulmonic valve areas
19
Q

CV: What are murmurs?

A
  • Blowing/Swooshing sound from turbulent blood flow
  • Innocent
    • Normal in healthy children and adolescents
  • Functional
    - From increased blood flow in the heart
  • Pathological
    - Valvular defect -> stenosis or regurgitation
  • Frequently found with a thrill
  • Repeat auscultation with pt. in L lateral position
20
Q

CV Physical Exam - Murmurs

A
  • Timing
  • Loudness
  • Pitch
  • Pattern
  • Quality
  • Location
  • Radiation
  • Posture
21
Q

CV Extra Heart Sounds

A
  • After listening to S1, S2, and murmurs
  • Bell at LLSB an apex in L lateral position
  • Filling sounds -> extra heart sounds
  • 3rd Heart sound, S3
    - Soft, dull, low-pitched after S2
    - Normal (physiological) children/young adults
    - Pathological in older adults
    - Ventricles resistant to filling
  • 4th Heart Sound, S4
    - Very soft, low-pitched, just before S1
    - Atria contract against resistant ventricles (CHF, MI)
    - May be normal in adults after exercise
    - R sided S4 LLSB; L sided S4 at apex
  • Summation Gallop S4, S1, S2, S3 together
  • Pericardial friction rub
22
Q

CV Developmental Considerations: Infants

A
  • Diff. in apical, radial pulses
  • Normal heart rates
  • Murmurs more common in 1st days
23
Q

CV Developmental Considerations: Children

A
  • Position of apical impulse
  • Venous hum
  • Innocent heart murmurs
24
Q

CV Developmental Considerations: Pregnant women

A
  • Changes in BP (varies with position)
  • Heart sound changes from increased blood volume and workload
  • Mammary souffle
25
Q

CV Developmental Considerations: Older adult

A
  • Orthostatic hypotension
  • Avoid pressure on carotid artery
  • Premature ectopic beats more common
26
Q

CV Physical Assessment: Assist to supine and… #2

A

a. Inspect anterior chest
b. Palpate apical pulse and precordium
c. Auscultation (APTM)
i. assess rate and rhythm (how long do you listen for?)
ii. identify S1 and S2 separately (S1 louder than S2 @ apex; at base S2 is louder)
iii. listen for murmurs in systole and diastole
iv. repeat with bell

27
Q

CV Physical Assessment: Assist to L lateral position #3

A
  • Auscultate APeToMan
  • Assess S3 and S4 at apex and 5th ICS, LSB
28
Q

PV: Veins

A
  • Veins run parallel to arteries but more veins than arteries in body and lie closer to skin so easier to palpate/examine
  • Jugular, arm, leg veins
  • No pump
29
Q

PV: Developmental Considerations; Infants and children

A
  • Transient acrocyanosis and skin mottling
30
Q

PV: Developmental Considerations; Pregnant women

A
  • Diffuse bilateral pitting edema
  • Varicose veins
31
Q

PV: Developmental Considerations; Older adults

A
  • Arteriosclerosis
  • Atherosclerosis
  • Increased risk of deep vein thrombosis (DVT)
  • Dorsalis pedis, posterior tibial pulses more difficult to find
  • Trophic changes associated with arterial insufficiency
32
Q

PV: Subjective Data; Health History

A
  • Leg pain or cramps
  • Skin changes on arm or legs
  • Swelling in arms or legs
  • Medications
  • Occupation
  • Recent travel
  • Recent surgery
33
Q

PV: Objective Data

A
  • Inspection
  • Palpation
  • Percussion (if relevant)
  • Auscultation
34
Q

PV Objective Data: Arms

A

Inspect and palpate
- Skin
- Profile sign
- Capillary refill
- Symmetry
- Radial pulses
- Ulnar pulses
- Brachial pulses
(3+, 2+ normal, 1+ weak, 0 absent)

35
Q

PV: Pulses in Arms

A
  • Radial
  • Ulnar
  • Brachial
36
Q

PV Remember to think about…

A
  • Cold room
  • Smoking
  • Decreased body temperature
  • Edema
  • Anemia
  • Low BP
37
Q

PB Objective Data: Legs

A

Inspect and palpate
- Skin and hair
- Symmetry
- Temperature
- Calf muscle
- Femoral pulse (near goin)
- Popliteal pulse (behind knee)
- Posterior tibial pulse (in foot)
- Dorsalis pedis pulse (in foot)
- Pretibial edema
- Measurement
- 1+ to 4+ grading scale for pitting edema
- Ankle circumference
- Colour
- Elevate and dangle

38
Q

PV: Edema

A

Test: depress skin over bone, and release
Rate: 1+ mild with slight indentation 2mm depression, 2+ moderate 4mm depression, 3+ deep pitting and swollen 6mm depression, 4+ very deep and very swollen 8mm depression
Characteristics: pitting, dependent, bilateral/unilateral

39
Q

PV Disease in Legs

A
  • Chronic arterial insufficiency
  • Chronic venous insufficiency
  • Arterial (ischemic) ulcer
  • Venous (stasis) ulcer
  • Diabetic changes
  • Chronic venous disease
  • Superficial varicose veins
  • Deep venous thrombophelebitis
40
Q

PV: Foot care

A
  • Often 1st sign of arthritis/diabetes/nerve or circulatory disorders
  • Check feet every day, and keep blood flowing to the feet
  • Wear comfortable-fitting shoes
  • Fit shoes to larger foot
  • Low-heeled shoes for women
  • Keep skin soft and smooth
41
Q

Abnormal Findings: PV disease in arms

A
  • Raynauds phenomenon
  • Lymphedema
42
Q

Abnormal Findings: PV Pain

A
  1. Arterial Disease
    - Causes signs and symptoms of O2 deficit
  2. Venous Disease
    - Causes signs and symptoms of metabolic waste buildup
  3. Symptom analysis of pain for:
    - Location, character, onset and duration, aggravating factors, relieving factors, associated symptoms, risk factors
    - OPQRSTU
43
Q

PV: Deep Vein Thrombosis

A

Risk Factors:
- Bedrest, immobility
- Surgery
Signs and symptoms:
- Redness, swelling, pain in calf
- +’ve Homan’s sign (not specific for DVT but requires further assessment)
Prevention
- Early mobilization
- Compression stockings
- Prophylactic anticoagulation

NURS 202 (8 decks)

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