Mod 4 Flashcards
1
Q
What is an arterial pulse?
A
A surge of blood
2
Q
What are major arteries of the arms and legs called?
A
Peripheral arteries
3
Q
What is the major artery that supplies the arm?
A
Brachial artery
4
Q
Where does the brachial artery divide and what arteries dose it become?
A
At the elbow and it becomes the radial and ulnar arteries
5
Q
Where can you palpate the radial and ulnar arteries and which is harder to find?
A
Radial- on the lateral aspect of the wrist
Ulnar- on the medial aspect of the wrist
The ulnar artery is header to palpate because it is deeper
6
Q
What artery is the major supplier of blood to the leg and where can you palpate it?
A
Femoral artery and it can be palpated just under the inguinal ligament
7
Q
How dose the femoral artery move down the leg?
A
It travels down the front of the thigh the crosses to the back of the thigh where it is termed popliteal at the back of the knee where it divides below the knee into the anterior and posterior branches. The anterior descends down to the top of the foot and becomes the dorsalis pedis artery. The posterior side becomes the posterior tibial artery.
8
Q
What are veins?
A
Are the blood vessels that carry deoxygenated, nutrients- depleted, waste-laden blood from the tissue back to the heart
9
Q
How do veins differ from arteries?
A
There is no force that propels forward the blood flow in the veins
10
Q
What are arteries?
A
Blood vessels that carry oxygenated blood, nutrient rich blood from the capillaries
11
Q
70% of the bodies blood volume is contained where?
A
Veins
12
Q
How many types of veins are there and what are they?
A
There are three types of veins:
Deep veins
Superficial veins
Perforator veins
13
Q
What are the two deep vein located in the leg?
A
Femoral vein in the upper thigh and the popliteal vein located behind the knee
14
Q
What are the longest of all the veins?
A
Saphenous vein
15
Q
What three mechanism propel blood through the veins?
A
One way valves permit blood to pass through them on the way to the heart and prevent blood from returning through the opposite direction
Skeletal muscle contract with movement and squeeze the blood toward the heart
Creation of pressure gradient through the act of breathing
16
Q
What are capillaries?
A
Are small blood vessels that form the connection between the arterioles and venules they allow the circulatory system to maintain the equilibrium between the vascular and interstitial spaces
17
Q
What is the primary function of the lymphatic system?
A
It is to drain excess fluid and plasma proteins from bodily tissue and return them to the venous system
18
Q
What is the second function of the lymphatic system?
A
Defending the body against microorganisms
19
Q
What is the third function of the lymphatic system?
A
To absorb lipids from the small intestine into the bloodstream
20
Q
Why is it important to ask a client if they notice any color, temperature, or texture changes in their skin?
A
Because cold, pale, clammy skin on the extremities and thin, shiny skin with loss of hair are associated with arterial insufficiency and warm skin with a brown pigmentation around the ankles is associated with venous insufficiency
21
Q
What increases the risk of varicosities?
A
Pregnancy and standing for long periods of time
22
Q
What type of ulcers are painless and are located on the lower legs or medial ankle?
A
Venous ulcer
23
Q
What are painful ulcer that are often located on the toes, foot, or lateral ankle associated with?
A
Arterial disease
24
Q
Obstruction of the lymphatic flow causes what?
A
Peripheral edema
25
What are some risk for deep vein thrombosis?
Reduced mobility, dehydration, increased viscosity in the blood and venous stasis
26
What can increase a woman risk of thrombophlebitis, Raynaud's disease, hypertension and edema?
Oral or transdermal contraceptives
27
What are the drug that inhibit platelet aggregation?
Cilostazol/ clopidogrel- to increase blood flow
Aspirin- prolongs blood clotting
Pentoxifylline- reduces blood viscosity
28
What equipment will you need during a peripheral vascular assessment?
```
Centimeter tape
Stethoscope
Droppler ultrasound device
Conductivity gel
Tourniquet
Gauze or tissue
Water proof pen
Blood pressure cuff
```
29
What should you look for if a client tells you that she had a breast surgery?
Lymphedema
30
What is Raynaud's disorder?
It is a vascular disorder caused by vasoconstriction or vasospasm of the fingers or toes characterized by rapid changes of color, swelling, pain, numbness,tingling, burning , throbbing and coldness and it last minutes to hours
31
If capillary refill exceeds 2 seconds it may indicate what?
Vasoconstriction, decreased cardiac output, shock, arterial occlusion or hypothermia
32
What do increased radial pulses indicate?
Hyperkinetic state
33
What could decreased pluses be do to?
Buerger's disease or scleroderma
34
Last of resilience or Inelasticity of the artery may indicate what?
Arteriosclerosis
35
If you suspect arterial insufficiency you can do what?
Palpate the brachial pulses
36
Editor glean lymph nodes are not what?
Palpable
37
Bilateral edema indicates what?
Systematic problem such as congestive heart failure or local problem such as lymphedema
38
Prolonged standing or sitting may aide what kind of edema?
Orthostatic edema
39
What are the associated systemic problems with pitting edema?
Congestive heart failure
Hepatic cirrhosis
Orthostatic edema
40
When palpating the legs what do you need to compare?
The temperature bilaterally
Coolness may indicate arterial insufficiency
Increased warmth mat indicate a superficial thrombophlebitis
41
When palpating lymph nodes what would be considered normal finding?
Nontender, movable lymph nodes up to 1 or even 2 cm are commonly palpated
42
What is a normal findings when auscultating the femoral pulses?
No sounds
Bruins over one or both femoral arteries suggest partial obstruction of the vessel
43
Why would you ask for a client to stand while inspecting varicose veins?
Because they may not be visible while sitting or in the supine
44
What are the stages of lymphedema?
Stage 0- no obvious signs or symptoms
Stage I- swelling is present
Stage II - skin tissue is firmer and may appear tight,shiny and feel spongy
Stage III - has progressed to lymphostatic elephantiasis (irreversible)
45
What a the pulse amplitudes?
0- absent
1+ weak, diminished
2+ normal
3+ bounding
46
What are characteristics of aterial and venous insufficiency?
Pain: intermittent claudication to sharp, unrelenting constant
Pulse: diminished or absent
```
Skin characteristics: dependent rubor
Elevation pallor of foot
Dry shiny skin
Cool- to- cold temperatures
Loss of hair over toes and dor sum of the foot
Nails thickened and ridged
```
Ulcer characteristics:
Location: tips of the toes, toe webs, heel or pressure areas if confined to bed
Pain: very painful
Depth of ulcer: deep often to joint space
Shape: circular
Ulcer base: pale black to dry and gangrene
47
What are characteristics of venous insufficiency?
Pain: aching cramping
Pulses: present but may be difficult to palpate through edema
Skin characteristics: pigmentation in fairer area skin thickened and tough
May be reddish- blue in color
Frequently associated with dermatitis
Ulcer characteristics:
Location: medial malleolus or anterior tibial area
Pain: if superficial, minimal pain; but may be very painful
Depth or ulcer: superficial
Shape: irregular boarder
Ulcer base: granulated tissue- beefy red to yellow fibrin oust in chronic long term ulcer
Leg edema: moderate to severe
48
What are characteristics of edema associated with lymphedema?
Caused by abnormal or blocked lymph vessels
Nonpitting
Usually bilateral; may be unilateral
No skin ulceration or pigment
49
What are characteristics of edema associated with chronic venous insufficiency?
Caused by obstruction or insufficiency of deep veins
Pitting documented as:
1+ slight pitting
2+ deeper than 1+
3+ noticeably deep pit; extremity looks larger
4+ very deep pit; gross edema in extremity
Usually unilateral; may be bilateral
Skin ulceration and pigmentation may be present
50
What are the four chambers of the heart?
Left and right atria
| Left and right ventricles
51
Where is the heart located?
In the middle of the thoracic cavity between the lungs in a space called the mediastinum
52
The anterior chest area that overlies the heart is called what?
Percordium
53
Which side of the heart pumps blood to the lungs for gas exchange?
Right side
54
Which side of the heart pumps blood to all the other parts of the body?
Left side
55
What part returns blood to the right atrium from the upper and lower torso?
Superior and inferior venal cava
56
What part carries blood to the lungs?
Pulmonary artery
57
What returns oxygenated blood to the left atrium?
Pulmonary veins
58
What transports oxygenated blood from the left ventricle to the body?
Aorta
59
What separate the lady and right side of the heart?
Septum
60
Why is the left ventricle thicker then the right?
Because it has a greater workload pumping blood out of the heart
61
What are the propose of the chordate tendineae
To anchor the AV flaps to the papillary muscles within the ventricles
62
What do the AV prevent?
Regurgitation of blood into the atria
63
What are the two phases of the cardiac cycle?
Diastole-relaxation of the ventricles, know as filling
systole- contraction of the ventricles, known as emptying
64
What is protodiastolic filling?
When the valves open and ventricles relaxes causing higher pressure in the atria then in the ventricles blood rushes in that early, rapid,passive filling is the protodiastolic filling
65
The emptying of blood out of the upper chambers of the heart are called what?
Presystol
66
What is the first heart sound?
S1= lub
67
The heart sound lub is caused by what?
Closure of the AV valves
68
What is the second heart sound?
S2= dubb
69
What causes the dubb?
Closure of the semilunar valve
70
Where is the s1 best heard?
Over the apex of the heart
| (fifth ICS)
71
The S1 is usually heard as one sound but can be heard as two if so what are those two sound?
Mitral valve closure (M1) and the tricuspid closure (T1)
72
The S2 is usually heard as one sound but can be heard as two if so what are those two sounds?
Closure of the aortic valve (A2) and closure of the pulmonic valve
73
What conditions contribute to the turbulent blood flow of a heart murmur?
Increased blood velocity
Structural valve defects
Valve malfunction
Abnormal chamber opening (septal defects)
74
What is cardiac output?
The amount of blood pumped by the ventricles durning a given period of time (usually 1 min)
75
What is the stroke volume for the left ventricle?
70 ml
76
Where do you auscultate heart sounds?
```
Aortic-2nd intercostal space
Pulmonic-2nd intercostal space
Erv's point -3rd intercostal space
Tricuspid-5th intercostal space
Mitral- 5th intercostal space mid-clavicular line (apex)
```
77
Why is assessment of the jugular veins important?
To determine hemodynamics of the right side of the heart
78
What are the two sets of jugular veins?
Internal and external
79
What do jugular veins do?
they return blood to the heart from the head and neck via the superior vena cava
80
Why would you want to ask a client about fatigue?
It may result from compromised cardiac output
81
Why is it important to ask a client about SOB?
Dyspnea may result from congestive heart failure, pulmonary disorders, coronary artery disease, myocardial ischemia and myocardial infarction
Orthopnea is the need to sit more upright to breathe easily due to fluid accumulation in the lungs
Paroxysmal nocturnal Dyspnea is waking up in the night from Dyspnea and can occur due to heart failure
82
Why is it important to as a client about coughing up mucous?
Fluid accumulation in the lungs from the heart can cause one to cough up white or pink tinged sputum
83
What might dizziness indicate?
May indicate decreased blood flow to the brain due to myocardial damage
84
Nocturia occurs with what?
Heart failure
85
What parts of a stethoscope are used to auscultate the heart?
Diaphragm of the stethoscope for high pitched sounds
Bell for low pitched or gallops
86
What are risk for coronary heart disease?
```
High blood pressure
High cholesterol
Cigarette smoking
Diabetes
Poor diet and physical inactivity
Overweight and obesity
65 years or older
Being male
Race: Mexican, Indians, Hawaiians, and Asians
```
87
While palpating the carotid artery you notice loss of elasticity which may indicate what?
Arteriosclerosis
88
What is considered bradycardia?
Less then 60 beats/ min
89
What is considered tachycardia,
More then 100 beats/ min
90
What is an apical impulse caused by?
The left ventricle moving outward during systole
91
When auscultating for a murmur you should do what?
Use the diaphragm and bell of the stethoscope across the entire heart are and auscultate with the client in different positions
92
What is the sinoatrial node?
It is located on the posterior wall of the right atrium. It is the peacemaker of the heart with an intrinsic rate of 60- 100 bump
93
What is the AV node?
Located in the lower interatrial septum and has an intrinsic rate of 40-60 BPM it serves to delay the electrical impulses coming from the atria and then relays that impulse to the AV bundle
94
What is the AV bundle?
Know as the bundle of his and it is the electrical impulses travels from the bundle of his to the right and left bundle branches and the purkinje fibers in the myocardium of both ventricles
95
What conditions contributed to heart murmurs?
Increased blood velocity
Structural valve defects
Valve malfunction
Abnormal chamber openings
96
What do diastolic heart murmurs almost always indicate?
Heart disease
97
What do you do if you detect an irregular rhythm?
Auscultate for a pulse rate deficit by palpating the radial pulse while you auscultate the apical pulse for a full min bot should be identical
98
A paradoxical pulse is alway considered what?
An emergency
99
How would you grade a heart murmurs?
Grade 1- is very faint
Grade 2- is quite but heard immediately on placing the stethoscope on the chest
Grade 5- is very loud and can be heard with the stethoscope partly off the chest
Grade 6- can be heard with the stethoscope all the way off the chest
100
The term thorax identities as what?
The portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly
101
What is the outer structure of the thorax called?
Thoracic cavity
102
The thoracic cage is made up of what?
```
Sternum
12 ribs
12 thoracic vertebrae
Muscles
Cartilage
```
103
What are the three parts of the sternum?
Manubrium
The body
The xiphoid process
104
A u-shaped indentation located on the superior border of the manubrium is what important land mark?
Suprastenal notch
105
A few centimeters below the supeasternal notch is a bonnet ridge that can be palpated at the point where the manubrium articulates with the body of the sternum this landmark is known as what?
Sternal angle
106
How many pairs of ribs articulate with the sternum?
7 pair
107
Which ribs connect to the pair lying superior to them?
7- 10
108
What is the important landmark for assessment that forms an angle between the right and left costal margins?
Costal angle
109
What are the 11th and 12th rib called?
Floating ribs
110
What is the leading cause of death in the U.S. and Europe?
Lung cancer
111
What are risk factors for lung cancer?
```
Cigarette smoking
Genetic predisposition
Exposure to toxins
History of previous lung cancer
Gender (women)
```
112
What does the thoracic cavity consists of?
Mediastinum and the lungs
113
The mediastinum contains what?
The trachea, bronchi, esophagus, heart and great vessels
114
What is the mediastinum and the lungs of the thoracic cavity lined by?
Pleural membranes
115
How long is the trachea of an adult?
10-12 cm long
116
What are the anterior vertical lines of the chest?
Midsternal line
Right midclavicular line
Left midclavicular line
117
What are the lateral vertical lines?
Anterior axillary line
Midaxillary line
Posterior axillary line
118
What composes the trachea?
C-shaped rings of the hyaline cartilage
119
Why do the bronchi and trachea represent "dead space" in the respiratory system?
Because they just transport air and no gas exchange takes place
120
What are lungs?
They are two come shaped elastic structures suspended within the thoracic cavity
121
Where is the apex of the lung?
Slightly above the clavicle
122
Where is the base of the lung?
At the level of the diaphragm
123
Which lung has three lobes?
The right lung
124
What is white or mucous sputum often seen with?
Common colds, viral infections or bronchitis
125
Yellow or green sputum is often associated with what?
Bacterial infections
126
Blood in the sputum is seen with what?
More serious respiratory conditions
127
Rust colored sputum is associated with what?
Tuberculosis and pneumococcal pneumonia
128
Pink or frothy sputum may be indicative of what?
Pulmonary edema
129
Traveling to area such as chin, Hong Kong, Hanoi, Vietnam and Singapore might expose you to what?
SARS
130
What is frequently seen in clients with poor nutrition both weight loss and obesity?
COPD
131
What are the two main conditions that make up COPD?
Emphysema and chronic asthmatic bronchitis
132
What are the risk associated with COPD?
Cigarette smoke exposure occupational exposure to dust and chemicals
Age 40 and above
Rarely genetics
133
What are the risk associated with lung cancer?
Smoking tobacco
Exposure to asbestos
Personal history
Family history
134
Nasal flaring is seen with labored respirations is indicative of what?
Hypoxia (especially in small children)
135
Pursed lip breathing may be seen when?
Asthma, emphysema or CHF
136
What makes white skin appear blue-tinged especially in perioral, nailbeds and conjunctival areas?
Cyanosis
137
What muscles are used to facilitate inspiration in cases of acute and chronic airway obstruction?
Trapezius or shoulders
138
Client leans forward and uses arms to support weight and lift cheats to increase breathing capacity is referred to as what position?
Tripod position
139
Tender or painful areas may indicate what?
Inflamed fibrous connective tissue
140
Pain over the intercostal space may indicate what?
Inflamed pleurae
141
When air escapes the lungs or other airways in to subcutaneous tissue you can palpate for what?
Crepitus
142
What is best to use while palpating for fr emits?
The ball of the hand
143
What do you ask the client to say when palpating for fremitus?
Ninety-nine
144
What is the percussion time elicited over normal lung tissue?
Resonance
145
When would dullness be present while percussing the lungs?
It the air filled spaces have been replaced with fluid or solid tissues
146
If you here a abnormal sound while auscultating the lungs what should you do?
Have the client cough and listen again
147
What is pectus excavatum?
Is a markedly sucken sternum and adjacent cartilage
148
What quadrant of the breast is most likely to get a breast tumor?
Tail of spence- upper outer quadrant
149
The breast are what?
Paired mammary glands
150
What causes the female breast tissue to enlarge?
It is in response to the hormones estrogen and progesterone
151
What are the breast two fictions?
To produce and store milk
| And aid in sexual stimulation
152
For assessment purposes the breast are divided in to how many quadrants?
4
153
Female breast consist of what three types of tissue?
Glandular, fibrous, and fatty
154
Glandular tissue does what?
Allows for milk production
155
Fibrous tissue does what?
Provides support for the glandular tissue largely by way of bands called coopers ligaments
156
What does fatty tissue do?
Provides shape to the breast tissue and embed glandular tissue
157
Who has a 100 times of greater risk than males do to get breast cancer?
Females
158
Pain and tenderness is coming in what kind of breast?
Fibrocystic breast
159
Any reports of blood or blood tinged discharge should be what?
Referred to a physician for further evaluation
