Module 6 Flashcards by Christina Stafstrom

what personal habits should be asked about in relevant history

Smoking
Diet
Exercise
Alcohol intake

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what family history should be asked about in relevant history

Diabetes
Hypertension
CAD
Hyperlipidemia

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Fainting; transient loss of consciousness

syncope

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Profuse sweating

Diaphoresis

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what are possible causes of chest pain

Cardiac
Aortic
Musculoskeletal
Pleural
Gastrointestinal
Pulmonary
Psychoneurotic

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what are the four chambers of the heart

Right atria
Right ventricle
Left atria
Left ventricle

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what are the four valves of the heart

Two atrioventricular
Tricuspid and Mitral
Two semiluunar
Pulmonic and Aortic

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what is the full circulation

Superior and Inferior vena cava
Right atrium Tricuspid valve Right ventricle Pulmonic valve Pulmonary arteries Lungs Pulmonary veins Left atrium Mitral valve Left ventricle Aortic valve Aorta Head and Body

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what occurs during systole

Ventricles contract and atria relax
Pressure in the ventricles rises
Blood is ejected

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what occurs during diastole

Atria contract and ventricles relax
As ventricular pressure falls below atrial pressure
Blood flows in a relatively passive manner
Then the atria contract to eject the remaining blood

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what equipment do you need

Marking pencil
Centimeter ruler
Stethoscope with bell and diaphragm
Sphygmomanometer

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what techniques are used

Inspection
Palpation
Percussion
Auscultation

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what do you look for in the general assessment

Color- General and Lips and mucus membranes
Ease of respirations
Signs of distress
Blood Pressure- Both upper extremities in at least two positions

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what do you inspect for in the extremities

Color
Temperature
Hair distribution
Capillary refill
Skin turgor
Skin integrity
Venous pattern
Nails

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Dilated and swollen

Evaluate venous incompetence- Trendelenburg test

Varicose Veins

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how do you Assess Jugular Venous Distension

Place person in supine position
Note the jugular vein
Gradually raise the head of the bed until the jugular vein is no longer visible in the neck

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Sharp, quick dorsiflexion of the foot with the knee slightly bent
Positive sign is calf pain

Homan’s sign

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what do you assess the peripheral pulse for

rhythm, contour, amplitude, and symmetry

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what are the peripheral pulse locations

Carotid
Brachial
Radial
Femoral
Popliteal
Dorsalis pedis
Posterior tibial

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Generally the larger the artery

the greater the expected amplitude

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Low-pitched bowing sound over a peripheral vessel

Usually indicates a narrowed vessel

bruit

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how do you check the carotid arteries

Listen for bruits

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what do you inspect the chest for

Contour
Heaves or lifts
Pulsations

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what do you palpate the chest for

Thrills
Pulsations
PMI

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2nd RICS @ SB

aortic

2nd LICS @ SB

pulmonic

3rd-5th LICS @ SB

right ventricle

5th LICS @ or just medial to the LMCL | Normal location of PMI in an adult

apical

do you generally percuss the chest

how do you auscultate the chest

Make sure room is warm Make sure stethoscope is warm Take time to isolate each sound and each pause in the cycle Avoid “jumping the stethoscope from one site to another

how is sound transmitted

the direction of blood flow

where are specific sounds heard best

over areas where the blood flows after it passes through a valve

auscultation should be performed..

in at least the five cardiac areas

what are cardiac auscultation areas named for

the locations where the valves are best heard

how should assessment be processed

in an systematic order From the base of the heart to the apex OR From the apex of the heart to the base

what is the base of the heart

Aortic area | Pulmonic area

what is the apex of the heart

Mitral area

2nd RICS @ RSB

aortic

2nd LICS @ LSB

pulmonic

3rd LICS @ LSB

Erb's point

4th or 5th LICS @ LSB

tricuspid

5th LICS in LMCL

mitral

how to remember the cardiac areas

All people enjoy their meals

describe S1 sounds

Closure of mitral and tricuspid valves at the beginning of systole Heard loudest at the apex: Mitral area Almost synchronous with carotid pulsation May be “split”

describe S2 sounds

Closure of aortic and pulmonic valves at the beginning of diastole Heard loudest at the base: Upper precordium May have a physiologic split

when is S3 normal

< 30 yoa | Pregnancy

when is S3 abnormal

Fluid overload | Mitral or tricuspid regurgitation

Variation during first rapid filling phase during diastole | Heard best at apex

Sound: Ken - tuc-ky Slosh-ing in

S1-3

Variation during 2nd rapid filling phase | Heard best at apex

Sound Ten-nes-see A stiff wall

S1, S2, S4

when is S4 abnormal

Hypertension Left venticular hypertrophy Mitral or tricuspid regurgitation

Mitral valve opening snap

Valvular stenosis

Ejection clicks

semilunar valves

Inflammation of the pericardium | Grating sound heard with the heartbeat

pericardial friction rub

Relatively prolonged extra sounds heard during systole or diastole

heart murmurs

what are causes of heart murmurs

Increased blood flow across normal valves Forward flow through a stenosed valve Backward flow through an incompetent valve

how do you describe heart murmurs

``` Location Timing and duration pitch character intensity ```

what are the intensity grades of heart murmurs

``` I: very faint II: faint III: moderately loud IV: loud V:very loud VI: very loud ```

what is normal for infants

HR very fast Apical impulse usually in 4th LICS just left of the MCL Murmurs are frequent in the newborn in the first 48 hours

when is Acrocyanosis normal

in infants is normal Bluish coloration of hands and feet Disappears within a few days after birth

what should you watch for in children

squatting

what is common in children

venous hum | Caused by turbulent blood flow in the internal jugular veins

is a physiologic event in childhood | Heart rate varies in a cyclic pattern, usually faster on inhalation and slower on exhalation

sinus arrhythmia

where is the apical impulse in children(<7)

in 4th LICS just left of the MCL until around age 4

what increases throughout pregnancy

Pulse rate gradually increases throughout | At term is 10-15 bpm faster

what gradually falls in the first 16-20 weeks

what are heard in 90% of pregnant women

Grade II systolic ejection murmurs

what is the norm in pregnant women

Dependent edema

what may you hear in pregnant women

audible S3

what is more common in the elderly

S4 and soft murmurs

what are difficult to find in elderly

Dorsalis pedis and posterior tibial pulses

what may increase in older adults

Systolic blood pressure

what does not respond as readily in older adults

heart rate during exercise