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Block 1 WK 8 > Mosbys > Flashcards

Mosbys Flashcards

1
Q

What is the force exerted against the wall of the artery when ventricles contract?

A

systolic pressure

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2
Q

The result of cardiac output, blood volume and compliance of the atrial tree is dependent upon (blank)

A

systolic presure

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3
Q

What is the secondary upstroke in the descending part of the pulse that corresponds to the transient increase in pressure upon closure of the aortic valve.

A

dicrotic notch

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4
Q

What is the force exerted against the wall of the artery when the heart is in filling or relaxed state and is primarily the function of peripheral vascular resistance

A

diastolic pressure

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5
Q

What is the difference between systolic and diastolic pressure?

A

pulse pressure

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6
Q

What is the stroke volume?

A

volume of blood ejected

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7
Q

What are these:
o Volume of blood ejected – Stroke volume
o Distensibility of the aorta and other large arteries
o Viscosity of the blood
o Peripheral arteriolar resistance

A

Contributors of arterial pulse and pressure

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8
Q

What are the three types of pressure that gives you an arterial pulse?

A

systolic, diastolic, pulse

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9
Q

(blank) reflect the activity of the right side of the heart

A

jugular veins

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10
Q

What is the order of venous pulsation?

A

A-> c -> x -> v ->y -> a

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11
Q

What are the three peaks of venous pulsation?

A

A,C,V

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12
Q

What are the 2 descending slopes of venous pulsation?

A

X and Y

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13
Q

What is happening during the A peak of venous pulsation?
C?
V?

A

 A
• Brief backflow of blood into the vena cava during right atrial contraction
 C
• Vigorous backward push from the tricuspid valve when it closes during ventricular systole
 V
• Increasing volume and concomitant increase in the right atrium
o Late in ventricular systole

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14
Q

What is happening during the descending slope X and Y?

A

 x
• Passive atrial filling
 Y
• Open tricuspid valve and rapid refilling of the ventricles

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15
Q

Infants and children, cutting the umbilical cord requires (blank)

A

respiration

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16
Q

What happens when you cut the umbilical cord of the child lung and vascular wise?

A

 Expansion of the lungs and air to the aveoli
 Pulmonary vascular resistance drops
 Systemic vascular resistance increases
 Once the pulmonary vascular resistance is lower than systemic vascular resistance, blood flows into the pulmonic arteries instead of across the interatrial foramen ovale
 foramen ovale Closes by shifting pressures of the right and left heart
 i.e. closes at birth
 Blood flows freely to the lungs but not peripherally.
 The ductus areteriosus closes within 12-14 hours of life

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17
Q

What happens to systemic vascular resistance in infants right after umbilical cord is cut?
pulmonary vascular resistance?
Why?

A

increases
decresases
blood flows into the pulmonic arteries instead of across the interatrial foramen ovale

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18
Q

How does the foramen ovale close?

A

Closes by shifting pressures of the right and left heart

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19
Q

Who does this describe:
o System vascular resistance decreases
o Peripheral vasodilation occurs
 Can lead to palmar erythema & spider telangiectasias
o Systolic BP decreases slighty
 Greater decrease in diastolic pressure
o Lowest levels seen in the second trimester
o Venous compression of the vena cava and impaired venous return lead to hypotension
o Blood in lower extremities pool in lower limbs
 Unless in lateral recumbent position
 Due to the enlarged uterus pressing on inferior vena cava and pelvic veins
 May cause and increase in dependent edema, varicosities of the legs and vulva and hemorrhoids

A

pregnant women

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20
Q

WHo does system vascular resistance decrease in?

A

pregnant women

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21
Q

Peripheral vasodilation occurs where?

A

in pregnant women

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22
Q

Systolic BP decreases slightly in ( greater decrease in disastolic pressure)

A

pregnant women

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23
Q

When are lowest level of BP seen in pregnant women?

A

second trimester

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24
Q

What happens to the blood in lower extremities of pregnant women?

A

blood in lower extremities pool in lower limbs

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25
Q

Why does blood in lower extremities pool in lower limbs of pregnant women? (unless in recumbent position)

A

due to enlarged uterus pressing on inferior vena cava and pelvic veins

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26
Q

What cal pooling of blood in lower limbs cause?

A

May cause and increase in dependent edema, varicosities of the legs and vulva and hemorrhoids

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27
Q

Who does this happen in:
o Calcification damages
o Superficial vessels become more tortuous and prominent
o Arterial walls lose elasticity and vasomotor tone
o Increased peripheral vascular resistance
 Elevated BP

A

older adults

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28
Q

In old people, what loses elasticity and vasomotor tone?
Do old people get increased or decreased vascular resistance?
In old people, which vessels become tortuous and prominent?

A

arterial walls
increased (i.e. elevated BP)
superficial vessels

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29
Q

During the HPI watch should you look for?

A 
leg pain and cramps?
swollen ankles?
other symptoms?
On a plane or at high elevation?
Do any medications help?
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30
Q

During PMH and FH what should you ask about?

A

 Any past cardiac problems?
 Any rheumatic fever?
 Any hypertension, hyperlipidemia, diabetes, stroke, arrhythmia etc.?

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31
Q

During SH what should you ask about?

A

 Any stress at work?
 Any tobacco, alcohol, or illegal drugs? If so, how often?
 Diet and exercise? Stay away from McDonald’s!
• Mosby’s says olive oil and red wine (in moderation) = healthy heart

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32
Q

What should you specifically look for in infants and children?

A

 Look for hemophilia, renal disease, and leg pain when exercising

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33
Q

What should you look for in pregnant women?

A

 Look for increases in BP, abnormal bruising or edema, varicosities, pain
 Can have preeclampsia -> more common with advanced maternal age (>40), first pregnancy, and previous Hypertension or diabetes

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34
Q

What is preeclampsia?

A

Hypertension during pregnancy along with protein in urine

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35
Q

In old people, what should you look for?

A 
	Look for leg edema and when it occurs 
	Ask if the symptoms hinder daily activity
	What medications make it better? 
	Varicose veins!
•	More common in:
o	Women  particularly in pregnancy 
o	Irish and German descent 
o	Sedentary lifestyles
o	Old age
36
Q

During the peripheral exam of the arteries, What are you going to palpate?
Which one should you NOT palpate bilaterally at the same time?

A

• Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial

Carotid, you might mess up blood flow to the brain

37
Q

When determining heart rate, how long do you do it for?

A

15 seconds and times it by four

38
Q

What is it called if heartbeat is irregular but in a repeated pattern? In this, when is HR higher, lower,
Normal?

A

sinus arrhythmia
on inspiration, on expiration
on expiration in little kids : )

39
Q

What is indicitative of a heart rate that is irregular but not in a repeated pattern?

A

CHF

40
Q

• Want to compare arteries on each side to look for differences in (blank)

A

pulse contour, amplitude, and symmetry

41
Q

When you are checking pulse contour, what are you checking?

A

for normal pulse

42
Q

What kind of pulse is Strong, then weak and it repeats -> left ventricle failure

A

alternating pulse

43
Q

What kind of pulse has 2 main peaks of pulsation at carotids-> aortic stenosis

A

pulsus bisferiens

44
Q

What kind of pulse has a Normal pulse and then premature contraction ->dysrhythmia

A

bigeminal pulse

45
Q

What kind of pulse has a Strong pulse (3+) -> exercise, anxiety, fever, hyperthyroidism

A

Large, bounding pulse

46
Q

What kind of pulse has ↓ upon inspiration, ↑ upon expiration ->premature contraction, obstruction in trachea or bronchi, asthma, pericarditis

A

paradoxic pulse

47
Q

What kid of pulse has High amplitude that is short in duration-> patent ductus arteriosus or aortic regurgitation

A

Water-hammer (Corrigan) Pulse

48
Q

When looking at arterial amplitude, what is the scale?

A 
1-4
	4 Bounding, aneurysmal
	3 Full, Increased
	2 Expected
	1 Diminished, barely palpable
	0 Absent, not palpable
49
Q

When looking at arterial symmetry, what could lack of symmetry show?

A

could be an obstruction in circulation

(coarctation of the aorta, atheroscletotic peripheral vascular disease, vasculitis)

50
Q

What is coarctation of the aorta?

A

o Aortic arch is narrow in location that ductus arteriosus inserts
(Congenital)

51
Q

What is vasculitis

A

inflammation of a blood vessel or blood vessels.

52
Q

What does the allen test do?

A

determines sufficiency of ulnar artery

53
Q

How does the allen test work?

A

o Kind of random but used when puncturing the radial artery (for blood gas sampling or catheter insertion)

54
Q

How should the allen test be performed?

A

1) Compress radial and ulnar artery with palm facing up
2) Have patient close and open fist 5 times
3) release pressure on ONLY ulnar artery
4) if color is regained in less than 5 seconds, your good, if not you have ulnar artery insufficiency THEN DONT PUNCTURE radial artery b/c your arm will then be diminished of a blood supply

55
Q

You should auscultate or listen over the artery for what?

A

bruits

56
Q

what are bruits?

A

pretty much a murmur sound over an artery  use BELL

57
Q

How do you listen for bruits?

A

Have patient hold breath so respiratory sounds don’t interfere! It is hard enough to hear as it is : (

58
Q

What is the most common bruit?

A

carotid bruit

59
Q

What sounds just like a carotid bruit?

A

venous hum

60
Q

When do you hear venous hum?

A

anemia and pregnancy

61
Q

Where can you hear carotid bruit?

A

subclavian, abdominal aorta, iliac, femoral

62
Q

When will you hear a carotid bruit?

A
  • Most common cause is aortic stenosis

* Can also occur if there is atherosclerosis in the carotid artery obviously

63
Q

 If you suspect peripheral artery disease/occlusion from this physical exam, how can you be sure?!

A

look for the P’s

64
Q

What are the p’s in Peripheral artery disease/occluision?

A

1) Pallor  should be localized, can see cyanosis
o 2) Pain  in area distal to stenosis
o 3) Pulselessness
o 4) Parasthesias (only with major arteries)
o 5) Paralysis (RARE)

65
Q

How can you see how severe the peripheral artery disease/occlusion is?

A

o Have patient elevate extremity above heart level so it loses color  then bring back down and see how long it takes to regain color  2 minutes = SEVERE!
ALSO can do same thing with capillary refill time test with squeezing finger tips, greater than 2 seconds bad. (not diagnosis)

66
Q

if color doesnt regain for 2 minutes in peripheral artery disease test, what does this indicate?

A

SEVERE

67
Q

If a patient has peripheral artery disease/occlusion and has pain in calf which artery is affected?
thigh?
glutes?

A

Superficial femoral
Common femoral or external iliac
Common iliac or distal aorta

68
Q

How should you measure blood pressure?

A 
in both arms
no clothing
Patient must be SITTING
USE BELL
correct size cuff
69
Q

When measuring blood pressure where should you put cuff?

A

2-3 cm superior to crease in arm

70
Q

While palpating radial pulse, increase pressure to 20-30mmHg above the values at which the radial pulse disappears, then what do you do?

A

slowly release pressure and wait until you hear pulse=systolic

71
Q

When reading BP, once the pulse disappears is the (blank) pressure/

A

diastolic

72
Q

The sounds you hear while reading BP are called (blank) sounds

A

Korotkoff sounds

73
Q

How many phases are there in the korotkoff sounds?

A

5 phases

74
Q

•(blank) can be wider in old patients = sounds quiet so be careful b/c you might have inaccurate systole reading

A

Auscultatory gap

75
Q

• In general ->taller and bigger = (blank) BP than shorter and leaner!

A

higher

76
Q 
	Normal vs. Pre-HTn vs. HTn
•	Normal? 
•	Pre-HTn? 120-139 or 80-89 
•	HTn
     o	Stage 1 ? 
     o	Stage 2 ?
A

120/
120-139 or 80-89
140-159 or 90-99
>160 or >100

77
Q

In pulse pressure, the difference between systolic and diastolic BP is bad if what?

A

too narrow or too wide

78
Q

 If diastolic value is above 90 and you expect coarctation of the aorta OR aortic stenosis, measure BP in (blank)

A

legs at popliteal artery

79
Q

BP at legs at popliteal artery is (blank) than in arms.

If it isnt, could be coarctation of the aorta or aortic stenosis

A

higher

80
Q

What is Orthostatic/postural hypotension?

A

greater than 15 mmHg drop in systolic BP upon standing (along with drop in diastolic BP).
Increase in heart rate

81
Q

When should you think about testing for Orthostatic/postural hypotension

A

o Is on anti-HTn medication
o Has less blood volume
o Has syncope (fainting/lightheadedness)

82
Q

When might you see Orthostatic/postural hypotension

A

• Can be seen with mild blood loss (as with a blood donation), drugs, ANS disorder, laying down too long, GI bleeding

83
Q

What kind of pulse is this: Difference in systolic BP upon expiration and inspiration should be 5 mmHg

A

paradoxical pulse

84
Q

WHen do you get an exaggerated paradoxical pulse? When does this happen?

A

1) Difference in systolic BP upon expiration and inspiration greater than 10 mmHg
2) cardiac tamponade, pericarditis, or COPD

85
Q

What are some disruptions to a blood pressure test?

A

cardiac dysrhythmias
aortic regurgiation
venous congestion
valve replacement

Block 1 WK 8 (7 decks)

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