NURS 203 Midterm Flashcards
Precordium
Region of the chest wall that overlays the heart area (surface)
Mediastinum
Place in the chest that holds the heart (cavity)
Base
Top of the Heart
Apex
Bottom of the heart
Pericardium
Protective, fluid-filled sac that surrounds the heart to help it function properly
Myocardium
Muscles of the Heart
Endocardium
Innermost layer of the heart
Atrium
Reservoir
Right Atrium
Receives deoxygenated blood from the body
Left Atrium
Receives oxygenated blood from the lungs
Ventricle
Pump
Right Ventricle
Contracts to send deoxygenated blood to lungs
Left Ventricle
Contracts to send oxygenated blood to the body
Atrioventricular (AV) Valves
Open with diastole, close with ventricular systole)
Tricuspid (Rt) and Mitral (Lt)
Semilunar (SL) Valves
Open with ventricular systole
Pulmonic valve (Rt) and Aortic Valve (Lt)
How many times does the heart beat per day
100,000
How many times does the heart beat per year
35 million
How many times does the heart beat in a lifetime
2.5 billion
How many km of blood is pumped through the body
120 000km of blood vessels
How many L per minute of blood does the heart pump
4-6L blood/minute
Blood Flow
Head + lower body – (superior/inferior) vena cava – RA – RV – Pulmonary artery – LUNGS – Pulmonary Veins – LA – LV – Aorta – Head + body
Diastole
Relaxed ventricles
Systole
Build P in ventricles for ejection
S1 Heart Sound
AV Valves close = lub
S2 Heart Sound
SL valves close = DUP
Effect of respiration on heart sounds
Split S2 (delayed pulmonary valve closure) = T-DUP
Heart Murmurs
Gentle blowing, clocking, rushing or gurgling
r/t velocity or viscosity of blood OR valve wall defects
Characteristic of Heart Sounds to look for
Frequency (pitch)
Intensity (loudness)
Duration (more silence than sound)
Timing (systole or diastole)
Sinoatrial node
Pacemaker
60-100 BPM
AV node
40-60BPM
AV Bundle of His
Collection of heart muscle cells
Rt and Lt Branches - Purkinje fibers
20-40BPM
P wave
Atrial depolarization
P-R interval
Atrial contraction
QRS complex
Ventricular depolarization
Q-T Interval
Ventricular contraction
T wave
Repolarization of ventricles
Cardiac Output formula
HR x SV = CO
Preload
Full ventricle, stretch at the end of diastole
Afterload
P necessary to overcome high P in aorta
Superior and inferior vena cava
return deoxygenated blood to heart
Pulmonary trunks (arteries)
deliver deoxygenated blood to lungs
Pulmonary Veins
Return oxygenated blood to heart
Aorta
Delivers oxygenated blood to head and body
Carotid Arteries
Deliver oxygenated blood to head
Jugular Veins
Drain the head, deoxygenated blood (internal and external)
Angina
Chest pain/tightness
Dyspnea
Shortness of Breath
Orthopnea
Difficulty breathing when laying down
Order of Objective Heart exam
- Pulse and BP
- Extremities
- Neck vessels
- Precordium
Jugular venous pressure (JVP)
Estimate by looking at neck veins, normal = 6-8cm
Jugular venous distention (JVD)
Bulging of major veins in your neck
It is a reflection of Rt atrial pressure
which heart sound is louder at the apex?
S1 is louder than S2 at apex
Which heart sound is louder at the base?
S2 is louder than S1 at the base
Which heart sound coincides with carotid artery pulse
S1
Influence of lifestyle/socioeconomic factors for CVD
High BP
Smoking
Elevated serum cholesterol
Obesity
Diabetes
Myocardial Infarction (MI)
Heart Attack
Factors that affect blood flow
- Pressure differences
- Vascular Resistance
Arteries
Deliver oxygenated blood
Typically run deeper than veins
Muscular-elastic layer = high compliance
Anastomosed
Re-connect/ create a connection
Pulse Sites
Temporal; Carotid; Brachial; Ulnar; Radial; Femoral; Popliteal; Posterior tibial; dorsalis pedis
How many L do capillaries filter per day
20L per day
Capillaries
U-turn of CVS
Smallest blood vessels
Exchange vessels through: simple diffusion, transcytosis, and bulk flow
Veins
Carry deoxygenated blood back to the heart
More numerous than arteries
Deep and superficial
Act as a blood reservoir
Major deep veins
Brachiocephalic; Internal jugular; Brachial; Radial and Ulnar; Iliac; Femoral; Popliteal: Great/small saphenous
Venous Return
Veins have valves to stop backflow
Calf mucles - milking
Lymphatic functions
- Drain excess interstitial fluid - assist venous system
- Act in immune response - Lymph nodes filter micro-organisms; Lymphocytes (WBC)
- Absorb fat from the gut - Dietary lipids and fat-soluble vitamins
Spleen
Largest mass of lymph tissue
Thymus gland
Not functional in adulthood, where T-lymphocytes are sent to mature
Organs essential to immunity
Spleen; Tonsils; Thymus gland (until puberty); Bone marrow
Pulse Grading
0=absent, 1+ weak, 2+=normal, 3+=bounding
Epitrochlear lymph node
Shake hands - medial side of arm, 1-2cm above elbow
How to test for edema
Press on area firmly for 5 seconds and release
Edema Grading
1+ = mild (<2mm, disappears rapidly)
2+ = moderate (2-4mm, detectable distortion)
3+ = deep pitting (> 1 min)
4+ = Very deep pitting (2-5mins)
Arteriosclerosis
Hardening of arteries
Atherosclerosis
Build up of plaque in arteries due to increased cholesterol
Raynaud’s disease
Arteries to the hands spasm and cut off supply
Lymphedema (non-pitting)
Damage to lymph nodes that obstruct flow
Ischemic ulcer
Arterial Ulcer
Lack of O2
Venous Stasis Ulcer
Pooling of blood in venous system, causes tissue breakdown
Varicose Veins
Form from incompetent valves, veins become twisted and enlarged
Deep Vein Thrombosis (DVT)
Blood clot in the deep vein
Can lead to pulmonary embolus
Peripheral Artery Disease
Narrowing/blockage of arteries
Can cause aneurysms or occlusions
Virchow’s Triad
- Flow/stasis
- Endothelial state
- Hypercoaguable state
All contribute to risk of clot formation
Preventing venous stasis
Devices used
Assess skin and pedal pulse
Remove periodically
Assess circulation of toes regularily
Intermittent Pneumatic Compression (IPC)
Air is pumped to alternate between inflation and deflation
Elastic Stockings Requirements
Proper sizing
Dry skin
Turn stockings inside out to apply
No folds/creases
2 fingers below knee and 2 fingers above toes
Apply in AM or 15 mins after rest
IPPA
Inspection
Palpation
Percussion
Auscultation
ADPIE
Assessment
Diagnosis
Planning
Implementing
Evaluating
Components of Central Nervous System
Brain + Spinal cord
Upper motor neurons
Components of Peripheral Nervous System
all nervous tissue outside of CNS; spinal nerves and cranial nerves
Lower motor neurons
Crossed representation
Left side of brain communicates with right side of body (and vice versa)
Nervous System Functions
- Sensory - detect stimuli
- Integrative - processes info and decides what to do
- Motor - activation of muscles/glands
Cerebrum
“Seat of intelligence”
Grey matter
Frontal Lobe
Voluntary movement, personality, emotions or “who we are”, contains broca’s area
Parietal Lobe
Primary sensation center
Occipital Lobe
Primary visual receptor center
Temporal Lobe
Primary auditory center, contains Wernicke’s area
Basal Ganglia
Control automatic movements
Corpus Callosum
Band of neural fibres connects hemispheres
Contains myolin
Thalamus
Major relay station
Hypothalamus
“hub between mind and body”, homeostasis, regulates hormones, temp, appetite, pleasure, pain, rage, sleep/wake
Cerebellum
Blends skilled movements + posture and balance
Parts of the brain stem
Midbrain
Pons
Medulla oblongata
Midbrain
Connects spinal cord to thalamus and hypothalamus
Pons
Ascending/descending fibre tracts (helps medulla to control breathing)
Medulla Oblongata
Vitals (HR, breathing) + other (vomiting, hiccupping, coughing, sneezing) centers
Grey Matter
Site of integration
White matter
Dozens of sensory and motor tracts
Spinal Cord
“main pathway”
Sensory pathways in the spinal cord
Spinothalamic - pain, temp, crude touch
Posterior dorsal columns - vibration, sterognosis, proprioception, fine touch
Motor pathways in the spinal cord
Pyramidal - direct, skilled purposeful movement
Extrapyramidal - indiriect, involuntary movement, respond to movement of head (tone, balance, locomotion), emotional expression
Cerebellum - movement
Motor pathways in the spinal cord
Pyramidal - direct, skilled purposeful movement
Extrapyramidal - indiriect, involuntary movement, respond to movement of head (tone, balance, locomotion), emotional expression
Cerebellum - movement, equilibrium, posture
Upper Motor Neurons
CNS - influence LMN by sending motor responses
Lower Motor Neurons
PNS - Located in periphery, receives from motor “final common pathway”
2 Divisions of PNS
- Somatic Nervous system (voluntary)
- Autonomic Nervous System (involuntary)
Divisions of Autonomic NS
Sympathetic - fight or flight
Parasympathetic - rest and digest
Enteric Nervous System
Brain of the gut - involuntary, independent functions
Analgesic vs Anesthetic Effects
Analgesic = sensory function
Anesthetic = motor function
Reflex arc
associated w spinal nerve
involuntary
protects NS
maintain balance
muscle tone
Deep Tendon reflexes
STRETCH - knee jerk
Superficial reflexes
CUTANEOUS - ABD
Visceral reflexes
AUTONOMIC - pupillary
Pathological reflexes
ABNORMAL - babinski response
Screening neuro check
Healthy patient with no hx of neuro problems
Complete neuro check
patient with a neuro complaint
Recheck neuro
Known neuro deficit (diagnosed)
Complete assessment of neuro (5)
- Mental status
- Testing Cranial nerves
- Inspect/palpate motor system
- Assess sensation
- Test reflexes
Reinforcement
Distraction (clench teeth, grab arms)
Reflex Grading
0 = absent
1+ = weak
2+ = normal
3 + = more brisk than normal
4+ = hyperactive
Clonus
Involuntary muscle contractions
Components of Glasgow Coma Scale
Eye opening response
Motor response
Verbal response
Cerebral Vascular Accident (CVA - stroke)
Ischemic stroke
Hemorrhagic stroke
Transient ischemic attacks
Modifiable Factors for Stroke
CVD
HTN
Smoking
Diabetes
Atrial Fibrilation
Dyslipidemia
Carotid Stenosis
Oral contraceptives
Hormone therapy
Diet and nutrition
Inactivity
Obesity
Non-modifiable risk factors for stroke
Age
Gender
Low birth weight
Ethnocultural background
Genetic factors
Stroke Prevention
Diet
Limit sodium intake
Moderate exercise
Maintain healthy weight
Smoking cessation
Limit alcohol intake
Manage underlying conditions
How many spinal nerves are there?
31
How many Cranial nerves are there?
12
How many Sensory Nerves are there?
3 sensory
How many motor nerves are there?
5 motor
How many sensory/motor nerves (both) are there?
4 both
Cranial Nerve Names in order
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Acoustic
- Glossopharyngeal
- Vagus
- Spinal Accessory
- Hypoglossal
CN I Function
Olfactory Nerve
Controls sense of smell
How to test CN I
Check patency
Have pt identify familiar scents (coffee or mint)
CN II Function
Optic Nerve
Controls Central and Peripheral vision
How to test CN II
Using the confrontation test
CN III Function
Oculomotor Nerve (extraocular)
Position of eyelids and size of pupils
CN IV Function
Trochlear Nerve (extraocular)
Supplies superior oblique muscles in the eyeball
CN V Function
Trigeminal Nerve
Face Sensations
CN VI Function
Abducens (extraocular)
Innervates the rectus lateral muscle (lateral movements)
How to test CN III
Check eyelids for ptosis
6 cardinal positions
How to test CN IV
Check pupils - measure in mm
How to test CN VI
Check pupils
6 cardinal positions
How to test CN V
Assess Ophthalmic, Maxillary and Mandibular areas by using cotton wisp test - LIGHT TOUCH SENSATION
CN VII Function
Facial Nerve
Controls facial movements and expression
How to test CN VII
Have pt to smile, frown, close eyes tightly, lift eyebrows, show teeth and puff cheeks - should be smooth and symmetrical
Use taste test only if facial nerve injury is suspected
CN VIII Function
Acoustic (Vestibulocochlear)
Controls hearing
How to test CN VIII
Whispered voice test
Weber and Rinne test (not routinely done)
CN IX Function
Glossopharyngeal
Provides motor and sensory information to the nose and throat
CN X Function
Vagus Nerve
Regulates internal organs, has some reflexes like coughing, sneezing, vomiting, etc.
How to Test CN IX and X
MOTOR: Depress tongue and have pt say “ahh” - uvula and soft palate should rise midline and tonsillar pillars move medially - touch wall to elicit gag reflex
SENSORY: Taste at the back of the tongue (not routinely done)
CN XI Function
Spinal Accessory Nerve
Controls neck and shoulder movement
How to test CN XI
Rotate head against resistance
shrug shoulders against resistance
CN XII Function
Hypoglossal Nerve
Innervates the tongue - controls the muscles that move it
How to test CN XII
Ask pt to stick tongue out - thrust should be midline, no tremors
Have pt say “light, tight, dynamite”
How to Test Spinothalamic tract
Pain - varied dull and sharp stimuli over various parts
Temp - 2 test tubes
Light touch - cotton wisp over various parts of the body
How to test Posterior column tract
Vibration (tuning fork)
Kinaesthesia
Fine touch (tactile discrimination)
How to test fine touch (tactile discrimination)
Stereognosis - ID object
Graphaesthesia - draw onto hand
Two-point discrimination - mm to determine 2 points
Extinction - bilateral perceptions
Point location - pt point to area that you touched
Conjunctiva
Membrane covering the sclera
Helps lubricate eyes
Sclera
“Whites” of the eye
Help in proper attachment of eye tendons
Provides stability and protection for the eye’s inner workings
Iris
Colored part of the eye
Regulates how much light reaches the retina by controlling the size of the pupils
Performs accommodation reflex - ability to shift focus from nearby to distant objects
Pupils
Black dot in the middle of the iris
Allows the eye to focus on the things in front of it and regulates how much light enters the eye
Cornea
Clear and protective outer layer = acts as barrier against dirt/microorganisms
Enables the eye to focus on ibjects effectively
Choroid
Vascular layer between sclera and retina - delivers nourishment through blood and oxygen supply
Retina
Sensitive membrane that covers the eye’s rear surface
Converts images to impulses before sent to brain
6 Eye Muscles - 4 rectus, 2 oblique
Superior Rectus - moves eye up
Inferior Rectus - moves eye down
Medial Rectus - moves eye toward nose
Lateral Rectus - moves eye toward temple
Superior Oblique - Rotates eye inwards and downwards
Inferior Oblique - Rotates eye outwards and upwards
Eye Lens
Changes its thickness and curvature allowing the eye to focus on objects in varying distances
Optic Nerve
Bundle of 1.2 million nerve fibers that transmit visual info to the CNS
Optic Disc
Place at which the axons of ganglion cells join and mark the beginning of the optic nerve
Fovea centralis
Houses cones that help with proper vision - located within the macula
Caruncle
Moisturize the eye and protect it (fleshy pink in coner)
Canthus
Provides an anchor point that allows eyelids to completely shut
Palpebral fissure
allows for movement of the eye without stretching the bulbar conjunctiva
Accessory Structures of the eye
eyelids, eye lashes, palpebral fissure, canthus
Middle layer of external eye
pupil lens, anterior/posterior chambers
Lacrimal apparatus
Lacrimal gland creates tears, and lacrimal sac releases them
Middle layer of internal eye
Choroid, iris, pupil lens, anterior/posterior chamber
Inner layer of the eye
retina, optic disc, vessels, macula, fovea centralis
Damage to the LEFT side of brain
Affect nasal field in the left eye, and temporal field in the right eye (right sides of both eyes)
Damage to the RIGHT side of brain
Affect nasal field in right eye, and temporal field in the left eye (left sides of both eyes)
Function of the eyes
Light rays enter corneas and are bent (refracted) onto lens
Ciliary body controls thickness of lens
Iris = diaphragm
Pupils control amount of light entering retina
Strabismus
Eyes not working in synchrony
Diplopia
Double vision
Glaucoma
Build up of pressure in anterior chamber
Snellen Eye Chart
Stand 20ft away, read letters
Expected ranges of peripheral vision
Superior = 50 degrees
Nasal = 60 degrees
Inferior = 70 degrees
Temporal = 90 degrees
Nystagmus
Jerkiness of the eye
PERRLA
Pupils equal, round, reactive to light and accommodate
Ocular Fundus
Supply blood to retina
Should see red reflex, optic disk, retinal vessels, fundus background (orange) and macula
Macular degeneration
Disorder of the retina
Cataracts
Lens becomes cloudy
Diabetic retinopathy
Retinal changes/hemorrhages
Presbyopia
‘old eye’ - lens less flexible, can’t change shape easily
Myopia
Nearsightedness
Hyperopia
Farsightedness
External Ear
Pinna and auricle, external auditory canal or tube
Tympanic membrane
divides the middle and external ear
Ossicles
3 small bones that transmit sound waves to the inner ear
- Malleus
- Incus
- Stapes
Eustachian Tube
Canal that links the middle ear with the back of the nose - helps to equalize pressure
Inner Ear (Labyrinth) parts
Cochlea, vestibule and semicircular canals
Cochlea
contains nerves for hearing
Vestibules
Contains receptors for balance
Semicircular canals
Contains receptors for balance
How does hearing work?
Sound made outside the outer ear and travels through auditory canal and strikes tympanic membrane - eardrum vibrates and these are passed to the ossicles which amplify the sound - they send sound waves to the cochlea - converted into electrical impulses and auditory nerve sends these impulses to the brain - brain translates the impulses as sounds
Cone of light
Reflected from the otoscope - tells you that the tympanic membrane is normal (should point towards the nose)
Bone Conduction
Starts at the stapes to vibrate the oval window (skips tympanic membrane)
Air Conduction
More sensitive - uses the tympanic membrane which causes the stapes to vibrate the oval window
Function of the Ears
Equilibrium, hearing and awareness of our orientation space
Otosclerosis
‘hardening’ of the oval window
Sensorineural
Nervous system damage
Tinnitus
ringing/buzzing in ears
Vertigo
Room spinning
How do you pull ears when using otoscope (adult)
Pull pinna up and back to straighten canal
How do you pull ears when using otoscope (children)
Pull straight down
Cephalic
Pertaining to the head
Cranial
Skull
Syncope
Fainting
Blephar/o
Eyelid
