NURS 264 Exam 3 Flashcards
What are the 3 layers of the heart
Heart wall has numerous layers.
➢ Pericardium: tough, fibrous, double-walled sac that
surrounds and protects heart
➢ Myocardium: muscular wall of heart
➢ Endocardium: thin layer of endothelial tissue that lines inner surface of heart chambers and valves
What are the 4 valves of the heart?
Four valves in heart:
➢ Two atrioventricular (AV) valves
➢ Mitral & Tricuspid
➢ Two semilunar (SL) valves
➢ Pulmonic & Aortic
Heart Chambers and Valves
What amount of the cardiac cycle do diastole and systole make up?
Diastole: ventricles relax and fill with blood
➢ 2/3 of cardiac cycle
Systole: heart’s contraction, blood pumped from
ventricles fills pulmonary and systemic arteries
➢ 1/3 of cardiac cycle
What is isometric contraction?
For a very brief moment, all four valves are
closed and ventricular walls contract
➢ Isometric contraction: this contraction against
closed system works to build high level pressure in
ventricles
What causes the first heart sound S1?
First heart sound (S1)
➢ Occurs with closure of AV valves—signals beginning of systole
➢ Mitral component of first sound (M1) slightly precedes tricuspid
component (T1), usually heard as one sound.
➢ S1 loudest at apex (left MCL, 4-5 ICS)
What causes the second heart sound S2?
Second heart sound (S2)
➢ Occurs with closure of semilunar valves—signals end of systole
➢ Aortic component of second sound (A2) slightly precedes pulmonic
component (P2), usually heard as one sound.
* S2 loudest at base (2nd ICS, right of sternum)
What causes the 3rd and 4th heart sound?
Third heart sound (S3) lub Dub dub
➢ Occurs when ventricles resistant to filling during early
rapid filling phase (protodiastole)
➢ Occurs immediately after S2, when AV valves open
and atrial blood first pours into ventricles.
Fourth heart sound (S4) Lub lub Dub
➢ Occurs at end of diastole, at presystole, when
ventricle resistant to filling
➢ S4 occurs just before S1
Cardiac output (what is its equation?)
Cardiac output: In resting adult, heart normally pumps between 4
and 6 L of blood per minute throughout body
➢ CO= HR x SV
➢ Heart can alter its cardiac output to adapt to metabolic needs of body.
➢ Preload and afterload affect heart’s ability to increase cardiac output.
What is different with pregnant women when it comes to the heart?
Pregnant woman
➢ Blood volume increases by 30% to 40% during pregnancy.
➢ Despite increased cardiac output, arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation.
What is orthopnea and nocturia?
- Inability to breath well when laying
- Getting up in the middle of the night
What equipment is needed for a heart exam?
Equipment
➢ Marking pen
➢ Small centimeter ruler
➢ Stethoscope with diaphragm and bell endpieces
➢ Alcohol wipe to clean endpiece
Preparation and Equipment
What are the 5 areas of auscultation and what shape do they make?
- Aortic area
- Pulmonic area
- Erbs point
- Tricuspid area
- Mitral area
(they make a z shape 3 ontop 2 on bottom)
What is the grading for murmurs?
1-6
Who is S3 more common in?
Children
Are murmurs normal in some populations?
Yes, children have a 30% chance of occurrence.
What Age related changes occur in terms of the heart?
- Pregnant women see a 10-15 bpm increase in heart rate.
- Mammary soufflé (murmur) occurs near term or when women is lactating)
- Older adults are at risk of orthostatic hypertension.
What veins are accessible?
- Jugular veins
- Leg veins
- Deep
- Superficial
- Perforators
What arteries are accessible for examination?
- Temporal and carotid arteries
- Arteries in the arm (Brachial, ulnar and radial)
- Arteries in the leg (Femoral, popliteal, anterior tibial to dorsals pedis and posterior tibial to plantar arteries
What are the functions of the lymphatic system?
Functions of lymphatic system are to
➢ conserve fluid and plasma proteins that leak out of capillaries.
➢ form a major part of immune system that defends body against
disease.
➢ absorb lipids from intestinal tract.
What does the spleen do in the lymphatic system?
Spleen
➢ Located in left upper quadrant of abdomen, it has four functions:
* Destroy old red blood cells
* Produce antibodies
* Store red blood cells
* Filter microorganisms from blood
What do the tonsils do in the lymphatic system?
Tonsils (palatine, adenoid, and lingual)
➢ Located at entrance to respiratory and gastrointestinal tracts and
respond to local inflammation
What does the thymus do in the lymphatic system?
Thymus
➢ Flat, pink-gray gland located in superior mediastinum behind
sternum and in front of aorta
➢ Develops T lymphocytes of the immune system in children
What developmental changes occur in the lymphatic system
- Children: nodes are relatively large when young
- Pregnant women: Drop in blood pressure, Edema in legs
- Older adult: fewer lymph nodes and decreased size of nodes
What does a modified Allen test assess for?
- assesses adequacy of collateral circulation.
What are the stages of pitting edema?
If pitting edema is present, grade it on following scale:
* 1+ Mild pitting, slight indentation, no perceptible swelling
* 2+ Moderate pitting, indentation subsides rapidly
* 3+ Deep pitting, indentation remains, leg looks swollen
* 4+ Very deep pitting, indentation lasts long time, leg grossly swollen and distorted
What should you do if you suspect arterial deficit?
If you suspect an arterial deficit, raise legs about 30 cm (12 in.) off table and ask the person to wag feet for 30
seconds to drain off venous blood.
➢ Skin color now reflects only contribution of arterial blood.
➢ Be aware of ethnic variations.
➢ Now have the person sit up with legs over side of table.
➢ Compare color of both feet, and note time it takes for color to
return to feet; normally this is 10 seconds or less.
➢ Note time it takes for superficial veins around feet to fill.
➢ About 15 sec is expected
➢ Test lower legs for strength and sensation.
➢ Dorsiflexion and plantar flexion against resistance, monofilament
assessment, sense of vibration and position.
Doppler Ultrasonic Probe (What does it do?)
Use this device to detect a weak peripheral pulse, to measure low blood pressure or blood pressure in lower extremity.
How to assess Ankle Brachial index (ABI)?
Use Doppler stethoscope.
➢ Apply regular arm BP cuff above ankle & determine SBP in either post. tibial or dorsalis pedis artery
➢ Divide ankle SBP by brachial SBP
➢ 132 ankle SBP/124 brachial SBP = 1.06 or 106%
➢ Indicates no flow reduction (pg. 522)
➢ Normally ankle pressure slightly higher than or equal to brachial SBP; normal ABI 1.0-1.4
➢ Two measurements taken and then the average is used as the recorded pressure
➢ 0.9-0.71 = mild PAD
➢ 0.7-0.41 – moderate PAD
➢ <0.4 = severe PAD, critical limb ischemia
What is the Wells score for DVT?
Higher the score, greater the risk.
➢ Score of 0 or less indicates a low probability.
➢ Score 1 or 2 indicates moderate probability.
➢ Score of 3 points or higher indicates high probability
What pulses may be harder to find in older adults?
Dorsalis pedis and posterior tibialis pulses may become more difficult to
find, should be able to palpate at least one on each foot
What is the difference between arterial ulcers and Venous ulcers?
- Arterial ulcers are usually black and look like pooling has occurred
- Venous ulcers look like scabbing and breaking of the skin
What does Lymphedema result in?
Lymphedema - surgical removal of lymph nodes (thick, heavy arm,
unilateral)
What is Raynaud phenomenon?
Raynaud phenomenon - color changes in fingers r/t cold temp, vibration & stress
Right Upper Quadrant (RUQ) What is located in this quadrant?
Right Upper Quadrant (RUQ)
➢ Liver
➢ Gallbladder
➢ Duodenum
➢ Head of pancreas
➢ Right kidney and adrenal
gland
➢ Hepatic flexure of colon
➢ Part of ascending and
transverse colon
Left Upper Quadrant (LUQ) What organs are in this quadrant?
Left Upper Quadrant (LUQ)
➢ Stomach
➢ Spleen
➢ Left lobe of liver
➢ Body of pancreas
➢ Left kidney and adrenal gland
➢ Splenic flexure of colon
➢ Part of transverse and descending colon
Anatomic Locations of Upper Quadrants
Right lower quadrant (RLQ) What organs are in this quadrant?
Right lower quadrant (RLQ)
➢ Cecum
➢ Appendix
➢ Right ovary and tube
➢ Right ureter
➢ Right spermatic cord
Left lower quadrant (LLQ) (What organs are in this quadrant?
Left lower quadrant (LLQ)
➢ Part of descending colon
➢ Sigmoid colon
➢ Left ovary and tube
➢ Left ureter
➢ Left spermatic cord
Developmental changes in pregnant women in terms of abdominal cavity.
Nausea and vomiting, or “morning sickness”
➢ Cause unknown; may be due to hormone changes, such as production of human chorionic gonadotropin (hCG)
➢ “Acid indigestion” or heartburn (pyrosis) caused by esophageal reflux
➢ Gastrointestinal motility decreases, which prolongs gastric emptying time, decreases absorption, and leads to constipation
What is Celiac disease?
Celiac disease
➢ Autoimmune disorder
➢ Intolerant of gluten ; protein found in wheat, rye, barley & some oats.
➢ Diarrhea, abdominal pain & distention; anemia, neuropathy, osteoporosis, abnormal liver functions, skin lesions
➢ Gluten-free diet (GFD)
What is dysphagia?
Difficulty swallowing
What order should inspection of the abdomen be done on older adults?
- Inspection
- Auscultation
- Palpation
- Percussion
What are the 4 types of abdomen contour?
- Flat
- Rounded (belly)
- Scaphoid (sunken belly)
- Protuberant (beer belly)
What order should the 4 abdominal quadrants be assessed in?
- RLQ
- RUQ
- LUQ
- LLQ
Borbogymus (What is it?)
Borborygmus is the sound of hyper peristalsis (stomach growling
Where should be assessed to assess the kidneys?
To assess kidney, place one hand over 12th rib at costovertebral angle on back
➢ Thump that hand with ulnar edge of your other fist
Hooking technique (What is it?)
Hooking technique
➢ Alternative method used to palpate liver
Is the spleen normally palpable?
No, only if distention has occurred
What tests can be performed for appendicitis?
Other special tests for Appendicitis:
➢ McBurney’s Point Tenderness
➢ Iliopsoas Muscle Test
Are the kidneys and liver easier to palpate in older adults?
- Yes, they stick out more
What is succession splash?
Succussion Splash
* Marked peristalsis +projectile vomiting in newborn = pyloric
stenosis
What should be assessed in each of the 4 stages of an abdomen examination?
Inspection
➢ Contour, symmetry, umbilicus, skin, pulsation or movement, hair distribution & demeanor
Auscultation
➢ Bowel sounds; note any vascular sounds
Percussion
➢ All four quadrants and borders of liver & spleen
Palpation
➢ Light and deep palpation in all four quadrants, & palpate for liver and spleen
