nurse 252 heart and neck Flashcards
where is the apical pulse heard?
fifth intercostal space, midclavicular line
what returns unoxygenated blood to the right side of the heart?
anterior and inferior vena cavae
what leaves the right ventricle and carries the venous blood to the lungs?
pulmonary artery
what returns freshly oxygenated blood to the left side of the heart
pulmonary vein
what is the pericardium?
a tough, fibrous, double walled sac that surrounds and protects the heart
what is the myocardium?
is the muscular wall of the heart, it does the pumping
what is the endocardium
is the thin layer of endothelial tissue that lines the inner surface of the heart chamber and valves
what is an atrium?
located at the top, a thin walled reservoir for holding blood
what is a ventricle?
at the bottom, thick walled and muscular pumped chamber
what are the four valves of the heart in order?
tricuspid value -> pulmonary valve -> mitral valve -> aortic valve
where are semilunar valves located?
between the ventricles and the pulmonary arteries (pulmonic valve and aortic value)-open when blood is ejected from the heart
where are the atrioventricular valves located?
they seperate the atria and ventricles (tricuspid and mitral) -open during diastole and allow ventricles to fill with blood
how does blood flow?
from areas of higher pressure to lower pressure
what is diastole?
the ventricles are relaxed, and the AV valves (tricuspid and mitral) are open
-heart is “chilling”
is it concerning if the heart is under high pressure during distole?
- when under high pressure during this phase, it is very concering
- keep this number under control
what is systole?
A large volume of blood has been pumped into the ventricles
-this volume raises ventricular pressure so that it is finally higher thna that in the atria, and the mitral and tricuspid valves swing shut to prevent regurgitation of blood back into the atria during contraction
what is the first heart sound (S1) made by?
closure of the AV valves (tricuspid and mitral)
-is the “LUB” noise
where is S1 loudest at?
the Apex
what is the second heart sounds (s2) make by?
occurs when the semilunar valves close and signals the end of systole
-“DUB” noise
what is the normal rate of range for beats per min?
60- 100 bpm
what is sinus arrhythmia?
one irregular beat that occurs normally in young adults and children
what are the two extra heart sounds?
S3 and S4
what is the S3 heart sound? is it normal?
is it sometimes abnormal, but cacn be normal.
-is heard when the ventricles are resisting to filling
when does S3 occur?
-this occurs immediately after S2, when the AV valves open and the atrial blood first pours into the venticles
is the S4 sound normal or abnormal?
always abnormal
when does S4 occur?
occurs at the end of diastole
- the atria contact and push blood into a noncompliant ventricle
- occurs right before S1
how do you assess the S3 heart sound?
lay pt on left side (bring heart closer to chest) -assess in two positions
why might a preggo woman have an S3 heart sound
heart needs to pump harder to supply baby with blood
what are some health history questions (subjective data) to ask about a pts cardiac system?
-chest pain
-dyspnea (difficult breathing)
-orthopnea- shortness of breath when laying down (lungs fill with fluid)
-cough
-fatigue
-cyanosis or pallor
-edema- swelling of lower extremities is a sign of heart failure
-nocturia (excessive urination at night, edema fluid from lower extremities goes to kidneys and is excreted through urine
cardiac history
-family cardiac history
-cardiac risk factors (nutrition, alcohol, smoking, excersise, stress, drugs
how would u assess someone for cardiac issue
ausculate the carotid artery ( on neck) for pts who show signs or symtoms of CVD, ausculate each side and lsiten for presense of a bruit
what is a bruit and what does it indicate
a swooshing noise (caused by turbulence-narrowing of artery
-is audible when lumen is half or two thirds blocked
what position would u put a pt in to auscultate for a bruit?
keep the neck in a neutral positio, lightly apply the bell over the carotid artery at:
1) angle of the jaw
2) midcervical area
3) base of neck
what is important to keep in mind when palpating the carotid artery?
only palpate one at a time, or can limit blood flow to the brain
where to hear aortic valve?
second right intercostal space
where to hear pulmoic valve?
second left interspace
how to hear tricuspid valve?
firth intercostal space left lower sternal borner
how to hear mital valve?
fifth intercostal space at approx left midclavicular line
what is a murmur and what does it sound like?
a blowing, swooshing sound that occurs with turbluent blood flow in the heart or great vessels
what may a murmur be caused by?
congential defects (born with abnormal heart) and aquired valvular defects
what are functional murmurs?
caused by increased blood flow in the heart
-eg, anemia, fever, preggo, hyperthyriodism
whats important to remember about listening to a murmor?
some disappear or are enhanced by a change in position
what is aortic stenosis*
- stiffening of valve
- Calcification of aortic valve cusps restricts forward flow to blood during systole
- pt will ned new heart valve
- pts will feel fatigue, dizziness
- pt will have pallor (pale), slow diminished radial pulse, low bp, murmur is loud and harsh
what is mitral regurgitation?
valvue doesnt close properly, blood flows back into atrium
-stream of blood regurgitates back into left atrium during systole through incompent mitral valve
objective and subjective finding with mitral regurgitation?
s: fatigue, palpitation, orthopnea (shortness of breath when laying horizontal)
o: thrill occurs in systole at apex
is the atrial rate faster or slower than the ventricle rate?
it should be equal- should always be working together, if not, there is something abnormal
whats the purpose of the lymphatic vessels?
removes and drains fluids, keeps immune system strong
-these vessels form a completly seperate vessle sysmte, which retreives excess fluid from the tissue spaces and returns it to the bloodstream
what would happen without the lymph drainage?
fluid would build up in the interstitial spaces and produce edema
what are the two main trunks that lymphatic vessles drain into?
the right lymphatic duct and the thoracic duct
what is the right lymphatic duct? where does it empty to?
empties into the right subclavian vein, it drains the right side of the head, neck, right arm, right side of thorax, right lung, right sie of heart, and right upper section of the liver
what does the thoracid duct drain?
drains the rest of the body, it empies into the left subclavian vein
what are the functions of the lymphatic system?
- conserve fluid and plasma proteins that leak out capillaries
- to form a major part of the immune system that defends the body against disease
- to absorb lipids from the intestinal tract
what are the functions of the spleen?
- to destroy old red blood cells
- to produce antibodies
- store red blood cells
- to filter microorganisms from blood
why are ppl with mono told to stay away from strenuous or physical activity?
spleen becomes largely vasular, and could rupture
whats the purpose of the thymus gland?
is large in young childre but atrophies after puberty. it is important in developing the T lymphocytes of the immune system in children, but serves no fuction in adults
what is some subjective data for the lymphatic system?
leg pain or cramps
- skin changes on arms or legs
- swelling in arms or legs
- lymph nodes enlarged
- medications
how are arteries made to withstand pressure demands?
they are strong, tough and tense
how do arteries control rate of blood flow?
the vascular smooth muscle contrals and dialtes which changes the diameter of the arteries to push blood
where to palpate temporal artery?
feel infront of ear
how to palpate carotid artery?
palpated in the groove between the sternomastoid muscle and the trachea
how to palpate femoral?
passes under the iguinal ligament
how to palpate popiteal?
lower thigh, back of knee- divides into dorsalis pedis artery and posterior tibial artery
where do deep veins run along? what do they conduct most of?
-they run alongside the deep arteries and conduct most pf the venous return from the legs- these are the femoral and popiteal veins
What do veins drain?
they drain deoxygenated blood and its waste products from the tissues and return it to the heart
veins keep blood moving by…
1) contracting skelatal muscle that milk the blood toward the heart- immobile pts dont get this
2) the pressue gradient caused by breathing- in which inspiration makes the thoracic pressure decrease and abdominal pressure increase
3) the intraluminal valves, which ensure undirectional fliow
what does venous statis occur from?
prolonged standing, sitting, or bed rest because of the absesen of the milking that walking accomplishes
what assessment tools can be used to determine venous return?
- note skin color or nail beds, temp, texture and turgor
- use the profile sign (veiwing the finger from the side) to detect early clubbing- curvature of the bail that reflects congential heart diease
- capillary refill (indicator of peripheral perfusion and cadiac output (refill time or more than 1 or 2 seconds signifies vasoconstriction.
what is the graded four point scale used for when it comes to pulse?
-palpare radial and dorsalis pedis pulses, noting rate, rhythm, elasticity, of vessel walls and equal force
3+= increase, full, bounding, means paranoid, psycholgic , fight or flight
2+ = normal
1+ = weal
0 = absent (medical emergency ) or clot in limb
what are some abnormal findings for veins?
- ischemic ulcer
- diabetes
- venous stasis ulcer
- Deep vein thrombosis
what is a doppler ulterasonic stethoscope used for?
- use this device to detect weak peripheral pulse
- doppler magnifies pulsatile sounds from the heart and blood vessles
- place ultrasound gel on the end of the handheld transducer and hold gently at 45 degree angle
what is peripheral artery disease?
- occlusions in the arteries are cause by atherosclerosis, which is the chronic gradual buildup of fatty streaks, fibroid plaque, calcification of the vessle wall and thrombus formation
- occlisions reduce blood flow, which reduces the availablilty of vital 02 and nutrients
what is an aneurym?
- an aneurysm is a sac formed by dilation in the artery wall
- artery wall weakened, coule be due to hypertension, high bp
- atherosclerosis weakens the middle later of vessle walls
- this streches the inner and outer layers, and the effect of blood pressure creates a balloon like enlargment
- most common site is the aorta
What is an abdominal aortic aneurysm?
- most common are fusiform in shape (dilation of vessles on both sides) extending from below the renal arteries to invole the entire inrfa-renal aorta and often invole the common iliac arteries
- pts die if it bursts
- mortality is high
- pressure causes lower abdominal pain and dull lower back pain
what is a characterist of pain assosiated with DVT?
sudden onset
