Quiz 3 Concepts Flashcards
What is the pericardium and why is it double-walled>
it is a sac that surrounds and protects the heart
-it is double-walled to make it harder for things to hurt the heart
What is the myocardium?
the muscular wall of the heart, it is responsible for contraction of the heart
What is the endocardium?
the thin layer of endothelial tissue that lines the inner surface of the heart chambers
What is the flow of blood starting at the vena cava?
right atrium –> tricuspid valve–> right ventricle–> pulmonary valve–> pulmonary artery–>pulmonary vein–> left atrium–> mitral valve–> left ventricle–> aortic valve–> aorta
What does S2 indicate?
the closing of the semilunar valves (aortic and pulmonary valves)
-this is the end of systole
Where is S2 heard the loudest?
the base of the heart
What does S1 indicate?
the closing of the mitral and tricuspid valves
-heard the loudest at the apex
What occurs after the pacemaker is initiated?
the impulse travels to the atria to the AV node, it delays, and gives the atria time to contract
What gives information about the activity on the right side of the heart?
jugular veins, they reflect volume changes and filling pressures
With aging, what happens to the heart?
systolic pressure increase
no change in diastolic pressure
What occurs with paroxysmal nocturnal dyspnea?
it is shortness of breath that occurs at night, lying down increases blood volume and the weak heart can’t accomodate
How do you assess for significant risk factors of coronary artery disease?
assess serum cholesterol, elevated BP, blood glucose levels, diabetes, obesity,
What should auscultate if cardiovascular disease is suspected?
each carotid artery to listen for a bruit
How do you avoid compromising arterial blood to the brain?
palpate one carotid artery gently at a time, medially
How does heart failure affect the heart?
it decreases cardiac output and circulation becomes backed up bc the heart can’t pump it
What sound is associated with heart failure?
S3
Where is S4 heard and who does it occur in?
its heard at the end of diastole and ventricles resist filling, mainly occurs in older adults
How do you auscultate the carotid artery for bruits?
applying the bell of the stethoscope over the carotid artery at three levels
-the patient should breath, exhale, and briefly hold it
How does blood move through the veins?
contracting skeletal muscles to milk the blood toward the heart
pressure gradients
the valves
What would occur if skeletal muscle, valves, and lumen didn’t work?
venous stasis
What would occur if somebody stood or sat for a prolonged amount of time?
venous disease because they do not get the milking action that walking causes
What propels the flow of lymph?
contracting skeletal muscles
Where does lymph flow?
from the tissue spaces to the bloodstream
Where are the epitrochlear nodes located and what do they drain?
in the antecubital fossa and they drain the lower arm
Where are the inguinal nodes and what do they drain?
drain lymph in the lower extremities and they are located in the groin
What happens to the peripheral blood vessels as aging occurs?
they become more rigid and cause a rise in systolic blood pressure (arteriosclerosis)
What is intermittent claudication?
feels like a cramp
What patient population is night leg pain common in and what does it indicate?
ischemic rest pain of peripheral arterial disease, common in aging adults
If there are alterations in arterial circulation,what can occur?
pain that worsens with leg elevation and eases when the extremity is dangled
What does a capillary refill time of 5 seconds indicate?
a decrease in capillary refill indicating vasoconstriction or decreased cardiac output
What does a weak thready pulse indicate?
shock or peripheral artery disease, associated with decreased cardiac output and peripheral arterial disease
What does unilateral coolness indicate?
arterial problems
How does brawny edema appear?
as nonpitting edema and it feels hard to the touch
What causes superficial varicose veins?
incompetent distant valves in the veins resulting in blood reflux and dilated veins
Raynaud phenomenon
episodes of abrupt progressive tricolor changes of the fingers in response to cold, vibration, stress
lymphedema
accumulation of lymph fluid in the interstitial spaces in the arm that may occur with breast cancer
What does lymphedema look like in someone who has breast cancer?
unilateral swelling and nonpitting brawny edmea
What is deep vein thrombosis and how does it present?
development of a clot in a deep vein, commonly in the legs
presents with swelling, pain, redness, and warmth
Where do arterial ischemic ulcers occur and how are they characterized?
toes, metatarsal heads, heels, and lateral ankles
-pale, no bleeding, well defined edges
What is held in the right upper quadrant?
liver, gallbladder, duodenum, head of the pancreas, right kidney, adrenal gland
What is held in the left upper quadrant
stomach, spleen, left lobe of the liver, body of the pancreas
What is held in the right lower quadrant of the abdomen?
cecum, appendix, right ureter, fallopian tube
what is held in the left lower quadrant?
descending colon, left ureter, left ovary, fallopian tube
What additional structures lie in the midline of the abdomen?
aorta, distended bladder, enlarged uterus
What is dysphagia?
diffuculty swalloing
What is dysphasia?
difficulty speaking
When can you palpate a spleen?
if its 3x the normal size
Contour
describes profile of the abdomen, describes nutritional state, ranges from flat to round
Convex
curved, rounded, outward protrusion
Hernia
protrusion of the abdominal viscera through an abnormal opening in the abdominal muscle wall
What can cause diminished or absent bowel sounds?
paralytic ileus
How long must you auscultate the abdomen before deciding that bowel sounds are absent?
5 minutes
When should you examine any identified tender areas of the abdomen?
at the end of the assessment
Why might decreasing gastric acid secretions cause pernicious anemia?
decreased gastric acid interferes with the absorption of vitamin B12
Ascites
free fluid in the peritoneal cavity
occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer
How do you assess for an inflamed appendix?
obturator and iliopsas muscle tests
What could rebound tenderness indicate?
peritoneal inflammation, cholecystitis
What test determines that someone has cholecystitis?
pain occurs when palpating the liver because the descending liver pushes the inflamed gallbladder onto the examining hand (murphy test)
How do peptic ulcers occur?
acid in the digestive tract erodes the inner surface of the stomach or small intestine
- can occur with frequent NSAID use, alcohol use, smoking
What are the signs and symptoms of acute venous problems?
sudden onset pain in the calf that is warm, red, and swollen
How do arterial symptoms present?
the pain begins with exertion and is relieved with rest or dangling, pale and cool skin
-pts. usually have a smoking history and diabetes
