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Health Assessment > Quiz #3 Heart and Neck Vessels > Flashcards

Quiz #3 Heart and Neck Vessels Flashcards

1
Q

S1 sound

A

Occurs with closure of the AV valves- beginning of systole

All over precordium, but loudest at the apex

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2
Q

S2 sound

A

Occurs with closure of the semilunar valves- end of systole.
Heard all over precordium, but loudest at the base.

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3
Q

S3 sound

A

Ventricles are resistant to filling during early filling phase- occurs immediately after S2 when AV valve opens. Can be heard at apex or left lower sternal border.

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4
Q

S4 sound

A

Occurs at the end of diastole when ventricle is resistant to filling. Atria contract and push blood into a noncompliant ventricle- creates vibrations heard as S4.
Could occur in adults older than 40 without cardiovascular disease, especially after exercise.

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5
Q

Causes of heart murmurs

A
  1. Velocity of blood flow increases (flow murmor)
  2. Viscosity of blood decreases (anemia)
  3. Structural valve defects or unusual openings- eg dilated chamber or septal defect
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6
Q

Blood volume during pregnancy

A

increases by 30-40%, most rapid expansion during second trimester

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7
Q

Pulse rate in pregnancy

A

increases by 10-15 bpm

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8
Q

Arterial BP in pregnancy

A

Decreases due to peripheral vasodilation

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9
Q

foramen ovale

A

opening in the atrial septum of a fetus through which oxygenated blood enters the heart

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10
Q

ductus arteriosus

A

Routes oxygenated blood from the pulmonary artery to the aorta.

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11
Q

Heart position in the infant

A

More horizontal— apex is higher. Reaches adult position at age 7 years

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12
Q

Hemodynamic changes in aging

A
  1. Increase in systolic BP due to thickening and stiffening of the arteries (arteriosclerosis).
  2. Increase in pulse wave velocity
  3. Left ventricular wall thickness increases.
  4. Diastolic BP may decrease— pulse pressure increases
  5. No change in resting HR
  6. Cardiac output at rest does not change
  7. Decreased ability to change output with exercise
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13
Q

Dysrhythmias in aging

A

Presence of supraventricular and ventricular dysrhythmias increases with age.
Ectopic beats are common
Tachydysrhythmias are not tolerated well in older people as myocardium is thicker and less compliant

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14
Q

ECG in older adult

A

Prolonged PR interval
Prolonged QT interval
QRS interval unchanged
Left axis deviation due to LV hypertrophy and fibrosis
Increased incidence of bundle branch block

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15
Q

9 modifiable factors for CVD prevention

A
  1. abnormal lipids
  2. hypertension
  3. diabetes
  4. abdominal obesity
  5. psychosocial factors
  6. inadequate consumption of fruits and vegetables
  7. alcohol use
  8. smoking
  9. lack of regular physical activity
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16
Q

Hypertension most common in what group

A
  1. Blacks
  2. American indians
  3. Whites
  4. Hispanics
  5. Asians
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17
Q

Smoking rates

A

decreased, but still 21.2% of men and 17.5% of women

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18
Q

Serum cholesterol highest in what group

A

Mexican-Americans

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19
Q

Risk of CVD in DM

A

2x greater— diabetes damages large blood vessels that nourish brain, heart, and extremities

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20
Q

MI in women

A

less likely to call 911, pain is more of an ache, women report fatigue, difficulty breathing, radiating pain

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21
Q

Subjective Data for Heart and Neck Vessels

A
  1. Chest pain
  2. Dyspnea
  3. Orthopnea
  4. Cough
  5. Fatigue
  6. Cyanosis or pallor
  7. Edema
  8. Nocturia
  9. Past cardiac hx
  10. Family cardiac hx
  11. Patient centered care
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22
Q

Additional subject hx for aging adult

A
  1. Any known heart of lung disease?
  2. Do you take any medications for your illness?
  3. Environment- stairs at home?
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23
Q

Non chest-pain symptoms of angina

A

Diaphoresis, pallor, grayness

Palpitations, dyspnea, nausea, tachycardia, fatigue

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24
Q

Dyspnea characteristics

A

Paroxysmal?
Constant or intermittent?
Recumbent?

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25
Q

Paroxysmal noctural dyspnea (PND)

A

Occurs with heart failure. Lying down increases volume of intrathoracic blood- weakened heart can’t accomodate increased load- person awakes after 2 hrs with feeling of needing fresh air

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26
Q

Hemoptysis can signal

A

mitral stenosis, pulmonary embolism

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27
Q

Fatigue that is worse in the evenings due to

A

decreased CO

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28
Q

Fatigue all day or worse in the morning due to

A

anxiety or depression

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29
Q

Cyanosis or pallor occurs with

A

MI or low CO due to decreased tissue perfusion

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30
Q

Cardiac edema characteristics

A

Worse in the evening, better in AM after elevating legs. Bilateral.

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31
Q

Nocturia

A

recumbency at night causes fluid resorption and excretion- occurs with heart failure in pt who ambulates during the day

32
Q

Risk factors for CAD (7)

A
  1. high cholesterol
  2. hypertension
  3. blood sugar above 100mg/dL or DM
  4. obesity
  5. smoking
  6. inactivity
  7. hormone replacement therapy in postmenopausal women
33
Q

Patient centered care for Heart and Neck Vessels (5)

A
  1. Nutrition
  2. Smoking
  3. Alcohol
  4. Exercise
  5. Drugs
34
Q

Objective data for the neck vessels

A
  1. Palpate carotid
  2. Auscultate the carotid
  3. Inspect jugular venous pulse
  4. Estimate jugular venous pressure
35
Q

How much blood does the heart pump per minute?

A

4-6L in a resting adult

36
Q

Carotid sinus hypersensitivity

A

Pressure over the carotid sinus leads to decreased HR, decreased BP, cerebral ischemia.

Occurs in older adults with hypertension or occlusion of the carotid artery.

37
Q

Normal carotid pulse contour

A

brisk upstroke, slower downstroke, moderate strength. Same bilaterally.

38
Q

Carotid bruit indicates

A

turbulence from local vascular cause, atherosclerotic disease. Increases risk of TIA and stroke.

Also occurs in 5% of those age 45-80 with no significant carotid disease

39
Q

Where to auscultate the thyroid

A
  1. angle of the jaw
  2. midcervical area
  3. base of the neck
40
Q

Carotid bruit is audible when

A

Lumen is occluded by 1/2 to 2/3,

When lumen is completely occluded, bruit disappears—absence of bruit does not indicate absence of carotid lesion

41
Q

On what side do you assess the central venous pressure?

A

right side

42
Q

What do you look for when assessing jugular venous pressure?

A

Top of the external jugular vein overlying the sternomastoid muscle

pulsation of the internal jugular vein in the sternal notch

43
Q

Unilateral distention of external jugular veins caused by

A

local cause- kinking or aneurysm

44
Q

full distended external jugular veins above 45 degrees caused by

A

increased CVP with heart failure

45
Q

Normal jugular venous pulsation

A

2cm or less above the sternal angle.

46
Q

Elevated jugular venous pressure

A

pulsation >3cm above sternal angle.

May indicate heart failure, cardiac tamponade, constrictive pericarditis

47
Q

If venous pressure is elevated, perform what test?

A

abdominojugular test

Watch level of jugular pulsation while pushing into right abdomen, pushing blood out of splanchnic vessels. If does not elevate CVP, jugular veins rise then back to normal. If heart failure, jugular veins elevate >4cm and stay as long as you push.

48
Q

Objective data: the precordium (4 steps)

A
  1. Inspect the anterior chest
  2. Palpate the apical impulse
  3. Palpate across the precordium
  4. Auscultation
49
Q

apical impulse

A

pulsation created as the left ventricle rotates against the chest wall during systole

occupies 4th or 5th intercostal space at the midclavicular line

easier to see in children/thinner chest walls

50
Q

heave or lift

A

sustained forceful thrusting of the ventricle during systole

occurs with ventricular hypertrophy due to increased workload

51
Q

palpating the apical impulse

A

use one finger pad, ask pt to exhale and hold it, may need to rotate the person to the left.

4th or 5th interspace @ midclavicular line

52
Q

Apical impulse in cardiac enlargement

A

left ventricular dilation displaces impulse down and to the left, increases size to more than one interspace.

53
Q

Apical impulse with left ventricular hypertrophy

A

Sustained impulse with increased force and duration but no change in location

54
Q

Apical impulse in pulmonary emphysema

A

not palpable due to overriding lungs

55
Q

Palpating precordium

A

use palmar aspects of four fingers to palpate apex, left sternal border, and the base, looking for pulsations.

56
Q

Thrill

A

palpable vibrations like a purring cat. Indicates turbulent blood flow- look for murmurs.

57
Q

Valve areas for Auscultation

A

aortic valve area- second right interspace
pulmonic valve area- second left interspace
tricuspid valve area- left lower sternal border
mitral valve area- fifth interspace at midclavicular line

58
Q

Auscultation pattern for heart

A

from base to the apex in zigzag formation

59
Q

premature beat

A

isolated beat is early, or pattern of early beats

60
Q

irregularly irregular

A

no pattern- beats come rapidly and randomly (eg afib)

61
Q

sinus arrythmia

A

occurs regularly in young adults and children

rhythm varies with breathing- increases at inspiration and decreases with expiration

62
Q

pulse deficit

A

auscultate apical beat and radial pulse simultaneously. subtract radial from apical to determine deficit.

signifies weak contraction of the ventricles as in afib, premature beats, heart failure

63
Q

Split S1

A

normal but rare

64
Q

split s2

A

increased on inspiration, normal

65
Q

midsystolic click

A

most common extra sound in systole, signals mitral valve prolapse

66
Q

pathologic S3

A

ventricular gallop- occurs with heart failure and volume overload

67
Q

pathologic s4

A

atrial gallop- occurs with CAD

68
Q

Describing murmurs

A
  1. Timing
  2. Loudness (Grade 1-6)
  3. Pitch
  4. Pattern
  5. Quality
  6. Location
  7. Radiation
  8. Posture
69
Q

Murmur of mitral stenosis

A

low-pitched and rumbling

70
Q

murmur of aortic stenosis

A

harsh

71
Q

innocent murmur

A

no valvular or other pathologic cause. Normally soft, midsystolic, short, heard at 2nd or 3rd left intercostal space. Disappears with sitting.

72
Q

functional murmur

A

caused by increased blood flow in the heart- anemia, fever, pregnancy, hyperthyroidism

73
Q

soft diastolic murmur of aortic regurgitation heard

A

when the pt is leaning forward in the sitting position

74
Q

Objective data for heart and neck in the older adult

A

Gradual rise in SBP common
Some adults experience orthostatic hypotension
Caution in palpating carotid- could cause HR slowing or compromise circulation when atherosclerosis present
Chest increases in AP diameter- more difficult to palpate apical impise and hear split S2.
S4 occurs with no cardiac disease
Systolic murmurs common
Occasional premature ectopic beats common

75
Q

S3 in older adult

A

associated with heart failure and always abnormal over age 35.

Health Assessment (20 decks)

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