Quiz #4 Concepts Review Flashcards
Cardiac & Peripheral Vascular
Define Precordium
Area of chest where you listen to the heart sounds
Where does blood flow in a healthy person?
Unidirectionally
When cardiac valves are pathologic..?
forward flow of the blood is restricted resulting in regurgitation and heart murmurs
What are cardiac murmurs associated with?
Tricuspid regurgitation, Tricuspid stenosis, Mitral regurgitation, Mitral stenosis, and Aortic regurgitation
How are cardiac murmurs graded?
Graded 1-6
1/6 barely audible & 6/6 being the loudest
Why is the S1 (lub) first heartbeat heard?
Due to the closure of the AV valves (Tricuspid/ Mitral valves) when ventricles are filled, heard loudest at the apex of the heart
Why is the S2 (dub) second heartbeat heard?
Due to the closure of the semi-lunar valves (aortic/ pulmonary valves) when ventricles empty blood to the Pulmonic Artery & Aorta, heard loudest at the base of the heart
What does the interatrial septum separate?
The right and left atrium
What does the interventricular septum separate?
The right and left ventricle
Describe pulse grading
Pulse grading 0-4+
0= no pulse
+1= weak and thready
+2= normal
+3= Brisk
+4= Bounding
What are the aortic landmarks?
2nd ICS, RSB (S2 louder than S1)
What are the pulmonic landmarks?
2nd ICS, LSB (S2 louder than S1)
What are the Erb’s Point landmarks?
3rd ICS, LSB (S1=S2)
What are the Tricuspid landmarks?
4th ICS, LSB (S1 louder than S2)
What are the Mitral landmarks?
5th ICS, LMCL (S1 louder than S2)
What are the 5 major risk factors of heart disease?
1) Hypertension
2) Smoking
3) DM
4) Obesity
5) High Cholesterol
How are the heart sounds interpreted?
PDIP
1) Pitch
2) Duration
3) Intensity
4) Phase
Where is the angle of Louis?
Between the manubrium & the body of the sternum, in-line with the 2nd rib
How are the ICS named?
By the rib above
What are the cardiac nerves?
1) Sympathetic Cardiac nerves
2) Parasympathetic Cardiac Nerves
What are the Sympathetic Nerves?
Cardiac nerves, responsible for stimulation of the heart, increase heart rate, increase dilation of the coronary arteries
What are the parasympathetic nerves?
Cardiac nerves, responsible for decrease in stimulation of the heart, decreased HR, and decreased dilation of the coronary arteries
Where is the PMI heard the loudest?
Adults- 5th ICS, LMCL (can be palpated or auscultated)
Infants- 4th ICS, LMCL, because their heart is horizontally positioned
What is a newborns heart rate?
160-180/ minute, then gradually reduces to 112 to 120/ minute 6-8 hours after birth
On what percussion of the heart, what should you anticipate?
Dull sounds
What is normal blood pressure, pre HTN, and HTN?
Normal: below 120/80
Pre HTN: 120/80-139/89
HTN: 140/90 and above
Who has the higher incidence of HTN?
African Americans
What are the locations of the pulse?
1) Dorsalis Pedis- top of feet, lateral to the big toe
2) Popliteal pulses- behind the knees medially
3) Femoral Pulse- inguinal areas
4) Posterior Tibialis- at the grooves behind the medial malleolus and Achilles tendon
5) Radial Pulses- lateral wrist, in line with thumb
6) Ulnar Pulses- medial wrist in line with the small fingers
Describe an ECG
Electrical presentation of the cardiac cycles that are documented by the deflection on recording paper
Where does electrical initiation of the heart occur?
The SA node known as the pacemaker of the heart, fires 60-100 joules/ minute
How many joules does the AV node fire?
60 joules/ minute
How many joules do bundle branches fire?
40-60 joules/ minute
When does cardiac depolarization occur?
When cardiac current from the SA Node spread across the atria causing cardiac contraction. The cardiac cells are + charged.
When does repolarization occur in the heart?
Cardiac cells are relaxed. The cardiac cells are negatively charged.
What do imbalance in electrolytes do to cardiac conduction and which are they?
Na, Potassium, & Calcium can result in dysregulation of the the cardiac conduction system
Describe P-wave
Atrial depolarization or contraction
Where is Atrial Repolarization?
Hidden behind the QRS complex
Describe QRS
Ventricular Depolarization or contraction
Describe T-wave
Ventricular Repolarization or relaxation
Describe Ventricular Fibrillation
Total absence of regular heart rhythm
Describe Ventricular tachycardia
rapid rhythm, regular heartbeat as high as 200 beat/ minute
Describe Heart Block
Slow heart rate, 20-40 beats/ minute. Conduction b/w the atria & the ventricles is disrupted
Describe the S/S of a heart failure
1) JVD over 3 cm at 45-degree elevation
2) Low BP
3) Fatigue
4) Heart rate over 120/ minute
5) Weak peripheral pulses
6) S3
7) SOB
8) Ankle edema
Describe severe aortic regurgitation
Synchronous heartbeat and head bobbing
What does thin red lines or splinter hemorrhages on the nails of a client indicate?
Ineffective Endocarditis
Describe Arterial Insufficiency
Legs are cold & no more hair growth on the legs
Describe Venous Insufficiency
Legs are warm with pain from prolonged sitting or standing
Describe Raynaud’s Syndrome
Fingers and hands have intermittent skin pallor and cyanosis
Describe Allen’s Test
Test used to determine the patency of the radial & ulnar arteries
When does varicosities not appear?
When the legs are elevated
What causes JVD over 3 cm?
1) Increased central venous pressure
2) Fluid overload
3) Pressure at the SVC
What is smoking attributed to?
Cardiovascular disease
What is the use of cocaine attributed to?
HTN, MI, and ruptured Aorta
S3 & S4 are more common in clients with…?
Clients with cardiac anomalies such as MI, CHF, Angina, and Ventricular Hypertrophy
When does S3 or Ventricular Gallop occur and where is this sound heard?
When there is vibration, when AV valves open and blood goes to the ventricles. Heard after S2. May also be heard in 1) healthy children, 2) healthy young adults, 3) 3rd trimester of pregnancy
When does S4 or Atrial Gallop occur and where is this sound heard?
When atrial contraction and ejection of blood to the ventricles in late diastole. This sound is heard before S1. May be heard in 1) Healthy children, 2) Athletes, 3) Elderly
Describe Tetralogy of Fallot
4 cardiac defects:
1) dextroposition of the Aorta
2) Pulmonary stenosis
3) Right ventricular hypertrophy
4) Ventricular Septal defect
Describe Patent Foramen Ovale
Passageway b/w the right & left atria. Should close shortly after birth. If it does not close, cardiac murmurs can be heard on auscultation.
What percentage of children will have innocent cardiac murmurs? How does this happen?
70% of children will have innocent cardiac murmurs which arise from high blood pressure flow across the normal heart structures
Describe Patent Ductus Arteriosus
Opening between the pulmonary artery & descending aorta. Should close within 24-48 hours after birth. If it does not close, cardiac murmurs can be heard on auscultation.
What increases cardiac murmurs in children?
Conditions that increase metabolism & anemia will increase cardiac murmurs in children
How many times does the heart beat in a 24-hour period for adults?
100,000 times
Describe Therapeutic Communication
1) Open ended questions
2) Active listening
3) Lean toward patient
4) Eye Contact
5) Open posture
Describe Non-therapeutic communication
1) “why” questions
2) Give opinion
3) Give advice
4) Close ended questions
5) False reassurance
