Respiratory Assessment Flashcards
apex of the heart
4-5th intercostal space, left midclavicular line (apical pulse)
-point of maximal impulse (PMI)
2 cardiac cycle phases
1) systole
- ventricles contract
2) diastole
- ventricles relax
atrial systole
atrial kick, 1/3 or 15% of cardiac output
atrial fibulation
- most common dysrythmia
- loss of atrial kick
sides of the heart function ____
in coordination
-when one sides contracting, other does too
normal: S1 and S2 sounds
s1: mitral valve closing prior to left ventricle contraction
-“lub”
S2: aortic valve closes after left ventricle empties
-“dub”
abnormal
s3, s4, clocks, rubs, murmurs
s3: ventricullar gallop
s4: atrial gallop
clicks: mechanical valve
murmurs: turbulent flow
- diastolic murmur is bad
history questions
- chest pain
- palpations
- fatigue
- cough
- dyspnea on exersion
- orthopnea
- leg pain / cramps
- pedal edema
- cyanosis
- medications
- smoking
- alcohol
- street drugs
- exercise
- dietary habits
- stress
more history
-personal or family history
- heart disease: “anyone die from heart failure?”
- diabetes? vascular disease: promotes devel of athelorsclorosis
- high cholesterol
- hypertension
- cerebrovascular accident(CVA) / stroke?
observe of visible pulsations
- shouldn’t see them (chest and abdomen)
- in skinny ppl: concern if hypertension (artery wall weakened because of constant high pressure -> aortic rupture = die)
- pulsation below sternum -> abdominal aortic abnormality
auscultation
- eliminate as much room noise as possible
- auscultate in systemic manner over
1) aortic valve: 2nd right intercostal
2) pulmonic valve: 2nd left intercostal
3) tricuspid valve: 3-4th left intercostal
4) mitral valve: 5th intercostal
abnormal findings 4 things
1) dysrhythmia
2) pulse deficit
3) extra heart sounds
4) bruit / thrill
dysrhythmia
- irregular heartbeat
- may be life threatening
pulse deficit
- radial pulse slower than apical pulse
- indicates inadequate peripheral circulation
extra heart sounds
- s3, s4
- murmurs
