Week 2: Cardio and Peripheral Assessment

Question 1

where does the heart extend from

Answer 1

Second to fifth intercostal spaces (rib spaces)
Goes from the sternum to the left midclavicular line

Question 2

Blood Flows from…

Answer 2

from the body (deoxygenated) through the vena cava to the RA through T-valve to RV through P-valve to pulmonary artery to lungs (to get oxygenated) to the pulmonary vein to the LA through the M-valve to the LV through the AV to the aorta and to the body again

Question 3

Heart Apex

Answer 3

At the bottom, 5th intercostal space, left midclavicular line (MCL)

Question 4

Heart Base

Answer 4

Top, 2nd intercostal space, right sternal border (SB) to LMCL

Question 5

how does the heart supply itself

Answer 5

through the cardiac arteries/veins

Question 6

pediatric hearts

Answer 6

Blood flows differently; bypasses the lungs during gestation, mother oxygenates it
- Foramen Ovale (oval hole) between RA and LA; 2/3rds of blood flows through -> aorta
Closes within 1 hour of birth
- Ductus Arteriosus: 1/3 of blood goes from RA to pulmonary artery through DA to aorta
Children’s apexes are at the 4th intercostal space, LMCL

Question 7

Dyspnea

Answer 7

(shortness of breath)

Question 8

Orthopnea/PND

Answer 8

(difficulty breathing lying down, ex., how many pillows do you use)
Paroxysmal Nocturnal Dyspnea

Question 9

Cyanosis/Pallor

Answer 9

(extremities/lips turning blue, or paleness)

Question 10

Edema

Answer 10

(swelling)

Question 11

Nocturia

Answer 11

(waking up at night to pee)

Question 12

cardio subjective assessment

Answer 12

Chest pain/Angina
Dyspnea (shortness of breath)
Orthopnea/PND (difficulty breathing lying down, ex., how many pillows do you use)
Paroxysmal Nocturnal Dyspnea
Cough
Fatigue (more tired than usual, tire more quickly)
Cyanosis/Pallor (extremities/lips turning blue, or paleness)
Medications (any medications specific for heart)
Edema (swelling)
Nocturia (waking up at night to pee)
Past cardiac history (have they had heart attack, surgery, CV surgery)
Family cardiac history (anybody in the family having those things)
Cardiac risk factors (lifestyle, genetics, exercise habits)

Question 13

peripheral vascular subjective assessment

Answer 13

Leg pain/cramps
History of vascular problems
Diabetes
Pregnancy
Smoking
Trauma
Skin changes on arms/legs
Edema
Lymph node enlargement
Medications
Occupation (on their feet a lot)
Recent travel (edema, DVT risk)
Recent surgery (blood clots)

Question 14

cardiac risk factors

Answer 14

Conditions (Non-modifiable risk factors)
Gender (men, usually), Age (men in 40s, women after menopause), family history
Modifiable risk factors:
Smoking (offer if they want to quit; ask/advise/assess/assist/arrange), physical inactivity/diet/stress, hypertension (140/90+, 130 for diabetics)

Question 15

heart sounds - s1 and s2 + split-s2

Answer 15

Heart sounds are really the sounds of valves closing
S1 is the sound of the Tricuspid/Mitral valves; systole beginning (LUB-dub)
S2 is the sound of the Aortic/Pulmonic valves; end of systole (lub-DUB)
Split-S2: Normal, aortic valve closes before pulmonic valve, Lub-T-DUB

Question 16

heart sounds - s3 and s4

Answer 16

When listening in Left-Lateral Position for abnormal sounds:
S3: Soft, dull, low-pitched sound after S2 – Al-Ber(ta)
Normal in children, young adults: pathological in older adults
S4: Very soft, low-pitched sound before S1 — (New)Bruns-Wick

Question 17

hearing all heart sounds - s4,s1,s2,s3…

Answer 17

Could be a pericardial friction rub

Question 18

murmurs

Answer 18

Murmurs: Blowing sounds from turbulent blood flow
Innocent (healthy, normal), Functional (from increased blood flow), Pathological (from valve defect; stenosis, regurgitation), often felt/found with a thrill
If you find a murmur, repeat the auscultation in Left-Lateral position, auscultate with bell
Listen for: timing (first or second), loudness (i-vi), pitch, pattern (louder/softer), quality (harsh/blowing), location (which valve), radiation (does it spread anywhere), posture (supine/left-lateral)

Question 19

bruit

Answer 19

Bruit: An abnormal swishing sound due to turbulent blood flow
Palpate then auscultate the carotid artery

Question 20

cardio assessment starting patient in supine: objective

Answer 20

Patient is supine
First, inspect for skin colour/condition (lumps, bumps, bruises)
Also inspect for pulsations (if you’re able to see the apical impulse)
Palpate for the apical impulse (5ICS LMCL), any thrills (rumbling)
Auscultate the apical impulse; take the heart rate from there (30 normal/60 abnormal)
Use diaphragm to auscultate 4 valve areas for S1/S2 sounds: APe To Man
Aortic (2ICS,RSB) Pulmonic (2ICS,LSB) Tricuspid (5ICS,LSB), Mitral (5ICS,LMCL)
Use the bell to auscultate the 4 valve areas for S3/S4 sounds and murmurs
Assist them into the left-lateral position, auscultate apex (mitral) w/ bell for S3,S4,murmurs
With them seated & leaning forward, use the bell at the base, left/right side for murmurs

Question 21

peripheral assessment: subjective

Answer 21

Patient is seated upright
Inspection arms for lumps/bumps/bruises/scars/tattoos/freckles/hair distribution/lesions/symmetry, assess nailbed angle, capillary refill, temperature
Palpate for any edema, texture
Palpate brachial and radial pulses on both arms, grade (0-3)
Legs
Inspection of legs for lumps/bumps/bruises/scars/tattoos/hair distribution, symmetry
Palpate shins for edema (grade based on time to disappear)
Is it dependent, pitting, bi/unilateral?
Palpate for texture, temperature
Palpate femoral pulse (leg crease), popliteal (knee crease), posterior tibialis (behind medial ankle), dorsalis pedis (middle of foot, between first two toes)

Question 22

DVT

Answer 22

DVT = Deep vein thrombosis = Blood clot
Risk factors are bedrest/immobility/surgery, smoking, birth control pills
Signs/symptoms are redness/swollen/painful calf, Homan’s sign (not specific enough)
Prevented by encouraging mobility, compression stockings, SQ heparin (blood thinner)