Week 2: Cardiovascular and Peripheralvascular Assessment

Question 1

Path of Blood through the heart

Answer 1

Superior vena cava -> Right atrium -> Tricuspid valve -> Right ventricle -> Pulmonary valve -> Pulmonary artery -> Lungs -> Left atrium -> Mitral valve -> Left ventricle -> Aortic valve -> Aorta -> rest of the body

Question 2

Risk factors of Cardiovascular (Heart) Disease

Answer 2

-Family history
-Increased age
-Elevated cholesterol
-HBP
-High sugar levels
-Ethnicity
-Obesity
-Cigarette smoking
-Diet
-For Women: menopause as risk for Coronary Artery Disease

Question 3

Signs and Symptoms of CV problem

Answer 3

-pain (breathing muscles)
-shortness of breath
-dyspnea, orthopnea
-paroxysmal nocturnal dyspnea
-cough
-lightheadedness
-nausea and vomiting
-edema

Question 4

Assessment of Cardiovascular System: History

Answer 4

1. Demographic/SDoH
2. OLDCARTSS
3. Current/recent symptoms
4. Associated symptoms
5. Inquire about respiratory concerns
6. Ask about risk factors
7. Discuss family history
8. Ask about past medical history, meds, allergies
9. Inquire about social history
10. Functional ability (ADL, IADL)

Question 5

Physical Assessment: Inspection

Answer 5

Start with Vital Signs

Inspection:
-general survey
-skin color
-respirations
-speech pattern
-diaphoresis
-size and shape of thorax
-finger ~ nailbeds, clubbing
-landmarks
-abnormal pulsations

Question 6

Physical Assessment: Palpation of Pulses

Answer 6

Take note of:
-rate
-rhythm
-strength/volume
-absent, weak, thready, normal, full/bounding, symmetry

Question 7

OBJECTIVE DATA: Carotid Pulse Assessment

Answer 7

-assess volume/character

Question 8

Auscultation: Unexpected Heart Sounds

Answer 8

-Murmurs: turbulence causes “swooshing” or “blowing” sounds
-result of cardiac abnormalities: increased blood velocity, structural valve defects, valve malfunction, abnormal chamber openings

Bruits: turbulent blood flow - usually by partial obstruction sites: carotids, abdominal aortic, renal, iliac, femoral

Question 9

Palpation of the PMI (point of maximal impulse)

Answer 9

-Aortic area
-Pulmonic area
-Tricuspid area
-Apical area
-Epigastric area

Question 10

Landmarking

Answer 10

Aortic area:
right second intercostal space

Pulmonary area:
left second intercostal space

Tricuspid area:
inferior left sternal margin

Mitral area
5th intercostal space (apex)

Question 11

Heart Sounds (s1 + s2)

Answer 11

S1 is the closing of AV valve (beginning of systole)

S2 is the closing of SL valve (beginning of diastole)

Question 12

Effects of Aging on the Heart

Answer 12

-collagen in the heart increases and elastin decreases
-decreased contractility and HR
-cardiac valves become thicker and stiffer from lipid accumulation, valve incompetence or stenosis = murmur
-# of pacemaker cells in SA node decreases = bradycardia, heart block
-decreased sympathetic nervous system control of cardiovascular system
-arterial blood vessels thicken and become less elastic = increased BP

Question 13

When to perform a neurovascular assessment

Answer 13

-trauma/injury to limb
-presence of cast or other protective device
-surgery to a limb
-presence of a wound on a limb, varicose veins
-conditions which may cause poor circulation

Question 14

Venous Insufficiency

Answer 14

occurs when your leg veins don’t allow blood to flow back to your heart

Question 15

Varicose veins

Answer 15

are swollen, twisted vein that lie under the skin and usually occur in the leg

Question 16

Arterial Insufficiency

Answer 16

Any condition that slows or stops the flow of blood through your arteries

Question 17

Atherosclerosis

Answer 17

the buildup of fats, cholesterol and other substances in and on the artery walls

Question 18

Clubbing

Answer 18

changes in areas under and around the toenails and fingernails that occur with some disorders
(may result from chronic low blood-oxygen levels)

Question 19

Arterial vs Venous Insufficiency

Answer 19

Arterial: Pain with exertion - intermittent claudication
-relieved by short rest
-pale when leg elevated, rubor with dependency

Venous: Pain described as aching, dull, heaviness
-swelling as day progresses
-pain and edema relieved when legs elevated
-varicose veins

Question 20

Peripheral Vascular Assessment (More Than Six Bananas Can Elevate Potassium)

Answer 20

-Circulation and nerve conduction ~ only on a limb

Movement
Temperature
Sensation
Blanching
Colour
Edema
Pulse

Question 21

Rating Scale: Extent of pitting Edema

Answer 21

0+ No pitting edema
1+ Mild pitting edema, 2mm depression that disappears rapidly

2+ Moderate pitting edema, 4mm depression that disappears in 10-15 secs

3+ Moderately severe pitting edema, 6mm depression that may last more than 1 min

4+ Severe pitting edema, 8mm depression that can last more than 2 min

Question 22

Palpating neuro component of assessment

Answer 22

Peroneal Nerve
Sensation: the web space between the big and second toe
Motion: dorsiflex ankle and extend toes at the metatarsal phalangeal joints

Tibial Nerve
Sensation: the medial and lateral surfaces of the sole of the foot
Motion: planter flex ankle and toes

Radial Nerve
Sensation: web space between the thumb and index finger
Motion: hyperextend thumb then wrist and hyperextend the 4 fingers at the knuckles

Ulnar Nerve
Sensation: distal fat pad of the small finger
Motion: abduct all fingers

Median Nerve
Sensation: distal surface of the index finger
Motion: oppose thumb and small finger (note if patient can flex wrist)

Question 23

Reynaud’s

Answer 23

-triggered by cold, stress
-vasospasm
-restricts blood supply to fingers/toes
-turns white, feels numb
-sometimes turns blue, then red before returning to normal

Question 24

Measuring Arterial Insufficiency: Ankle-Brachial Index

Answer 24

Normal ABI: ankle/brachial = 120/120 = 1.0
the lower ankle pressure, the greater the severity of occlusive disease and the higher the risk of cardiovascular events

Question 25

ACUTE Neurovascular Assessment

Answer 25

Acute situations of serious vascular compromise:
1. Arterial occlusion
2. Deep Venous Thrombosis (DVT)
3. Compartment syndrome
COMPARTMENT SYNDROME = EMERGENCY

All accompanied by EXCRUTIATING pain

Question 26

Circulation Assessment: 5 Ps

Answer 26

Pain

Pulse

Pallor - scale of paleness

Paresthesia - can you feel this?

Paralysis - can you move this