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1180: Holistic Health Assessment > week 2: CV and PV assessment > Flashcards

week 2: CV and PV assessment Flashcards

1
Q

describe the pathway of blood through the heart?

A
  • deoxygenated blood enters the heart through the superior/inferior vena cava and travels to the right atrium
  • deoxygenated blood from the right atrium passes through the tricuspid valve and into the right ventricle
  • deoxygenated blood from the right ventricle travels through the pulmonary valve and exits the heart through the pulmonary artery and to the lungs
  • after gaining oxygen from the lungs, the oxygenated blood enters the left atrium
  • the oxygenated blood from the left atrium passes through the mitral valve and into the left ventricle
  • oxygenated blood from the left ventricle passes through the aortic valve and into the aorta
  • the oxygenated blood is then distributed to the rest of the body
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2
Q

what is hypertension?

A

high blood pressure, long term force of blood against the walls of the arteries makes the heart work harder which can lead to hardening and narrowing of vessels, stroke, heart attack

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3
Q

what is a myocardial infraction?

A

a heart attack

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4
Q

what is angina?

A

chest pain from deprivation of oxygen to the heart muscle due to narrowing, usually happens with exertion
- Stable angina – the pain that occurs with exertion
- Unstable angina – angina pain even at rest (much worse)

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5
Q

what are palpitations?

A

electrical problems

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6
Q

what is atrial fibrillation?

A

electrical, chaotic beating of the atria, uncoordinated with ventricles, places clients at risk for stroke, often accompanied by shortness of breath

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7
Q

what is a cerebrovascular accident (CVA)?

A

stroke (from a clot or from bleeding)

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8
Q

Describe heart failure/ congestive heart failure (CHF).

A

this is a pumping problem, the muscle becomes weak/stiff over time from high BP, CAD, narrow vessels, leaving its pumping action inadequate to move fluid through and around the body which causes fluid to back up, usually into the chest or lower legs. The failure starts on the left mostly, and then advanced left sided heart failure causes right sided heart failure

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9
Q

what is coronary artery disease (CAD)?

A

coronary arteries or the ones right on the actual heart, atherosclerosis narrows or blocks them

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10
Q

what are possible risk factors for cardiovascular disease? (11)

A
  • family history
  • increased age
  • elevated cholesterol
  • high BP
  • High blood sugar levels or known diabetes mellitus
  • ethnicity
  • obesity
  • cigarette smoking
  • sedentary lifestyle
  • diet, sodium
  • for women: menopause as risk for coronary artery disease (CAD) increased thereafter
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11
Q

what are the signs and symptoms of a potential CV problem?

A
  • pain (chest, jaw, neck, left shoulder, left arm, subscapular, stomach pain)
  • “elephant sitting on my chest”
  • racing heart
    -palpitations
    -shortness of breath (SOB)
  • orthopnea (sensation of breathlessness in the recumbent position, relieved by sitting for standing)
    -paroxysmal nocturnal dyspnea (PND): the sudden onset respiratory distress that wakes a patient out of sleep
  • cough
  • nocturia: getting up to pee at night
  • lightheadedness
  • presyncope/syncope: the sensation that you are going to faint/ when you faint and regain consciousness
  • nausea and vomiting
  • diaphoresis
  • heart burn
  • fatigue
  • edema
  • leg pain
  • difficulty walking
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12
Q

what would you want to include during a cardiovascular assessment to gain an appropriate history? (10)

A
  1. demographic/SDOH
  2. OLDCARTSS
  3. current/recent symptoms
  4. associated symptoms
  5. respiratory concerns?
  6. risk factors
  7. family history
  8. medical history, meds, allergies
  9. social history
  10. FUNCTIONAL ABILITY (ADL, IADL)
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13
Q

where on the body can you NOT hear a bruit (the wooshing sound)?

A

carotid

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14
Q

what would a heart murmur sound like?

A

swooshing or blowing sound

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15
Q

what are the 5 sites for auscultating heart sounds?

A

carotids, abdominal aortic, renal, iliac, femoral

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16
Q

what are the effects of aging on the heart?

A
  • Amount of 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
  • Number 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 = increases blood pressure
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17
Q

what is included in the arterial system?

A

arteries, arterioles, and capillaries that deliver oxygen rich blood from the heart to the rest of the body

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18
Q

what is included in the venous system?

A

veins, venules, and connecting veins called perforators which collect deoxygenated blood from the body and return it to the heart

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19
Q

what is an artery?

A
  • thick walled
  • muscular
  • have an endothelial layer
  • prone to damage which contributes to pathogenesis of development of atherosclerosis
20
Q

what is a vein

A
  • thin walled
  • low pressure
  • can stretch and accommodate large volumes of fluid
  • has valves which prevent backflow
21
Q

what is included in a vascular assessment?

A
  • information related to circulation (both venous and arterial), including colour, temperature, cap refill, edema, and pulse
22
Q

when do you perform a neurovascular assessment?

A
  • Trauma/injury to limb – ie. Soft tissue injury or fracture or both
  • Presence of cast or other protective device (mostly the ones that are rigid, like a plaster or fiberglass cast)
    • Swelling does not do well under casts or plasters!
  • Surgery to a limb (you can consider this trauma – it’s just controlled trauma)
  • Presence of a wound on a limb, varicose veins
  • Conditions which may cause poor circulation – heart failure, diabetic peripheral neuropathy
  • Client complaining of discomfort or pain in a limb
  • Other risk factors for poor neurovascular circulation:
    • Smoking restricts circulation
    • Arterial/venous insufficiency
    • Extreme edema ie. Lymphedema, compartment syndrome
    • Hypothermia
23
Q

what is the first sign of venous insufficiency?

A

edema

24
Q

what is venous insufficiency?

A
  • Caused by decreased venous blood return
  • Venous blood, which contains waste products, is unable to return to the heart, causing congestion and edema
  • The temp may be normal but brownish discolouration may appear, as waste products seep into tissues
25
Q

what are the symptoms of venous insufficiency?

A

Symptoms like pain, varicosities, and ulceration of the skin over the vein may follow

26
Q

what are varicose veins?

A
  • Are close to the surface, usually in the legs, and look like full, bulging tortuous vessels
  • They’re caused by excess pressure in the veins, damaged or weak vein walls, and damaged or leaky valves
  • The venous return is sluggish because of the damaged veins, so you will see edema in the feet and ankles
27
Q

what are the 6 causes of arterial insufficiency?

A
  1. inadequate blood flow through the arteries related to blockage by plaque or emboli
  2. damaged vessels
  3. arteriovenous fistulas (these are abnormal connections between arteries and veins – you get blood flowing from an artery straight into a vein without going through the capillaries and out to the body first)
  4. aneurysms (bulging section of vessel at a weakened wall)
  5. hypercoagulability state (formation of a lot of clots)
  6. heavy tobacco use
28
Q

what is arterial insufficiency?

A

Arterial blood is diminished, which means vital nutrients and oxygen have difficulty reaching tissues in the limb. This leads to changes in skin texture and patterns of hair distribution. The pulse may be diminished, and the limb is cool

29
Q

what are the signs and symptoms of arterial insufficiency? (9)

A
  1. Pallor
  2. Cyanosis
  3. Mottled skin (like a purply/bluey blotchy looking skin)
  4. Tingling
  5. Pain/cramping
  6. Cool skin temperature
  7. Reduced or absent (full on emergency) peripheral pulses
  8. Advanced – arterial ulcers
  9. Muscle atrophy
30
Q

what are the treatment options for arterial insufficiency?

A
  • symptom management and attempt to slow progression
  • medications to prevent clots and manage pain
  • increased activity
31
Q

what is atherosclerosis?

A
  • Is sometimes called “hardening of the arteries”
  • Due to plaques/lipid accumulation inside the vessel
32
Q

what groups are more susceptible to atherosclerosis?

A
  • Common with aging, individuals who smoke, and clients with obesity, hypertension, and diabetes
  • Contributes to stroke, arterial insufficiency, MI
33
Q

how might you investigate for atherosclerosis?

A

bloodwork, imaging (like ultrasound), angiogram, other physical assessment

34
Q

how do you treat atherosclerosis?

A
  1. Lifestyle modification, medications to prevent clots, surgery, cardiac catheterization, endarterectomy
    - Prevention here is key – reducing the risk for atherosclerosis is much more reliable and easier than trying to treat and manage it once it develops
35
Q

what is clubbing?

A

Like a rounding of the fingernails, found in patients with chronic respiratory disease, a sign of oxygenation problems over time
- When there’s chronic respiratory disease, there are consequences for the cardiovascular and neurovascular systems

36
Q

what are the 2 types of peripheral vascular disease?

A

arterial and venous insufficiency

37
Q

what is the difference between arterial and venous insufficiency?

A
  • Arterial insufficiency – usually related to a blockage (often atherosclerosis) resulting in decreased blood flow to the periphery, and therefore decreased oxygenation to tissues and muscles
  • Venous insufficiency – is related to stretched out valves that do not pump blood back up to the heart, resulting in pooling of blood in the periphery, cause distention (varicose veins), edema, etc.
38
Q

what is the neurovascular assessment acronym mean?

A

“Classy Men Spend Time Buying Expensive Presents”
- colour
- movement
- sensation
- temperature
- blanching
- edema
- pulse

39
Q

true or false: a neurovascular assessment can be done anywhere on the body. (explain)

A

false: it is only done on limbs, and at the most distal point from the injury

40
Q

how do you assess for edema?

A

first you inspect, then palpate to see if it is pitting or not
- most of the time you can see it first, but it is important to compare both sides

41
Q

how does the scale for extent of pitting edema work?

A

0= no pitting edema
1= mild pitting edema (2mm depression)
2= moderate pitting edema (4mm depression- disappears in 10-15sec)
3= moderately severe edema (6mm depression- may last more than 1min)
4= severe pitting edema (8mm depression- may last more than 2min)

42
Q

what 2 nerves do you palpate during a neuro assessment on the lower limb?

A

peroneal nerve (between big and 2nd toe) and tibial nerve (medial/lateral surface on sole of foot)

43
Q

what 3 nerves do you palpate during a neuro assessment on the upper limb?

A
  • radial nerve (between thumb and pointer)
  • ulnar nerve (tip of pinky)
  • median nerve (tip of pointer)
44
Q

what are the 6 P’s when assessing for compartment syndrome?

A
  • pain
  • pallor (mottled looking skin)
  • pulse
  • Poikilothermia (cold to touch)
  • paresthesia (burning sensation)
  • paralysis
45
Q

what causes compartment syndrome?

A
  • Can happen after severe injury (particularly crushing-type injuries, so find out the MOI) or fracture, and other types of soft tissue injuries
  • Critical levels of pressure build up in the upper or lower limbs due to edema or even bleeding, and the fascia around the muscle compartments don’t stretch
  • The pressure builds and decreases blood flow which means oxygen and other components of blood needed to keep the tissue alive can’t get there
46
Q

how do you treat compartment syndrome?

A
  • The only way to deal with the problem by the time it has started is to relieve the pressure (fasciotomy) to relieve the pressure and allow for expansion beyond the non-stretchy fascia. It won’t reverse damage done though! – time is critical
  • Pain and paresthesia are most reliable

1180: Holistic Health Assessment (4 decks)

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