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Health Assessment > Week 6 - Cardiovascular and Peripheral Vascular Assessment > Flashcards

Week 6 - Cardiovascular and Peripheral Vascular Assessment Flashcards

1
Q

Peripheral Vascular System

A

Made up of a series of vessels that carry fluids throughout our body:

  • Arteries
  • Veins
  • Lymphatic
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2
Q

Function of Arteries (5)

A
  1. Carry oxygenated blood away from the heart
  2. High-pressure system
  3. Have fewer
  4. Vessel walls thicker and more tough- elastic and muscle fibers to withstand, adapt to and maintain pressure
  5. Have a ‘pump’ to keep blood moving
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3
Q

Arteries accessible during examination (9)

A
  • temporal
  • carotid
  • brachial
  • radial
  • ulnar
  • femoral
  • popliteal
  • dorsalis pedis
  • posterior tibial
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4
Q

Function of Veins (5)

A
  1. Carry deoxygenated blood back to the heart
  2. Low-pressure system
  3. Have more
  4. Vessel walls are thinner and larger in diameter
  5. No pump, rely on 3 mechanisms to keep blood moving:
    - contracting skeletal muscles
    - pressure gradient
    - intraluminal valves (no backflow)
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5
Q

Veins accessible during examination (close to skin’s surface) (9)

A
  • external jugular
  • internal jugular
  • superficial arm
  • deep arm
  • femoral
  • popliteal
  • great saphenous
  • small saphenous
  • perforators
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6
Q

Artery in the neck

A

Carotid

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7
Q

Arteries in the arm (3)

A
  1. Radial
  2. Brachial
  3. Ulner
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8
Q

Arteries in the Leg (4)

A
  1. Femoral
  2. Popliteal
  3. Posterior tibial
  4. Dorsalis pedis
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9
Q

Vein in the Neck

A

Jugular

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10
Q

Veins in the leg (3)

A
  1. Great saphenous
  2. Small saphenous
  3. Great saphenous
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11
Q

Function of the Lymphatic System

A

Retrieving excess fluid from tissue spaces and returning to blood stream (like a sponge), in the capillary bed

  1. Return fluid back to venous system
  2. Forms major part of immune system
  3. Absorbs lipids from IT and transport fat soluble nutrients bac into venous circulation
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12
Q

Right lymphatic duct

A

Empties into right subclavian -

Drains the:

  • right side of the head and neck
  • right arm
  • right side of thorax
  • right lung/ pleural
  • right side of heart
  • right upper section of liver
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13
Q

Thoracic duct

A
  • Drains rest of body

- Empties into left subclavian vein

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14
Q

Movement of lymph

A

Lymph flow is propelled by:

  1. Contracting skeletal muscles
  2. Pressure changes during breathing
  3. Contraction of the vessels themselves
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15
Q

Lymph Nodes

A
  • Small oval clumps of lymphatic tissue located along intervals in the vessels
  • Filter fluid before it is returned to the bloodstream (immune defense)
  • Palpable
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16
Q

Location of nodes (4)

A
  • Cervical nodes (neck)* palpable (should be movable and non-tender)
  • Axillary nodes (armpits)
  • Epitrochlear node (arm)
  • Inguinal nodes (groin)
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17
Q

Developmental Considerations for Children and Infants

A
  • Larger lymph nodes

- Palpable even when healthy

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18
Q

Considerations for Pregnancy

A

Hormonal changes (increased progesterone) cause vasodilation, resulting in drop in BP (2nd and 3rd trimester)

The growing uterus blocks drainage of certain veins, resulting in pooling of venous blood, causing:

Edema in the lower extremities, varicose veins, hemorrhoids

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19
Q

Considerations for Aging Adults

A
  • Arteriosclerosis: Blood vessels become more rigid, thick, less elastic, resulting in increase in BP
  • Enlargement of the calf veins, greater risk of venous pooling
  • Loss of lymphatic tissue (fewer nodes and atrophy of nodes)
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20
Q

Subjective Assessment of PV (6)

A

PQRSTUAAA:

  1. Leg pain or cramps
  2. Skin changes on arms or legs
  3. Swelling in the arms or legs
  4. Lymph node enlargement
  5. Medications
  6. History of vascular problems?
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21
Q

Objective Assessment of PV - Arms (5)

A
  1. Colour, temperature, texture, turgor, lesions, scars, edema, clubbing
  2. Capillary refill
  3. Symmetry
  4. Pulses (on 4-point scale):
    - Radial
    - Ulnar
    - Brachial
  5. Epitrochlear lymph node (normally not palpable):
    - Shake hands, with other hand reach under elbow into groove, feel for node-like structure
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22
Q

Objective Assessment of PV - Legs (5)

A
  1. Skin colour, hair distribution, venous pattern (flat, visible, not varicose) at standing, size, symmetry, skin lesions, ulcers
  2. Palpate for temperature
  3. Palpate inguinal lymph nodes
  4. Pulses (on 4-point scale):
    - Femoral
    - Popliteal
    - Dorsalis pedis
    - Posterior tibial
  5. Asses for edema
23
Q

Disorders of PV (2)

A
  1. Deep Vein Thrombosis (DVT)

2. Peripheral Arterial Disease (PAD)

24
Q

Deep Vein Thrombosis (DVT)

A
  • Clot in a deep vein, blood comes in from arteries but can’t go back up
  • Warm, red, swollen
25
Q

Peripheral Arterial Disease (PAD)

A
  • Build-up of fatty substances in the wall of the artery (plaques)
  • Pallor, coolness
26
Q

Cardiovascular System

A

Consists of pump (heart) and connecting vessels

27
Q

Diastole (2 stages)

A

Ventricles relaxing and filling with blood

Stage 1: Protodiastolic filling (passive filling)
- AV valves open, pressure in atria is higher than ventricles, so blood rushes in

Stage 2: Presystole/Atrial systole/Atrial kick (active filling)

  • Occurs toward end of diastole
  • Atria contract and push last bit of blood into ventricle
28
Q

Systole (4)

A
  1. AV valves close (S1/lub)
  2. For a moment, all 4 valves are closed, ventricles are contracting against the closed vessels and pressure is building
  3. When pressure in ventricles is greater than in aorta and PA, the semilunar valves open and blood Is pumped from the ventricle and out through aorta and PA.
  4. Semi-lunar valves close (S2/dup)
29
Q

Expected Heart Sounds (3)

A
  • S1 (“Lup”)
  • S2 (“Dup”)
  • Split S2 (“Lup-T-Dup”)
30
Q

Extra Heart Sounds (unexpected)

A
  • S3
  • S4
  • Murmurs
  • Bruits (Turbulent blood flow in a great vessel)
31
Q

S1 heart sound

A

“Lup”

  • Expected
  • Occurs with closure of the AV valves
  • Loudest at the apex
32
Q

S2 heart sound

A

“Dup”

  • Expected
  • Occurs with closure of the SL valves
  • Loudest at the base
33
Q

Split S2 heart sound

A

“Lup-T-Dup”

  • Expected
  • When aortic valve closes significantly earlier than the pulmonic valve
  • Gives an extra beat
  • Can be heard on inspiration sometimes
34
Q

S3 heart sound

A

Unexpected

  • Heard during diastole (protodiastole)
  • Occurs just after S2
  • Physiologic
  • Pathologic (ventricular gallop)
35
Q

S4 heart sound

A

Unexpected

  • Heard at the end of diastole during presytole
  • Occurs just before S1
  • Physiologic
  • Pathologic (atrial gallop)
36
Q

Murmurs

A
  • A blowing or swooshing sound

- Signals turbulent blood flow

37
Q

Physiologic conditions that may result in a heart murmur

A
  • Increased velocity of the blood
  • Decreased viscosity of the blood
  • Structural defects in the valves or unusual openings in the chambers
38
Q

Bruit

A

Turbulent blood flow in a great vessel

39
Q

Conductivity of the heart

A
  • Automaticity (contracts by itself independent from signals from rest of the body)
  1. SA node, initiates impulse, travels to:
  2. AV node, atria contract, then impulse travel to
  3. Bundle of His, branches out to
  4. Right and Left Bundle Branches, that contract ventricles
40
Q

Pumping Ability of the heart

A

Preload=

Afterload=

41
Q

Cardiac Output

A

The amount of blood being pumped by the heart per minute

CO = SV x rate

42
Q

Stroke Volume

A

The amount of blood ejected from the heart

43
Q

Preload

A

The length the ventricle must stretch just before contraction

44
Q

Afterload

A

The pressure the ventricles must generate in order to open the valves and eject the blood

45
Q

CV Developmental Considerations for Infants and Children (2)

A
  1. Physiologic murmurs due to openings in the heart that compensate for non-functional lungs
  2. Position of the heart in infants is higher and more horizontal until age 7
46
Q

CV Developmental Considerations for Pregnant People (2)

A
  1. Blood volume increases 30-40% to compensate for growing fetus
    - Increases stroke volume and CO
    - Pulse rate increases 10-15bpm
  2. BP drops slightly due to hormones (see PV assessment)
47
Q

CV Developmental Considerations for Older Adults (4)

A
  • Systolic BP increases (due to rigidity of arteries)
  • Left ventricle wall thickens
  • Increased prevalence of arrhythmias
  • Increased incidence of cardiovascular disease, hypertension and heart failure
48
Q

Foramen ovale

A

In infants, blood is rerouted through FO into atrial septum and then pumped through the aorta

Closes wtihin 1h of birth

49
Q

Ductus arteriosus

A

In infants, blood is rerouted past pulmonary artery through this hole (DA) to the aorta

Closes within 10-15h of birth

50
Q

Components of Subjective CV assessment (11)

A 
PQRSTUAAA:
1. Chest pain/tightness
2.  Back pain, indigestion
3. Dyspnea (difficulty breathing)
4.  Orthopnea (needing to be upright to breathe properly)
5.  Cough
6. Fatigue
7. Cyanosis/pallor
8.  Edema
Nocturia (urgent need to pee in the night)
  1. Current/past cardiac history
  2. Family cardiac history
  3. Personal habits
51
Q

Components of Objective CV assessment (4)

A

Inspect, Palpate, Auscultate:

  1. Neck vessels: Carotid
  2. Precordium (anterior chest): Apical impulse

Percussion:

  1. Place finger on the 5th intercostal space on the left chest at the axillary line, percuss inwards to test for heart enlargement

Auscultate:

  1. Listen in a ‘Z’ pattern based on where sounds are heard best
52
Q

Things to listen for in auscultation of the heart (5)

A
  1. Note the rate and rhythm
  2. Identify S1 (apex) and S2 (base)
  3. Assess S1 and S2 separately
  4. Listen for extra heart sounds
  5. Listen for murmurs
53
Q

Describing murmurs (8)

A
  1. Timing: systole? diastole? always?
  2. Loudness (grade 1-6)
  3. Pitch/frequency
  4. Pattern
  5. Quality
  6. Location
  7. Radiation
  8. Posture (does changing position help?)
54
Q

Grading loudness of murmurs

A

Grade 1= barely audible, only in a faint room and then with difficulty

Grade 2= clearly audible, but faint

Grade 3= moderately loud, easy to hear

Grade 4= loud, associated with a thrill

Grade 5= very loud, heard with one corner of stethoscope lifted off chest wall

Grade 6= loudest, heard with entire stethoscope lifted just off the chest wall

Health Assessment (8 decks)

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