Week 8 - Cardio

Question 1

heart and vessels located in the…

Answer 1

mediastinum
- protected by the sternum and rib cage

Question 2

3 layers

Answer 2

1. pericardium - tough, fibrous, double-walled sac
2. myocardium - muscular wall, pump
3. endocardium - thin layer of endothelial tissue

Question 3

4 major valves

Answer 3

atrioventricular (AV) valves (tricuspid and mitral/bicuspid)
semilunar valves (aortic and pulmonic)

Question 4

diastole

Answer 4

heart filling phase when AV valves open

Question 5

systole

Answer 5

the heart pumping phase when valves are closed

Question 6

carotid artery

Answer 6

located in the groove between the trachea and sternomastoid muscle

Question 7

jugular veins

Answer 7

internal deep, medial to sternomastoid muscle; external - superficial, lateral to sternomastoid muscle
empties into superior vena cava

Question 8

subjective data - cardio

Answer 8

Any chest pain or tightness?
Any SOB?
Use more than one pillow to sleep?
Do you have a cough?
Do you seem to tire easily?
Facial skin ever turn blue?
Any swelling of feet or legs?
Awaken at night to urinate?
Any past history of heart disease?
Any family history of heart disease?
Assess cardiac risk factors (nutrition, smoking, alcohol, exercise, medications, drugs, stress)
Sudden onset chest pain or tightness, and SOB is a medical emergency and nurses must intervene immediately

Question 9

angina

Answer 9

chest pain from the heart
- may have an order for nitroglycerin spray if known cardiac disease, otherwise, apply oxygen, assist to maximize respiratory function, place on full monitors, and alert most responsible provider (MRP)

Question 10

myocardial infraction

Answer 10

arm pain, nausea, jaw or throat pain, weakness, fatigue, and dizziness. Since these may be attributed to other causes, theses symptoms are often disregarded by individuals

Question 11

objective data - cardio

Answer 11

Inspect skin color, warmth, sensation, movement (CWMS) and JVD & PMI
Auscultate apical pulse for 1 full minute at the PMI, then listen in all 5 places the diaphragm for:
- Rate (60-100), bradycardia, tachycardia
- Rhythm: Regular or irregular
Then auscultate in all 5 places with the bell for:
- Extra heart sounds
- Murmurs
Check for apical pulse deficit (listen over apical with stethoscope while simultaneously palpating the radial pulse). Do they match up?

Question 12

S1

Answer 12

closure of AV valves, beginning of systole
- louder at the apex
Tricuspid and Mitral valve closure happen at the same time

Question 13

S2

Answer 13

closure of the semilunar valves, end of systole
- louder at the base
Aortic valve closure happens before the pulmonic valve closure
Therefore, the S2 sound is ‘ Split’.

Question 14

CWMS

Answer 14

color, warmth, movement, sensation

Question 15

cap refill

Answer 15

less than or equal to 2 sec
- indicator of perfusion

Question 16

carotid arteries and jugular venous distension (JVD) assessment

Answer 16

Inspect bilaterally
Auscultate for bruits
Palpate carotid arteries (ONE at a time)
- strength, regularity
While patient supine, turn head away from you and inspect for the external jugular vein

Question 17

jugular veins

Answer 17

give us information about the right side of the heart (filling pressure and volume changes – preload)

Question 18

apical pulse

Answer 18

mid-clavicular line, 5th intercostal space
- note strength, regularity

Question 19

S3

Answer 19

Ventricular filling sound/ ventricular gallop/ early diastolic gallop
- could be an indication of systolic dysfunction (vibration of the walls of the ventricles)

Question 20

S4

Answer 20

An extra heart sound – closer to the apex related to mitral valve stenosis
Low frequency sound closer to the apex
- use the bell part of the stethoscope

Question 21

order of auscultation

Answer 21

start at the base of the heart and end at the apex
order = S2, S2, & S1, S1

Question 22

“lubb-dubb”

Answer 22

Listen selectively to ONE sound at a time:
Rate
Rhythm
Assess S1 and S2 at EACH of the 5 places of the heart
Then use your bell and listen for extra heart sounds and murmur at EACH of the 5 places of the heart
Note whether each sound is normal, accentuated, diminished, split.

AO=aortic area
PA=pulmonic area

Question 23

orthostatic hypotension

Answer 23

steps:
Patient to rest supine x2-3 min
Measure lying BP and HR
Have your patient sit up and wait 2 min
Measure sitting BP and HR
Have your patient stand up and wait 2 min
Measure standing BP and HR

A SIGNIFICANT finding is a drop in systolic BP over 20 mm Hg on any reading OR an increase in HR of 20 bpm or more. This can determine fall risk, fainting, dehydration

Question 24

strength/grading of pulses

Answer 24

+1 = weak
+2 = normal/expected
+3 = bounding

Question 25

subjective data - peripheral vascular system

Answer 25

Any leg pain (cramps)? Where?
Any skin changes in arms or legs?
Any sores or lesions in arms and legs?
Any swelling in the legs?
Any swollen glands? Where?
What medications are you taking?

Claudication distance = how many blocks one can walk or stairs one can climb before experiencing calf pain.

Question 26

types of lymph nodes

Answer 26

1.Cervical – drains fluid from head and neck.
2.Axillary – drains fluid from breast and upper arms.
3.Epitrochlear – drains fluid from hands and lower arms.
4.Inguinal – drains fluid from lower extremities, genitalia, and lower abdomen.

Question 27

lymph-related organs

Answer 27

Tonsils
– fight infections locally (mouth and throat)
Thymus gland
– behind the sternum develops T-lymphocytes in children, no function in adults (in adults, the T-lymphocytes are made in the bone marrow)
Spleen
– destroys old RBCs, produces antibodies, stores RBCs, filters microorganisms

Question 28

objective data - peripheral and lymphatic system

Answer 28

inspection:
lack of hair on legs –> malnutrition from arterial insufficiency, skin is thin, shiny and atrophic, nails have thick ridges and hair loss occurs
presence of varicose veins
unilateral or bilateral edema
- unilateral = DVT
- bilateral = lymphatic obstruction
wounds and stage of healing
- need blood flow/circulation for healing

Question 29

pitting edema

Answer 29

palpation
1+ mild
2+ moderate
3+ deep
4+ very deep

Question 30

causes of edema

Answer 30

Heart failure
Liver disease
- derangement in the extracellular fluid volume regulatory mechanisms, portal hypertension leads to arterial vasodilation and leaking of fluids through capillary walls into interstitial tissue
Kidney disease
- loss of proteins through urine, kidneys notice and retain salt which retains water
Venous insufficiency
Lymph drainage insufficiency

Question 31

S&S of DVT

Answer 31

swelling of leg
pain/tenderness in calf
warmth
red/discolored skin

homons sign in dorsiflexion
positive sign = pain in popliteal region

Question 32

peripheral artery disease (PAD)

Answer 32

S&S of arterial occlusion
pain on ambulating
pallor
pulselessness
decreased sensation
cool/coldness

Question 33

cardiac output

Answer 33

cardiac output is affected by HR and SV
CO = HR x SV
Preload and afterload affect the heart’s ability to increase cardiac output
Preload - amount of blood in right atrium that fills during diastole
Afterload - resistance which ventricles must overcome to pump blood out of left ventricle