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nurs 220 - holistic assessment > Exam 4 (Nov. 15) > Flashcards

Exam 4 (Nov. 15) Flashcards

1
Q

peripheral Vascular & lymphatic system included (note for with PPT done)

A
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2
Q

Peripheral Vascular System:

When we think about the head and neck, what arteries are we looking at (2)

A

temporal and carotid

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3
Q

what arteries are in the arm? (3)

A

brachial
Ulnar
radial

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4
Q

What arteries are in the leg? (4)

A
  • femoral
  • popliteal
    posterior tibial
    dorsalis pedis
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5
Q

what are the veins in the arm? (2)

A

Superficial and deep

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6
Q

What veins are in the leg (3)

A

femoral
popliteal
great/small saphenous

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7
Q

Arteries:
____ pressure system that delivers _______ blood to body system

A

High; oxygenated

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8
Q

Arteries:
_____, tough walls withstand ____ pressure

A

Strong; High

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9
Q

Arteries:
what do they allow?
(stretching)

A

allows walls to stretch w/ systole and recoil w/ diastole

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10
Q

What controls the amount of blood delivered to tissue?

A

Muscle fibers (VSM)

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11
Q

A pressure wave created by the heartbeat is called what?

A

A Pulse

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12
Q

The simple function of the Arteries:

A

Supply oxygen and nutrients to tissues

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13
Q

What is ischemia?

A

Low supply of oxygenated blood to tissue

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14
Q

Simple Function of Veins

A

Drain deoxygenated blood from tissues and return to heart

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15
Q

Veins have what kind of valves?

A

one-way valves

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16
Q

Venous return depends on pressure gradient caused by what? (3)

A
  • breathing
  • skeletal muscle contraction
  • competent valves in veins
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17
Q

Peripheral Vascular: Veins

What is the vessel name that can stretch and hold more blood when volume increases? This also reduces stress on the heart

A

Capacitance Vessels

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18
Q

The simple function of the Lymphatic system

A

Retrieves fluid from the interstitial space and returns it to the blood stream

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19
Q

Without the lymphatic system there would be what?

A

edema

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20
Q

How is lymph flow propelled?
It is propelled by….

A
  • propelled by contracting skeletal muscle
  • Pressure change secondary to breathing
  • Contraction of vessel walls
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21
Q

What are lymph nodes?
(What are they, not what their function is)

A
  • clumps of lymphatic tissue, bead-like at interval along vessels
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22
Q

function of Cervical lymph nodes?

A

drains fluid from head and neck

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23
Q

function of Axillary lymph nodes

A

Drains fluid from breast and upper arm

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24
Q

Function of Epitochlear lymph nodes

A

Drains fluid from hand and lower arm

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25
Q

Function of Ingual lymph nodes

A

drains the fluid from the lower extremity, external genitalia, and anterior abdominal wall

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26
Q

Change in perfusion can show what types of changes or pain? (8) Just a general thing, don’t study too hard

A
  • Changes in skin: color, temperature, texture
     Pain/Cramping in legs?
     Aching in legs?
     Contorted, bulging leg veins?
     Sores/open wounds on legs?
     Edema in bilateral lower extremities?
     Swollen glands or lymph nodes?
     Difficulty achieving or maintaining an erection?
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27
Q

what is intermittent claudication?
First symptom of what?

A

lower extremity skeletal muscle pain that occurs during exercise. It is relieved with rest
The first symptom of peripheral arterial disease

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28
Q

edema in bilateral lower etremities is a sign of what?

A

veinous insufficiency

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29
Q

edema in one leg is a sign of

A

Deep vein thrombus

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30
Q

swollen lymph nodes also know as what?

A

lymphadenopathy

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31
Q

(Peripheral and vascular) Personal Health History: What questions do we ask to the patient?

A

We asked about any problems in the past with peripheral circulation
- history of blood clots, cold feet, swelling, any hair loss?

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32
Q

Peripheral Vascular & Lymphatics:

For Family history, what would we ask the patient?
Family illness history of what?

A

Deep vein thrombus
Diabetes
Hypertension
Coronary Heart Disease
Intermittent claudication
Hyperlipidemis

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33
Q

Peripheral Vascular & Lymphatics:

For Lifestyle and Health Practices, what questions do we ask the patient when it comes to lifestyle? (8)

A

 Smoking? Tobacco?
 Exercise?
 Oral or transdermal contraceptive use?
 Stress?
 Circulatory problems interfering with ability to
function?
 Self-image
 Medications
 Support stockings

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34
Q

Peripheral Vascular & Lymphatics:

Health Promotion Opportunities for Patient

A
  • Smoking
  • Exercise
  • Support stockings
  • Foot care (TAKE CARE OF FEET)
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35
Q

What to inspect for when looking at feet?
How to take care of feet (8)

A
  • skin changes/lesions
  • look at the bottom of the feet
  • exercise
  • Massage
  • quit smoking
  • raise legs when sitting
  • Wear comfortable shoes
  • Practice good skin care
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36
Q

what are the 10 risk factors for PERIPHERAL ARTERIAL DISEASE (need to know for exam!!!)

A

 Smoking
 Diabetes
 History of CHD
 Obesity
 HTN
 Hyperlipidemia
 Increasing age
 Family history of PAD, CHD
 African American descent
 High levels of homocysteine (protein to build tissue)

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37
Q

The pulse is the reflection of our what?

A

heart rate

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38
Q

one irregularity commonly found in children and young adults (need to know on exam!!!)
Heart beat speeds up during inhale, slows during exhale

A

Sinus arrhythmia

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39
Q
A
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39
Q

what is BP?

A

force of blood pushing against side of its container, vessel wall

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40
Q

maximum pressure felt on artery during left ventricular contraction

A

Systolic pressure

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41
Q

Elastic recoil, or resting pressure that blood exerts constantly between each contraction

A

diastolic pressure

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42
Q

The difference between systolic and diastolic is called

A

the pulse pressure

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43
Q

The pressure forcing blood into tissues, averaged over cardiac cycle

A

Mean arterial pressure (MAP)

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44
Q

what happens to BP with age

A

it gradually rises through childhood and into adult years

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45
Q

What happens to female’s BP after puberty

A

females BP is lower than males: after menopause, females is higher than males

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46
Q

With Black people, what happens with their BP

A

it tends to be usually higher than a white person’s of the same age
Tends to be twice as high than whites

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47
Q

What goes away with rest?

A

Angina

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48
Q

If heart pumps more blood into blood vessels, pressure on container walls _________

A

increases

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49
Q

When vessels become smaller or constricted, pressure needed to push becomes ________

A

greater

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50
Q

What is volume of circulating blood referring to?

A

refers to how tightly blood is packed into arteries; increasing contents in vessels increases pressure

51
Q

When blood vessels become stiff and rigid, pressure needed to push _______

A

increases

52
Q

What 9 factors affect blood pressure

A

 Age
 Exercise
 Stress
 Race
 Gender
 Medications
 Obesity
 Diurnal variations
 Disease process

53
Q

When do you take orthostatic or postural vital signs?

A

When:
 You suspect volume depletion
 Person is known to have hypertension or taking
antihypertensive medications
 Person reports fainting or syncope
 Position changed from supine to standing, normally slight decrease (less than 10 mm Hg) in systolic pressure may occur

54
Q

When inspecting skin of arms, what do we look for? (6)

A

 Color
 Temperature
 Texture
 Turgor
 Lesions (venous pattern)
 Edema

55
Q

When inspecting nailbeds, what do we look for? (2)

A
  • capillary refill
  • Clubbing
56
Q

When checking brachial, radial, and ulnar pulse? what are the 4 numbers to consider when leveling the pulse?

A

 3+ = increased, full, bounding
 2+ = Normal
 1+ = weak
 0 = absent

57
Q

Objective Data: what do we inspect for when looking at the legs? (7)

A

 Color of skin
 Texture
 Turgor
 Lesions
 Calf muscle
 Leg veins
 Symmetry

58
Q

What is Homan’s Sign

A

it is doen to assess DVT

59
Q

What is the Edema pitting grading scale?

A

 1+ = mild pitting, slight indentation, no noticeable swelling of leg
 2+ = moderate pitting, indentation subsides rapidly
 3+ = deep pitting, indentation remains short time, leg looks swollen
 4+ = very deep pitting, indentation lasts long time, leg is very swollen

60
Q

Peripheral Vascular:

Developmental considerations for Newborns/infants

A

Acrocyanosis (blue discoloration in hands and feet in newborn)
- Cyanosis
- Temperature in the periphery
-** Remember that the lymphatic system is established at birth**

61
Q

Peripheral Vascular:

Developmental Considerations for Children

A
  • is there Cyanosis/coolness in the extremities?
  • Pulse force same upper/lower, normal, symmetric
  • Lymphatic system established by age 6
  • Palpable lymph nodes often occur
62
Q

Peripheral Vascular:

Developmental considerations for Pregnancy

A

Bilateral pitting edema lower extremities end of day, third trimester
- Vasodilation
- Venous pressure increases: edema, hemorrhoids, varicosities

63
Q

Peripheral Vascular:

Developmental considerations for Aging adult

A
  • Dorsalis pedis and posterior tibial are difficult to locate
  • Trophic changes with arterial insufficiency
  • Arteriosclerosis (rigid artery walls)
64
Q

Raunaud’s phenomenon

A

blood flow is impaired to sites such as a few fingers are white/blue then disappears

65
Q

lymphedema, what is it?

A

lack of lymph node drainage

66
Q

Deep vein thrombus

A

blood clot formation in the deep vein

67
Q

if both legs have edema, it is…

A

heart failure

68
Q

If one leg has edema, it is…
What do you need to measure?

A

DVT, needs to measure the circumference of the calf

69
Q

Do you smoke? How old are you?
This can assess the risk of what?

A

Can assess for risk of cardiovascular disease

70
Q

Central Venous Pressure can be the reflection of…

A

body’s fluid volume

71
Q

what is angina?

A

A type of temporary chest pain, pressure or discomfort

72
Q

contorted or bulging leg veins is also known as what?

A

Varicose veins

73
Q

when assessing veins for varicosity, have patient…

A

stand up

74
Q
A
75
Q

Function of the pericardium?

A

protects heart, doubled walled sac

76
Q

What is myocardium?

A

muscular wall

77
Q

what is endocardium?

A

endothelial tissue lines inner surface of heart chambers and valves

78
Q

what are the right and left atrioventricular valves called?

A

right: tricuspid
left: mitral

79
Q

What is the right and left semilunar valves called?

A

right: pulmonic
left: aortic

80
Q

Systole description
Ventricles do what
does it pump or fill?
AV valves closed or open
S1 or S2
Are aortic/pulmonic valves open or closed?

A

1/3 cardiac cycle is systole
- ventricles contract
- pumps blood
- AV valve closed
- S1
- Aortic/Pulmonic valve open

81
Q

Diastole description
how long in the cardiac cycle is Diastole?
- fills or pumps blood?
AV valves open or closed
- Aortic/pulmonic valves open or closed

A

2/3 Diastole
- ventricles relax
- Fills with blood
- AV valves open
- Aortic/Pulmonic valves closed
- S2
O2 delivery

82
Q

S1 is described as what?

A

the closure of AV valves, signals the beginning of systole
- Mitral and tricuspid fuse as one sound and heard loudest at the apex (bottom)

83
Q

S2 is described as what?

A

the closure of semilunar valves, signals the end of systole
- Aortic and pulmonic closure heard loudest at the base (top)

84
Q

S3 is described as what?

A

abnormal heart sounds
- ventricular filling creates vibrations, occurs after S2, stiff ventricles

85
Q

S4 is described as what?

A

Abnormal heart sound
- Occurs at the end of diastole, before S1

86
Q

What is the name for turbulent blood flow?

A

murmurs

87
Q

murmurs happen in what situations of the body?

A

Increase blood flow velocity: exercise
- Viscosity of blood decreases: anemia
- Structural defects in valves, narrowing, incompetence or unusual opening

88
Q

palpitations are

A

irregular beating of the heart

89
Q

orthopnea heart failure domino chain

A

heart failure leads to kidney malfunction. This leads to kidneys not being able to perfuse and not do their job and leads to excess fluid = fluid volume overload

90
Q

nocturia

A

excessive urination at night
easier for kidney to filter when laying down

91
Q

pyrosis

A

heartburn

92
Q

heart attack or MI have similar symptoms to what?

A

heartburn (pyrosis)

93
Q

cardiovascular chest pain is what type of pain?

A

vise-like

94
Q

pulmonary chest painis what type of pain?

A

dull, aching pain

95
Q

as heart becomes weaker, its heart rate goes up or down?

A

up to accommodate for the body

96
Q

paroxysmal nocturnal dyspnea is a result of what

A

heart failure

97
Q

dizziness can result from

A

lack of blood flow to the brain

98
Q

congenital heart defect is what

A

something your’e born with

99
Q

what is an acquired disorder

A

something that was developed after birth

100
Q

rheumatic fever can lead to damage of the

A

heart tissues

101
Q

dyslipidemia

A

increased levels of bad cholesterol or LDL

102
Q

increased levels of LDL correlate to developing what (2)

A

atherosclerosis
coronary heart disease

103
Q

family history question for inc. risk of developing heart disease

A
  • hypertension
  • myocardial infarction
  • coronary heart disease
  • hyperlipidemia
  • diabetes mellitus
104
Q

what does smoking do

A

damages endothelium lining, including heart
Less O2 in hemoglobin
- damage blood vessels = hypertension

105
Q

When auscultating neck, what part of stethoscope do we use?

A

The diaphragm

106
Q

Jugular Veins what parts do we inspect? (3)
and how do we inspect?

A

Internal: See pulsation in area suprasternal notch
External: Supine, with HOB 30-45 degrees
distended jugular veins: RED FLAG, volume overload with HF

107
Q

What is apical impulse
How is the pulse created?

A

pulsation is created as L ventricle rotates against the chest wall during systole

108
Q

What is a heave/lift?
what is the D/T?

A

forceful thrust of ventricle

d/t ventricular hypertrophy

109
Q

when measuring precordium area, how do we measure

A

with bone from fingers

110
Q

where is aortic valve located?

A

right 2nd ICS

111
Q

where is Pulmonic valve located?

A

Left 2nd ICS

112
Q

where is ERB’s point located

A

Left 3rd ICS where S2 is best auscultated

113
Q

Where is tricuspid valve located

A

left lower sternal border 4th ICS

114
Q

Where is mitral valve located?

A

left 5th ICS at left MCL

115
Q

Heart & Neck Vessels:

questions for children?

A

Growth? good or bad?
Are activity levels normal?
- Are headache or nosebleeds present? (BP issue)
history of upper resp. infections?

116
Q

how much does blood volume increase in a pregnant individual?

A

by 30-40%

117
Q

for pregnant individual, how much does pulse rate inc.

A

10-15 beats

118
Q

for pregnant individuals, what happens to BP

A

it lowers

119
Q

what to monitor on pregnant patient

A
  • if BP goes higher
  • any faintness/dizziness (BP may be dropping to quickly)
120
Q

What do we see in vital signs of older adults?

A

Systole in BP increases
- orthostatic hypotension

121
Q

Systolic murmurs, Diminished pedal pulses, decreased maximal heart rate. This all relates to what age group?

A

Older adult patient

122
Q

The BP of an older adult patients admitted with pneumonia is 160/70 mm Hg. What is the age-related change contributed to the finding?

A

Loss of elasticity in arterial vessels

123
Q

difference between angina and MI

A

angina symptoms increase with increased activity levels and decrease with rest

124
Q

A murmur is an indication of what?

A

turbulent blood flow across a heart valve

125
Q

a deficit in heart conductivity that impair normal contractility is an indication of what?

A

Aarythmia or dysrythmia

126
Q
A

nurs 220 - holistic assessment (5 decks)

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