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307 Health Assessment > TEST 2 > Flashcards

TEST 2 Flashcards

1
Q

CULTURE AND GENETICS

NUTRITION

A

Foods Choices and Eating Patterns are Heavily Influenced by Culture
Newly Arrive Immigrants May be at Increased Nutritional Risk
Religious Dietary Practices- Can affect food choices and eating patterns

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2
Q

types of nutrition screenings

A
  • Admission nutrition screening tool
    *If risk is identified complete comprehensive nutritional assessment
  • 24 hour diet recall
  • Food frequency
  • Food diaries
  • Direct observation
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3
Q

2015-2020 dietary guidelines for americans

A

*Make small shifts in your daily eating habits to improve health over the long run
*Healthy eating patterns along with regular physical activity has been shown to help people reach and maintain good health and reduce chronic disease risk

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4
Q

healthy eating patterns focus on

A

◦ Variety of vegetables
◦ Fruits, especially whole fruits.
◦ Grains, primarily whole grains
.◦ Fat-free or low fat dairy
◦ Variety of Protiens
◦ Limit Salt, Saturated and Trans Fats, and Added Sugars

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5
Q

health history questions

nutritional subjective data

A
  1. Eating patterns
  2. Usual weight
  3. Changes in appetite, taste, smell, chewing, swallowing
  4. Recent surgery, trauma, burns, infections
  5. Chronic illness
  6. Vomiting, diarrhea, constipation
  7. Food allergies
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6
Q

health history questions

nutritional subjective data- continued

A
  1. Medications and/or nutritional supplements
  2. Self-care behaviors
  3. Alcohol or illegal drug use
  4. Exercise and activity patterns
  5. Family history
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7
Q

clinical signs of malnutrition

A

◦ Skin- Should be smooth, no bruises, rashes, or flaking
◦ Hair- Should be shiny, scalp intact and without lesions, does not fall out easily
◦ Eyes- corneas clear & shiny, membranes pink and moist, no bumps or sores
◦ Lips- Should be smooth, not chapped, cracked, or swollen
◦ Tongue- Should be red, not swollen or abnormally smooth, no lesions

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8
Q

clinical signs of malnutrition

continued

A

Gums- Should be pink and moist, no swelling or bleeding
◦ Nails- Smooth, pink
◦ MS- Erect posture, good muscle tone, ambulates without pain
◦ Neuro- Appropriate affect, normal reflexes

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9
Q

derived weight measures

A
  • Body weight as percent of ideal bodyweight
  • Percent usual body weight-
  • Recent weight change
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10
Q

body mass index

A

marker of optimal weight for height and indicator for obesity & protein-calorie malnutrition
BMI = weight (kg)/height (m)2
or
BMI = weight (lb)/height (inches)2 x 703

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11
Q

bmi ranges

A

under 18.5 Underweight
18.5-24.9 Normal weight
25.0-29.9 Overweight
30.0-39.9 Obesity
>40 Extreme obesity

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12
Q

Assessment of body fat distribution and indications of health risks

A

Waist-to-hip ratio = waist circumference / hip circumference
Indication of upper body obesity “android”:

Ratio of > 1.0 in men or > 0.8 in women* Increased risk for obesity-related diseases & early mortality

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13
Q

total arm span or total arm length

A

roughly equal to height

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14
Q

what do hemoglobin and hematocrit show

A

indicators of iron status

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15
Q

what are the indicators of cardiovascular risks

A

cholesterol with triglycerides, ldl, and hdl levels

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16
Q

malnutrition classifications

A

obesity
marasmus
kwashiorkor

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17
Q

marasmus

A

protein calorie malnutrition

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18
Q

kwashiorkor

A

protein malnutrition

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19
Q

layers of skin

A

epidermis
dermis
subcutaneous

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20
Q

epidermis

A
  • Replaced every 4 weeks
    ◦ Outermost layer; thin but tough; houses keratin
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21
Q

dermis

A

◦ Inner supportive layer; consists of connective tissue (collagen); contains elastic tissue
◦ Nerves, sensory receptors, blood vessels, & lymphatics housed here

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22
Q

subcutaneous

A

◦ Aka Adipose tissue
◦ Stores fat for energy, provider insulation for temp control, and cushions/protects

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23
Q

FUNCTIONS OF SKIN

A

protection
perception
temp regulation
identification
communication
wound repair
absorption/excretion
vitamin d production

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24
Q

protection

functions of skin

A

◦ Thermal
◦ Physical
◦ Chemical
◦ UV
◦ Microorganisms

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25
Q

perception

functions of skin

A

Houses neurosensory end-organs for touch, pain, temperature, and pressure

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26
Q

temp regulation

functions of skin

A

Heat dissipation thru sweat glands
Heat storage thru subcutaneous tissue

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27
Q

identification

functions of skin

A

Facial characteristics, hair, skin color, & fingerprints

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28
Q

communication

functions of skin

A

blushing, blanching, expressions

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29
Q

vitamin d production

functions of skin

A

uv light converts cholesterol into vitamin d

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30
Q

infants

developmental care- hair/skin/nails

A

Lanugo- Fine hair
Vernix caseosa- white, cheesy substance
High risk for fluid loss
Poor thermal regulation

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31
Q

pregnancy

developmental care - hair/skin/nails

A

◦ Increased sweat and sebaceous glands
◦ Increased fat deposits primarily in buttocks and hips
◦ Linea nigra- mid-abdominal dark line
◦ Melasma (Chloasma)- increased pigment in face
◦Striae gravidarum- aka stretch marks (abd, thighs, breasts)

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32
Q

older adults

developmental care - hair/skin/nails

A

◦ Thin epidermis, ↓ elasticity, ↑ dryness
◦ Less protective mechanisms (functioning decreases)

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33
Q

melanin

A

ncreased in Indians and African Americans therefore increased protection from UV rays. Caucasians 20x more likely to develop melanoma (deadliest form of skin cancer)

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34
Q

keloids

A

scars with increased height and width

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35
Q

pigmentary disorders

A

increased incidence of pigment problems in african americans

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36
Q

pseudofolliculitis

A

razor burn/bumps, ingrown hairs

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37
Q

melasma

A

mask of pregnancy
patchy tan to dark brown discoloration of face

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38
Q

subjective data

hair, skin, nails

A

Hx skin dz
pigmentation
mole (size color) = ABCDE
Excessive dryness (xerosis) or moisture (seborrhea)
Pruritis
Bruising

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39
Q

subjective data

hair/skin/nails (cont.)

A

Rash, lesion
Meds
Hair loss
Nails
Environmental/ occupational exposures noteworthy
Self-care behaviors

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40
Q

what should you assess first

hair/skin/nails

A

hands

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41
Q

what areas must you not forget to assess

hair/skin/nails

A

intertriginous areas (skin folds)

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42
Q

color

objective assessment of hair/skin/nails

A

nevus
pallor
erythema
cyanosis
juandice

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43
Q

nevus

A

mole
abcde

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44
Q

pallor

A

white, anemia, shock, arterial insufficiency, anxiety, fear, exposure to cold, cigarette smoke

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45
Q

erythema

A

redness, fever, local inflammation, blushing

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46
Q

cyanosis

A

blue, low perfusion, unoxygenated hgb

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47
Q

juandice

A

yellow, excessive bilirubin, sclera and hard and soft palate of mouth

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48
Q

in darker skinned people, where may you be better able to assess color changes

A

tongue, buccal mucosa, palpebral conjunctiva, sclera

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49
Q

external variable influencing skin color

A

emotions
environment
physical

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50
Q

emotions

influence on skin color

A

◦ Fear, anger= peripheral vasoconstriction= pallor
◦ Embarrassment- facial/neck flushing= erythema

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51
Q

environment

influence on skin color

A

◦ Hot room= vasodilation= erythema
◦ Chilly/air conditioned room= vasoconstriction= pallor
◦ Cigarette smoke= vasoconstriction= pallor

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52
Q

physical

influence on skin color

A

◦ Prolonged elevation- decreased arterial perfusion= pallor, cool
◦ Dependent position= venous pooling = redness, warmth, distended veins
◦ Immobilization = slowed circulation = pallor, coolness, prolonged capillary filling time

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53
Q

temperature

objective assessment of hair/skin/nails

A

◦ Dorsa
◦ Hypothermia
◦ Hyperthermia

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54
Q

moisture

objective assessment of hair/skin/nails

A

◦ Dry vs. diaphoretic
◦ Dehydration- locations: mucous membranes, lips, sunken fontanel, turgor

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55
Q

texture

objective assessment of hair/skin/nails

A

smooth, firm, even surface

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56
Q

thickness

objective assessment of hair/skin/nails

A

◦ Mostly thin
◦ Some callus (overgrowth of epidermis)- normal on palms & soles

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57
Q

edema

objective assessment of hair/skin/nails

A

accumulation of fluid in intercellular space
Most evident dependent parts of body (feet, ankles, sacral)

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58
Q

how to check for edema

A

place thumbs on ankle malleous or tibia to check

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59
Q

anasarca

A

generalized edema

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60
Q

edema scale

A

1+ = mild, 2+ = moderate, 3+ = deep, 4+ = very deep

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61
Q

mobility and turgor

objective assessment of hair/skin/nails

A

Mobility= how easy the skin rises when pinched
Turgor= how quickly returns to its place when released
◦ Mobility + Turgor= Elasticity

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62
Q

how to check mobility and turgor

objective assessment of hair/skin/nails

A

Pinch up a large fold of skin on the anterior chest under the clavicle

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63
Q

what are some causes of poor turgor

A

dehydration, weight loss, change with aging (decreased elasticity)

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64
Q

scleroderma

A

hard skin
chronic connective tissue disorder
makes it hard to asses turgor

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65
Q

vascularity or bruising

objective assessment of hair/skin/nails

A

cherry angioma
ecchymosis
tattoo marks
bruising at venous access points (drug use)

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66
Q

cherry angioma

A

bright red dots

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67
Q

ecchymosis

A

bruising

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68
Q

lesions

objective assessment of hair/skin/nails

A

primary vs secondary

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69
Q

hair

objective assessment of hair/skin/nails

A

Color-Common to gray as we age
*Texture-Shiny and soft
*Distribution-Lesions

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70
Q

profile of the nail bed

objective assessment of nails

A

◦ 160° = Normal
◦ < 160° = Curved
◦ 180° = Early clubbing- Caused by disrupted pulmonary circulation
◦ > 180°= Late clubbing
◦ Nail base feels spongy (feel your nail bases

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71
Q

consistency

objective assessment of nails

A

◦ Smooth, regular, firm to palpation
◦ Pits, transverse grooves, or lines= nutrient deficiency or may accompany some acute illnesses

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72
Q

color

objective assessment of nails

A

even
pink
cyanosis
brown linear streaks- suddent onset could be melanoma

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73
Q

capillary refill

objective assessment of nails

A

◦ < 3 seconds= normal
◦ > 3 seconds = sluggish refill = CV or pulm prob

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74
Q

What are the skin changes that accompany pregnancy/newborn time period?

A

Pregnancy: Linea nigra, melasma, striae gravidarum, increase in sweat glands, redistribution of fat
Newborn- lanugo, vernix caseosa, very thin skin, more permeable

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75
Q

What are the skin changes that occur with an older adult?

A

oses elasticity, thinning of the epidermis, wrinkles become more noticeable, fewer sweat/sebaceous glands leads to dryer skin, less collagen makes skin more prone to tearing
* Palpate for temperature and texture

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76
Q

nevus assessment

A
  • ABCDEF
  • A-Asymmetry
  • B-Border Irregularity
  • C-Color Variation
  • D-Diameter
  • E-Elevation or Evolution
  • F-Funny looking
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77
Q

what tool is used to assess risk of skin breakdown in patients

A

braden scale

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78
Q

This can slow as you age, contributes to constipation and indigestion

A

GI MOTILITY

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79
Q

Dry flaky skin; dull dry hair; dry cracking lips

A

MALNUTRITION

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79
Q

Cholesterol that is bad

A

LDL

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80
Q

Factor that has a huge impact on food choices/accessibility

A

FINANCES

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81
Q

A form of malnutrition (imbalanced nutrition) arising from excessive intake, leading to accumulation of body fat that impairs health

A

OVERNUTRITION

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82
Q

Lack of proper nutrition, caused by not having enough food or not eating enough food containing substances necessary for growth and health

A

UNDERNUTRITION

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83
Q

This value is derived by looking at both height and weight

A

BMI

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84
Q

This nutrition status means that a person is receiving and using the essential nutrients to maintain health and well-being at the highest possible level

A

OPTIMAL

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85
Q

his tool can be used to help understand what a patient’s dietary habits are like over a 3 day period

A

DIARY

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86
Q

This varies from people group to people group, but always influences diet

A

CULTURE

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87
Q

HgbA1C is a chronic indicator of this disease process

A

DIABETES

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88
Q

cholesterol that is considered “good”

A

HDL

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89
Q

STERNUM

A

consists of 3 parts:
manubrium
body
xiphoid process

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90
Q

ribs

A

12 pair
1-7 attached to sternum
8-10 attached to costral margin
11-12 floatin

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91
Q

thoracic vertebra

A

12

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92
Q

diaphragm

A

a musculotendinous septum

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93
Q

anterior thoracic landmarks

A

suprasternal notch
sternum
manubriosternal angle (angle of louis)
intercostal spaces
costal angle

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94
Q

posterior thoracic landmarks

A

vertebra prominens
spinous processes
inferior border of scapula
twelfth rib

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95
Q

reference lines

A

midsternal
midclavicular
anterior axillary
mid axillary
posterior axillary
scapular
vertebral

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96
Q

mediastinum

thoracic cavity

A

middle section
contains esophagus, trachea, heart and great vessels

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97
Q

pleural cavities

thoracic cavity

A

located on either side of the mediastinum

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98
Q

lungs

thoracic cavity

A

right lung: RUL, RML, RLL
left lung: LUL, LLL (no middle lobe)

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99
Q

pleurae

thoracic cavity

A

visceral and parietal

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100
Q

where is the trachea located

A

in the thoracic cavity

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101
Q

bronchial tree

thoracic cavity

A

right is wider and more vertical
trachea and bronchi transport air
dead space- contains air not involved in gas exchange

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102
Q

acinus

thoracic cavity

A

functional respiratory unit
includes bronchioles, alveolar ducts, alveolar sacs, and alveoli

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103
Q

the anterior chest contains what

A

mostly the upper and middle lobe, very little lower lobe and that the apex extends 3-4cm above the inner third of the clavicles.

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104
Q

what does the posterior chest contain

A

almost all of the lower lobe

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105
Q

what are the functions of respiration

A
  1. Supplying oxygen
  2. Removing carbon dioxide
  3. Maintaining acid-base balance
  4. Maintaining heat exchange
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106
Q

hypoventilation

A

slow, shallow breathing
 increased CO2 in the blood

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107
Q

hyperventilation

A

deep, rapid breathing
decreased co2 in the blood

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108
Q

respiration control

A

respiration center in the brain stem is the pons and medulla

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109
Q

what is the normal stimulus for breathing

A

co2, not o2 like you would think

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110
Q

infants and children

respiration developmental considerations

A
  • Foramen ovale closes after birth
  • Ductus arteriosus closes hours later
  • Smaller & immature resp. system = ↑ of respiratory infections
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111
Q

pregnant female

respiration developmental considerations

A

effects of increased estrogen
- Elevation of diaphragm (elevates 4cm  ↓ vertical diameter of thoracic cage

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112
Q

explain the relaxation of the rib cage in a pregnant female and its relation to respiration

A

circumference is increased by 2cm with the widening of the costal margin

there is an increaased tidal volume with deeper breathing that may be mistaken as dyspnea

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113
Q

apgar scoring system

A

used for the newborn’s initial respiratory assessment
* 1-minute score of 7-10: indicates newborn in good condition
* 1-minute score of 3-6: indicates moderately depressed newborn requiring more resuscitation
* 1-minute 0-2: indicates severely depressed newborn requiring full resuscitation

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114
Q

older adults

respiratory considerations

A
  • Decreased mobility of thorax from calcified cartilage
  • Decreased muscle strength
  • Decreased elasticity of lungs
  • Decreased vital capacity (max exhalation)
  • Increased residual volume (what’s left over after exhale)
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115
Q

older adults

respiratory considerations (cont)

A
  • Histologic changes with loss of intra
  • lveolarseptum & number of alveoli leading to decreased surface area for gas exchange
  • Increased risk of dyspnea & pulmonary complications
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116
Q

asthma

A

most common chronic disease in childhood

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117
Q

tuberculosis TB

A

higher incidence in asian americans
peaks in the first 2 months immigrating to the us

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118
Q

cough

respiratory subjective data

A

sudden or gradual onset, frequency, duration, dry or productive with sputum (color & consistency), hemoptysis, congested, precipitating factors, associated symptoms, any treatment

119
Q

shortness of breath

respiratory subject data

A

orthopnea, paroxysmal nocturnal dyspnea, diaphoresis, cyanosis, precipitating factors, any effect on ADLs, increasing, the same or getting better

120
Q

smoking history

respiratory subjective data

A

type
packs per day
note in packs per year

121
Q

other respiratory subjective data

A

Hx
respiratory infections
asthma

122
Q

environmental exposure

respiratory subjective data

A

works in factory, chemical plant, coal mine, farming, in heavy traffic area, x-ray exposure

123
Q

self care behaviors

respiratory subjective data

A

last TB test, chest x-ray, pneumonia or flu immunizations

124
Q

children

subjective respiratory assessment

A

◦ 4-6 URI per year is acceptable in early childhood
◦ Consider new foods or formula as possible allergens
◦ Child proofing the home to px inhalation/consumption of poisons
◦ Environmental smoke increases risk of ear and respiratory infections

125
Q

older adults

respiratory subjective data

A

◦ Decreased functional reserve- takes them longer to recover from activity
◦ Decreased vital capacity
◦ Decreased surface area for gas exchange
◦ Pain response is reduced in older adults- this is a risk factor

126
Q

respiratory inspection

objective data

A

thoracic cage
respirations
skin color/condition
position of the person
facial expression
loc

127
Q

inspection of the thoracic cage

respiratory objective data

A

for shape and configuration, compare anteroposterior to the transverse diameter (normal ratio is 1:2 or 5:7)
* Abnormal finding: barrel chest (anteroposterior = transverse diameter)

128
Q

respirations

respiratory objective data

A

assess rate, depth, effort, use of accessory muscles

129
Q

normal respiratory pattern of adult

A

10-20 breaths per minute, even & unlabored, depth of 500-800ml

130
Q

sigh

respiratory pattern

A

punctuate the normal breathing pattern; if frequent, can result in hyperventilation & dizziness

131
Q

tachypnea

A

rapid, shallow breathing

132
Q

bradypnea

A

slow, regular breathing

133
Q

chyne-strokes respirations

A

cyclic gradually wax and wane in regular pattern with periods of apnea

134
Q

hyperventilation

A

increase in rate and depth

135
Q

hypoventilation

A

irregular shallow pattern

136
Q

biot’s respirations

A

irregular pattern with periods of apnea

137
Q

chronic obstructive breathing

A

normal inspiration with prolonged expiration (from increased airway resistance)

138
Q

Barrel chest

A

anteroposterior-to-transverse diameter is equal (with aging, emphysema, asthma)

139
Q

pectus excavatum

A

funnel chest
sunken sternum

140
Q

pectus carinatum

A

pigeon breast
forward protrusion of sternum

141
Q

scoliosis

A

lateral s shaped curvature of the thoracic and lumbar spine

142
Q

kyphosis

A

exaggerated posterior curvature of the thoracic spine
humpback

143
Q

palpate for symmetric expansion of the thorax

A

note any lag in expansion
* Abnormal finding: unequal chest expansion (present with atelectasis, pneumonia, trauma, or pneumothorax)

144
Q

palpate the thorax for tactile fremitus

A

is a palpable vibration, produced by the larynx and transmitted through patent bronchi & lung tissue to the chest wall

145
Q

decreased fremitis

A

occurs with any obstruction of vibration (obstructed bronchus, pleural effusion, pneumothorax or emphysema)

146
Q

increased fremitus

A

occurs with compression or consolidataion of lung tissue

indicates increased density of lung tissue (must have a patent bronchus)

147
Q

palpation of the entire chest wall

A

or tenderness, skin temperature, moisture, superficial lumps, crepitus (indicates air escaping from the lung into the subcutaneous tissue)

148
Q

pleural friction fremitus

A

esults from inflammation of the pleura (visceral or parietal) with decrease in the normal lubricating fluid

149
Q

percussion of the lung fields

A

percuss in the intercostal spaces, starting at apices, compare from side to side moving down the lung region
* Normal finding: resonance for adult lung; hyperresonance for the young child

150
Q

what does hyperresonance over an adult lung indicate

A

emphysema or pneumothorax

151
Q

diaphragmatic excursion

A

maps out the lower lung border in inspiration and expiration by use of percussion
* Difference between inspiration and expiration should be equal bilaterally and be 3-5cm (can be 7- 8 in a physically fit person)

152
Q

auscultate breath sounds

A

listen to full breath at each location using the diaphragm of the stethoscope
* Compare from side-to-side

153
Q

characteristics of normal breath sounds

A

bronchial (tracheal)- at the trachea
bronchovesicular - at the sternum
vesicular- outside of chest

154
Q

adventitious breath sounds

A

crackles
rhonchi
friction rub
wheezes

155
Q

crackles

A

high pitched popping sounds

156
Q

rhonchi

A

long low pitched, coarse, gurgling sounds

157
Q

friction rub

A

harsh grating sound

158
Q

wheezes

A

high pitched whistling sound

159
Q

bronchophony

A

have pt. say “99” (increased transmission of voice sound with increased lungd ensity or consolidation)

160
Q

egophony

A

have pt. say “ee” (sounds like “a” with consolidation)

161
Q

whispered pectoriloquy

A

have pt. whisper a phase (one, two, three) normally faint, muffled increased with consolidation)

162
Q

pulse oximeter

A

noninvasive procedure
assesses arterial o2 saturation
normal 97-98%

163
Q

12 or 6 minute distance walk
12 md

A
  • measures functional status of O2 arterial saturation
  • used for patients with chronic obstructive pulmonary disease (COPD)
164
Q

common respiratory disorders

A

atelectasis
bronchitis
copd
asthma (restrictive airway disease)
pneumothorax
pulmonary embolism
pleural effusion
heart failure

165
Q

cardiovascular system

A

heart and blood vessels

166
Q

2 circulatory types in the body

A

pulmonary circulation
systemic circulation

167
Q

the heart is really what

A

2 pumps, each consisting of an atrium and a ventricle

168
Q

precordium

A

region on the anterior chest, over the heart and great vessels

169
Q

mediastinum

A

the middle third of the thoracic cavity between the lungs, contains the heart and the great vessels

170
Q

base of the heart

A

top

171
Q

apex of the heart

A

bottom

172
Q

great vessels

A

superior/inferior vena cava
aorta
pulmonary veins
pulmonary artery

173
Q

4 chambers of the heart

A

Right atrium
right ventricle
Left atrium
Left ventricle

174
Q

4 valves of the heart

A
  • Two atrioventricular (AV) valves:
  • Tricuspid
  • Mitral
  • Two semilunar valves:
  • Pulmonic valve
  • Aortic valve
175
Q

s1 is the sound of the closure of what

A

tricuspid and bicuspid

176
Q

s2 is the sound of the closure of what

A

pulmonic and aortic valves

177
Q

p wave

A

depolarization of the atria

178
Q

pr interval

A

from start of p wave to beginning of qrs

179
Q

qrs

A

depolarization of ventricles

180
Q

t wave

A

repolarization of ventricles

181
Q

qt interval

A

electrical systole of the ventricles

182
Q

effect of respiration of the heart

A

inspiration –>decreased intrathoracic pressure –>increased venous return to right side of heart–>increased right ventricular stroke volume–>aortic valve closes earlier–> normal split S2

183
Q

moRe to the Right heart, Less to the Left

A

more venous return to the right side on inspiration

184
Q

s3
third heart sound

A

“ventricular gallop”
- caused by ventricles being resistant to filling during the rapid filling phase (systolic heart failure)
- heard right after S2, sounds like “Kentucky”

185
Q

s4
fourth heart sound

A

“atrial gallop”
- present at the end of diastole with resistance of the ventricles to filling (diastolic heart failure)
- sounds like “Tennessee”

186
Q

murmurs

A
  • Result from turbulent blood flow caused by:
    - Increased velocity
    - Decreased viscosity
    - Structural defects
187
Q

heart sounds are descibed by

A

Frequency or pitch
Intensity or loudness
Duration (early, late, pan (continuous))
Timing (systolic or diastolic)

188
Q

when to use the bell side of the stethoscope

A

Use the bell for soft, low pitched sounds
(murmurs & extra heart sounds)

189
Q

cardiac output

A

is 4-6L/min
* Stroke volume X heart rate = CO

190
Q

preload

A

venous return, the volume of blood in the ventricle at the end of diastole
* Amount of stretch prior to systole
* Frank-Starling law: the greater the stretch, the stronger the cardiac contraction

191
Q

afterload

A
  • The resistance the heart has to pump against
192
Q

carotid arteries

A

lies between the trachea and the sternomastoid muscle (medial to this muscle)

193
Q

jugular venous pulse and pressure

A

reflect the filling pressure & volume in the right side of heart

194
Q

internal jugular

A

larger, located deep & medial to the sternomastoid, generally not visible, diffuse pulsation may be visible in the sternal notch muscle in supine position

195
Q

external jugular

A

more superficial, located lateral to the sternomastoid muscle

196
Q

fetal circulation is rerouted to bypass what

A

the nonfunctional lungs

197
Q

foramen ovale

A

opening in the atrial septum
closes within 1st hour after birth

198
Q

ductus arteriosus

A

opening between the aorta and pulmonary artery
closes within 10-15 hrs after birth

199
Q

describe an infants heart

A

Heart more horizontal & apex is higher, located at 4th left intercostal space

200
Q

cardiovascular considerations of a pregnant female

A
  • Increased blood volume by 30%-40%
    - Increased stroke volume & cardiac output
    - Increased heart rate
201
Q

when is the arterial blood pressure decreased to its lowest point during pregnancy

A

during the 2nd trimester

202
Q

hemodynamic changes

older adults considerations in the vascular system

A
  • Increased systolic BP
    - Left ventricule (wall) thickens
    - Heart rate: unchanged at rest
    - Cardiac output: unchanged at rest
    * Decreased adaptation to exercise
203
Q

dysrhythmias

older adult considerations for the vascular system

A

supraventricular & ventricular
Increased cardiovascular diseases

204
Q

CAD

A

CVD (Cardiovascular Disease) is the number one cause of death worldwide
* influenced by genetics and lifestyle factors
*CAD-Coronary Artery Disease

205
Q

risk factors of cad

A

Hypertension
Smoking
Serum cholesterol
Overweight/Obesity
Physical inactivity
Diabetes
Age
Poor nutrition
Family history of premature CAD

206
Q

chest pain or tightness

vascular subjective data

A

note onset, character (crushing, stabbing, burning, duration, precipitating factors (activity, emotional upset), associated symptoms (sweating, pallor, SOB, heart beat skipping, N & V, diaphoresis), radiates, relieved by rest or nitroglycerin
* Need to differentiate between cardiac and non cardiac origin!
* “Clenched fist” characteristic sign of angina

207
Q

dyspnea

vascular subjective data

A

shortness of breath (on exertion or at rest), paroxysmal, constant or intermittent, paroxysmal nocturnal dsypnea “PND” (a sign of heart failure)

208
Q

orthopnea

vascular subjective data

A

note how many pillows are needed to improve breathing

209
Q

cough

vascular system subjective data

A

Note duration, frequency, dry or productive, mucus (color, odor, blood tinged), hemoptysis, precipitating factors

210
Q

fatigue

vascular subjective data

A

onset, sudden or gradual
* From cardiac dysfunction – fatigue worse in evening
* With anxiety or depression - worse in morning or present all day

211
Q

edema

vascular subjective data

A

unilateral or bilateral, dependent edema with heart failure (bilateral, increases in the evening, decreases with elevation of legs)

212
Q

nocturia

vascular subjective data

A

recumbent position–>increased fluid reabsorption & excretion (with heart failure)

213
Q

past cardiac Hx

vascular subjective data

A

HTN, elevated cholesterol levels, rheumatic fever, anemia, recurrent tonsillitis, meds, heart surgery, last ECG, stress test

214
Q

family cardiac Hx

vascular subjective data

A

HTN, obesity, diabetes, CAD, sudden death at younger age

215
Q

personal habits for risk cardiac factors

vascular subjective data

A

nutrition (diet), smoking, alcoholic intake, exercise, drugs
* Hormonal replacement therapy (HRT) is no longer used for prevention of CAD

216
Q

infants and children

vascular subjective data

A

note fatigue, poor weight gain, cyanosis, limitations with exercise, frequent respiratory infections

217
Q

pregnant female

vascular subjective data

A

hypertension, protein in urine, swelling (in feet, legs or face), excessive weight gain

218
Q

aging adult

vascular subjective data

A

heart or lung disease, HTN, CAD, COPD, meds, noncompliance with meds, limitations with ADLs

219
Q

order of regional cardiovascular assessment

A
  1. Pulse and BP
    2. Extremities
    3. Neck vessels
    4. Precordium
220
Q

palpate the carotid arteries

cardiovascular objective data

A

(medial to the sternomastoid muscle): avoid excessive vagal stimulation (decreases heart rate) by using gentle pressure over the lower part of the neck, palpate only one carotid artery at a time (avoids cerebral ischemia with syncope)
* Note contour & amplitude - normal is 2+ and equal bilaterally
* Diminished pulse (small & weak) - decreased stoke volume
* Increased pulse (full & strong) - hyperkinetic states

221
Q

auscultate the carotid arteries for bruits

cardiovascular objective data

A

for persons > 40 age or have S/S of CV disease
Use the bell side of the stethoscope for bruits

222
Q

bruits

A

Bruit: blowing, swishing sound, indicates turbulent blood flow from a local vascular cause; audible when the lumen is occluded by ½ to 2/3

Absence of bruit does NOT necessarily exclude partial occlusion

223
Q

unilateral distension of the external jugular veins

cardiovascular objective data

A

indicates local cause (aneurysm or kinking)

224
Q

bilateral distension of the external jugular veins

cardiovascular objective data

A

above 45 degrees indicates increased central venous pressure (CVP) from systemic disorder such as heart failure

225
Q

estimate the jugular venous pressure

cardiovascular objective data

A

“reading” the CVP at the highest level of venous pulsations
* Place pt. in supine position with HOB elevated 45 degrees
* Elevated pressure indicated by level of pulsation is > 3 cm with HOB elevated at 45 degrees
*Look at illustration on page 481

226
Q

inspect the anterior chest

cardiovascular objective data

A

with tangential lighting
for any pulsations, heaves, liftss

227
Q

heave or lift

A

(sustained forceful thrusting of ventricle during systole)
– indicates ventricular hypertrophy from increased workload

228
Q

palpate the apical pulse

cardiovascular objective data

A

(for the apex beat) and note its normal characteristics:
- Location: normally at 4 or 5th intercostal space at or medial to midclavicular line & only occupying one intercostal space
- Size: normally 1cm X 2cm
- Amplitude: normally a short, gentle tap
- Duration: normally occupies only one half of systole

229
Q

left ventricular dilation

cardiovascular objective data

A

(volume overload) – increases its size, displaces it more laterally, increases its duration & amplitude

230
Q

palpate across the precordium for a thrill

cardiovascular objective data

A

(palpable vibration)
* Note its timing if present auscultate or use carotid artery as a guide)
* Thrill: generally indicates a significant murmur

231
Q

auscultate the precordium

cardiovascular objective data

A

using the Z pattern technique from the base of the heart and down
Locations of the heart valves:
* Second right interspace – aortic valve
* Second left interspace – pulmonic valve
* Left sternal border – tricuspid valve
* Fifth interspace near the left midclavicular line – mitral valve

232
Q

all pigs eat too much

A

aortic
pulmonic
erb’s point
tricuspid
mitral

233
Q

at what point does s1 and s2 the same loudness

A

erb’s point

234
Q

where is s2 the loudest

A

base

235
Q

where is s1 the loudes

A

apex

236
Q

With the apical pulse, start with the diaphragm part of the stethoscope and use the following routine

A
  1. Note the rate & rhythm
    2. Identify S1 and S2
    3. Assess S1 and S2 separately
    4. Listen for extra heart sounds
    5. Listen for murmurs
237
Q

what does s1 coincide with

A

the carotid artery pulse
the R wave
the upstroke of the QRS complex on the ecg monitor

238
Q

s1 sound indicates what

A

from closure of the AV valves, indicates the beginning of systole

239
Q

s2 indicates what

A

from closure of the semilunar valves, indicates beginning of diastole

240
Q

splitting of the s2

A

normal physiological split occurs during inspiration only (not during expiration) in some people

241
Q

what heart sound splits are abnormal

A

Fixed split (occurs in both inspiration & expiration) or a parodoxical split (occurs with expiration but not with inspiration)

242
Q

grading murmurs

A
  • Grade I - barely audible
    * Grade II - clearly audible– most common
    * Grade III - moderately loud
    * Grade IV - loud with audible thrill
    * Grade V - very loud
    * Grade VI - loudest, can hear with stethoscope lifted off the chest
243
Q

murmurs can be what

A

*Mid-systolic
*Pan-systolic
*Diastolic rumbles
*Early diastolic murmurs

244
Q

ins and outs of s3 gallop

A
  • Occurs in early diastole (during rapid filling phase)
    - Low pitch, sounds like distant thunder
    - Physiologic (normal): in children & some young adults, disappears
    when pt. sits up
    - Pathologic (abnormal): doesn’t disappear when pt. sits up
    - Right ventricular S3 (right sided heart failure): heard at the left
    lower sternal border with pt. in supine position
    - Left ventricular S3 (left-sided heart failure): heard at the apex with
    pt. in left lateral position
    - Early sign of heart failure
    - Results from volume overload, and also in high cardiac output
    states (without cardiac dysfunction) such as with hyperthyroidism,
    anemia , and pregnancy
245
Q

ins and outs of s4 sounds

A

a ventricular filling sound, referred to as “atrial gallop” or “S4 gallop”
- Heard right before S1 (in late diastole)
- Soft, low-pitched sound
- Listen at the apex with pt. in left lateral position (right sided is less common, heard at the left lower sternal border)
- Results from decreased compliance of the ventricles
- Physiologic: in adults > age 40 or 50, especially after exercise
- Pathologic: from decreased compliance of the ventricles (CAD, cardiomyopathy, or increased afterload)

246
Q

Patent Ductus Arteriosus (PDA):

congenital heart defects

A

persistence channel between left pulmonary artery to aorta

247
Q

Atrial septal defect (ASD):

congenital heart defects

A

abnormal opening in the atrial septum

248
Q

ventricular septal defect
vsd

congenital heart defect

A

abnormal opening in the ventricular septum

249
Q

tetrology of fallot

congenital heart defect

A

*Right ventricular outflow obstruction
*VSD
*Right ventricular hypertrophy
*Over-riding aorta

250
Q

Coarctation of the Aorta

A

Congenital Heart Defect

251
Q

vascular system

A

Job is to circulate blood and lymph throughout the body
Comprised of arteries, veins, and lymphatics

252
Q

arteries

A

Arteries-deliver freshly oxygenated blood to body, strong, tough vessels that must withstand high pressure demands, expand and recoil with each heartbeat/pulse

253
Q

veins

A

Veins-bring blood back to the heart go to through lungs to be oxygenated, lie closer to the skin surface than arteries, are more elastic/distensible, contain valves so blood cannot flow backwards

254
Q

lymphatics

A

Lymphatics-made up of vessels, nodes, ducts, some organs
Bring excess fluid and plasma proteins back to the bloodstream from the interstitial space
Major part of the immune system
Absorb lipids from the small intestine

255
Q

know location of arteries listed

A

Temporal artery
Carotid artery
Brachial artery
Radial artery
Ulnar artery
Femoral artery
Popliteal
Posterior tibial
Dorsalis pedis

256
Q

know the location of the veins listed

A

Deep veins in the legs:
- Femoral
- Popliteal
Superficial veins in the legs:
- Great saphenous
- small saphenous

257
Q

know the location of the lymph nodes listed

A

cervical
axillary
epitrochlear
inguinal

258
Q

cervical nodes

A

drain head and neck

259
Q

axillary nodes

A

drain breast and upper arm

260
Q

epitrochlear nodes

A

drains the hand & lower arm; located in the antecubital fossa

261
Q

inguinal nodes

A

drain the lower extremities, the external genitalia, & the anterior abdominal wall

262
Q

vascular considerations of the pregnant female

A

increased estrogen levels  vasodilation & drop in BP; uterus exerts pressure on iliac veins & inferior vena cava resulting in:
- Edema (diffuse, bilateral, pitting) in the
lower extremities
- Varicose veins

263
Q

vascular considerations for the aging adult

A
  • Arteriosclerosis from increased rigidity
    of the peripheral blood vessels
    • Increased risk for deep vein thrombosis
    • Decreased lymphatic tissue
264
Q

leg pain or cramps

vascular subjective data

A

note location, type, precipitating factors, claudication distance, relived by rest walking, rubbing, night pain, recent change in exercise, past history of vascular problems
* Note any sudden worsening of
claudication (decrease in claudication
distance) & pain suddenly not relieved
with rest

265
Q

skin changes on arms or legs

vascular subjective data

A

discolorations (redness, pallor, blueness, brownish), varicose veins, coolness, sores or ulcers

266
Q

swelling in the arms or legs

vascular subjective data

A

in one side or both, worse in the morning or evening, constant or intermittent, precipitating & relieving factors, associating factors (pain, heat, redness, ulcers, hardened skin)
* Bilateral edema indicates a systemic problem
* Unilateral edema indicates an obstruction or inflammation

267
Q

lymph node enlargement

vascular subjective data

A

location, duration, any recent changes, presence of pain or infection
* Enlarged nodes indicate infection, immunologic disease or malignant disease

268
Q

medications

vascular subjective data

A

oral contraceptives or hormonal replacement (increased risk for thrombosis)

269
Q

capillary refill

vascular objective data

A

index of peripheral perfusion & cardiac output
* Abnormal finding- refill lasting more than 1 or 2 seconds (indicates vasoconstriction or decreased cardiac output)

270
Q

vascular objective data

A

temperature
symmetry or presence of edema
Presence of any lesions, scars, needle tracks in antecubital fossa (indicates intravenous drug use)

271
Q

nailbeds

vascular objective data

A

for pallor, cyanosis, clubbing (enlargement of
terminal phalanges) indicates chronic hypoxia
* Normal angle is 160 degrees

272
Q

skin color

vascular objective data

A

(pale, erythema, cyanosis), texture, turgor
* Pallor with vasoconstriction, erythema with vasodilation

273
Q

how to assess radial pulse

A

assess both for rate rhythm and amplitude

274
Q

palpate the following pulses for amplitude and elasticity

A
  • Radial
    - Ulnar (usually not palpated)
    - Brachial
    - Femoral
    - Popliteal
    - Posterior tibial
    - Dorsalis pedis
275
Q

Three-point scale for grading the amplitude(Force)

A

3+ Increased, full, bounding
2+ Normal
1+ Weak
0 Absent

276
Q

what does a full bounding pulse indicate

A

hyperkinetic states (exercise, anxiety, fever & hyperthyroidism)

277
Q

what does a weak thready pulse indicate

A

shock and peripheral arterial disease

278
Q

inspect and palpate extremities for

A

Hair distribution
Venous pattern
Lesions/ulcers
Size, swelling, atrophy

279
Q

what does an enlarged lymph node indicate

A

infection of the draining area

280
Q

assessing edema

A
  • location
    - pitting or nonpitting
    - measurement
281
Q

Signs of malnutrition:

A

thin, shiny, atrophic skin, thick-ridged nails, loss of hair, ulcers, gangrene

282
Q

signs of arterial insufficiency

A

pallor, coolness, diminished pulse strength

283
Q

unilateral vs bilateral swelling

A

Unilateral swelling signifies a local problem
*If asymmetry of the calves is > 1 cm, refer
the pt. (possible deep vein thrombosis)
Bilateral swelling of legs indicates a systemic
problem

284
Q

brownish skin discoloration

A

Brownish discoloration: indicates chronic venous stasis

285
Q

venous ulcers

A

generally located on the medial malleolus

286
Q

location of arterial ulcers

A

located on tips of toes, metatarsal heads, or lateral malleoli

287
Q

what does a bruits indicate

A

turbulent blood flow from partial occlusion

288
Q

modified allen test

A

evaluates the adequacy of collateral circulation prior to cannulating the radial artery
* Persistent pallor or sluggish return of color indicates occlusion of collateral circulation

289
Q

doppler ultrasound stethoscope

A

use to detect a weak peripheral pulse
* Presence of a swishing, whooshing sound indicates a pulse

290
Q

Lymphedema

A
  • Impediment of lymph drainage
    - Unilateral
    - Lymphedema is nonpitting edema, unilateral, overlying skin is indurated and brawny
291
Q

raynaud’s syndrome

A
292
Q

Chronic Arterial Insufficiency:

A
  • deep muscle pain
    - pain with walking “claudication”
    - coolness, pallor
    - diminished pulses
    - thin, shinny skin
    - absence of hair
    - necrotic ulcers on toes, heels, lateral
    malleolus
293
Q

Chronic Venous Insufficiency:

A
  • dull ache, heaviness in lower leg pain
    - pulses present
    - thick brawney, edematous skin
    - brown pigmentation
    - weeping ulcers on medial malleolus
294
Q

Chronic Venous Stasis:

A
  • aching, heaviness, night leg or foot cramps
    - dilated, tortuous veins
295
Q

acute venous thrombosis

A
  • sudden onset pain
    - increased warmth, swelling, redness
    • Homan’s sign – not diagnostic
296
Q

Grade pitting edema on the following scale:

A

1+ Mild
2+ Moderate
3+ Deep pitting
4+ Very deep pitting

307 Health Assessment (6 decks)

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