Module 5 Feb 8 Cardiac, Abdominal, Vital Signs

Question 1

Clues to pulmonary and cardiac functioning - 4

Answer 1

Edema, Clubbing, Skin, Capillary refill

Question 2

5 places to listen for cardiac sounds, where, hear what

Answer 2

Aortic - Louie right to RICS2, sternal border - S2 louder
Pulmonic - LICS2 sternal border - S2 louder
Erbs - LICS3 sternal border - S2 = S1
Tricuspid - LICS4 sternal border - S1 louder
Mitral - LICS5 Mid Clavicular Line - S1 louder
All People Enjoy Time Magazine

Question 3

What makes heart sounds, where best heard, phase

Answer 3

S1 - Tricuspid and Mitral valves closing, Apex, Systole start
S2 - Pulmonic and Aortic valves closing, Base, Diastole start

Question 4

Stethoscope - 2 sides, sounds and frequencies heard

Answer 4

Diaphram - Push - high pitched - Pulmonary

Bell - light touch - low pitched - carotid

Question 5

Cardiac preparation of patient - 5

Answer 5

Golden rule - stethoscope to skin
Sitting up or back 35 degrees
Generally stand on right side
Privacy, stethoscope and hands warm
Talk to them, comfortable, listen for long time, no panic

Question 6

Inspect jugular vein - 2

Answer 6

Sitting up or partly back. Not found is good.

If found, lay back see where it disappears.

Question 7

Inspect chest cardiac

Answer 7

Bulges, masses, heaves & lifts. Pulsations are normal on thin.

Question 8

Palpate chest, apical pulse - 4

Answer 8

Use palm for greater coverage. 5 spots
At Mitral, feel heartbeat. May lean Pt forward, on left side. Feel gentle tap
Point of Maximal Impact PMI

Question 9

Auscultate Cardiac - areas, look for, do twice why

Answer 9

APETM
Rate and Rhythm, S1 and S2
Do with diaphragm, bell

Question 10

Objective: Cardiac Focused Interview Questions - 23

Answer 10

+Family History -Heart murmur, -Heart attack, -Hypertension, -High cholesterol, -Stroke, -Obesity
+Personal -Same as Family, -Venous thrombosis (blood clots)
+Other -Swelling, -Palpitations, -Chest pain, -SOB, -Weight, -Fatigue, -Smoking, -Alcohol, -Nutrition, -Exercise

Question 11

What is in each Abdominal quadrant

Answer 11

RLQ: Appendix, colon, sm intestines, ureter, major vasc to R leg
RUQ: Liver, R kidney, gall bladder, colon, pancreas
LUQ: Stomach, L kidney, spleen, colon, pancreas
LLQ: colon, sm intestines, ureter, major vein/artery to L leg

Question 12

Abdomen questions - 12

Answer 12

• Appetite; -Weight change; -Swallowing difficulty;
• Food intolerance, diarrhea, nausea; -Indigestion; -Pain;
• Nausea or vomiting; -Changes in bowel habits;
• History of Abdominal problems, pain, complaints;
• Medications Typical or used acutely; -Nutritional assessment;
• Family history of abdominal problems

Question 13

Lines for quadrants

Answer 13

Center sternum to pubic; Horizontally at umbilicus

Question 14

Abdomen inspect - 7

Answer 14

Contour; Symmetry; Skin characteristics; Pulsations; Lesions;
Scars; Umbilical innie or outie
Use light, look from multiple angles, including across

Question 15

Abdomen auscultation

Answer 15

DONE SECOND
Two spots in each quadrant
5 minutes to say absent sounds
RLQ first
Active, Hypoactive, Hyperactive, Absent

Question 16

Abdominal percussion

Answer 16

Same spots as auscultation
Expect tympanic sounds
Dull over liver, feces

Question 17

Abdominal palpation

Answer 17

Bend knees to relax abs
Flat hand, 1 cm first pass, note and ask about tenderness
If all OK, do Deep palpation, 2-3 inches deep
Note tenderness, masses pain
If tender, try for rebound tenderness

Question 18

Abdominal changes with age - 4

Answer 18

• Decreased digestive enzymes
• Decreased peristalsis
• Decreased response to rectal distention, stool retention
• Loss if internal sphincter tone - fecal incontinence

Question 19

Abdominal health promotion - 6

Answer 19

• Diet, fiber, fluids, regularity
• Dental hygiene
• Risks and screening
• Food handling and storage procedures
• Immunizations
• Stress reduction

Question 20

Vitals signs when/why - 10

Answer 20

• Baseline; -Evaluate; -Quick health check; -Provider ordered;
• Before/after a procedure; -Before/after medication;
• Before/after blood administration; -Patient change;
• Before/after nursing intervention;
• Patient reports nonspecific distress symptoms

Question 21

Pulse felt where - 9

Answer 21

• Temporal; -Carotid; -Apical; -Brachial; -Radial; -Femoral;
• Popliteal; Posterior tibial; -Dorsal pedis

Question 22

Pulse report - 4

Answer 22

Regular or irregular rhythm
1+ (weak) to 4+ (see bounding)
Equality left and right
May need doppler

Question 23

Respiration rate - 2

Answer 23

Depth shallow/deep

Rhythm regular/irregular