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Cardiac Vascular Certification > Cardiac and Vascular Assessment > Flashcards

Cardiac and Vascular Assessment Flashcards

(85 cards)

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1
Q

What should be included in focused cardiovascular history?

A

History, common symptoms, triggers, psychosocial status, PQRST

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2
Q

PQRST Pain Acronym

A

Provoking, Quality, Region, Severity and Timing

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3
Q

What does the nurse ALWAYS evaluate first on initial survey of patient?

A

A - airway
B - breathing
C - circulation

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4
Q

Where on the chest does the nurse hear the aortic valve?

A

2nd and 3rd right interspace

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5
Q

Where on the chest does the nurse hear the pulmonic valve?

A

2nd and 3rd left interspace

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6
Q

Where on the chest does the nurse hear the tricuspid valve?

A

left sternal border

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7
Q

Where on the chest does the nurse hear the mitral valve?

A

apex (just to the right and slightly below left nipple)

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8
Q

Definition of pulse pressure

A

difference between systolic and diastolic

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9
Q

Definition of orthostatic BP

A

drop of 20 mmHg in systolic, drop of 10 mmHg in diastolic with standing

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10
Q

Definition of pulse deficit

A

difference between pulse rate and heart rate seen with arrhythmias

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11
Q

How do you assess pulse deficit

A

assess apical and radial pulse simultaneously for 1 minute

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12
Q

ankle-brachial index definition

A

ratio of BP at the ankle and upper arm; normal 0.9-1.3

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13
Q

What does a low ankle brachial index indicate?

A

occluded arteries caused by PVD

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14
Q

What does a high ankle-brachial index indicate?

A

abnormally hardened blood vessels

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15
Q

What is a normal range for ankle-brachial index?

A

0.9-1.3

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16
Q

Prehypertension begins at what systolic range?

A

120-130

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17
Q

Stage 1 hypertension begins at what systolic and diastolic range?

A

130-140 systolic, 80-90 diastolic

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18
Q

Stage 2 hypertension beings at what systolic and diastolic range?

A

140 - 180+ systolic, 90-120+ diastolic

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19
Q

3 categories of Glascow Coma Scale

A

Eye Opening, verbal response, motor response

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20
Q

PERRLA is assessing what cranial nerves

A

CN III, IV and VI via pupils

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21
Q

PERRLA acronym

A

P - pupils
E - equal
R - round
R - react
L - light
A - accommodation

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22
Q

Cranial Nerve I and assessment

A

Olfactory - have patient close eyes and smell

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23
Q

Cranial Nerve II and assessment

A

Optic - have patient read and assess periphery

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24
Q

Cranial Nerve III and assessment

A

Oculomotor - pupil response; follow finger with eyes making an “H”

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25
Cranial Nerve IV and assessment
Trochlear - follow finger moving towards nose to assess downward eye movement
26
Cranial Nerve V and assessment
Trigeminal - Sensation of forehead, cheeks and jaw - have clench teeth
27
Cranial Nerve VI and assessment
Abducens - have patient look towards each ear to check sideways eye movement
28
Cranial Nerve VII and assessment
Facial - assess symmetry of face and puff cheeks
29
Cranial Nerve VIII and assessment
Vestibulocochlear - assess hearing and equilibrium
30
Cranial Nerve IX and assessment
Glossopharyngeal - gag reflex check and sour/sweet taste on tongue
31
Cranial Nerve X and asssessment
Vagus - swallow while speaking, say "ah" (sensory and motor)
32
Cranial Nerve XI and assessment
Accessory - shrug shoulders and turn head against resistance
33
Cranial Nerve XII and assessment
Hypoglossal - have patient stick out tongue and move side to side
34
Mnemonic for cranial nerves
Oh Oh Oh Those Trippy Alien Fruit Vines Generate Visions And Hallucinations
35
Mnemonic for cranial nerves - motor sensory or both
Some Say Marry Money, But My Brother Says Big Brains Matter More
36
When percussing lungs, what does the tone indicate?
indicates where lungs are solid and filled with air or fluid
37
The nurse describes your percussed lung sounds as RESONANT - what does this mean?
normal air-filled lung sounds
38
What does DULL percussed lung sounds indicate?
fluid/tissue filled cavities - often pneumonia
39
what does HYPERRESONANT (drum-like) percussed lung sounds indicate?
air filled tissues - seen with emphysema and pneumothorax
40
Kussmaul breathing and associated state
hyperventilation with deep labored breathing; associated with metabolic acidosis
41
Cheyne Stokes breathing and associated issue
deep breathing alternating with apnea OR faster rate; associated with L heart failure or sleep apnea
42
Where are vasicular breath sounds heard?
over the lungs
43
Wheezing | description, etiology and disease process
1. musical-like 2. forced air through narrow airway 3. COPD, asthma
44
Rhonchi | description, etiology and disease process
1. low pitched, coarse rattles 2. secretions in airway 3. pneumonia and cystic fibrosis
45
Stridor | description, etiology and disease process
1. high pitched, wheezing sound 2. air through UPPER airway is obstructed/narrow 3. aspiration or larygnospasm
46
Rales (crackles) | description, etiology and disease process
1. rattling - can be coarse or fine 2. fluid in small airways of lung 3. pulmonary edema, pneumonia
47
Pleural Friction Rub | description, etiology and disease process
1. grating/creaking sound 2. inflamed pleural tissue 3. pleuritis/pulmonary embolism
48
Diminished Lung Sounds | description, etiology and disease process
1. decreased intensity due to lack of airflow 2. air or fluid in lungs/blocked airway 3. pleural effusion, pneumothorax
49
Egophony | description, etiology and disease process
1. "e" sound heard as a "a" 2. due to increased resonance of sound traveling across fluid 3. pleural effusion, pneumonia
50
Bronchophony | description, etiology and disease process
1. increased volume of spoken voice over area of lung consolidation 2. fluid in lungs 3. pleural effusion, pneumonia
51
Whispered Pectoriloquy | description, etiology and disease process
1. increased volume of whispered voice over areas of lung consolidation 2. fluid in lungs 3. pleural effusion, pnuemonia
52
Patient position to check carotid arteries
position patient at 45 degree angle with head turned away
53
How to inspect and palpate jugular veins?
relax sternomastoid muscle so pulsation can be seen in internal jugular
54
Positive JVD = elevated _____?
CVP
55
Cardiac auscultation mnemonic
A PET Monkey (aortic, pulmonic, Erb's point, tricuspid, mitral)
56
Location of PMI
Point of Maximal Intensity = apex of heart (very bottom tip of heart)
57
Where is the best place to hear the mitral valve?
5th LEFT intercostal space at midclavicular line
58
Where is the best place to hear the tricuspid valve?
5th intercostal space at LEFT sternal border
59
Where is the best place to heart the Erb's Point?
3rd LEFT intercostal space at left sternal border
60
Where is the best place to hear the pulmonic valve?
2nd LEFT intercostal space at left sternal border
61
Where is the best place to hear the aortic valve?
2nd RIGHT intercostal space at right sternal border
62
This sound is caused by the closure of the atrioventricular valves
S1
63
This sound is caused by the closure of the semilunar valves
S2
64
Other name for S3 sound and what causes this?
ventricular gallop rush of blood into ventricles that is normal in children/young adults
65
What cardiac conditions are related to S3 sounds?
ventricular dysfunction or volume overload in the ventricles MI, systolic HF, dilated cardiomyopathy, mitral valve regurgitation
66
What is the other name for S4 sound and what causes this?
atrial gallup; atrial contraction into a noncompliance ventricle
67
when is S4 heard?
before S1
68
What cardiac conditions are related to S4 sounds?
decreased ventricular compliance - hypertrophic cardiomyopathy, hypertension, aortic stenosis
69
What is a carotid bruit?
heard over carotid artery and is caused by turbulent blood flow - indicates carotid artery disease
70
Where is pericardial friction rub heard and describe sound?
fourth intercostal space with patient leaning forward high pitched, leathery sound
71
What cardiac sound is associated with pericarditis?
pleural friction rub
72
systolic murmur occurs when?
occurs during ventricular contraction
72
systolic murmur occurs when?
occurs during ventricular contraction
72
systolic murmur occurs when?
occurs during ventricular contraction
73
diastolic murmur occurs when?
during ventircular filling
74
systolic murmur causes
anemia, pregnancy, hyperthyroidism, fever, exercise
75
Name for loud, rumbling sounds caused by shifting fluid/gas in bowel?
Borborygmi
76
Do you palpate the painful part of the abdomen FIRST or LAST?
LAST!
77
Tympanic abdominal percussion indicated what?
air-filled intestines
78
Dull sounds on percussion of abdomen indicate?
organomegaly, masses or fluid
79
high pitched bowel sounds can indicate?
early bowel obstruction
80
term for redness of skin caused by inflammation
Rubor
81
what causes shiny skin on extremities
peripheral vascular disease
82
What is hemosiderin staining?
brown skin color caused by iron deposits within cells seen with venous insufficiency and iron overload
83
what is clubbing and what causes this?
def: enlargement of tissue at distal phalange which occurs over long periods of time from chronic cardiovascular/respiratory disorders

Cardiac Vascular Certification (6 decks)

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